COVID-19 Research Articles

COVID-19 in the years 2020 to 2022 in Germany: effects of comorbidities and co-medications based on a large-scale database analysis

BackgroundThe SARS-CoV-2 pandemic was a challenge for health care systems worldwide. People with pre-existing chronic diseases have been identified as vulnerable patient groups. Furthermore, some of the drugs used for these chronic diseases such as antihypertensive drugs have been discussed as possible influencing factors on the progression of COVID-19. This study examines the effect of medication- and morbidity-associated risk factors suspected to moderate the disease course and progression of COVID-19.MethodsThe study is based on claims data of the Techniker Krankenkasse, Germany’s largest statutory health insurance. The data cover the years 2020 to 2022 and include insured persons with COVID-19 diagnosis from both the outpatient and inpatient sectors and a control of insured persons without COVID-19 diagnosis. We conducted a matched case-control study and matched each patient with an inpatient diagnosis of COVID-19 to (a) 10 control patients and (b) one patient with an outpatient diagnosis of COVID-19 to form two study cohorts. We performed a descriptive analysis to describe the proportion of patients in the two cohorts who were diagnosed with comorbidities or medication use known to influence the risk of COVID-19 progression. Multiple logistic regression models were used to identify risk factors for disease progression.ResultsIn the first study period the first study cohort comprised a total of 150,018 patients (13,638 cases hospitalised with COVID-19 and 136,380 control patients without a COVID-19 infection). Study cohort 2 included 27,238 patients (13,619 patients hospitalised with COVID-19 and 13,619 control patients with an outpatient COVID-19 diagnosis). Immunodeficiencies and use of immunosuppressives were strongest risk modifying factors for hospitalization in both study populations. Other comorbidities associated with hospitalization were diabetes, hypertension, and depression.ConclusionWe have shown that hospitalisation with COVID-19 is associated with past medical history and medication use. Furthermore, we have demonstrated the ability of claims data as a timely available data source to identify risk factors for COVID-19 severity based on large numbers of patients. Given our results, claims data have the potential to be useful as part of a surveillance protocol allowing early-stage access to epidemiological data in future pandemics.

Early COVID-19 and protection from Omicron in a highly vaccinated population in Ontario, Canada: a matched prospective cohort study

ObjectivesPredictions regarding the on-going burden of SARS-CoV-2, and vaccine recommendations, require an understanding of infection-associated immune protection. We assessed whether early COVID-19 provided protection against Omicron infection.MethodsWe enrolled a cohort of adults in Ontario, Canada, with COVID-19 prior to October 2020 (early infection, EI), and a matched cohort with COVID-19 testing and a negative PCR (non-EI). Participants completed baseline surveys then surveys every two weeks until January 2023. Multivariable Cox regression was used to assess factors associated with COVID-19 infection during the first 14 months of Omicron.ResultsOverall, 624 EI (70%) and 175 (77%) non-EI participants met criteria for analysis; 590 (95%) EI and 164 (94%) non-EI had received at least 2 COVID-19 vaccine doses prior to Omicron. Of 624 EI, 175 (28%) had one SARS-CoV-2 re-infection and 8 (1.3%) had two, compared to 84 (48%) non-EI participants with one, 5 (2.9%) with two and 1 (0.6%) with 3 infections (P < 0.0001). In multivariable analysis of risk factors for Omicron infection, the overall hazard ratio (HR, 95%CI) associated with EI was 0.56 (0.43–0.74); HRs for BA.1/2, BA.4/5 and mixed BA.5/BQ.1/XBB periods were 0.66 (0.45–0.97), 0.44 (0.28–0.68) and 0.71 (0.32–1.56). EI and BA.1/2 infection combined reduced later Omicron infection (HR 0.07 (0.03–0.21) compared to no prior infection. Older age, non-White ethnicity, no children in household, and lower neighbourhood income were associated with reduced risk of infection.ConclusionsIn our highly vaccinated population, early SARS-CoV-2 infection was associated with a 44% reduction in symptomatic COVID-19 during the first 14 months of Omicron, providing significant protection against re-infection for more than 2 years.

Examining recovery trajectories of physical function, activity performance, cognitive and psychological functions, and health related quality of life in COVID-19 patients treated in ICU: a Swedish prospective cohort study.

