Search

Background: Severe acute respiratory infection (SARI) is a major cause for hospital admission and associated with high mortality among children worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses and respiratory syncytial virus (RSV) are the most frequently identified pathogens in children with SARI. The duration of care can be affected by the type of infection and patient characteristics. Therefore, the objective of this study was to identify factors affecting the length of hospitalization in children infected with SARS-CoV-2, influenza A and RSV. Methods: We collected data on 713 children with SARI from the medical databases of a university hospital in Hungary. To examine whether there is a difference in the length of hospitalization in children with the SARI Kruskal-Wallis test was performed. To determine the factors that may have an impact on the duration of care a multiple logistic regression analysis was executed. Results: Our results showed that among RSV infected patients the proportions of children requiring intensive care (8.94%), mechanical ventilation (8.94%) and oxygen therapy (13.01%) and suffering from pneumonia (29.27%) were larger than among cases with SARS-CoV-2 and influenza A infection. Considering the age distribution and the duration of care in children with SARI, cases with RSV were significantly younger (p < 0.001) and stayed longer in the hospital (median: 5 days, IQR: 4–7 days, p < 0.001) than those with SARS-CoV-2 and influenza A virus. Multiple logistic regression analysis showed that RSV infection (adjusted odds ratio (aOR): 3.25, 95% confidence interval (CI): 1.43–7.38; p = 0.005), pneumonia (aOR: 3.65, 95% CI: 2.14–6.24; p < 0.001), mechanical ventilation or oxygen therapy (aOR: 3.23, 95% CI: 1.29–8.11; p = 0.012) and underlying illnesses (aOR: 2.39, 95% CI: 1.35–4.23; p = 0.003) significantly increased the odds of hospitalization for more than 4 days. Conclusions: Our research showed that of the viruses causing SARI, RSV had the greatest clinical relevance, contributing to hospital stays of more than 4 days in a large share of paediatric patients below 1 year of age. Our results supply new information on children with SARI, and provide evidence for health policy makers to allocate additional resources to hospitals during SARI epidemics. [ABSTRACT FROM AUTHOR]

Purpose: The present study explored the molecular characterization of human Adenovirus (HAdV) and its strains among hospitalized SARI cases in the pediatric unit of a tertiary care hospital in North-East India. Methods: Nasal and throat swabs were collected from 70 patients of Pediatric Unit, of a tertiary hospital in NE India from April 2023-October 2023. The samples were screened for the presence of HAdV using an adenovirus-specific Real-Time PCR Kit. For molecular characterization, Next Generation Sequencing (NGS) was performed by targeting the hexon gene of HAdV followed by post-sequencing analysis. Results: Overall, 18.57% (13/70) of samples were positive for HAdV. In context of the severity of illness, 3/13 adenovirus-positive patients (23.07%) died after hospitalization, had severe pneumonia among which two were of less than one year of age. Molecular characterization using NGS indicated that 4/13 individuals were infected with HAdV-B type 3 and 5/13 patients were infected with HAdV type 7. Notably, 4/7 cases of severe pneumonia were under five years of age and associated with HAdV type 7 infection. The ratio of non-synonymous to synonymous mutation (dN/dS) was comparatively low in HAdV type 7 positive samples (dN/dS=0.31). No non-synonymous mutation was observed in HAdV-B type 3 positive samples. The higher neutrophil percentage among the death cases suggested an acute immune response. Conclusion: The study demonstrated HAdV type 7 and HAdV-B type 3 as strains associated with pediatric SARI cases from April 2023-October 2023. Further, HAdV type 7 infection was primarily linked with lower respiratory tract infections mainly severe pneumonia. [ABSTRACT FROM AUTHOR]

Abstract Background Human papillomavirus (HPV) is responsible for the most common sexually transmitted infection, particularly among sexually active individuals. Understanding the geographical distribution and epidemiology of the most prevalent HPV genotypes is essential for developing effective prevention strategies. Consequently, this study aimed to examine the distribution of HPV genotypes among HPV-positive women and men in Sari, the capital city of Mazandaran province in northern Iran. Materials and methods HPV DNA was extracted (PZP Company, Molecular IVD, Iran) from genital and cervical samples of the study participants. Genotyping was conducted for 90 cases utilizing the High + Low Papilloma Strip test (Operon Company, Spain). Demographic data were statistically analyzed in correlation with the virological data (STATA version 17). Results Overall, 67.7% (61 out of 90) of the cases tested positive for HPV, with 75% of those being classified as high-risk. The participant group consisted of 92% females (83) and 8% males (7). The highest HPV prevalence, 75% (36), was observed in females and males aged under 31, with the majority of positive cases belonging to high-risk genotypes. The most frequently identified genotypes were HPV-11 (23%), HPV-6 (21%), HPV-56 (18%), HPV-39 (16%), HPV-16, HPV-91, and HPV-66 each comprising (14%). HPV-56 was the most common high-risk genotype, accounting for 11 cases (18%), followed by HPV-39, which was present in 10 cases (16%). Conclusion The prevalence of HPV infection was particularly high among individuals under the age of 31 for both genders, with men exhibiting a 100% infection rate. These findings emphasize the urgent need for targeted education aimed at the younger population and the implementation of infection control measures. Specifically, widespread HPV vaccination targeting HPV-6, HPV-11, HPV-39, and HPV-56 should be prioritized for the general population.

In December 2023, we observed through hospital-based surveillance a severe outbreak of enterovirus D68 infection in pediatric inpatients in Dakar, Senegal. Molecular characterization revealed that subclade B3, the dominant lineage in outbreaks worldwide, was responsible for the outbreak. Enhanced surveillance in inpatient settings, including among patients with neurologic illnesses, is needed.

Background: Coronavirus disease 2019 (COVID-19) continues to be a significant global public health issue. Aims and Objectives: This study aims to describe the demographic characteristics, comorbidities, clinical presentations, inflammatory biomarkers, and chest computed tomography (CT) findings of patients with severe acute respiratory infection (SARI) at a tertiary care hospital in Odisha, India. Additionally, the study aims to evaluate different COVID-19 diagnostic methods. Materials and Methods: A prospective observational study was conducted at a tertiary care hospital in Odisha, India. All admitted SARI patients underwent COVID-19 testing. Data on demographics, clinical presentations, laboratory investigations, and outcomes at 72 h were collected. COVID-19 diagnostic methods were also analyzed. Statistical Analysis: The statistical analysis was performed using GraphPad Prism 9.5. Results: Among the 830 patients studied, 305 tested positive for COVID-19. The rapid antigen test (RAT) demonstrated a sensitivity of 93.85% and a specificity of 97.43% compared to the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test. Discrepancies with RAT results were noted in cases with higher cycle threshold (Ct) values (>25). A male predominance was observed, with a mean age of 43.30 ± 15.19 years in the COVID-19-positive group and 40.95 ± 17.15 years in the COVID-19-negative group. Patients with multiple comorbidities (15.68%) had a higher susceptibility to COVID-19 infection. The COVID-19-positive group showed a significantly elevated neutrophil-to-lymphocyte ratio (NLR) (P = 0.0001) and thrombocytopenia (P = 0.001). Inflammatory biomarkers, including CRP, LDH, ferritin, D-dimer, and IL-6, were markedly elevated in swab-positive cases. Bilateral chest involvement and ground glass opacities were common radiological findings in both groups. Conclusion: In resource-limited settings, the RAT is considered an alternative screening tool for COVID-19. Initial laboratory and radiological investigations may aid clinicians in effective management of such patients.

