BioMed

Despite the availability of vaccines and antivirals and the biological evolution of SARS-CoV-2, the rate of hospitalizations and deaths from COVID-19 remains high in Italy. It is crucial to understand whether and how the clinical characteristics of patients hospitalized for COVID-19 have changed over 2021–2022 and which risk factors are currently associated with adverse outcomes to develop targeted interventions. In this study, we present and compare the characteristics and outcomes of 310 patients with COVID-19 who were hospitalized between 1 August and 9 December 2021, when the Delta SARS-CoV-2 variant was prevalent (Group A), and between 3 January and 30 June 2022, when the Omicron variant was predominant (Group B). Using Survival Analysis, we estimated the cumulative 28-day hazard ratio (H.R.) of Intensive Care Unit (ICU) admission/death of patients in Group B vs. A. We built uni- and multivariate Cox regression models for the overall population and each group to identify risk factors for ICU admission/death among patient features. We found that Group B had a comparable risk of ICU admission/death (HR 1.60, 95% Confidence Interval, C.I. 1.00–2.58, p = 0.05) but a higher prevalence of elderly and co-morbid subjects than Group A. Non-invasive ventilation requirement was associated with adverse outcomes in both Group A (HR 21.03, 95% C.I. 5.34–82.80, p < 0.001) and Group B (HR 4.53, 95% C.I. 2.39–8.59, p < 0.001), as well as in the overall population (HR 3.88, 95% C.I. 2.49–6.06, p < 0.001). During the Omicron wave, elderly and co-morbid subjects had the highest risk of hospitalization and poor outcomes. Full article

The COVID crisis of the past three years has greatly impacted stakeholder relationships between scientists, health providers, policy makers, pharmaceutical industry employees, and the public. Lockdowns and restrictions of civil liberties strained an already fraught relationship between the public and policy makers, with scientists also seen as complicit in providing the justification for the abrogation of civil liberties. This was compounded by the suppression of open debate over contentious topics of public interest and a violation of core bioethical principles embodied in the Nuremberg Code. Overall, the policies chosen during the pandemic have had a corrosive impact on public trust, which is observable in surveys and consumer behaviour. While a loss of trust is difficult to remedy, the antidotes are accountability and transparency. This narrative review presents an overview of key issues that have motivated public distrust during the pandemic and ends with suggested remedies. Scientific norms and accountability must be restored in order to rebuild the vital relationship between scientists and the public they serve. Full article

Machine learning is being increasingly applied in various aspects of medicine. The availability of large amounts of digital health records has enabled researchers to apply machine learning algorithms to tackle different medical problems. Urinary tract infections (UTIs) are common bacterial infections that are prone to being misdiagnosed and over-treated with antibiotics. For appropriate tailored antibiotic therapy, new diagnostic methods providing rapid pathogen identification and antibiotic susceptibility testing are urgently needed. In this review, we first discuss emerging technologies that have employed machine learning models to deliver speedy diagnostic results, particularly for urinary tract infections. We then explore how machine learning models are enabling sequence-based diagnostics by predicting antibiotic resistances from genome sequencing data. Finally, we examine different studies that apply machine learning to electronic health records to improve UTI diagnosis, to reduce antibiotic use and guide treatments without urine culture, and to reduce clinical workload and unnecessary hospital visits. Full article

Baricitinib, a reversible Janus-associated kinase-inhibitor, is approved for treating COVID-19, combined with Dexamethasone and, eventually, with Remdesivir (RDV). This retrospective cohort study assesses the real-life advantages and limits of Baricitinib in the current pandemic scenario. Data of all patients consecutively hospitalized with moderate/severe COVID-19 between 1 October 2021 and 31 March 2022 were retrospectively collected and described according to the treatment received (Baricitinib, Baricitinib + RDV, none). We performed survival analyses to estimate the 21-day probability of Intensive Care Unit (ICU) admission, death, and composite. We built multivariate Cox regression models to identify ICU admission/death predictors among patients’ features. Of 111 subjects, 28 received Baricitinib, 21 received Baricitinib + RDV, and 62 could not be treated due to pre-existing conditions. Treated patients had a comparable risk of death (HR 0.50, 95% C.I. 0.20–1.26, p = 0.14) but remarkably lower risk of 21-day ICU admission (H.R., 0.10, 95% C.I., 0.01–0.86, p = 0.03), regardless of the type of treatment received. At multivariable analysis, older age was the only predictor of ICU admission/death (HR 1.14, 95% C.I. 1.03–1.26, p ≤ 0.01).Although effective, the high prevalence of elderly, co-morbid patients limits Baricitinib use in the current pandemic setting. Full article