To investigate the recovery trajectories of physical function, activity performance, cognitive and psychological functions, and health related quality of life, as well as potential interaction effects, in individuals with COVID-19 treated in an intensive care unit (ICU). This prospective cohort study included patients with confirmed COVID-19 infection, treated in an ICU. Clinical assessments and self-ratings of functioning, disability and health were performed > 1 month and > 12 months after discharge from hospital. Among the 65 included individuals (mean age 56.6, SD 11) significant improvements in physical and psychological function were observed over time, although not reaching population norms. Cognition remained unchanged (MoCA median 27, IQR 4). At the 12-month follow-up, physical limitations in activity (RAND-36) were found to be associated with dyspnea (mMRC-Dyspnea), mental and physical fatigue (MFI-20), and walking endurance (6-minute walk test) (r2 0.509 p < 0.001). Role limitations due to physical health (RAND-36) was found to be associated with physical and mental fatigue (MFI-20) and pain (r2 0.530 p < 0.001). Despite improvements in functioning and health in this group of predominantly younger age recovery did not reach population norms. These results highlight persistent impairments and activity limitations that may necessitate long-term healthcare interventions.

The patients' perspective of bedside teaching in the post-Covid era.

Bedside teaching with real patients is vital to the education of medical students. With the onset of the Covid-19 pandemic in 2020, all student-patient interactions were suspended in order to prevent the spread of the virus. Research has previously focussed on the medical professional and medical student views concerning bedside teaching, with less of a focus on patient insights. The purpose and aims of this study were to explore the patient's perspectives of encountering medical students and contributing to their learning in the clinical setting, beyond the Covid restrictions. Qualitative semi-structured interviews were carried out with a cohort of Mayo University hospital inpatients, who had participated in a bedside teaching session. An interview guide was employed to facilitate consistent and analogous data. An interpretative phenomenological approach was used for data analysis yielding a number of themes. Participants recognised the value of their involvement in the clinical education of future doctors, in addition to the positive impacts of such contributions for their own future healthcare. Participants had no concerns about partaking in bedside teaching sessions relating to Covid infection. This study assessed the opinions of hospital inpatients with regards to participating in clinical teaching sessions and found that they do not perceive their role as passive.

Perspectives of the COVID-19 pandemic and vaccination among racially and ethnically diverse gay, bisexual, and other men who have sex with men with and without HIV in the US South: findings from qualitative individual in-depth interviews

BackgroundThe impact of COVID-19 on specific populations, including gay, bisexual, and other men who have sex with men (GBMSM), varies based on a range of factors such as access to health care, underlying health behaviors and conditions, and social determinants of health. Our community-based participatory research partnership sought to better understand perspectives about and experiences with the COVID-19 pandemic, COVID-19 vaccination, and related health care among GBMSM.MethodsWe collected, analyzed, and interpreted qualitative in-depth interview data from a diverse sample of GBMSM (N = 30) in North Carolina, USA. Using purposive sampling, we recruited native English (n = 15) and Spanish (n = 15) speakers and persons with HIV (n = 13) and persons without HIV (n = 17). We analyzed interview data using constant comparison, an approach to grounded theory.ResultsParticipant mean was 33.4 (SD = 8.5) years. Sixteen themes emerged that were categorized into five domains: trust/mistrust of politicians, healthcare professionals, and the US government (n = 4 themes); engagement in COVID-19 prevention strategies (n = 2 themes); attitudes towards COVID-19 vaccination (n = 3 themes); access to and use of health care (n = 4 themes); and impact of COVID-19 on social determinants of health and mental health (n = 3 themes).ConclusionsThis research increases our understanding of the COVID-19 pandemic among particularly minoritized and underserved communities: racially and ethnically diverse, English- and Spanish-speaking GBMSM with and without HIV in the US South. By addressing the unique needs and concerns of these communities, we can promote more equitable public health responses; enhance preventive healthcare delivery; improve preparedness for subsequent outbreaks (e.g., mpox), epidemics, and pandemics; and be better equipped to support delivery and uptake of potential future preventive HIV vaccines among communities impacted by health disparities.

