Positive COVID-19 Research Articles

Relationship between Ocular Manifestations and Chest pain: A frequency based analysis of Systemic and Ocular Signs in COVID-19 Patients

Objective: To find the frequencies of systemic and ocular signs in confirmed polymerase chain reaction (PCR) positive COVID-19 cases and to find association between ocular manifestation and systemic signs in Covid-19 patients. Study Design: A prospective cross-sectional study. Place and Duration: Department of Medicine and Ophthalmology, KRL Hospital Islamabad. The research lasted six months, from 1st January 2021 to 31st August 2021. Methodology: A total of 416 PCR-confirmed COVID-19 positive patients were included. As a sample strategy, purposive sampling was adopted. SPSS version 21 was used for statistical analysis. Descriptive statistics was calculated for continuous variables. Chi square test was applied to find association among systemic and ocular signs. Results: The study included 73% men, and 27% women. Patients presented with body aches 67%, sudden onset retrosternal chest pain 21.9%, abdominal pain 14.4%, ocular symptoms 10.3%, loss of taste 67%, and loss of smell 66.7%, loose motion 1.1% and shortness of breath in 1%. The patients' mean platelet counts were 230.30 ±65.63, mean lymphocyte counts were 3702 ±176, t mean total leucocyte counts (TLCs) were 7.524 ±5, and mean c-reactive protein (CRP) level was 21.816 with SD of ±25.992.Assessing the relation between ocular symptoms and other systemic symptoms, the Chi-square test revealed an insignificant relationship. However, it showed a significant association between chest pain and ocular symptoms with a p-Value 0.001. Conclusion: This study found a significant association between chest pain and conjunctivitis in COVID-19 patients, attributing chest pain to respiratory issues, inflammation, and blood clotting. Conjunctivitis was prevalent, especially in healthy, young individuals. Keywords: COVID-19, Chest Pain, Conjunctivitis, Ocular Symptoms.

Rural Health Disparities during the COVID-19 Pandemic in the United States: A Scoping Review

COVID-19 has proven to be detrimental across the globe, most notably affecting the United States at an alarming rate compared to comparable countries. The pandemic has had multifactorial implications on the way communities in the United States prevent, prepare for, and address the virus; however, the impact of the pandemic on rural health is less well understood. Historically, rural communities have faced a unique set of challenges regarding accessing and receiving adequate healthcare, addressing chronic illness, and eliminating health disparities closely associated with the population’s socioeconomic status; the pandemic has exacerbated these challenges. The objective of the scoping review was to review peer-reviewed literature and identify gaps to evaluate the effect of the COVID-19 pandemic on rural populations both at the individual and community level. Articles for review were included if published between the 1st of January 1998 and to the 30th of December 2022. Keys words and phrases such as “COVID-19”, “Rural”, “Preventative Measures”, “heart disease”, “Diabetes”, “Substance Use”, “Access to Healthcare”, “Telehealth”, “Mental Health” and “Vaccines”. Articles that did not match and/or were published outside of history range were excluded. Databases utilized to generate results included PubMed, Web of Science, Scopus, USDA, Economic Research Service, Johns Hopkins University Center for system Science and Engineering, U.S. Department of Commerce, Bureau of Census, Current Population Survey, and annual American Community Survey estimates. Seventy-six articles or resources were generated between July 2022 and February 2023 and deemed appropriate for reference in this review. Pertinent results and findings were thoroughly discussed within the paper alongside figures. Limitations of evidence within this review were due to a lack of studies conducted on the impact of COVID- 19 in rural America specifically. Key findings were that rural health disparities increased both at the individual and system-wide levels as a direct result of the pandemic. The lack of infectious disease specialists, access to larger medical centers with substantial numbers of ICU beds and ventilators, and an overall lack of preparedness overwhelmed rural communities. Although comorbidities such as diabetes and heart disease were associated with poorer health outcomes for a multitude of reasons, the lack of clinic and physician availability for routine care during the pandemic further exacerbated the clinical link from COVID-19 positivity to comorbidities. Important lessons include that health comorbidities, mental health, substance use, health literacy, access to healthcare, among others can serve as key indicators for evaluating healthcare in rural communities’ Future studies should seek to identify gaps in the availability of rural health resources that can improve the lives of millions of Americans now and during the next pandemic.