Background and purpose: Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis and about 2 billion people are infected with tuberculosis. Every year, millions of children are exposed to Mycobacterium tuberculosis, and tuberculosis is still one of the main infectious causes of death among children in the world. Considering the importance of tuberculosis in children and the lack of information about the effects of the COVID-19 pandemic on it, this study aimed to investigate the characteristics and clinical outcomes of children with tuberculosis admitted to Buali Hospital of Sari before and after the COVID-19 pandemic. Materials and methods: In this descriptive-cross-sectional study, all children with tuberculosis who were admitted to Buali Hospital between 2014 to 2019 were divided into two groups before and after COVID-19 (Before: from June 2014 to the end of 2019; After: from the end of 2019 to June 2023). Demographic information, type of disease, contact history, underlying disease, clinical symptoms, laboratory tests, radiological findings, medications, duration of hospitalization, and clinical outcome of the patients were recorded. The data was statistically analyzed with SPSS software version 22. Results: In the present study, 15 children were hospitalized before the COVID-19 pandemic and 17 people after it. There were 19 girls (59.37%) and 13 boys (40.63%) with an average age of 6.60±4.24 years. The median duration of hospitalization after the COVID-19 pandemic was significantly longer (4 days vs. 5 days; P=0.019). 22 patients (68.75%) had active tuberculosis and the remaining cases were asymptomatic and diagnosed with latent tuberculosis (P=0.811). Pulmonary involvement was observed in 17 patients (53.12%) and extrapulmonary involvement was observed in 5 patients (46.87%) (P=0.323). 19 patients (59.37%) were new cases and other cases were disease recurrences (P=0.571). History of contact with TB patients was positive in 19 patients (59.37%). The skin tuberculin test of the patients was positive in 24 patients (75%), and the gastric aspirate examination of none of the patients was positive before COVID-19, but 4 patients (33.33%) were positive after COVID-19 (P=0.245). IGRA test was positive in 1 patient (3.12%) before COVID-19 and in 2 patients (6.25%) after the pandemic (P=1.000). The most common clinical symptom was cough (68.75%), followed by fever (43.75%), vomiting and weight loss (32.25%), rhinorrhea and anorexia (28.12%) and night sweats (15.62%). Three patients (17.5%) needed intensive care unit admission after the pandemic. The laboratory markers did not have a statistically significant difference between the two groups, and ESR was high in 66.67% of the patients before the pandemic and 81.2% after it. Disturbance in the laboratory tests including electrolytes and liver and kidney function tests was not observed in both groups. All patients recovered and no deaths were reported. Conclusion: Comparing the results showed a significant increase in the duration of hospitalization after the pandemic. Although some studies have reported a more severe form of tuberculosis after the COVID-19 pandemic, finding the association between the changes in the clinical manifestations of TB and its type before and after COVID-19 and generalizing the results requires multicenter studies with higher sample sizes.

Background: Human papillomavirus (HPV) is responsible for the most common sexually transmitted infection, particularly among sexually active individuals. Understanding the geographical distribution and epidemiology of the most prevalent HPV genotypes is essential for developing effective prevention strategies. Consequently, this study aimed to examine the distribution of HPV genotypes among HPV-positive women and men in Sari, the capital city of Mazandaran province in northern Iran. Materials and methods: HPV DNA was extracted (PZP Company, Molecular IVD, Iran) from genital and cervical samples of the study participants. Genotyping was conducted for 90 cases utilizing the High + Low Papilloma Strip test (Operon Company, Spain). Demographic data were statistically analyzed in correlation with the virological data (STATA version 17). Results: Overall, 67.7% (61 out of 90) of the cases tested positive for HPV, with 75% of those being classified as high-risk. The participant group consisted of 92% females (83) and 8% males (7). The highest HPV prevalence, 75% (36), was observed in females and males aged under 31, with the majority of positive cases belonging to high-risk genotypes. The most frequently identified genotypes were HPV-11 (23%), HPV-6 (21%), HPV-56 (18%), HPV-39 (16%), HPV-16, HPV-91, and HPV-66 each comprising (14%). HPV-56 was the most common high-risk genotype, accounting for 11 cases (18%), followed by HPV-39, which was present in 10 cases (16%). Conclusion: The prevalence of HPV infection was particularly high among individuals under the age of 31 for both genders, with men exhibiting a 100% infection rate. These findings emphasize the urgent need for targeted education aimed at the younger population and the implementation of infection control measures. Specifically, widespread HPV vaccination targeting HPV-6, HPV-11, HPV-39, and HPV-56 should be prioritized for the general population. [ABSTRACT FROM AUTHOR]

Depressive disorders are leading contributors to the global mental health-related burden, and they represent a challenge for real-world clinicians, due to the low rates of remission despite the high availability of treatments. Often, depression shows in the context of multiple chronic comorbidities, thus requiring precise and accurate management of pharmacological treatments to avoid interactions and side effects. These criticalities call for the need for new strategies of treatment, which may include new insights into the pharmacological properties of currently available antidepressant drugs, to enhance their efficacy in the different contexts in which depression may arise. Trazodone is the prototype serotonin antagonist/reuptake inhibitor antidepressant (SARI). Due to the malleability granted by its multiple formulations, trazodone is frequently used to treat depression, both as an add-on to other antidepressants and as a monotherapy, with satisfying results. Moreover, its tolerability makes it one of the most prescribed antidepressants in patients with poly-treated comorbid medical illnesses, especially in the elderly. Herein, a case series is presented regarding the use of trazodone in patients with complex comorbid diagnoses or distressing side effects. Each of the three cases has been discussed in three specific Round Tables, involving expert clinicians in the fields of Psychiatry, Neurology, General Practice, and Geriatrics using the Nominal Group Technique. The ideas collected have been used to integrate the cases and the discussion with the intent of facilitating accessibility to the widest audience of physicians and clinical workers in different clinical practice contexts. The final aim of this paper is to promote an increasingly personalized use of trazodone in realworld patients with depression. [ABSTRACT FROM AUTHOR]