Speculating About Futures with Covid Reinfection in the UK: The Body as a Site of Educated Guesswork

ABSTRACT We revisit a time in 2021 when people in the UK were coming to terms with an unwanted future characterized by chronic COVID-19 infection. Drawing on experiences of people who had already experienced COVID-19 infection, we explore how they made sense of newly perceived vulnerabilities and the possibility of reinfection. We highlight the work of speculating about the future, which involved making “educated guesses” based on embodied knowledge as understanding about different consequences of “living with COVID-19” moved in and out of view.

Uptake and hesitancy of the second booster dose of COVID-19 vaccine among the general population in China after the surge period of the COVID-19 pandemic: a large-scale national study

BackgroundAlthough the second booster dose of COVID-19 vaccines is available, vaccine hesitancy among the public may have peaked due to the surge in infections caused by the Omicron variant. To improve coverage of the second booster dose, it is crucial to investigate the prevalence of vaccine hesitancy among the general population during this period and explore the reasons for this phenomenon.MethodsA cross-sectional survey was conducted between January 5 to February 9, 2023. Variables including sociodemographics, mental health, COVID-19 infection status, COVID-19 vaccination status, and vaccine hesitancy were collected. Univariate and multivariate logistic regression analysis were performed to identify factors associated with the hesitancy of the second booster dose of COVID-19 vaccine among the general population.ResultsAmong the 10,623 participants, the uptake rate of the second booster dose was 4.3%. Among those who did not receive the second booster dose, 43.6% expressed vaccine hesitancy. The highest hesitancy rate was observed among participants who had not completed primary immunization (71.4%), followed by those with chronic diseases (48.6%) and those aged 60 and above (33.2%). The COVID-19 vaccine hesitancy was higher among females, participants with high incomes, those with a history of COVID-19 infection, those with depressive symptoms and post-traumatic stress disorder, and those with adverse events after COVID-19 vaccination. Conversely, lower hesitancy was observed among students, participants aged 60 and above, those from southern China, and those with higher level of perceived social support.ConclusionsCOVID-19 vaccine hesitancy remains prevalent among the general population in China after the surge period of the pandemic. Crucial steps, such as raising public awareness of the benefits and potential side effects of regular COVID-19 vaccination, ensuring timely monitoring and disclosure of pandemic information, and implementing targeted measures to improve social support and mental health, should be taken. These efforts will be instrumental in reducing vaccine hesitancy, advancing vaccination campaigns, and effectively preparing for the potential future outbreaks.

Pityriasis Rubra Pilaris Following COVID-19 Infection: A Case of Successful Treatment With Ixekizumab

Pityriasis Rubra Pilaris Following COVID-19 Infection: A Case of Successful Treatment With Ixekizumab

Interventions for the management of post-COVID-19 condition (long COVID): protocol for a living systematic review and network meta-analysis

BackgroundUp to 15% of survivors of COVID-19 infection experience long-term health effects, including fatigue, myalgia and impaired cognitive function, termed post-COVID-19 condition or long COVID. Several trials that study the...

The process of obtaining information about COVID-19 among students of physiotherapy and rehabilitation department

BackgroundThis cross-sectional study was conducted to determine the process of obtaining information about COVID-19 infection among students of the Department of Physiotherapy and Rehabilitation (DPR) by examining the topic of information seeking, information source preference, and factors influencing these preferences.MethodsA total of 495/645 (76.74%) DPR students participated in the study. The data collection form prepared by the researchers was administered between May-June 2022 using face-to-face interview technique. Students’ sociodemographic data (age, biological sex, body mass index) and the main topics they researched about COVID-19, information sources, and factors influencing their choice of sources were recorded.ResultsStudents often preferred to use internet social media (61.00%) and sources they considered reliable (81.40%) to access basic clinical information about COVID-19 (the routes of transmission = 30.30%, the main symptoms = 26.30%, number of cases = 22.60%). While biological sex (pbiologicalsex) and class level (pclasslevel) influenced the choice of sources (pbiologicalsex=0.011; pclasslevel:0.0001) and the factors determining this choice (pbiologicalsex=0.011–0.022; pclasslevel=0.0001–0.005), topic preferences were only influenced by class level (pbiologicalsex>0.05; pclasslevel = 0.0001–0.022).ConclusionDPR students should be supported with reliable and up-to-date social media-based digital content prepared by experts in the field about physiotherapy practice and with easy access to scientific data, even in the late stages of pandemic processes such as COVID-19, when the need for access to information is high due to their professional role.