Pulmonary High Resolution Computed Tomography Findings of COVID-19 Patients Using CO-RADS Classification: A Study on Pakistani Population

Background: This study aimed to use high-resolution computed tomography (HRCT) and the CO-RADS grading system to diagnose COVID-19 patients and determine severity. Methodology: A retrospective study analyzed data from 280 patients at Aziz Bhatti Shaheed Hospital Gujrat between January and August 2021. Informed consent and ethical approval were secured. Data collection used a 64-slice multi-detector CT scanner, including patients with positive and negative COVID-19 polymerase chain reaction (PCR) findings. Data were analyzed using SPSS version 23. Results: The study included more males (170, 60.7%) than females (110, 39.3%), with the most affected age group being 45-64 years. HRCT findings showed ground glass opacities in 212 cases (35.6%), consolidations in 158 cases (26.5%), Crazy paving sign in 54 cases (9.1%), pulmonary lesions in 54 cases (9.1%), interstitial lung disease in 42 cases (7.0%), pulmonary infiltrates in 32 cases (5.4%), atelectasis in 26 cases (4.4%), and pulmonary fibrosis in 18 cases (3.0%). CO-RADS classification results were: CO-RADS 1 (5, 1.8%), CO-RADS 2 (11, 3.9%), CO-RADS 3 (101, 36.1%), CO-RADS 4 (68, 24.3%), CO-RADS 5 (56, 20%), and CO-RADS 6 (39, 13.9%). PCR results were positive only in severe cases (starting from CO-RADS 2), while HRCT detected pulmonary findings even in less severe cases (starting from CO-RADS 1). Conclusion: High-resolution computed tomography accurately and quickly identifies COVID-19 infections, even when PCR findings are negative. The CO-RADS technique effectively determines the severity and spread of COVID-19. CO-RADS 3 was the most frequently reported category, with typical findings including peripheral ground glass opacities and bilateral pleural consolidations.

Asociación entre el empleo informal y los casos positivos de COVID-19 en el Perú

Objectives: To identify the association between the number of informal employees and the number of positive COVID-19 cases in Peru. Methods: Data from the Peruvian National Institute of Statistics and Informatics and the National COVID-19 database were used. Bivariate linear regression and multivariate logistic regression were performed to evaluate the number of informal employees, population density, and altitude in relation to the number of COVID-19 positive cases. Results: Bivariate analysis showed that the number of informal employees was significantly associated with the number of COVID-19 positive cases in both high and low altitude regions (p<0.001). In the multivariate analysis, it was found that the number of informal employees (p<0.001), population density (p=0.02), and altitude (p<0.001) were associated with the number of COVID-19 positive cases. Conclusions: Informal employees are common in low- and middle-income countries where there is no social security and they are economically dependent on daily wages. Their situation worsened due to social mobility restrictions, forcing them to continue working and, consequently, becoming quickly infected, further contributing as a contagion focus.

Comparison of Genetic Algorithm (GA) and Particle Swarm Optimization (PSO) for Estimating the Susceptible-Exposed-Infected-Recovered (SEIR) Model Parameter Values

Background: The most commonly used mathematical model for analyzing disease spread is the Susceptible-Exposed-Infected-Recovered (SEIR) model. Moreover, the dynamics of the SEIR model depend on several factors, such as the parameter values. Objective: This study aimed to compare two optimization methods, namely genetic algorithm (GA) and particle swarm optimization (PSO), in estimating the SEIR model parameter values, such as the infection, transition, recovery, and death rates. Methods: GA and PSO algorithms were compared to estimate parameter values of the SEIR model. The fitness value was calculated from the error between the actual data of cumulative positive COVID-19 cases and the numerical data of cases from the solution of the SEIR COVID-19 model. Furthermore, the numerical solution of the COVID-19 model was calculated using the fourth-order Runge-Kutta algorithm (RK-4), while the actual data were obtained from the cumulative dataset of positive COVID-19 cases in the province of Jakarta, Indonesia. Two datasets were then used to compare the success of each algorithm, namely, Dataset 1, representing the initial interval for the spread of COVID-19, and Dataset 2, representing an interval where there was a high increase in COVID-19 cases. Results: Four parameters were estimated, namely the infection rate, transition rate, recovery rate, and death rate, due to disease. In Dataset 1, the smallest error of GA method, namely 8.9%, occurred when the value of , while the numerical error of PSO was 7.5%. In Dataset 2, the smallest error of GA method, namely 31.21%, occurred when , while the numerical error of PSO was 3.46%. Conclusion: Based on the parameter estimation results for Datasets 1 and 2, PSO had better fitting results than GA. This showed PSO was more robust to the provided datasets and could better adapt to the trends of the COVID-19 epidemic. Keywords: Genetic algorithm, Particle swarm optimization, SEIR model, COVID-19, Parameter estimation.