Pregnant women (PW) are at a higher risk of diseases and hospitalization from viral respiratory infections, particularly influenza and SARS-CoV-2, due to cardiopulmonary and immunological changes. This study assessed the impact of viral respiratory infections on PW hospitalized with severe acute respiratory infection (SARI) prior to the COVID-19 pandemic. It is a cross-sectional study with 42 PW and 85 non-pregnant women (NPW) admitted with SARI to two tertiary hospitals between January 2015 and December 2019. The rates of virus prevalence, SARI hospitalization, length of hospital stay, oxygen supplementation, intensive care unit (ICU) admission, and death were comparable between PW and NPW. A multivariate analysis showed that PW had a higher rate of viral SARI hospitalizations (OR = 2.37; 95% CI = 1.02–5.48) as compared to NPW, with the influenza virus being the most prevalent (aOR = 7.58; 95% CI = 1.53–37.66). The length of hospital stays (aOR = 0.83; 95% CI = 0.73–0.95) and admissions to the ICU (aOR = 0.028; 95% CI = 0.004–0.25) were lower in PW as compared to hospitalized NPW. The influenza virus had a greater impact on the frequency of SARI in the group of PW, and these had a better outcome than NPW due to the earlier antiviral treatment they received. [ABSTRACT FROM AUTHOR]

Background: Changes in the epidemiology of illnesses caused by respiratory syncytial virus (RSV) infection following the COVID‐19 pandemic are reported. The New Zealand (NZ) COVID‐19 situation was unique; RSV community transmission was eliminated with the 2020 border closure, with a rapid and large increase in hospitalizations following the relaxation of social isolation measures and the opening of an exclusive border with Australia. Methods: This active population‐based surveillance compared the age‐specific incidence and seasonality of RSV‐associated hospitalizations in Auckland, NZ, for 2 years before and after the 2020 border closures. Hospitalisation rates between years were compared by age, ethnicity (European/other, Māori, Pacific and Asian) and socioeconomic group (1 = least, 5 = most deprived). Results: There was no RSV transmission in 2020. In all other years, hospitalisation rates were highest for people of Pacific versus other ethnic groups and for people living in the most deprived quintile of households. RSV hospitalisation rates were higher in 2021 and 2022 than in 2018–19. The epidemic peak was higher in 2021, but not 2022, and the duration was shorter than in 2018–19. In 2021, the increase in RSV hospitalisation rates was significant across all age, sex, ethnic and socioeconomic groups. In 2022, the increase in hospitalisation rates was only significant in one age (1– < 3 years), one ethnic (Asian) and one socioeconomic group (quintile 2). Conclusions: COVID pandemic responses altered RSV‐related hospitalisation seasonal patterns. Atypical features of RSV hospitalisation epidemiology were the increase in rates in older children and young adults, which lessened in 2022. Despite these variations, RSV hospitalisations in NZ continue to disproportionately affect individuals of Pacific ethnicity and those living in more socioeconomically deprived households. Whilst future public health strategies focused on RSV disease mitigation need to consider the potential shifts in epidemiological patterns when the transmission is disrupted, these variances must be considered in the context of longer‐standing patterns of unequal disease distribution. [ABSTRACT FROM AUTHOR]

Background and purpose: Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis and about 2 billion people are infected with tuberculosis. Every year, millions of children are exposed to Mycobacterium tuberculosis, and tuberculosis is still one of the main infectious causes of death among children in the world. Considering the importance of tuberculosis in children and the lack of information about the effects of the COVID-19 pandemic on it, this study aimed to investigate the characteristics and clinical outcomes of children with tuberculosis admitted to Buali Hospital of Sari before and after the COVID-19 pandemic. Materials and methods: In this descriptive-cross-sectional study, all children with tuberculosis who were admitted to Buali Hospital between 2014 to 2019 were divided into two groups before and after COVID-19 (Before: from June 2014 to the end of 2019; After: from the end of 2019 to June 2023). Demographic information, type of disease, contact history, underlying disease, clinical symptoms, laboratory tests, radiological findings, medications, duration of hospitalization, and clinical outcome of the patients were recorded. The data was statistically analyzed with SPSS software version 22. Results: In the present study, 15 children were hospitalized before the COVID-19 pandemic and 17 people after it. There were 19 girls (59.37%) and 13 boys (40.63%) with an average age of 6.60±4.24 years. The median duration of hospitalization after the COVID-19 pandemic was significantly longer (4 days vs. 5 days; P=0.019). 22 patients (68.75%) had active tuberculosis and the remaining cases were asymptomatic and diagnosed with latent tuberculosis (P=0.811). Pulmonary involvement was observed in 17 patients (53.12%) and extrapulmonary involvement was observed in 5 patients (46.87%) (P=0.323). 19 patients (59.37%) were new cases and other cases were disease recurrences (P=0.571). History of contact with TB patients was positive in 19 patients (59.37%). The skin tuberculin test of the patients was positive in 24 patients (75%), and the gastric aspirate examination of none of the patients was positive before COVID-19, but 4 patients (33.33%) were positive after COVID-19 (P=0.245). IGRA test was positive in 1 patient (3.12%) before COVID-19 and in 2 patients (6.25%) after the pandemic (P=1.000). The most common clinical symptom was cough (68.75%), followed by fever (43.75%), vomiting and weight loss (32.25%), rhinorrhea and anorexia (28.12%) and night sweats (15.62%). Three patients (17.5%) needed intensive care unit admission after the pandemic. The laboratory markers did not have a statistically significant difference between the two groups, and ESR was high in 66.67% of the patients before the pandemic and 81.2% after it. Disturbance in the laboratory tests including electrolytes and liver and kidney function tests was not observed in both groups. All patients recovered and no deaths were reported. Conclusion: Comparing the results showed a significant increase in the duration of hospitalization after the pandemic. Although some studies have reported a more severe form of tuberculosis after the COVID-19 pandemic, finding the association between the changes in the clinical manifestations of TB and its type before and after COVID19 and generalizing the results requires multicenter studies with higher sample sizes. [ABSTRACT FROM AUTHOR]

Background Human metapneumovirus (HMPV) is a common respiratory pathogen that causes respiratory tract infections. In India, HMPV has been identified as one of the leading causes of morbidity and mortality in infants and young children with respiratory tract infections. The most reported sublineages of HMPV in India are B1, B2, A2b and A2c.Objective A retrospective study was conducted to determine the circulating genotypes of HMPV among SARI cases from January 2016 to December 2018.Materials and methods Positive throat swab samples were confirmed with real-time RT–PCR. Subsequently, these samples were analysed using semi-nested conventional RT–PCR targeting the G gene, followed by sequencing and phylogenetic analysis. Clinical data analysis was also performed using SPSS 15.0 software.Results All 20 samples from the SARI cases were classified under the A2c sublineage of HMPV. Phylogenetic analysis indicated that these strains were genetically related to those circulating in Japan, China, and Croatia. Among the samples, ten showed 111-nucleotide duplications, while the other ten had 180-nucleotide duplications.Conclusion Clinical analysis showed that four cases had coinfections with other pathogens. Our extensive analysis of patient samples determined that HMPV, especially the A2c genotype, significantly contributed to SARI cases within our study population, which signifies the importance of considering HMPV as a probable aetiological agent when investigating SARI outbreaks.