Prevalence of cardiovascular symptoms in post-acute COVID-19 syndrome: a meta-analysis

BackgroundSince its emergence in 2019, COVID-19 has continued to pose significant threats to both the physical and mental health of the global population, as well as to healthcare systems worldwide (Raman et al., Eur Heart J 43:1157–1172, 2022). Emerging evidence indicates that COVID-19 may lead to post-acute COVID-19 syndrome (PACS) with cardiovascular implications, potentially driven by factors such as ACE2 interaction with viruses, systemic inflammation, and endothelial dysfunction. However, there remains a limited amount of research on the cardiovascular manifestations of PACS, which may delay the development of optimal treatment strategies for affected patients. Therefore, it is crucial to investigate the prevalence of cardiovascular sequelae in COVID-19 patients and to determine whether COVID-19 infection acts as an independent risk factor for these outcomes.MethodsThis meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024524290). A systematic search of PubMed, Embase, and the Cochrane Library was conducted up to March 17, 2024. The primary outcomes included hypertension, palpitations, and chest pain, with pooled effect estimate reported as proportions and odds ratios (ORs) with 95% confidence intervals (CIs). Sensitivity and subgroup analysis were performed to assess the robustness of the results and to identify sources of heterogeneity.ResultsA total of 37 studies, encompassing 2,965,467 patients, were included in the analysis. Pooled results from case–control studies revealed that, compared to the control group, the ORs of chest pain in the COVID-19 group was 4.0 (95% CI: 1.6, 10.0). The ORs for palpitation and hypertension were 3.4 (95% CI: 1.1, 10.2) and 1.7 (95% CI: 1.6, 1.8), respectively. The proportions of PACS patients experiencing chest pain, palpitation, and hypertension as sequelae were 22% (95% CI: 14%, 33%), 18% (95% CI: 13%, 24%), and 19% (95% CI: 12%, 31%), respectively.ConclusionsOur findings indicate that 15% of COVID-19 patients experience cardiovascular sequelae. Furthermore, COVID-19 infection significantly increases the likelihood of developing these sequelae compared to uninfected individuals. Future research should prioritize investigating the underlying pathological mechanisms and developing targeted preventive and management strategies.Trial registrationCRD42024524290.

A tale of two drugs: Molnupiravir and Paxlovid.

The orally administered antiviral drug Lagevrio or molnupiravir (MOV) and the combination antiviral drug nirmatrelvir/ritonavir or Paxlovid (PAX) have been shown to reduce the likelihood of hospitalization and death for high-risk patients with COVID-19. Clinical studies, including those comparing PAX and MOV, were reviewed; both drugs are effective in reducing morbidity and mortality in COVID patients, although PAX generally appears to be more efficacious. Both drugs received Emergency Use Authorization in the United States for mild to moderate COVID-19 infection, while only PAX has subsequently been given full FDA approval. The principal disadvantage of PAX is that it interacts with many commonly used drugs, while MOV does not. The purpose of this review is to summarize current information and knowledge about these two drugs. The two drugs have completely different mechanisms of action. PAX inhibits viral replication while MOV induces viral replication errors that are expected to lead to viral inactivation. There is, however, the potential that MOV also could mutate host DNA and cause the virus to mutate into variants with new features. The package insert for MOV states that patients should be notified of relevant toxicity issues before administration. Sensitive mutation detection/analysis studies, such as error corrected Next Generation Sequencing (ecNGS) or HPRT mutation detection assays, in MOV-treated patients are needed to establish the safety of MOV.

The relationship between health literacy and COVID-19 prevention behaviors among people living with HIV