Changes in Physical Function and Physical Therapy Use in Older Veterans Not Infected by CoVID-19 Residing in Community Living Centers during the CoVID-19 Pandemic

ObjectivesExamine physical function change and physical therapy (PT) use in short-stay and long-stay residents not infected by CoVID-19 within Veterans Affairs (VA) Community Living Centers (CLCs). DesignRetrospective cohort study using Minimum Data Set (MDS) 3.0 assessments. Settings and Participants12,606 Veterans in 133 VA CLCs between September 2019 and September 2020. MethodsDifference in physical function [MDS Activities of Daily Living Score (MDS-ADL)] and PT use (minutes in past 7 days) from admission to last assessment in a period were compared between the pre-CoVID-19 (September 2019 to February 2020) and early CoVID-19 (April 2020 to September 2020) period using mixed effects regression with multivariable adjustment. Assessments after a positive CoVID-19 test were excluded. Differences were examined in the sample and repeated after stratifying into short- and long-stay stratums. ResultsVeterans admitted during early CoVID-19 had more comorbidities, worse MDS-ADL scores, and were more often long-stay residents compared with those admitted during pre-CoVID-19. In comparison to pre-CoVID-19, Veterans in VA CLCs during early CoVID-19 experienced greater improvements in their MDS-ADL (−0.49 points, 95% CI –0.27, −0.71) and received similar minutes of therapy (2.6 minutes, 95% CI –0.8, 6.0). Stratification revealed short-stay residents had relative improvements in their function (−0.69 points, 95% CI –0.44, −0.94) and higher minutes of PT (5.1 minutes, 95% CI 0.9, 9.2) during early CoVID-19 whereas long-stay residents did not see differences in functional change (0.08 points, 95% CI –0.36, 0.51) or PT use (−0.6 minutes, 95% CI –6.1, 4.9). Conclusions and ImplicationsDuring early CoVID-19, physical function improved while the amount of PT received was maintained compared with pre-CoVID-19 for Veterans in VA CLCs. Short-stay residents experienced greater improvements in physical function and increases in PT use. These findings may be partly due to selection bias relating to Veterans admitted to CLCs during early CoVID-19.

Factors influencing fatigue, mental workload and burnout among Chinese health care workers during public emergencies: an online cross-sectional study

ObjectivesThe purpose of this study was to investigate fatigue, mental workload, and burnout among health care workers (HCWs) and explore the possible underlying factors.Materials and methodsAn online cross-sectional survey design was used to collect data from HCWs in Chongqing, China. The online survey included the Fatigue Severity Scale, NASA Task Load Index, and Chinese version of the Maslach Burnout Inventory-General Survey to assess fatigue, mental workload, and burnout, respectively, and was conducted from February 1 to March 1, 2023.ResultsIn this study, the incidence of fatigue and burnout among HCWs was 76.40% and 89.14%, respectively, and the incidence of moderate to intolerable mental workloads was 90.26%. Work–family conflict, current symptoms, number of days of COVID-19 positivity, mental workload, burnout and reduced personal accomplishment were significantly associated with fatigue. Mental workload was affected by fatigue and reduced personal accomplishment. Furthermore, burnout was influenced by marital status and fatigue. Moreover, there was a correlation among mental workload, fatigue, and burnout.ConclusionsFatigue, mental workload and burnout had a high incidence and were influenced by multiple factors during COVID-19 public emergencies in China.

