Search Results (814)

Many patients experience unique or persistent symptoms several months following the onset of infection with severe acute respiratory syndrome coronavirus 2, the causative agent of COVID-19. While this condition is commonly referred to as long COVID, no universally accepted definition exists; therefore, many patients go underrecognized and underreported. Long COVID can involve almost any major organ system and is characterized by widely heterogeneous persistent or recurrent symptoms including fatigue, headache, cough, dyspnea, chest pain, cognitive dysfunction, anxiety, and depression. In line with the wide array of symptoms, numerous potential underlying pathophysiologic pathways, including viral persistence, prolonged inflammation, autoimmune reactions, endothelial dysfunction, and dysbiosis of the microbiome of the gut, may contribute to the symptomology of long COVID. Therapy is directed at symptomatic control; however, no pharmacologic treatments are specifically approved for the management of symptoms associated with long COVID. Several common symptoms of long COVID may be managed with nonprescription treatments (pharmacologic and nonpharmacologic). The goal of this review is to provide clinicians with a better understanding of long COVID and review the latest recommendations for managing common mild-to-moderate symptoms with nonprescription treatment options. Full article

The built environment requires retrofitting on a massive scale to both mitigate the impacts of climate change and adapt to future conditions. Buildings of high thermal mass offer useful insights into the limits of passive measures in futureproofing against overheating. Historic buildings typically have a higher thermal mass and also offer a paragon case to study improvement options that do not compromise heritage or character. This paper focuses on the Tower of London as a case study. Data from pre- and post-COVID-19 allows insights into the building performance in the absence of end users. A thermal model is calibrated to accurately represent both the physics of the building and the impacts of its occupants in use. Future weather files then test the extent to which the building’s thermal mass can mitigate against overheating under a range of climate warming scenarios. The results suggest that prolonged heat waves pose a serious risk to passive mitigation strategies as the mass of the building stores heat it cannot shed overnight. These scenarios also reduce the heating demand in winter. The results suggest that the built environment faces subtle design challenges in understanding the limits for passive design techniques versus the need for cooling in a warming climate. For the Tower in particular, a significant increase in overheating is likely in the coming decades. Full article

Dry eye disease (DED) is a prevalent and disabling condition. Artificial tears are commonly used but often inadequate for moderate-to-severe cases. Secretagogues such as pilocarpine, cevimeline, and diquafosol offer potential alternatives, though their comparative effectiveness remains unclear. To evaluate the safety and efficacy of these secretagogues versus artificial tears in adults with DED, we searched CENTRAL, PubMed, Scopus, LILACS, ClinicalTrials.gov, and WHO ICTRP without language restrictions. Randomized controlled trials (RCTs) comparing secretagogues to artificial tears were eligible. Data extraction and synthesis were conducted using Covidence and the Cochrane RoB 2 tool, and 19 RCTs (n = 2697) were included. Fifteen were analyzed quantitatively; however, only eight trials evaluating diquafosol were suitable for meta-analysis, as data for pilocarpine and cevimeline were insufficient for quantitative synthesis. GRADE was used to assess evidence certainty. PROSPERO registration: CRD42020218407. Diquafosol significantly improved rose bengal staining at 4 weeks and OSDI scores and TBUT in post-cataract patients at 4 and 12 weeks. However, it increased mild adverse events (RR, 1.81; 95% CI, 1.15–2.84). Evidence for pilocarpine and cevimeline was limited. Diquafosol 3% shows greater efficacy than artificial tears in post-cataract DED but with more side effects. Further research is needed for other secretagogues. Full article

Background/Objectives: The coexistence of metabolic syndrome and COVID-19 presents a major challenge for healthcare systems, as individuals with metabolic syndrome are at significantly higher risk of severe disease and poor outcomes. The aim of this study was to assess how metabolic syndrome influences the outcomes of rehabilitation in patients recovering from COVID-19. Methods: This is a prospective observational study conducted at a rehabilitation hospital in Szczecin (Poland). One hundred and forty-six patients with COVID-19 were enrolled. Data on age, gender, BMI, comorbidities, and hospitalization were analyzed. The intervention included a comprehensive post-COVID-19 rehabilitation program. Data were collected using functional tests (6MWT and spirometry), and clinical records were analyzed. Results: Patients with metabolic syndrome had significantly higher BMI (p < 0.001), lower HDL cholesterol (p < 0.001), and higher triglyceride levels (p < 0.001) compared with the group without metabolic syndrome. After rehabilitation, both groups showed significant improvements in 6MWT distance (with MetS p < 0.001; without MetS p < 0.001) and FEV₁% predicted (MetS p = 0.025; without MetS p = 0.021). However, regression analysis shows that age was a significant negative predictor of 6MWT performance in both groups (p < 0.01), whereas hypertension and diabetes predicted worse post-rehabilitation outcomes in the group without MetS. Conclusions: Comprehensive rehabilitation after COVID-19 benefits all patients, regardless of the presence of metabolic syndrome. However, individual clinical factors such as age, hypertension, diabetes, and male gender are crucial to its effectiveness. This highlights the need for individualized rehabilitation programs, especially for patients with metabolic conditions, which can significantly increase the effectiveness of therapeutic interventions. Full article