Background: A number of corticosteroids are commonly used to treat COVID-19 infection. The aim of this retrospective study was to compare various hospital outcomes among mechanically ventilated COVID-19 patients in an ICU, who were administered either dexamethasone or methylprednisolone. Methods: A total of 121 mechanically ventilated COVID-19 patients from the ICU were included in the analysis, of which 43.8% (n = 53) received methylprednisolone, while 56.2% (n = 68) received dexamethasone. Results: In-hospital mortality (p = 0.381) and hospital length of stay (p = 0.307) were lower among the methylprednisolone group, compared to the dexamethasone group, though not significantly. Survival analysis showed that there were no significant differences between the methylprednisolone and dexamethasone groups (p = 0.978). A Cox proportional regression analysis showed that in-hospital mortality was lower among COVID-19 patients receiving methylprednisolone, compared to the dexamethasone group, though not significantly (hazard ratio (HR), 0.64; 95% CI: 0.35–3.17). Conclusion: Our study showed that in-hospital mortality was lower and hospital length of stay was higher among COVID-19 patients receiving methylprednisolone, compared to dexamethasone. These findings could have been due to the small sample size and limited scope of the study. Therefore, future large-scale studies should evaluate and confirm the findings in this study. Full article

Introduction: Alcohol and other drug (AOD) treatment services were required to rapidly adapt delivery of care in response to the coronavirus (COVID-19) pandemic. This study examined longitudinal changes in the delivery of AOD counselling in Australia over 21 months (October 2019–July 2021) before and throughout the pandemic, using both staff self-report and service data. Methods: Treatment staff from a large AOD service in Queensland, Australia provided self-report data on time spent delivering counselling via face-to-face, outreach (home visits), telephone, and virtual (video) formats. Two waves of online questionnaires were collected, with staff reporting on their time before the pandemic (retrospectively for October 2019–February 2020); during the first lockdown period (retrospectively for March–May 2020); when restrictions were initially eased (June–September 2020); and one year later (July 2021). Service records of the number of counselling episodes conducted by each treatment modality were extracted between October 2019 and July 2021, and analysed by month. Results: Staff (n = 117) and service records indicated an increase in telephone-delivered AOD counselling during the first lockdown, alongside an increase in total counselling records. Telephone-delivered counselling was still significantly higher one year later. Face-to-face counselling declined after the onset of the pandemic, but increased quickly when restrictions were eased. Outreach counselling decreased during the first lockdown. Virtual counselling remained negligible throughout. Conclusion: AOD treatment services quickly utilised telephone counselling options at the start of the pandemic, and demonstrated continued utilisation of this method one year later. Increased virtual (video) counselling was not observed and may be due to limited infrastructure, staff training, and clients lacking Internet connectivity or technology required. Full article

Background: Timely recognition of high-risk individuals with novel Coronavirus disease (COVID-19) is important. Yet, validated risk scores for kidney transplant recipients with COVID-19 are lacking. The present study aimed to externally validate the novel ImAgeS risk score in this population. Methods: A retrospective analysis of 65 kidney transplant recipients with COVID-19 was conducted. A robust external validation of the novel ImAgeS risk score with respect to 30-day all-cause mortality was performed using regression analysis, discrimination and calibration methods. Results: An overall mortality rate during the study follow-up was 18.5% (N = 12). The ImAgeS risk score showed a statistically significant association with 30-day all-cause mortality (HR 1.04 95% CI 1.00–1.08, p =  0.040). This risk score demonstrated a modest, statistically significant discrimination of all-cause mortality (AUC of 0.679 (95% CI 0.519–0.840, p = 0.027). The calibration of the model was acceptable with a Hosmer-Lemeshow value of 3.74, Harrell’s C concordance index of 0.699 and Somers’ D of 0.397. Conclusions: The ImAgeS risk score demonstrated a significant association with 30-day all-cause mortality in kidney transplant recipients with COVID-19. The model showed modest discrimination and satisfactory calibration, confirming the findings from the computational study. Further studies are needed to determine the utility of the ImAgeS score in this high-risk population. Full article