The impact of COVID-19 on microRNA and CD marker expression in AML patients

Acute myeloid leukaemia (AML) is an aggressive leukaemia characterised by uncontrolled blast cell proliferation. miRNAs and Clusters of Differentiation (CD) molecules play essential roles in AML progression. This study aims to investigate the effect of COVID-19 on the expression of circulating miRNA and CD molecules in AML. This cross-sectional study recruited 32 AML patients and 20 controls. Blood samples were collected and analysed using molecular cytogenetic, miRNA/mRNA expression, and flow cytometry techniques. The expression of miRNAs varied significantly between patients with AML and control individuals. The co-expression of these miRNAs was higher (P < 0.05), indicating that the presence of one miRNA led to increased expression of other miRNAs. A differential correlation was observed between miRNAs and CD markers. Additionally, miRNA 16, miRNA 21, and miRNA 221 showed significant downregulation (P < 0.05 and P < 0.01, respectively) in AML patients with COVID-19 infection compared to those without a disease. Interestingly, this study identified a higher expression level (P < 0.01) of miRNA 137 as a novel biomarker for AML patients. Moreover, the expression of miRNA 137 showed a high correlation (P < 0.05) with most of the CD markers examined in this study and FISH features data. Furthermore, a strong correlation (P < 0.01) was observed between CD markers and miRNA among AML patients with positive and negative COVID-19 infection. These data demonstrated that COVID-19 contributed to increased expression of microRNAs in AML patients. MicroRNA 137 was identified as a novel microRNA that exhibited significant differences between patients and healthy individuals, highlighting its role in AML pathogenesis.

COVID-19 Booster Vaccination Status and Long COVID in the United States: A Nationally Representative Cross-Sectional Study.

Early studies have found that the initial COVID-19 vaccination series was protective against severe symptoms and long COVID. However, few studies have explored the association of booster doses on severe disease outcomes and long COVID. This cross-sectional analysis used data from the 2022 US National Health Interview Survey data to investigate how vaccination status correlates with COVID-19 infection severity and long COVID among previously infected individuals. Participants were categorized into three groups: those who had received at least one booster, those with only the initial complete vaccination series, and those with either an incomplete series or no vaccinations. Out of 9521 survey respondents who reported a past positive COVID-19 test, 51.2% experienced moderate/severe infections, and 17.6% experienced long COVID. Multivariable regression models revealed that receiving at least one booster shot was associated with lower odds of experiencing moderate/severe symptoms (aOR = 0.78, p < 0.001) compared to those unvaccinated or with an incomplete series. Additionally, having at least one booster reduced long COVID odds by 24% (aOR = 0.76, p = 0.003). Completing only the primary vaccine series did not significantly decrease the likelihood of severe illness or long COVID. These findings support the continued promotion of booster vaccinations to mitigate long COVID risks in vulnerable populations.

Increased number of ruptured aortic aneurysms during SARS-CoV-2 pandemic

Background and purpose: The aim of the study was to verify whether ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic or Coronavirus disease (COVID-19) vaccination has any influence on established increased number of ruptured aortic aneurysms (RAA) during SARS-CoV-2 pandemic (years 2020-2021) regarding two-year of pre-pandemic period (2018-2019). Materials and methods: Medical records of patients treated for the ruptured abdominal aortic aneurysm (RAAA) by surgical or endovascular reconstruction at the Department of Surgery, University Hospital Center Zagreb, between 2018 and 2021, were retrospectively analyzed. Categorical variables were analyzed using Fisher’s exact test, while numerical variables were analyzed using Student’s t-test or Mann-Whitney U test, depending on the normality of the distribution. Results: The analysis revealed an increase in number of RAAAs by 55.56% in pandemic time (28 versus 18 in pre-pandemic years), decrease in their 30-day mortality by 18.65 % (53.57% vs. 72.22% respectively) and decrease in outpatient examinations during pandemic by 13.82%, but the differences were not statistically significant. Conclusion: No statistically significant relation between SARS-CoV-2 pandemic or the COVID-19 vaccination and the number of treated RAAAs could be established. History of COVID-19 positivity or vaccination were not associated with RAAA outcome. The increase of RAAAs in pandemic along with decrease of its 30-day mortality compared to pre-pandemic time suggests patients’ hesitance to go to elective surgery and avoidance of regular check-ups in the hospitals, where lots of patients with SARS-CoV-2 are presumed to be concentrated, since hospital service policy and protocols remained the same. The patients were never directly asked to answer this question, so even if the fear of getting SARS-CoV-2 infection remains the most plausible answer, it should be verified by an independent survey.