PurposeThe present study explored the molecular characterization of human Adenovirus (HAdV) and its strains among hospitalized SARI cases in the pediatric unit of a tertiary care hospital in North-East India.MethodsNasal and throat swabs were collected from 70 patients of Pediatric Unit, of a tertiary hospital in NE India from April 2023-October 2023. The samples were screened for the presence of HAdV using an adenovirus-specific Real-Time PCR Kit. For molecular characterization, Next Generation Sequencing (NGS) was performed by targeting the hexon gene of HAdV followed by post-sequencing analysis.ResultsOverall, 18.57% (13/70) of samples were positive for HAdV. In context of the severity of illness, 3/13 adenovirus-positive patients (23.07%) died after hospitalization, had severe pneumonia among which two were of less than one year of age. Molecular characterization using NGS indicated that 4/13 individuals were infected with HAdV-B type 3 and 5/13 patients were infected with HAdV type 7. Notably, 4/7 cases of severe pneumonia were under five years of age and associated with HAdV type 7 infection. The ratio of non-synonymous to synonymous mutation (dN/dS) was comparatively low in HAdV type 7 positive samples (dN/dS=0.31). No non-synonymous mutation was observed in HAdV-B type 3 positive samples. The higher neutrophil percentage among the death cases suggested an acute immune response.ConclusionThe study demonstrated HAdV type 7 and HAdV-B type 3 as strains associated with pediatric SARI cases from April 2023-October 2023. Further, HAdV type 7 infection was primarily linked with lower respiratory tract infections mainly severe pneumonia.

Abstract Respiratory diseases, including influenza and coronaviruses, pose recurrent global threats. This study delves into the respiratory surveillance systems, focusing on the effectiveness of SARI sentinel surveillance for total and severe cases incidence estimation. Leveraging data from the COVID-19 pandemic in Chile, we examined 2020–2023 data (a 159-week period) comparing census surveillance results of confirmed cases and hospitalizations, with sentinel surveillance. Our analyses revealed a consistent underestimation of total cases and an overestimation of severe cases of sentinel surveillance. To address these limitations, we introduce a nowcasting model, improving the precision and accuracy of incidence estimates. Furthermore, the integration of genomic surveillance data significantly enhances model predictions. While our findings are primarily focused on COVID-19, they have implications for respiratory virus surveillance and early detection of respiratory epidemics. The nowcasting model offers real-time insights into an outbreak for public health decision-making, using the same surveillance data that is routinely collected. This approach enhances preparedness for emerging respiratory diseases by the development of practical solutions with applications in public health.

Objective: To investigate effect of SARI expression induced by IFN-β on proliferation and apoptosis of acute myeloblastic leukemia( AML) cells, and to explore its potential regulatory molecules. Methods: qPCR and Western blot were used to screen AML cells with low SARI expression as experimental cell lines. AML cells were treated with different concentrations of IFN-β, and expression of SARI was detected by qPCR and Western blot at different time to select appropriate concentration and time of IFN-β. RNA-Seq transcriptome sequencing and KEGG enrichment analysis were used to preliminarily screen potential regulatory molecules of IFN-β-induced SARI expression in AML cells. AML cells were treated with corresponding molecular inhibitors combined with IFN-β, cell proliferation was detected by MTS assay, and apoptosis was detected by flow cytometry. To clear this molecule was involved in IFN-β-induced SARI expression on AML cell proliferation and apoptosis. Results: SARI expression in HL60 and NB4 cells were relatively decreased, so they were selected as experimental cell lines. After treatment with 1 ng/ml IFN-β for 12 h, SARI expression in AML cells was increased, cell proliferation was inhibited and apoptosis were increased. STAT1 was screened as a potential regulatory molecule for IFN-β-induced SARI expression. After inhibiting STAT1, effects of IFN-β on SARI expression, proliferation inhibition and apoptosis promotion of AML cells were reversed significantly. Conclusion: IFN-β can promote SARI expression in AML cells by STAT1, inhibit cell proliferation and promote apoptosis. [ABSTRACT FROM AUTHOR]

Aims: Endemic SARS-CoV-2 infections still burden the healthcare system and represent a considerable threat to vulnerable patient cohorts, in particular immunocompromised (IC) patients. This study aimed to analyze the in-hospital outcome of IC patients with severe SARS-CoV-2 infection in Germany. Methods: This retrospective, observational study, analyzed administrative data from inpatient cases (n = 146,324) in 84 German Helios hospitals between 1 January 2022 and 31 December 2022 with regard to in-hospital outcome and health care burden in IC patients during the first 12 months of Omicron dominance. As the primary objective, in-hospital outcomes of patients with COVID-19-related severe acute respiratory infection (SARI) were analyzed by comparing patients with (n = 2037) and without IC diagnoses (n = 14,772). Secondary analyses were conducted on IC patients with (n = 2037) and without COVID-19-related SARI (n = 129,515). A severe in-hospital outcome as a composite endpoint was defined per the WHO definition if one of the following criteria were met: intensive care unit (ICU) treatment, mechanical ventilation (MV), or in-hospital death. Results: In total, 12% of COVID-related SARI cases were IC patients, accounting for 15% of ICU admissions, 15% of MV use, and 16% of deaths, resulting in a higher prevalence of severe in-hospital courses in IC patients developing COVID-19-related SARI compared to non-IC patients (Odds Ratio, OR = 1.4, p < 0.001), based on higher in-hospital mortality (OR = 1.4, p < 0.001), increased need for ICU treatment (OR = 1.3, p < 0.001) and mechanical ventilation (OR = 1.2, p < 0.001). Among IC patients, COVID-19-related SARI profoundly increased the risk for severe courses (OR = 4.0, p < 0.001). Conclusions: Our findings highlight the vulnerability of IC patients to severe COVID-19. The persistently high prevalence of severe outcomes in these patients in the Omicron era emphasizes the necessity for continuous in-hospital risk assessment and monitoring of IC patients. [ABSTRACT FROM AUTHOR]