Introduction: Human metapneumovirus (HMPV), though commonly perceived as a pediatric pathogen, significantly impacts adults, yet its role in acute respiratory tract infections (ARTIs) remains underappreciated. The COVID-19 pandemic has reshaped respiratory virus epidemiology and amplified the need for comprehensive differential diagnosis. This study aimed to comprehensively investigate the prevalence, clinical characteristics, and post-COVID-19 trends of HMPV infection in adults and to elucidate its critical role in the differential diagnosis of ARTIs by distinguishing it from other common viral pathogens. Methods: This was a retrospective, multicenter study conducted across six hospitals within the Acibadem Hospitals Group in Istanbul, Turkey. Data were collected from two periods: January 2016 to January 2020 (pre-COVID-19) and January 2021 to September 2023 (post-COVID-19), excluding the peak pandemic phase (March 2020 to May 2021). Respiratory samples (sputum, BAL, nasopharyngeal/nasal/throat swabs) were analyzed using multiplex PCR (Seegene RV12-ACE), with an expanded panel including SARS-CoV-2 in the post-COVID-19 era. Demographic data, comorbidities, symptoms, hospitalization, and ICU admission rates were collected. Results: In the post-COVID-19 period, 2197 positive viral panels were recorded, an increase from 1357 in the pre-COVID period, reflecting enhanced testing. HMPV prevalence reached 9.7% post-COVID-19, making it the fourth most common respiratory virus in adults (8.7% of 644 positive adult tests), following SARS-CoV-2 (26.4%), influenza A (21.3%), and rhinovirus (17.5%). The average age of HMPV-infected adults was 52.14 years (18–90 years); 64% were female. While 52% had no comorbidities, common underlying conditions included hypertension (24%), cancer (12%), and diabetes (10%). Weakness (34%), lower respiratory symptoms (16%), and fever (12%) were frequent. A significant proportion of HMPV patients required hospitalization (34%) and ICU admission (18%), with 40% receiving antibiotics. Despite potential severity, the mortality rate was low (2.8%). No significant difference in severity was observed between HMPV monoinfection and co-infected groups (e.g., with influenza A, rhinovirus, SARS-CoV-2, parainfluenza virus 2). Conclusion: Our findings establish HMPV as a significant and increasingly prevalent respiratory pathogen among adults in Istanbul in the post-COVID-19 era. Its non-specific clinical presentation underscores the critical importance of multiplex PCR for accurate differential diagnosis, enabling appropriate patient management and antimicrobial stewardship. While HMPV can lead to severe outcomes requiring hospitalization and ICU admission, particularly in patients with comorbidities, the overall mortality rate remains low. Given the lack of specific antiviral treatments and vaccines, sustained surveillance and continued research into targeted interventions are crucial. Full article

The impacts of the COVID-19 pandemic and post-pandemic recovery in urban communities in the Arctic have been substantial, but their gendered aspects remain largely unknown. The goal of this study was to enhance the understanding of the gender-based impact on women in the urban areas of Alaska by exploring strengths and constraints to resilience in the social and economic domains of gender equality during and in the aftermath of the COVID-19 pandemic. Drawing on grounded theory methodology, this study is based on 29 in-depth, semi-structured interviews. The study methodology utilized a conceptual framework that integrated deficit-based and strength-based analytical perspectives. The paper implemented a voice-centered approach that drew on thematic interviews conducted with women in Anchorage and Nome. Alaska’s urban women demonstrated resilience rooted in self-empowerment and community caregiving. This was reflected in their critical re-evaluation of social and economic gendered structures, a reassessment of priorities in family and social relationships, and the mobilization of support networks. These acts of reflection and care transformed into processes of constructing new meanings of life during dramatic events and became a source of personal strength. The crisis also enabled a re-evaluation of entrenched gender dynamics and women’s ability to challenge gendered divisions in both the workplace and at home. Despite signs of resilience, the pandemic signified a setback for gender equality. It exacerbated pre-existing gender disparities within households, disrupted established pre-pandemic social support networks, increased unpaid domestic labor and a motherhood penalty, and deepened unemployment and income gaps. To further adapt to post-pandemic conditions, women need empowerment and greater representation in decision-making roles, which are critical to strengthening resilience in both the social and economic domains of gender equality. Full article