In the early months of the outbreak (2020–2022), COVID-19 was responsible for acute respiratory distress syndrome (ARDS) and an exceptional number of intensive care unit (ICU) admissions. Weaning difficulties from invasive mechanical ventilation (IMV) and many deaths related to COVID-19 were associated with persistent pulmonary hyperinflammation leading to pulmonary fibrosis and sometimes, in the first wave of the pandemic and before the use of dexamethasone was introduced, pulmonary cystic necrosis. A 72-year-old man hospitalized with severe COVID-19 required IMV and died on day 31 of refractory ARDS. Postmortem examination of the lungs found obliterative endotheliitis proximal to pulmonary cystic necrosis. The presence of SARS-CoV-2 envelope and complement/lectin (MASP-2) deposits near the endotheliitis lesions suggested that the virus acted directly on vascular involvement by a complement-mediated mechanism. Together with classic features of ARDS (epithelial lesions and diffuse alveolar damage), endothelial involvement with endotheliitis was the hallmark of severe COVID-19. Corticosteroids and complement blockade were sometimes beneficial for treating severe COVID-19, perhaps by preventing microvascular damage. Full article

The SARS-CoV2 pandemic is the most significant global health emergency of the last century. While the pathophysiology of SARS-CoV2 is understood, the early and long-term outcomes of natural infection are increasingly being recognised. Multisystem inflammatory syndrome (MIS) represents a manifestation of the extreme immune dysfunction that SARS-CoV2 infection heralds and has been described in both children (MIS-C) and adults (MIS-A). Here, we discuss current knowledge of MIS-A and the vast questions that remain unanswered. Full article

Recently, in Italy, a flowchart to be used by General Practitioners for the at-home treatment of patients with COVID-19, has been released. It states that early at-home treatment for SARS-CoV-2 infection is possible due to the availability of specific antiviral drugs to be used in at-risk patients, and that non-steroidal anti-inflammatory drugs (NSAIDs) have an important function in combating the virus. Therefore, the use of NSAIDs is not only rational but also effective in cases that cannot be treated using antivirals. These seemingly simple concepts have been applied in Italy since the beginning of the pandemic by doctors that belong to Italian groups created in order to help COVID-19 patients early at home, at a time of organizational difficulties within Italian health institutions and government. However, this approach was largely boycotted by both the Italian Ministry of Health and medical institutions, which mainly suggested the use of paracetamol as symptomatic, and a wait-and-watch approach for the first three days from the onset of symptoms. In this article, we analyze the rationale for the use of NSAIDs and, in particular, the multi-targeted approach including indomethacin in synergism with flavonoids and low-dose aspirin, as early at-home treatment of patients with COVID-19. Applying these simple concepts from the beginning could have reduced the high lethality of the disease during the first two years of the pandemic and prevented hospital overload. In perspective, it is still necessary to systematically address the comparison between different therapeutic approaches to this viral disease on an experimental basis. Full article

Despite the adverse effects of self-medication (SM), such as antimicrobial drug resistance, drug addiction, allergy, worsening of ailment, organ damage, disability, and death, the practice is still common and increasingly practiced globally, even among pregnant women. This study investigated the prevalence and factors influencing self-medication among pregnant women attending antenatal clinics in urban tertiary hospitals in Nigeria. A facility-based cross-sectional study was carried out in two tertiary hospitals in Port Harcourt between 25 September and 24 October 2022, using an interviewer-administered questionnaire. Data were analyzed using descriptive and logistics regression techniques, and statistical significance was set at p < 0.05. A total of 413 respondents participated in the study. The prevalence of SM was 31.0% (95% CI = 26.7–73.3). Women who were not married and those with less than secondary education had the highest prevalence, 60.5% (95% CI = 45.1–74.0) and 51.1% (95% CI = 42.7–59.4), respectively. The common drugs used for SM were Paracetamol, antimalarials, antibiotics, cough and cold medicines, and herbal products. While the reasons for SM were emergency illness, high cost at health facilities, and distance to the health facility. The commonest illnesses/symptoms that necessitated SM included body pain, headache, fever, cold and cough, and vaginal discharge. Married women and those educated above the secondary level had lower odds of practicing SM compared to their counterparts; married (AOR = 0.37, 95% CI = 0.18–0.78) and >secondary level (AOR = 0.31, 95% CI = 0.18–0.51). This study showed that a significant proportion of pregnant women practiced SM and marital status and educational level were the factors influencing SM in the studied population. We recommend public health education and reproductive health programmes aimed at discouraging unmarried women and those with minimal education from the irrational use of drugs during pregnancy. Full article