Respiratory diseases, including influenza and coronaviruses, pose recurrent global threats. This study delves into the respiratory surveillance systems, focusing on the effectiveness of SARI sentinel surveillance for total and severe cases incidence estimation. Leveraging data from the COVID-19 pandemic in Chile, we examined 2020–2023 data (a 159-week period) comparing census surveillance results of confirmed cases and hospitalizations, with sentinel surveillance. Our analyses revealed a consistent underestimation of total cases and an overestimation of severe cases of sentinel surveillance. To address these limitations, we introduce a nowcasting model, improving the precision and accuracy of incidence estimates. Furthermore, the integration of genomic surveillance data significantly enhances model predictions. While our findings are primarily focused on COVID-19, they have implications for respiratory virus surveillance and early detection of respiratory epidemics. The nowcasting model offers real-time insights into an outbreak for public health decision-making, using the same surveillance data that is routinely collected. This approach enhances preparedness for emerging respiratory diseases by the development of practical solutions with applications in public health. [ABSTRACT FROM AUTHOR]

Background: Data from the sentinel surveillance system of severe acute respiratory infections in Spain were used to estimate the impact of administration of nirsevimab to children born from 1 April 2023 onwards. Methods: Estimated RSV hospitalisations in < 1‐year‐olds during weeks 40, 2023, to 8, 2024, were compared to the number that would be expected after accounting for the background change in RSV circulation in the 2023/24 season, compared to 2022/23. Results: We estimated 9364–9875 RSV hospitalisations less than expected, corresponding to a 74%–75% reduction. [ABSTRACT FROM AUTHOR]

Depressive disorders are leading contributors to the global mental health-related burden, and they represent a challenge for real-world clinicians, due to the low rates of remission despite the high availability of treatments. Often, depression shows in the context of multiple chronic comorbidities, thus requiring precise and accurate management of pharmacological treatments to avoid interactions and side effects. These criticalities call for the need for new strategies of treatment, which may include new insights into the pharmacological properties of currently available antidepressant drugs, to enhance their efficacy in the different contexts in which depression may arise. Trazodone is the prototype serotonin antagonist/reuptake inhibitor antidepressant (SARI). Due to the malleability granted by its multiple formulations, trazodone is frequently used to treat depression, both as an add-on to other antidepressants and as a monotherapy, with satisfying results. Moreover, its tolerability makes it one of the most prescribed antidepressants in patients with poly-treated comorbid medical illnesses, especially in the elderly. Herein, a case series is presented regarding the use of trazodone in patients with complex comorbid diagnoses or distressing side effects. Each of the three cases has been discussed in three specific Round Tables, involving expert clinicians in the fields of Psychiatry, Neurology, General Practice, and Geriatrics using the Nominal Group Technique. The ideas collected have been used to integrate the cases and the discussion with the intent of facilitating accessibility to the widest audience of physicians and clinical workers in different clinical practice contexts. The final aim of this paper is to promote an increasingly personalized use of trazodone in real-world patients with depression.

IntroductionIn today's world, challenges related to agriculture, food security, water and energy resources, productivity, and greenhouse gas emissions have emerged as significant issues for global societies. Through their international impacts, these challenges have led to economic, social, and environmental changes on a global scale. One of the most crucial issues that should be highlighted is the shortage of water resources. Water, as a vital factor in agriculture and food production, holds special importance. Therefore, in order to achieve sustainable agriculture, it is necessary to pay attention to the energy indicators, the efficiency of water consumption in the production of agricultural products and the amount of greenhouse gas emissions. In general, a combination of energy indicators, water efficiency and reduction of greenhouse gas emissions in agriculture can help to develop sustainable agriculture and preserve the environment and help to provide safe and accessible food for the society. The aim of the present study was to investigate the indicators of physical water, energy efficiency, and greenhouse gas emissions on alfalfa and barley crops in two different climates: a warm and arid climate (Shahr-e-Qom Plain, Qom) and a temperate and humid climate (Sari Plain, Mazandaran). This was done to assess the impact of climate on the outcomes of these indicators. Materials and MethodsTo investigate the physical water efficiency and evaluate energy indicators in this study, major agricultural products in Sari and Sharifabad Plains, including barley and alfalfa, were analyzed using cross-sectional data from the agricultural year 2021-2022. Initially, the sample size was determined based on the Cochran formula and the Bartlett method (2001). Subsequently, sampling was carried out using a questionnaire designed by the researchers themselves. The questionnaires totaled 250 (Sari Plain: 150, Sharifabad Plain: 100), and the collected information included the amount of input consumption and production quantity. The questionnaire, designed by the researcher, was validated for validity and reliability by experts and specialists. The inputs used in the study of water efficiency and energy indicators for the mentioned products in Sari and Sharifabad Plains included person-days of human labor, machine working hours, fuel consumption of machines, the quantity of nitrogen, phosphorus, potassium fertilizers per hectare, the quantity of various chemical pesticides (herbicides, fungicides, and insecticides) per liter per hectare, the amount of water consumption in cubic meters per hectare, and the amount of seed consumption in kilograms per hectare.Results and DiscussionThe results of the descriptive statistics of input consumption in Sari and Sharifabad Plains in barley and alfalfa crops showed that the highest input consumption of manpower in the cultivation of alfalfa crops in Sharifabad Plains with an average of 225 hours per hectare, the highest amount of fertilizer consumption related to the alfalfa crop in Sharifabad Plain is related to nitrogen fertilizer with an average of 130 kg per hectare, the highest amount of fuel consumption of machinery related to alfalfa crop in Sari Plain with an average of 405 liters per hectare, the highest amount of water consumption related to alfalfa crop in Sharifabad Plains with an average of 17500 cubic meters per hectare and the highest yield of alfalfa was obtained in Sharifabad Plains with an average of 11550 kg per hectare. The obtained results indicated that the highest input energy level in Sharifabad Plain for alfalfa was 5,674.50 MJ per hectare. The results of energy efficiency indicated that alfalfa production in Shahrifabad Plain had the highest value with 0.19 kilograms per MJ, while this index for alfalfa in Sari Plain was 0.13 kilograms per MJ. Additionally, the energy efficiency for barley in Shahrifabad Plain was 0.13 kilograms per MJ, and for Sari Plain, it was 0.12 kilograms per MJ, showing a somewhat similar level. The physical water use efficiency results revealed that the highest and lowest efficiency levels were observed for barley in Sari Plain, amounting to 0.96 kilograms per cubic meter, and for alfalfa in Shahrifabad Plain, amounting to 0.57 kilograms per cubic meter, respectively. Furthermore, this index for alfalfa in Sari Plain was 0.67 kilograms per cubic meter, and for barley in Shahrifabad Plain, was 0.8 kilograms per cubic meter. The results for greenhouse gas emissions demonstrated that the level of emissions in Sari Plain was higher than Sharifabad Plain, attributed to excessive fertilizer and pesticide use in Sari Plain. The highest greenhouse gas emissions in Sari Plain for alfalfa were 2681.65 kilograms of CO2 per hectare, while in Sharifabad Plain, was 2351.85 kilograms of CO2 per hectare. ConclusionThe overall results indicated that crop performance in humid regions was not higher than in dry and semi-arid regions, and this index depends on various parameters, including water consumption and managerial considerations. However, water consumption in temperate and humid regions is significantly lower than in dry and semi-arid areas due to higher precipitation. This result is increased efficiency in temperate and humid regions.