BackgroundHealth literacy (HL)has been identified as one of the important determinants of healthy behaviors and the health of individuals and communities. The global attempts to control the HIV disease were emphasized, in the midst the new coronavirus disease (COVID-19) emerged as a pandemic. This study aimed to determine HL level and its relationship with COVID-19-prevention behaviors among people living with HIV(PLWH).MethodsThis cross-sectional study was conducted on 112 PLWH referred to behavioral disorders consulting center in Arak, Iran from May to December 2022. The data collection tool was a questionnaire including COVID-19 prevention behaviors (5 items) and a health literacy instrument (14 items). The data were analyzed using SPSS software version 18 and for all tests, the significance level of α was considered as 0.05.ResultsThe average (SD)age of the participants was 42.9 (10.6) and the education level of 11.6% of the participants were university. The mean score of HL was 3.5 (0.73) out of 5 and 36.6% of them had higher HL. The mean of behaviors was 17.2 (3.4) out of 25 and 53.6 had higher behaviors. The HL had a significant relationship with behaviors (r = 0.48; p < 0.001). Multiple linear regression indicated that HL had a significant association with age (P = 0.002), education (P = 0.046), and economic status (p < 0.001) and explained 32% of the variance of HL.ConclusionAccording to the findings, HL affected COVID-19-prevention behaviors. Effective educational interventions intended for PLWH based on health literacy can be useful to this extent.

Does perceived social cohesion moderate the effect of parental stressors on depressive symptoms? A longitudinal, multi-level analysis before and during the COVID-19 pandemic

Background Perceived social cohesion (PSC) is a protective factor for mental health. Yet, evidence on social mechanisms influencing mental health is scarce. Aims We examined the moderating role of PSC between parental stressors and depressive symptoms before and during the COVID-19 pandemic. Methods We performed a multilevel moderated linear regression analysis using German Socio-Economic Panel (G-SOEP) data to investigate the interaction of PSC in 2018 and in 2020 with parental stressors (having pre-school-aged child(-ren), concerns about COVID-19 infection, financial insecurity, working from home, changes at work) and depressive symptoms (PHQ-4) in 2020 and 2021. Results 3,112 observations from 1,621 participants were included in the regression analyses. The parental stressors had mostly negative, although not always significant effects on PHQ-4. Both PSC measures positively moderated the association between experienced financial insecurity and PHQ-4. PCS 2020 positively moderated the association between the stressors “not working from home” and “being unemployed in 2020 or 2021” compared to “having no changes at work” for those employed. It negatively moderated the association between “having some concerns about infection” and PHQ-4. Conclusions PSC can act as a buffer for parental mental health. Social cohesion should be promoted in public health interventions, especially during pandemics or disasters.

Impact of COVID-19 on Hospital Admissions for Children With Developmental Disadvantages: A Western Sydney Metropolitan Hospital Experience on Health Inequity.

To investigate the impact of Sydney's COVID-19 lockdown on children with developmental disadvantages and reflect on current clinical practice. Retrospective data was collected from a western Sydney metropolitan hospital's electronic database and patients. We reviewed all children with Autism Spectrum Disorder (ASD), Cerebral Palsy (CP) or Intellectual Disability (ID) admitted 36 months prior to and after lockdown policy being implemented. The prevalence of hospital presentation was reduced during the lockdown period. The average length of stay (LoS) increased by approximately 1.5 folds. Comparatively, the average LoS of the general paediatric population increased minimally. Seizures, asthma, and upper respiratory tract infections were the three commonest issues for hospital admissions in both periods. COVID-19 infection accounted for 4% of admissions in the lockdown period. Around 20.8% of patients with disadvantages were admitted with more than two major issues. None of these patients had concurrent COVID-19 infection. Children with developmental disabilities experience greater disadvantages during lockdown. The likely reasons include inequity caused by increased barriers to healthcare service. The indirect benefit of reducing infection transmission during lockdown was not reflected in our patient group, contributing to the disease burden. Chronic diseases remain the most common causes of admissions in all periods, suggesting the essentiality of improving chronic disease management in future clinical practice.

Vocal cord dysfunction/inducible laryngeal obstruction induced by hyperventilation in healthy individuals, people with asthma and following coronavirus infection.

Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) commonly co-exists with asthma and can start after viral infections. In this setting evidence suggests that dysfunctional breathing may induce the disorder but this possibility has not been researched. We therefore postulated that dysfunctional breathing can induce VCD/ILO, more so in people with asthma and after viral infections. Eight healthy control subjects, 16 people with asthma and eight people who had recent COVID-19 infection (three with asthma) were recruited. Video-recorded laryngoscopy was performed at tidal breathing and during controlled hyperventilation (used as a proxy for dysfunctional breathing). VCD/ILO was diagnosed by laryngoscopy using accepted criteria and correlated with study cohorts, clinical attributes, asthma severity and spirometry. Overall, 32 subjects were studied. Hyperventilation was verified in all subjects. None of the healthy control group or people with mild asthma developed VCD/ILO during or after hyperventilation but one person with moderate/severe asthma had clear evidence of VCD/ILO. In contrast, in people who had COVID-19 infection, hyperventilation induced VCD/ILO in 3/8 people (38%). These proof-of-concept studies suggest that hyperventilation can provoke VCD/ILO in asthma and after recent viral infection. How and why VCD/ILO develops is not known and these preliminary findings should prompt further studies of links between dysfunctional breathing, asthma and viral infections.