The impact of cardiorespiratory fitness on COVID-19 related outcomes: the ETHOS Study

Abstract Background Comorbidities such as cardiovascular disease, diabetes, obesity and hypertension are associated with more severe COVID-19 outcomes, but the relative impact of cardiorespiratory fitness (CRF) on outcomes in COVID-positive patients is largely unknown. Objective To assess the association between objectively measured CRF and COVID-19-related health outcomes including mortality, hospitalization, and mechanical ventilation in non-COVID vaccinated patients. Design, Setting and Participants. Retrospective analysis of 750,302 subjects (23,140 [mean age 65.8±12.0 years] with a positive COVID-19 test between March 2020 and September 2021) who underwent a maximal exercise test between 1999 and 2020. Main Outcomes and Measures. Association between all-cause mortality, hospitalization due to COVID-19, and need for intubation with risk for severe COVID-19 outcomes after adjustment for 15 covariates. Subjects were stratified into five age-specific CRF categories (Least-fit, Low-fit, Moderate-fit, Fit and High Fit), based on peak metabolic equivalents achieved. Results During a median of follow-up of 100 days, 1,643 (7.1%) patients died, 4,995 (21.6%) were hospitalized, and 927 (4.0%) required intubation for COVID-19 related reasons. When compared to the Least-Fit subjects (referent), the Low-Fit, Moderately-Fit, Fit, and High-Fit subjects had hazard ratios for mortality of 0.82 (95% CI; 0.72-0.93), 0.73 (95% CI; 0.63-0.86), 0.61 (95% CI; 0.53-0.72), and 0.54 (95% CI; 0.45-0.65), respectively (Figure). Subjects who were more fit also had significantly lower need for hospital admissions and intubation. Similar patterns were observed for elderly subjects and subgroups with comorbidities including hypertension, diabetes, cardiovascular disease, and chronic kidney disease; for each of these conditions, those in the High-Fit category had mortality rates that were roughly half those in the Low-Fit category. Conclusion Among subjects positive for COVID-19, higher CRF had a favorable impact on survival, need for hospitalization, and need for intubation regardless of age, BMI, or the presence of comorbidities.

Metabolic changes assessed by 1H MR spectroscopy in the corpus callosum of post-COVID patients

ObjectiveMany patients with long COVID experience neurological and psychological symptoms. Signal abnormalities on MR images in the corpus callosum have been reported. Knowledge about the metabolic profile in the splenium of the corpus callosum (CCS) may contribute to a better understanding of the pathophysiology of long COVID.Materials and methodsEighty-one subjects underwent proton MR spectroscopy examination. The metabolic concentrations of total N-acetylaspartate (NAA), choline-containing compounds (Cho), total creatine (Cr), myo-inositol (mI), and NAA/Cho in the CCS were statistically compared in the group of patients containing 58 subjects with positive IgG COVID-19 antibodies or positive SARS-CoV-2 qPCR test at least two months before the MR and the group of healthy controls containing 23 subjects with negative IgG antibodies.ResultsAn age-dependent effect of SARS-CoV-2 on Cho concentrations in the CCS has been observed. Considering the subjective threshold of age = 40 years, older patients showed significantly increased Cho concentrations in the CCS than older healthy controls (p = 0.02). NAA, Cr, and mI were unchanged. All metabolite concentrations in the CCS of younger post-COVID-19 patients remained unaffected by SARS-CoV-2. Cho did not show any difference between symptomatic and asymptomatic patients (p = 0.91).DiscussionOur results suggest that SARS-CoV-2 disproportionately increases Cho concentration in the CCS among older post-COVID-19 patients compared to younger ones. The observed changes in Cho may be related to the microstructural reorganization in the CCS also reported in diffusion measurements rather than increased membrane turnover. These changes do not seem to be related to neuropsychological problems of the post-COVID-19 patients. Further metabolic studies are recommended to confirm these observations.