Introduction In today's world, challenges related to agriculture, food security, water and energy resources, productivity, and greenhouse gas emissions have emerged as significant issues for global societies. Through their international impacts, these challenges have led to economic, social, and environmental changes on a global scale. One of the most crucial issues that should be highlighted is the shortage of water resources. Water, as a vital factor in agriculture and food production, holds special importance. Therefore, in order to achieve sustainable agriculture, it is necessary to pay attention to the energy indicators, the efficiency of water consumption in the production of agricultural products and the amount of greenhouse gas emissions. In general, a combination of energy indicators, water efficiency and reduction of greenhouse gas emissions in agriculture can help to develop sustainable agriculture and preserve the environment and help to provide safe and accessible food for the society. The aim of the present study was to investigate the indicators of physical water, energy efficiency, and greenhouse gas emissions on alfalfa and barley crops in two different climates: a warm and arid climate (Shahr-e-Qom Plain, Qom) and a temperate and humid climate (Sari Plain, Mazandaran). This was done to assess the impact of climate on the outcomes of these indicators. Materials and Methods To investigate the physical water efficiency and evaluate energy indicators in this study, major agricultural products in Sari and Sharifabad Plains, including barley and alfalfa, were analyzed using cross-sectional data from the agricultural year 2021-2022. Initially, the sample size was determined based on the Cochran formula and the Bartlett method (2001). Subsequently, sampling was carried out using a questionnaire designed by the researchers themselves. The questionnaires totaled 250 (Sari Plain: 150, Sharifabad Plain: 100), and the collected information included the amount of input consumption and production quantity. The questionnaire, designed by the researcher, was validated for validity and reliability by experts and specialists. The inputs used in the study of water efficiency and energy indicators for the mentioned products in Sari and Sharifabad Plains included person-days of human labor, machine working hours, fuel consumption of machines, the quantity of nitrogen, phosphorus, potassium fertilizers per hectare, the quantity of various chemical pesticides (herbicides, fungicides, and insecticides) per liter per hectare, the amount of water consumption in cubic meters per hectare, and the amount of seed consumption in kilograms per hectare. Results and Discussion The results of the descriptive statistics of input consumption in Sari and Sharifabad Plains in barley and alfalfa crops showed that the highest input consumption of manpower in the cultivation of alfalfa crops in Sharifabad Plains with an average of 225 hours per hectare, the highest amount of fertilizer consumption related to the alfalfa crop in Sharifabad Plain is related to nitrogen fertilizer with an average of 130 kg per hectare, the highest amount of fuel consumption of machinery related to alfalfa crop in Sari Plain with an average of 405 liters per hectare, the highest amount of water consumption related to alfalfa crop in Sharifabad Plains with an average of 17500 cubic meters per hectare and the highest yield of alfalfa was obtained in Sharifabad Plains with an average of 11550 kg per hectare. The obtained results indicated that the highest input energy level in Sharifabad Plain for alfalfa was 5,674.50 MJ per hectare. The results of energy efficiency indicated that alfalfa production in Shahrifabad Plain had the highest value with 0.19 kilograms per MJ, while this index for alfalfa in Sari Plain was 0.13 kilograms per MJ. Additionally, the energy efficiency for barley in Shahrifabad Plain was 0.13 kilograms per MJ, and for Sari Plain, it was 0.12 kilograms per MJ, showing a somewhat similar level. The physical water use efficiency results revealed that the highest and lowest efficiency levels were observed for barley in Sari Plain, amounting to 0.96 kilograms per cubic meter, and for alfalfa in Shahrifabad Plain, amounting to 0.57 kilograms per cubic meter, respectively. Furthermore, this index for alfalfa in Sari Plain was 0.67 kilograms per cubic meter, and for barley in Shahrifabad Plain, was 0.8 kilograms per cubic meter. The results for greenhouse gas emissions demonstrated that the level of emissions in Sari Plain was higher than Sharifabad Plain, attributed to excessive fertilizer and pesticide use in Sari Plain. The highest greenhouse gas emissions in Sari Plain for alfalfa were 2681.65 kilograms of CO2 per hectare, while in Sharifabad Plain, was 2351.85 kilograms of CO2 per hectare. Conclusion The overall results indicated that crop performance in humid regions was not higher than in dry and semi-arid regions, and this index depends on various parameters, including water consumption and managerial considerations. However, water consumption in temperate and humid regions is significantly lower than in dry and semi-arid areas due to higher precipitation. This result is increased efficiency in temperate and humid regions. [ABSTRACT FROM AUTHOR]

Metagenomic next‐generation sequencing (mNGS) is a valuable technique for identifying pathogens. However, conventional mNGS requires the separate processing of DNA and RNA genomes, which can be resource‐ and time‐intensive. To mitigate these impediments, we propose a novel method called DNA/RNA cosequencing that aims to enhance the efficiency of pathogen detection. DNA/RNA cosequencing uses reverse transcription of total nucleic acids extracted from samples by using random primers, without removing DNA, and then employs mNGS. We applied this method to 85 cases of severe acute respiratory infections (SARI). Influenza virus was identified in 13 cases (H1N1: seven cases, H3N2: three cases, unclassified influenza type: three cases) and was not detected in the remaining 72 samples. Bacteria were present in all samples. Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii were detected in four influenza‐positive samples, suggesting coinfections. The sensitivity and specificity for detecting influenza A virus were 73.33% and 95.92%, respectively. A κ value of 0.726 indicated a high level of concordance between the results of DNA/RNA cosequencing and SARI influenza virus monitoring. DNA/RNA cosequencing enhanced the efficiency of pathogen detection, providing a novel capability to strengthen surveillance and thereby prevent and control infectious disease outbreaks. [ABSTRACT FROM AUTHOR]