Mayaro virus is a neglected virus that causes a mild, dengue-like febrile syndrome characterized by fever, headache, rash, retro-orbital pain, vomiting, diarrhea, articular edemas, myalgia, and severe arthralgia, symptoms which may persist for months and become very debilitating. Though the virus is limited to forest areas and is most frequently transmitted by Haemagogus mosquitoes, Aedes mosquitoes can also transmit this virus and, therefore, it has the potential to spread to urban areas. This study focuses on the metabolic foot-printing of Vero cells infected with the Mayaro virus. Nuclear magnetic resonance combined with multivariate analytical methods and pattern recognition tools found that metabolic changes can be attributed to the effects of Mayaro virus infection on cell culture. The results suggest that several metabolite levels vary in infection conditions at different time points. There were important differences between the metabolic profile of non-infected and Mayaro-infected cells. These organic compounds are metabolites involved in the glycolysis pathway, the tricarboxylic acid cycle, the pentose phosphate pathway, and the oxidation pathway of fatty acids (via β-oxidation). This exometabolomic study has generated a biochemical profile reflecting the progressive cytopathological metabolic alterations induced by Mayaro virus replication in the cells and can contribute to the knowledge of the molecular mechanisms involved in viral pathogenesis. Full article

The acute rupture of the Achilles tendon is an increasingly common injury due to an active lifestyle and participation in sports, especially in the middle-aged group. We conducted a focused review of the literature and found that the acute rupture of the Achilles tendon leaves long-term changes in the structure of the triceps surae muscle, regardless of whether it was treated surgically or conservatively. Significant elongation of the Achilles tendon and atrophy of the triceps surae can be observed on the injured leg, even 4 years or more after the injury. The injury also has long-lasting consequences on movement patterns of walking, running and jumping. These compensatory strategies place stress on other musculoskeletal structures, which are then at greater risk for injury. Full article

Little is known about how family-level factors influence children’s caries prevention views and practices in Nigeria. The purpose of this study was to assess the associations between family level characteristics and caries prevention views and practices of 6–11-year-old primary school children. Data was collected through a cross-sectional survey of 1326 children in Ile-Ife, a Nigerian suburb. The child’s family structure, size, and birth rank were independent variables while the child’s caries prevention views and self-care practices were dependent variables. Multivariable logistic regression analysis was conducted to identify risk indicator(s) for caries prevention views and practices. The study participants’ mean (SD) age was 8.7 (1.9) years, 407 (30.7%) children had positive caries prevention views, and 106 (8.0%) children did not use the recommended self-care caries preventive methods. Children from larger families had significantly lower odds of having positive prevention views (AOR: 0.572; p = 0.002). Children who were not living with both parents had higher odds of using recommended self-care caries preventive methods (AOR: 3.165; p = 0.048). The findings suggest that family size and family living structure may be social determinants of caries risks in children 6–11 years old in the study population. These findings need to be studied further. Full article

The aim of this study was to identify the sociodemographic factors associated with emotional distress and determine if the quality of family relationships and the perception of social isolation can protect those who transacted sex or used psychoactive substances from emotional distress during the COVID-19 pandemic. Data for 426 people who transacted sex and 630 persons who used psychoactive drugs during the COVID-19 pandemic were extracted from a database of participants recruited from 152 countries. The extracted data were the dependent (emotional distress), independent (age, sex, education status, employment status, HIV status, the perception of social isolation, and the quality of family relationships), and confounding (country income level) variables. Multivariable logistic regression analyses were conducted to determine the associations between the dependent and independent variables after adjusting for confounders. Students who transacted sex (AOR:2.800) and who used psychoactive substances (AOR:2.270) had significantly higher odds of emotional distress. Participants who transacted sex, lived with HIV (AOR:2.582), or had the same/better quality of family relationships (AOR:1.829) had significantly higher odds of emotional distress. The participants who used psychoactive substances, had tertiary education (AOR:1.979), were retired (AOR:2.772), were unemployed (AOR:2.263), or felt socially isolated (AOR:2.069) had significantly higher odds of emotional distress. Being a student was the only sociodemographic risk indicator common to both populations. The risk indicators and protective factors for emotional distress differed for both populations despite both being at high risk for emotional distress. Full article