Since the start of the COVID-19 pandemic, increasing evidence has shown that SARS-CoV-2 infection can cause long-term symptoms, collectively known as long COVID, and that patients with mild COVID-19 can also be affected by persistent fatigue, cognitive impairment, dyspnea, muscle pain, etc. Recent research has also found multiple organ systems, including the liver, to be significant sites of ongoing injury. This narrative review summarizes current knowledge on organ involvement during and after COVID-19, with particular focus on early and delayed hepatic manifestations and associated risk factors. Pathogenesis appears to be multifactorial, involving direct virus action, the body’s immune-mediated inflammatory response, microvascular damage, drug-induced hepatotoxicity, and, in some cases, reactivation or exacerbation of pre-existing liver conditions. The hepatic clinical manifestations range from asymptomatic elevations of transaminases to cholangiopathy and even fibrosis. These can persist or progress for months after the initial infection with SARS-CoV-2 is resolved, requiring prolonged monitoring and interdisciplinary care, especially in the presence of metabolic disorders, obesity, or hepatitis. Neurological, cardiovascular, and other sequelae are discussed in parallel, with attention paid to common inflammatory and thrombotic pathways. This review concludes that liver dysfunction is of particular interest in long-COVID due to the liver’s central role in metabolism and inflammation. While further research is being conducted into organ-specific and systemic interactions, the available evidence makes a compelling case for extended monitoring and integrated management strategies post infection. Full article

SARS-CoV-2 infection can be followed by prolonged symptoms, signs and sequelae, collectively known under the term Long COVID. Hundreds of millions are estimated to suffer from Long COVID. Long COVID, therefore, is a public health crisis that deserves the utmost urgency from all relevant stakeholders, from policymakers to advocacy groups, researchers and healthcare providers. The development of effective definitions and guidelines for Long COVID is crucial to support patients and carers. In this review, I address the following two case definitions of Long COVID developed in the US as a case study for a broader discussion on the sequelae of SARS-CoV-2 infection: the U.S. Government (USG) working definition for Long COVID and the NASEM definition published in 2024. In the first part of this review, I provide a critical appraisal of the USG in light of research, pathophysiology and lived experience, building upon my intervention as a patient expert on a National Academies of Sciences, Engineering, and Medicine (NASEM) panel for defining Long COVID, which examined the USG. In the second part, I raise some pressing concerns to address when approaching Long COVID as a disease entity and as a concept, which I originally submitted to NASEM. In the third part, I offer a critical appraisal of the NASEM definition, the most recent benchmark for Long COVID in the US. The review highlights the importance of broad, expansive and inclusive definitions for Long COVID, accounting for the disease’s heterogeneous, fluctuating and multi-system manifestations. Clinical case definitions for Long COVID must retain their focus on the broader spectrum and scope of the disease entity, while incorporating feedback from people with lived experience, advocates and patient-researchers. Full article

Background/Objectives: Secular trends in children’s physical development are important indicators of population health, nutritional status, and socioeconomic conditions. This study aimed to assess long-term changes in the height, weight, Body Mass Index (BMI), and nutritional status of boys from Eastern Poland between 1986 and 2021. Methods: Anthropometric data were collected from 13,172 boys aged 8, 13, and 17 years at five time points (1986, 1996, 2006, 2016, and 2021). Standardized measurement protocols were used throughout the study. The BMI was calculated and categorized using international cut-off points for age and gender. Secular changes in the height, weight, and Body Mass Index (BMI) were analyzed using an analysis of variance (ANOVA) with post hoc tests, and differences in dietary categories were assessed using chi-square tests (p ≤ 0.05). Results: The height, weight, and BMI increased significantly across all ages. The largest height gain was seen in 13-year-olds, while the greatest BMI increase occurred between 2016 and 2021. The overweight and obesity prevalence rose sharply by an average of 21.70% across age groups, with the normal BMI prevalence decreasing by 18.41%. The underweight prevalence declined, especially among adolescents; however, this likely reflects a general upward shift in the BMI rather than a true nutritional improvement. Conclusions: Strong secular trends are evident, influenced by global and local socioeconomic factors, including Poland’s EU accession and the COVID-19 pandemic. While an increased height suggests better living standards, the rising overweight and obesity rates indicate emerging health risks. Due to the lack of direct lifestyle and socioeconomic data, further research incorporating these factors and the pubertal BMI variability is needed to clarify underlying causes. Targeted regional strategies promoting healthy diets, physical activity, and lifestyles are urgently required. Full article