Wastewater threshold as an indicator of COVID-19 cases in correctional facilities for public health response: A modeling study

Although prison facilities are not fully isolated from the communities in which they are located, most of the population is confined and requires high levels of health vigilance and protection. This study aimed to examine the dynamic relationship between facility-level wastewater viral concentrations and the probability of at least one positive COVID-19 case within the facility. The study period was from January 11, 2021 to May 8, 2023. Wastewater samples were collected and analyzed for SARS-CoV-2 (N1) and pepper mild mottle virus (PMMoV) three times weekly across 14 prison facilities in Kentucky (USA). Positive clinical case reports were also provided. A hierarchical Bayesian facility-level temporal model with a latent lagged process was developed. We modeled facility-specific SARS-CoV-2 (N1) normalized by the PMMoV wastewater concentration ratio threshold associated with at least one COVID-19 clinical case at an 80 % probability. The threshold differed among facilities. Across the 14 facilities, our model demonstrates a mean capture rate of 94.95 % via the N1/PMMoV ratio threshold with pts≥0.5. However, as the pts threshold was set higher, such as at ≥0.9, the mean capture rate of the model was reduced to 60 %. This robust performance underscores the effectiveness of the model for accurately detecting the presence of positive COVID-19 cases among incarcerated people. The findings of this study provide a facility-specific threshold model for public health response based on frequent wastewater surveillance.

Few-shot learning for COVID-19 chest X-ray classification with imbalanced data: an inter vs. intra domain study

Medical image datasets are essential for training models used in computer-aided diagnosis, treatment planning, and medical research. However, some challenges are associated with these datasets, including variability in data distribution, data scarcity, and transfer learning issues when using models pre-trained from generic images. This work studies the effect of these challenges at the intra- and inter-domain level in few-shot learning scenarios with severe data imbalance. For this, we propose a methodology based on Siamese neural networks in which a series of techniques are integrated to mitigate the effects of data scarcity and distribution imbalance. Specifically, different initialization and data augmentation methods are analyzed, and four adaptations to Siamese networks of solutions to deal with imbalanced data are introduced, including data balancing and weighted loss, both separately and combined, and with a different balance of pairing ratios. Moreover, we also assess the inference process considering four classifiers, namely Histogram, kNN, SVM, and Random Forest. Evaluation is performed on three chest X-ray datasets with annotated cases of both positive and negative COVID-19 diagnoses. The accuracy of each technique proposed for the Siamese architecture is analyzed separately. The results are compared to those obtained using equivalent methods on a state-of-the-art CNN, achieving an average F1 improvement of up to 3.6%, and up to 5.6% of F1 for intra-domain cases. We conclude that the introduced techniques offer promising improvements over the baseline in almost all cases and that the technique selection may vary depending on the amount of data available and the level of imbalance.

The EPICOVID19-BS study: a web-based epidemiological survey in bariatric patients

Abstract Purpose To assess the occurrence and severity of SARS-CoV-2 infection/COVID-19, frequency of symptoms, clinical manifestations and behaviours in a sample of patients undergoing bariatric surgery (BS). Methods The EPICOVID19-BS is an observational cross-sectional study conducted in Italy during the second wave of the COVID-19 pandemic (September 2021-February 2022). Patients with severe/extreme obesity undergoing BS were asked to complete an online multiple-choice questionnaire and to provide additional clinical information and blood biochemistry. Positive COVID-19 cases were defined by the combination of positive nasopharyngeal swab test results and/or positive serological test results. Sociodemographic, clinical and behavioural characteristics were compared between positive and negative COVID-19 cases. Results A total of 745 participants were enrolled (mean age 44.5 ± 10.5 years SD, 78% female). The proportion of positive COVID-19 cases was 20.4%. They were more likely to be health care workers, to have close contacts with confirmed cases, to use anti-inflammatory drugs, to have immune system disorders, to have previous CMV infection, to have lower cholesterol levels and to have less metabolic syndrome than negative cases. Infected participants significantly increased their use of national health resources for minor health problems. The majority of participants experienced flu-like symptoms and taste and smell disturbances. Only 9.6% were hospitalised and none required intubation. Conclusions Our results seem to support the evidence that patients undergoing BS have a low rate of severe SARS-CoV2. Further longitudinal studies in multiple obesity treatment centres are needed to more effectively monitor and control obesity in this specific population. Graphical Abstract