Background and purpose: Chronic obstructive pulmonary disease (COPD) is a progressive pulmonary ailment characterized by prolonged respiratory symptoms and airflow constriction. COPD stands as the third most prominent cause of mortality on a global scale. It is commonly linked to numerous extra-pulmonary conditions, such as cardiopulmonary disorders, musculoskeletal frailty, and anemia. Osteoporosis, regarded as one of the principal systemic complications arising from COPD, represents an elevated susceptibility to osteoporotic fractures and imposes a significant financial burden. Considering the clinical significance surrounding the emphysema phenotype in COPD, as well as the lack of investigation on this matter in the country, the objective of this study is to determine the comparative prevalence of osteoporosis and osteopenia in COPD patients, with and without emphysema, who receive medical attention at Tubi Sari Clinic and Imam Khomeini Hospital in Sari. Materials and methods: This cross-sectional study was conducted in 2021 on patients referred to the rheumatology and lung clinic, and COPD patients admitted to Imam Khomeini Hospital in Sari. In this study, 50 patients with COPD with emphysema as a case group and 50 patients with COPD without emphysema as a control group were included in the study. Then, using densitometry and examining the bone mass density of all COPD patients, the patients were divided into two groups: with and without osteoporosis. Then, the patient's information was entered into SPSS software and analyzed. Results: There was no significant difference in vitamin D serum levels, vertebral fracture score, or BMD between emphysema and non-emphysema patients (P=0.09, P=0.098). Multivariate analysis showed that (in a model including age, BMI, FEV1, PaO2, emphysema score, CRP, and dyspnea score) only BMI, FEV1, and PaO2 decreased as independent risk factors for low BMD. Conclusion: Our findings showed that emphysema is an independent risk factor for osteoporosis according to the multivariate model. Low BMI, severity of COPD, and hypoxia play a dominant role in the development of osteoporosis.

Abstract Background Severe acute respiratory infection (SARI) is a leading cause of mortality globally, peaking during the COVID-19 pandemic. We analyzed SARI-associated deaths during the pre-and-pandemic periods in Bangladesh to identify the contributing factors. Methods We analyzed data from hospital-based influenza surveillance at nine tertiary-level hospitals in Bangladesh. We considered March 2018–February 2020 as the pre-pandemic period and March 2020–February 2022 as the pandemic period and included adult (≥ 18 years) participants in our study. Surveillance physicians identified WHO-SARI case definition meeting inpatients and collected demographics, clinical characteristics, and outcomes at hospital discharge and 30 days post-discharge. We performed rRT-PCR for influenza and SARS-CoV-2 viruses on collected nasopharyngeal and oropharyngeal swabs. We used multivariable Cox's regression models to calculate the hazard ratio (HR) for factors associated with SARI deaths in these adult patients. Results We enrolled 4392 SARI patients during the pre-pandemic and 3824 SARI patients during the pandemic period. Case fatality ratio was higher during the pandemic: 13.62% (521) [in-hospital: 6.45% (247); post-discharge: 7.17% (274)] compared to pre-pandemic, 6.01% (264) [in-hospital: 2.01% (89), post-discharge: 4% (175)] (p

Background and purpose: According to the World Bank report, air pollution is the fourth leading risk factor for death in the world, and one in ten deaths is attributed to air pollution. Sand and dust storms tend to occur in arid and semi-arid regions, and this phenomenon affects human health, agricultural land, industry, infrastructure and the transportation sector. In this report, the situation of air pollution caused by dust storms was studied storm in the city of Sari in September 2023 Materials and methods: In a descriptive cross -sectional study, the concentration of airborne particles in the city of Sari was measured at7 different points in the city using the Dust Monitor device. The concentration of total suspended particles (TSP), particulate matter less than 10 micrometers (PM10), particulate matter less than 2.5 micrometers (PM2.5) and particulate matter less than 1 micrometers (PM1) were measured. Results: The results of this study showed that the highest concentrations of TSP, PM10 and PM2.5 were measured at the Baghban clinic station (Tuba) which was equal to 179, 88 and 55 µg/m3 respectively. Also, the Air Quality Index (AQI) of Sari city was 149 (unhealthy for sensitive groups) on September 11. Conclusion: The phenomenon of sand and dust storms (SDS) rarely occurs in the northern provinces of Iran, based on reports from abroad and caused by the occurrence of this phenomenon in the Qara-Qom desert in Turkmenistan. Therefore, it is of great importance for Mazandaran province, which is one of the most densely populated regions in the country, to continuously monitor the air quality index and install and equip fixed air pollution monitoring stations.

Objective. Study of the viral etiology of severe acute respiratory infections (SARI) in children hospitalized in a hospital in Yekaterinburg during the epidemic season of 2022—2023. Materials and methods. 267 clinical samples (nasopharyngeal swab) obtained from children hospitalized with symptoms of acute respiratory disease were studied. The etiology of the disease was deciphered by RT-PCR, using standard sets of reagents. The material was examined for the presence of influenza A and B viruses, as well as for viruses of non-influenza etiology. 267 individual patient records were analyzed. Results. As a result, it was found that cases of SARI were more often registered among younger children, the structure of SARI of influenza etiology was represented by influenza A(H1N1)pdm09 virus — 29.9% and influenza B virus — 20.7%, while it was found that most children were not vaccinated against influenza. The proportion of viruses of non-influenza etiology was represented by RS viruses (23.0%), rhinoviruses (9.2%) and bokaviruses (6.3%).

Pregnant women (PW) are at a higher risk of diseases and hospitalization from viral respiratory infections, particularly influenza and SARS-CoV-2, due to cardiopulmonary and immunological changes. This study assessed the impact of viral respiratory infections on PW hospitalized with severe acute respiratory infection (SARI) prior to the COVID-19 pandemic. It is a cross-sectional study with 42 PW and 85 non-pregnant women (NPW) admitted with SARI to two tertiary hospitals between January 2015 and December 2019. The rates of virus prevalence, SARI hospitalization, length of hospital stay, oxygen supplementation, intensive care unit (ICU) admission, and death were comparable between PW and NPW. A multivariate analysis showed that PW had a higher rate of viral SARI hospitalizations (OR = 2.37; 95% CI = 1.02–5.48) as compared to NPW, with the influenza virus being the most prevalent (aOR = 7.58; 95% CI = 1.53–37.66). The length of hospital stays (aOR = 0.83; 95% CI = 0.73–0.95) and admissions to the ICU (aOR = 0.028; 95% CI = 0.004–0.25) were lower in PW as compared to hospitalized NPW. The influenza virus had a greater impact on the frequency of SARI in the group of PW, and these had a better outcome than NPW due to the earlier antiviral treatment they received.