This study evaluates the performance of U.S. data center Exchange-Traded Funds (ETFs) relative to major equity and technology benchmarks, using monthly returns from January 2000 through December 2024, with particular emphasis on the COVID-19 period and the subsequent post-vaccine era. Data center ETFs have not provided better risk-adjusted returns even though they are often advertised as access points to the digital economy. Digital infrastructure demand increased through the pandemic but did not improve the performance of these funds which stayed weak across both traditional and conditional multi-factor asset pricing models. These ETFs struggle with asset selection and market timing proficiency, which leads to relatively poor performance results during volatile market conditions. The downside risks linked to these funds tend to match or exceed the downside risks of broader indices like the S&P 1500 Information Technology Index. Although these investments are based on strong thematic narratives, they do not achieve returns that align with investor expectations. Full article

Tuberculosis remains a serious infectious disease that causes over 1.3 million deaths annually. Following the COVID-19 pandemic, the global incidence of tuberculosis has increased to 10.8 million cases. Pregnant women represent a particularly vulnerable population requiring tailored approaches to the prevention, diagnosis, and treatment of tuberculosis. SARS-CoV-2 infection may have impacted existing clinical protocols. Implementing updated methods of tuberculosis prevention, diagnosis, and treatment in pregnant women could help reduce adverse maternal and fetal outcomes. The aim of this review was to explore potential modifications in tuberculosis management among pregnant women in the post-COVID-19 era, including co-infection with SARS-CoV-2. Methods: A review was conducted, incorporating a systematic literature search across major international databases, including Medline, PubMed, Web of Science, Scopus, and Google Scholar. The search covered publications released between December 2019 and September 2024 and used targeted keywords such as “COVID-19” OR “SARS-CoV-2”, “tuberculosis” OR “TB” OR “latent tuberculosis infection” OR “pulmonary tuberculosis”, and “pregnancy” OR “pregnant women”. Results: Pregnant women living with HIV are at increased risk of developing tuberculosis, which can negatively affect both maternal and perinatal outcomes. Screening for tuberculosis is recommended for all HIV-positive pregnant women, even in the absence of clinical symptoms. Notably, immunological testing before and during pregnancy facilitates the timely and safe detection of tuberculosis infection, enabling preventive and therapeutic interventions during any stage of gestation and the early postpartum period, for the benefit of both mother and child. Drug–drug interactions play a significant role in tuberculosis management, both among anti-tuberculosis agents and with medications for comorbid conditions. Current knowledge of the pharmacokinetics and pharmacodynamics of antituberculosis agents, coupled with therapeutic drug monitoring, supports the development of individualized and effective treatment regimens, which are particularly critical for pregnant patients. Recommendations for managing tuberculosis in pregnant women after COVID-19 infection include measuring D-dimer levels, performing echocardiography, and consulting cardiologists to prevent treatment-related complications. Conclusions: Pregnant women represent a distinct subgroup of tuberculosis patients requiring individualized management. Changes observed in tuberculosis progression and treatment responses in pregnant women before and after SARS-CoV-2 infection should inform therapeutic choices, especially in cases of drug-resistant tuberculosis treated with bedaquiline. COVID-19 has been associated with increased cardiovascular risk, which may heighten the likelihood of adverse drug reactions in this population, especially given the limited therapeutic options. Further research is required to assess the long-term outcomes of latent tuberculosis infection in pregnant women and to evaluate the safety and efficacy of novel regimens for drug-resistant TB during pregnancy. Full article