COVID-19 vaccine related anxiety partially mediates the association between COVID-19 related anxiety and student adjustment to college during the pandemic

The COVID-19 pandemic caused severe disruptions in living and learning to millions of college students. Here we investigated using mediation analysis two dimensions of anxiety that were specific to the pandemic – COVID-19 related anxiety and COVID-19 vaccine anxiety – to evaluate their relationship to college adjustment during the pandemic. Using cross-sectional survey data across three semester waves (Spring 2021, Fall 2021, and Spring 2022) we probed whether anxiety functioned as a challenge or hindrance stressor on adjustment. We found that although anxiety decreased in both COVID-19 dimensions across semesters, student adjustment to college remained consistently low. Our mediation analysis revealed that both COVID-19 related anxiety and COVID-19 vaccine-related anxiety functioned as challenge stressors, elevating academic, social, personal-emotional, and institutional adjustment during the pandemic. We discuss the role of positive COVID impacts on college adjustment, including enhanced social support.

Excess burden of respiratory and abdominal conditions following COVID-19 infections during the ancestral and Delta variant periods in the United States: An EHR-based cohort study from the RECOVER program.

The frequency and characteristics of post-acute sequelae of SARS-CoV-2 infection (PASC) may vary by SARS-CoV-2 variant. To characterize PASC-related conditions among individuals likely infected by the ancestral strain in 2020 and individuals likely infected by the Delta variant in 2021. Retrospective cohort study of electronic medical record data for approximately 27 million patients from March 1, 2020-November 30, 2021. Healthcare facilities in New York and Florida. Patients who were at least 20 years old and had diagnosis codes that included at least one SARS-CoV-2 viral test during the study period. Laboratory-confirmed COVID-19 infection, classified by the most common variant prevalent in those regions at the time. Relative risk (estimated by adjusted hazard ratio [aHR]) and absolute risk difference (estimated by adjusted excess burden) of new conditions, defined as new documentation of symptoms or diagnoses, in persons between 31-180 days after a positive COVID-19 test compared to persons without a COVID-19 test or diagnosis during the 31-180 days after the last negative test. We analyzed data from 560,752 patients. The median age was 57 years; 60.3% were female, 20.0% non-Hispanic Black, and 19.6% Hispanic. During the study period, 57,616 patients had a positive SARS-CoV-2 test; 503,136 did not. For infections during the ancestral strain period, pulmonary fibrosis, edema (excess fluid), and inflammation had the largest aHR, comparing those with a positive test to those without a COVID-19 test or diagnosis (aHR 2.32 [95% CI 2.09 2.57]), and dyspnea (shortness of breath) carried the largest excess burden (47.6 more cases per 1,000 persons). For infections during the Delta period, pulmonary embolism had the largest aHR comparing those with a positive test to a negative test (aHR 2.18 [95% CI 1.57, 3.01]), and abdominal pain carried the largest excess burden (85.3 more cases per 1,000 persons). We documented a substantial relative risk of pulmonary embolism and a large absolute risk difference of abdomen-related symptoms after SARS-CoV-2 infection during the Delta variant period. As new SARS-CoV-2 variants emerge, researchers and clinicians should monitor patients for changing symptoms and conditions that develop after infection.

Characterizing the Impact of the Covid-19 Pandemic on Adults with Autosomal Dominant Polycystic Kidney Disease: A Cross-Sectional Study.