Treatment of Covid-19 Ambulatory Patients with A Medicinal Preparation of Echinacea Purpurea: The Ecco-2 Investigator-Initiated, Randomised, Double Blind, Controlled Trial

Background: The COVID-19 pandemic has affected millions throughout the entire world, causing an unprecedented disruption of the daily lives of many more millions. While vaccines have proven to be a powerful prophylactic tool co contain the spread of the disease, treatment options are very limited. Echinacea phytotherapy is known to be efficacious in the treatment of mild respiratory viral infections, therefore we and others hypothesized that it might be helpful in the treatment of ambulatory COVID-19. Purpose: To evaluate the clinical efficacy and safety of a medicinal preparation of cryo-milled root of Echinacea purpurea added to the standard-of-care (SOC) treatment in ambulatory COVID-19 patients with mild clinical symptoms, with a respiratory profile. Methods: We designed and conducted a prospective, double-blind, multicentre, randomized, controlled clinical trial involving four hospitals in Spain, from July 2021 to June 2022. Participants were ambulatory adults with COVID-19 infection, assessed by a positive PCR or antigen test, with mild symptoms of a respiratory profile. Patients were given Echinacea Arkopharma, hard caplets containing 250 mg of Echinacea purpurea (L.) Moench, 1.5 g/day (2 caplets every 8 hours, i.e., 6 g/day, 7 days) added to standard care (vide infra). Participants were followed for 28 additional days. The primary outcome of effectiveness (OE) was OE1: number of days with fever (body temperature ≥ 37ºC at any moment of the day). The secondary outcomes were OE2: days with subjective dyspnea, OE3: days with unsaturation (≤ 96%), OE4: days with disease, OE5: percentage of hospitalizations, OE6: length of hospitalization (days), OE7: days of sick leave, OE8: percentage to visits to emergency room, OE9: percentage of admissions to intensive care units, OE10: percentage of deaths, OE11: subjective perception by the recruiting physician of the treatment usefulness to improve the evolution of the disease, OE12: subjective perception by the patient of the treatment usefulness to improve the evolution of the disease. The secondary outcomes of safety (OS) were OS1: incidence of respiratory adverse effects, OS2: incidence of palpitations (&gt; 110x'), OS3: incidence of transaminase elevations (AST level ≥ 3x the normal range limit), OS4: incidence of headaches, OS5: incidence of digestive adverse effects, OS6: incidence of insomnia and nervousness. For all cases, OS1 to OS6, percentage of dropouts for that specific reason. Results: The target recruitment number, 230, was not achieved. Rather, 99 eligible patients could be recruited (age 35.50 ± 11.9 years; 51.5 % female). They were randomised to SOC + treatment (n=50) and SOC + placebo group (n=49). There were no statistically significant differences between the treatment and placebo groups in the main variables studied, however, it should be noted that an important limitation of the study is the fact that we could not reach our recruitment target by far. Incidence of serious AEs was nil. Mild AE consisting of diarrhea were seen in 2 cases, and 1 effort- induced tachycardization, although there is no statistical evidence supporting that they were caused by the treatment. Conclusion: Echinacea, added to the SOC treatment for mild COVID-19, was safe and well tolerated but had no major impact on clinical outcomes. Some effectiveness trends suggest that further studies with full recruitment are warranted to definitively assess its efficacy in moderately affected COVID-19 patients.