This paper investigates the dynamics of volatility spillovers in the South African foreign exchange market across calm and crisis periods, with particular attention paid to the pre- and post-COVID-19 eras. Employing daily exchange rate returns from 2015 to 2025, we apply a Quantile Vector Autoregression (QVAR) model to uncover asymmetries in spillover transmission across the distribution of returns. We evaluate the implications of these spillovers for portfolio performance under three canonical strategies: risk parity, tangency, and naïve equal-weighting. Our findings indicate that the COVID-19 shock intensified volatility spillovers and exacerbated their asymmetry, especially in the lower tail, while the pre-COVID period portrayed higher volatility compared to the post-COVID period under calm market conditions. While risk-based strategies dominate in tranquil markets, equal-weighted portfolios exhibit superior downside resilience under stress, although they ignore risk exposure. These results underscore the importance of accounting for tail-risk-driven interconnectedness in portfolio construction and risk management. This study contributes to the growing literature on volatility spillovers and offers practical insights for managing currency exposure in emerging markets under nonlinear dependence structures. Full article

Background: Coronavirus disease 2019 (COVID-19) has led to the expansion of the spectrum of invasive fungal infections beyond traditional immunocompromised populations. Although COVID-19-associated pulmonary aspergillosis is increasingly being recognised, COVID-19-associated mucormycosis remains rare, particularly in non-endemic regions. Concurrent COVID-19-associated invasive tracheobronchial aspergillosis and pulmonary mucormycosis with histopathological confirmation is exceedingly uncommon and poses significant diagnostic and therapeutic challenges. Case presentation: We report the case of a 57-year-old female with myelodysplastic syndrome who underwent haploidentical allogeneic haematopoietic stem cell transplantation. During post-transplant recovery, she developed COVID-19 pneumonia, complicated by respiratory deterioration and radiological findings, including a reverse halo sign. Bronchoscopy revealed multiple whitish plaques in the right main bronchus. Despite negative serum and bronchoalveolar lavage fluid galactomannan assay results, cytopathological examination revealed septate hyphae and Aspergillus fumigatus was subsequently identified. Given the patient’s risk factors and clinical features, liposomal amphotericin B therapy was initiated. Subsequent surgical resection and histopathological analysis confirmed the presence of Rhizopus microsporus. Following antifungal therapy and surgical intervention, the patient recovered and was discharged in stable condition. Conclusions: This case highlights the critical need for heightened clinical suspicion of combined invasive fungal infections in severely immunocompromised patients with COVID-19, even in non-endemic regions for mucormycosis. Early tissue-based diagnostic interventions and prompt initiation of optimal antifungal therapy are essential for obtaining ideal outcomes when co-infection is suspected. Full article

Nasal irrigation (NI) is an effective, safe, low-cost strategy for treating and preventing upper respiratory tract diseases. High-volume, low-pressure saline irrigations are the most efficient method for removing infectious agents, allergens, and inflammatory mediators. This article reviews clinical evidence supporting NI use in various conditions: nasal congestion in infants, recurrent respiratory infections, acute and chronic rhinosinusitis, allergic and gestational rhinitis, empty nose syndrome, and post-endoscopic sinus surgery care. NI improves symptoms, reduces recurrence, enhances the efficacy of topical drugs, and decreases the need for antibiotics and decongestants. During the COVID-19 pandemic, NI has also been explored as a complementary measure to reduce viral load. Due to the safe profile and mechanical cleansing action on inflammatory mucus, nasal irrigations represent a valuable adjunctive treatment across a wide range of sinonasal conditions. Full article

The COVID-19 pandemic catalyzed the rapid adoption of remote patient monitoring (RPM) technologies such as telemedicine and wearable devices (WDs), significantly transforming healthcare delivery. Telemedicine made virtual consultations possible, reducing in-person visits and infection risks, particularly for the management of chronic diseases. Wearable devices enabled the real-time continuous monitoring of health that assisted in condition prediction and management, such as for COVID-19. This narrative review addresses these transformations by uniquely synthesizing findings from 13 diverse studies (sourced from PubMed and Google Scholar, 2020–2024) to analyze the parallel evolution of telemedicine and WDs as interconnected RPM components. It highlights the pandemic’s dual impact, as follows: accelerating RPM innovation and adoption while simultaneously unmasking systemic challenges such as inequities in access and a need for robust integration approaches; while telemedicine usage soared during the pandemic, consumption post-pandemic, as indicated by the reviewed studies, suggests continued barriers to adoption among older adults. Likewise, wearable devices demonstrated significant potential in early disease detection and long-term health management, with promising applications extending beyond COVID-19, including long COVID conditions. Addressing the identified challenges is crucial for healthcare providers and systems to fully embrace these technologies and this would improve efficiency and patient outcomes. Full article