The Covid-19 pandemic greatly affected those with chronic diseases, impacting healthcare access and healthcare seeking behaviors. The impact of the pandemic on adults with Autosomal Dominant Polycystic Kidney Disease (ADPKD) has not been investigated. Participants were recruited from a cohort of 239 ADPKD patients enrolled in a longitudinal study at the University of Maryland. Patients on renal replacement therapy were excluded. N = 66 patients participated in a phone questionnaire from June 2022-December 2022 about ADPKD-related complications, concern about contracting Covid-19, healthcare-seeking behaviors, and telehealth utilization before and after March 2020. N = 34 (51.5%) of participants reported a positive Covid-19 test result and N = 29 (44%) expressed high concern of contracting Covid-19. Those who avoided medical care at least once (N = 17, 25.8%) had similar demographics and ADPKD severity to those who did not, but reported greater telehealth utilization (88.2% vs. 42.9%, p = 0.002), greater use of non-prescribed medication for Covid-19 treatment or prevention (35.3% vs. 8.2%, p = 0.01), and were more likely to contract Covid-19 (76.5% vs. 42.9%, p = 0.02). Among the N = 53 who reported very good or excellent ADPKD disease management pre-pandemic, N = 47(89%) reported no significant change during the pandemic. In this highly educated, high-income cohort with a mean age of 46.1 years, most people reported well-managed ADPKD prior to the pandemic. This may explain why less than half of participants expressed high concern for contracting Covid-19. Overall, there was no significant pandemic-related decline in self-reported ADPKD management, like due to excellent access to, and uptake of, telehealth services. Notably, 1 in 4 participants reported healthcare avoidant behavior, the effect of which may only be seen years from now. Future studies should investigate potential impacts of avoidant behaviors, as well as expand investigation to a more diverse cohort whose care may not have been as easily transitioned to telehealth.

Prevalence and factors associated with thyroid autoimmunity among children newly diagnosed with type 1 diabetes before and during the COVID-19 pandemic: Evidence from Kuwait.

This study reports the prevalence and characteristics related to the development of thyroid autoimmunity among children newly diagnosed with type I diabetes (T1D) during the COVID-19 pandemic in Kuwait. This is a prospective observational study of all children under age 14years newly diagnosed with T1D in Kuwait. We define the duration of the COVID-19 pandemic from the official declaration of the first identified positive COVID-19 case on 24 February 2020 until 31 December 2022. For comparison, we use the time period directly before the COVID-19 pandemic, 1 January 2017 to 23 February 2020. One thousand twenty-four (1024) children newly diagnosed with T1D in Kuwait during the study period were included. Among newly diagnosed children, 20.3% tested positive for thyroid antibodies during the COVID-19 pandemic, compared with 14.5% during the pre-pandemic period (p=0.015). Children with positive COVID-19 status were more likely to present with thyroid antibodies (p=0.035). After adjusting for other characteristics, patients diagnosed with T1D during the COVID-19 pandemic had double the odds of testing positive for thyroid antibodies (Adjusted odds ratio=2.173, 95%CI: 1.108, 4.261, p=0.024). Incident cases of T1D during the COVID-19 pandemic may be different in aetiology or contextual factors leading to a higher risk of thyroid autoimmunity. Longitudinal studies are needed to understand the role of COVID-19 in the onset and progression of T1D and on thyroid autoimmunity and disease.

Tracking the genetic diversity of SARS-CoV-2 variants in Nicaragua throughout the COVID-19 Pandemic.

The global circulation of SARS-CoV-2 has been extensively documented, yet the dynamics within Central America, particularly Nicaragua, remain underexplored. This study characterizes the genomic diversity of SARS-CoV-2 in Nicaragua from March 2020 through December 2022, utilizing 1064 genomes obtained via next-generation sequencing. These sequences were selected nationwide and analyzed for variant classification, lineage predominance, and phylogenetic diversity. We employed both Illumina and Oxford Nanopore Technologies for all sequencing procedures. Results indicated a temporal and spatial shift in dominant lineages, initially from B.1 and A.2 in early 2020 to various Omicron subvariants towards the study's end. Significant lineage shifts correlated with changes in COVID-19 positivity rates, underscoring the epidemiological impact of variant dissemination. The comparative analysis with regional data underscored the low diversity of circulating lineages in Nicaragua and their delayed introduction compared to other countries in the Central American region. The study also linked specific viral mutations with hospitalization rates, emphasizing the clinical relevance of genomic surveillance. This research advances the understanding of SARS-CoV-2 evolution in Nicaragua and provide valuable information regarding its genetic diversity for public health officials in Central America. We highlight the critical role of ongoing genomic surveillance in identifying emergent lineages and informing public health strategies.