Endovascular Management of a Giant Aortic Arch Aneurysm Diverticulum: A Case Report

Abstract Background Thoracic aortic diverticulum, or Kommerell's aneurysm, is a developmental outpouching at the anteromedial aspect of the thoracic aorta, specifically at the site of the aortic isthmus, with an incidence of up to 9% in adults. It represents a notable anatomical variation that, over time, undergoes aneurysmal dilatation, posing the risk of rupture. Case We present a 66-year-old male initially referred with a 7.35 cm giant thoracic aortic arch diverticulum (TAD). It was initially discovered incidentally as a 2.1 cm type 3 Salomonowitz; however, it subsequently increased to 7.36 cm following the third COVID-19 infection with cytokine storm. He underwent a right-to-left carotid necklace c-shaped configuration crossover bypass using an 8 mm ringed Dacron silver graft. Six weeks post-bypass, the patient underwent a successful repair of TAD using the NEXUS-Endospan-Artivion system (ArtivionTM, GA 30144, USA), employing a double inner branch to the innominate and left subclavian artery through a single groin approach. Postoperatively, he recovered fully without any neurological or cardiovascular issues with no signs of endoleaks, graft migration, or separation. Conclusions The saccular nature of the aneurysm at the arch reveals a distinctive set of challenges, mainly the low wall shear stress, which exposes their malignant potential, emphasizing the crucial need for intervention, especially when surpassing the critical 30 mm threshold. This premiere marks a significant milestone by introducing the ‘IDEALIST’ Artivion/Endospan Nexus, which pioneers a total endovascular approach post-CE marking, ushering in a new era in aortic arch interventions.

Long-COVID incidence proportion in adults and children between 2020 and 2024.

Incidence estimates of post-acute sequelae of SARS-CoV-2 infection, also known as long-COVID, have varied across studies and changed over time. We estimated long-COVID incidence among adult and pediatric populations in three nationwide research networks of electronic health records (EHR) participating in the RECOVER Initiative using different classification algorithms (computable phenotypes). This EHR-based retrospective cohort study included adult and pediatric patients with documented acute SARS-CoV-2 infection and two control groups-- contemporary COVID-19 negative and historical patients (2019). We examined the proportion of individuals identified as having symptoms or conditions consistent with probable long-COVID within 30-180 days after COVID-19 infection (incidence proportion). Each network (the National COVID Cohort Collaborative (N3C), National Patient-Centered Clinical Research Network (PCORnet), and PEDSnet) implemented its own long-COVID definition. We introduced a harmonized definition for adults in a supplementary analysis. Overall, 4% of children and 10-26% of adults developed long-COVID, depending on computable phenotype used. Excess incidence among SARS-CoV-2 patients was 1.5% in children and ranged from 5-6% among adults, representing a lower-bound incidence estimation based on our control groups. Temporal patterns were consistent across networks, with peaks associated with introduction of new viral variants. Our findings indicate that preventing and mitigating long-COVID remains a public health priority. Examining temporal patterns and risk factors of long-COVID incidence informs our understanding of etiology and can improve prevention and management.

Impact of Severity of COVID-19 in TB Disease Patients: Experience from an Italian Infectious Disease Referral Hospital

Background/Objectives: Tuberculosis (TB) remains a major global health issue, further complicated by the COVID-19 pandemic. This study assesses the clinical outcomes of TB-COVID-19-coinfected patients compared to those with TB disease alone at an Italian infectious disease hospital during the pandemic’s first two years. Methods: Retrospective data analysis was conducted on TB patients hospitalized from March 2020 to June 2022. Data included demographics, comorbidities, clinical characteristics, and outcomes. Coinfection was defined as concurrent TB disease and SARS-CoV-2 infection. Statistical methods included Fisher’s exact test and Mann–Whitney statistics. Results: Of 267 TB patients, 25 (9.4%) had concurrent COVID-19 infection. The TB-COVID-19 group showed higher rates of diabetes and cough. Acute respiratory failure was more prevalent in coinfected patients (odds ratio, 5.99), and coinfection was associated with worse outcomes compared to TB alone (odds ratio, 0.15). Despite similar socio-demographic factors, the coexistence of TB and COVID-19 led to exacerbated respiratory failure and increased mortality. Conclusions: Coinfection with TB and COVID-19 significantly increases the risk of acute respiratory failure and poor outcomes. Clinicians should be aware of this risk, especially in patients with pulmonary involvement. Although specific protocols are unavailable, prompt diagnosis and management may enhance outcomes. Additional research is necessary to understand the long-term effects of TB-COVID-19 coinfection, particularly as COVID-19 becomes endemic.