Dyslipidemia is a condition of abnormalities in blood lipids, such as increased LDL and decreased HDL. Exposure to intracellular static magnetic fields (SMFs) can affect membranes to modulate the number of Ca²⁺ ions, which can affect cell biological effects. Increasing the number of Ca²⁺ ions will affect the expression of genes that help reduce LDL levels as an indicator of CHD. This study aims to see whether the influence of SMFs can affect calcium levels, lipid profiles, SREBP-2 protein excretion, and LDLR gene expression, which affects the process of breaking down cholesterol. We used obese C57BL/6J male mice divided into standard and HFD feed groups. The HFD feed group was split into Obes0, Obes2, Obes7, Obes14, and Obes21 groups based on the day of exposure. The exposure was carried out with an intensity of Bmax = 2 mT for 1 h daily. After exposure to SMFs, there were changes in blood cholesterol and LDL levels, which tended to decrease in the Obes2 and Obes7 groups and increase in the Obes14 and Obes21 groups. In addition, the exposed group tended to have an increase in the expression of the LDLR gene, SREBP-2 protein, and calcium ion compared to the control. Although it managed to increase after exposure on days 14 and 21, there was a decrease in the expression of the LDLR gene and SREBP-2 protein; hence, the effect of SMF exposure can reduce the risk of CHD. However, research still needs to be done regarding the effective duration of exposure. Full article

The present work presents evaluation and experimental verification of the use of X-ray computed tomographic microscopy (micro-CT) for accurate characterization of geometry, microarchitecture, and stiffness properties of bones. These properties are crucial for designing and building optimized implants for joint and dental reconstruction applications. High-resolution micro-CT scans would provide more detailed and accurate information about the microarchitecture and density distribution across patient bones. Nevertheless, micro-CT applications on live patients require invasive procedures involving small bone biopsy specimens. Alternatively, micro-CT could be used on samples collected from selected cadavers of different age, gender, and race groups to establish a database that could be used for providing useful microarchitecture information. The micro-CT scans of investigated bone samples reveal that the trabecular bone is anisotropic and heterogeneous. The results also showed considerable degree of parametric variability and uncertainty on microarchitecture and stiffness properties of patient’s trabecular bone. Full article

Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen with a great ability to adapt to stress, in particular, to the selective pressure of antibiotics in the hospital environment. This pathogen constitutes a real public health concern, especially in low- and middle-income countries. In Cameroon, little is known about the drug resistance patterns of Pseudomonas aeruginosa. This study sought to determine the prevalence of Pseudomonas aeruginosa strains producing carbapenemases in six health facilities in the center, littoral, and west regions of Cameroon. An analytical cross-sectional study was conducted over a four-month period from July to October 2021. All Pseudomonas aeruginosa or suspected strains isolated from pathological products at the bacteriology laboratory of different health facilities were systematically collected and underwent a re-identification. After growing on cetrimide agar and successfully subculturing on nutrient agar, an oxidase test was performed on pure colonies, followed by biochemical identification (API 20NE system) of the bacterial suspension (0.5McFarland standard). Drug susceptibility testing for the detection of extended-spectrum beta-lactamases of overproduced inducible cephalosporinases and carbapenemases was performed according to adequate standard procedures. Of the 468 isolates collected, 347 (74.14%) were confirmed Pseudomonas aeruginosa after re-identification, of which 34.49% (120/347) produced inducible cephalosporinases (CAZ^R and C/T^S) and 32.26% (112/347) extended-spectrum beta-lactamases. The prevalence of carbapenemase-producing P. aeruginosa (IMP^R and C/T^R) was 25.07% (87/347), with 17.24% (15/87) class A and 82.76% (72/87) class B. A high rate of resistance to penicillin (piperacillin: 70.58% and ticarcillin: 60.24%) was observed. We also noted a 34.49% resistance to ceftazidime, 30.22% to imipenem against 37.02% to meropenem, and 25.1% to ceftolozane/tazobactam (C/T). These strains also exhibited 79.57% resistance to quinolones and about 26% to aminoglycoside families. Multivariate analysis revealed that carbapenemase-producing Pseudomonas aeruginosa-related infections were significantly associated with hospitalization (p = 0.04), maternity (p = 0.03), surgery (p = 0.04), and intensive care wards (p = 0.04). This study highlighted a high burden of resistant strains of carbapenemase-producing Pseudomonas aeruginosa. Surveillance should be intensified to prevent the dissemination and spread of these strains. Full article