ABSTRACTThe SARS-CoV-2 XBB is a group of highly immune-evasive lineages of the Omicron variant of concern that emerged by recombining BA.2-descendent lineages and spread worldwide during 2023. In this study, we combine SARS-CoV-2 genomic data (n = 11,065 sequences) with epidemiological data of severe acute respiratory infection (SARI) cases collected in Brazil between October 2022 and July 2023 to reconstruct the space-time dynamics and epidemiologic impact of XBB dissemination in the country. Our analyses revealed that the introduction and local emergence of lineages carrying convergent mutations within the Spike protein, especially F486P, F456L, and L455F, propelled the spread of XBB* lineages in Brazil. The average relative instantaneous reproduction numbers of XBB* + F486P, XBB* + F486P + F456L, and XBB* + F486P + F456L + L455F lineages in Brazil were estimated to be 1.24, 1.33, and 1.48 higher than that of other co-circulating lineages (mainly BQ.1*/BE*), respectively. Despite such a growth advantage, the dissemination of these XBB* lineages had a reduced impact on Brazil’s epidemiological scenario concerning previous Omicron subvariants. The peak number of SARI cases from SARS-CoV-2 during the XBB wave was approximately 90%, 80%, and 70% lower than that observed during the previous BA.1*, BA.5*, and BQ.1* waves, respectively. These findings revealed the emergence of multiple XBB lineages with progressively increasing growth advantage, yet with relatively limited epidemiological impact in Brazil throughout 2023. The XBB* + F486P + F456L + L455F lineages stand out for their heightened transmissibility, warranting close monitoring in the months ahead.IMPORTANCEBrazil was one the most affected countries by the SARS-CoV-2 pandemic, with more than 700,000 deaths by mid-2023. This study reconstructs the dissemination of the virus in the country in the first half of 2023, a period characterized by the dissemination of descendants of XBB.1, a recombinant of Omicron BA.2 lineages evolved in late 2022. The analysis supports that XBB dissemination was marked by the continuous emergence of indigenous lineages bearing similar mutations in key sites of their Spike protein, a process followed by continuous increments in transmissibility, and without repercussions in the incidence of severe cases. Thus, the results suggest that the epidemiological impact of the spread of a SARS-CoV-2 variant is influenced by an intricate interplay of factors that extend beyond the virus's transmissibility alone. The study also underlines the need for SARS-CoV-2 genomic surveillance that allows the monitoring of its ever-shifting composition.

Background: Severe acute respiratory infection (SARI) is a leading cause of mortality globally, peaking during the COVID-19 pandemic. We analyzed SARI-associated deaths during the pre-and-pandemic periods in Bangladesh to identify the contributing factors. Methods: We analyzed data from hospital-based influenza surveillance at nine tertiary-level hospitals in Bangladesh. We considered March 2018–February 2020 as the pre-pandemic period and March 2020–February 2022 as the pandemic period and included adult (≥ 18 years) participants in our study. Surveillance physicians identified WHO-SARI case definition meeting inpatients and collected demographics, clinical characteristics, and outcomes at hospital discharge and 30 days post-discharge. We performed rRT-PCR for influenza and SARS-CoV-2 viruses on collected nasopharyngeal and oropharyngeal swabs. We used multivariable Cox's regression models to calculate the hazard ratio (HR) for factors associated with SARI deaths in these adult patients. Results: We enrolled 4392 SARI patients during the pre-pandemic and 3824 SARI patients during the pandemic period. Case fatality ratio was higher during the pandemic: 13.62% (521) [in-hospital: 6.45% (247); post-discharge: 7.17% (274)] compared to pre-pandemic, 6.01% (264) [in-hospital: 2.01% (89), post-discharge: 4% (175)] (p < 0.001). Pre-pandemic, influenza was detected in 14% (37/264) of SARI deaths. Influenza was detected during the pandemic in 2.3% (12/521), SARS-CoV-2 in 41.8% (218/521), and both viruses in only one SARI death. History of smoking and the presence of 1 or more co-morbid conditions independently attributed to SARI deaths in adults in the pre-pandemic period. SARI deaths in such patients were also associated with respiratory difficulties on admission in both pre-pandemic (aHR 2.36; 95% CI:1.65–3.36) and pandemic period (aHR 2.30; 95% CI: 1.57–3.35) after accounting for age, sex, smoking status, presence of 1 or more co-morbid conditions, and detection of influenza and SARS-CoV-2 viruses. Conclusions: During the pandemic, SARI mortality increased; influenza-associated mortality declined, and SARS-CoV-2 caused over a third of SARI deaths. Post-discharge mortality was higher than in-hospital mortality during both periods. Limiting premature discharge and strengthening post-discharge monitoring and nursing services could reduce unexpected deaths. Formative research to better understand post-discharge mortality is essential to reduce SARI deaths. [ABSTRACT FROM AUTHOR]

The contractor of the gas line transition from Damghan to Neka destroyed and recovered two tombs in 2014. The site is located 80 km south of Sari. Archaeological excavations led to discovering two historical cemeteries, settlements, and an Islamic castle and cemetery. Architectural remains and objects indicate historical catacomb burials. There are questions about the site including the architectural structure of the catacombs, burial method and dating. Systematic survey and excavation and subsequent comparison of data, with burial method, suggest a vast Parthian settlement in the site. Vestemin is the first Parthian site in Mazandaran. What distinguishes the site from the other Parthian cemeteries is the family catacombs. The Vestemin catacombs consist of three parts, including 1) the rectangular space or the corridor, 2) threshold or entrance between the rectangular space and the catacomb chamber, 3) the catacomb chamber. Armaments including swords, daggers, arrowheads, trefoil arrowheads, and armor were among the findings of the cemetery. Varieties of the objects and using armaments as gifts, had nothing to the deceased’s gender. Investigating the types of armaments reveal how the cavalries applied them, because armaments such as swords, daggers, and arrowheads, are light weapons that Agile Parthian cavalries used against the romans’ heavy weapons, as their classic enemy. [ABSTRACT FROM AUTHOR]

Copyright of Art-E is the property of Suleyman Demirel University, Faculty of Fine Arts and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objective: The high risk of Sars-CoV-2 infection in dental centers is a serious problem for doctors and patients. The main purpose of this study was to investigate the environmental health measures related to corona disease in the dental offices of Sari city during the COVID-19 epidemic in 2021. Materials and Methods: The present study is descriptive and cross-sectional, and the tool used in it is a researcher-made questionnaire collected with the cooperation of the personnel working in 100 active dental service centers in Sari. to determine content validity, two qualitative and quantitative -qualitative methods were used. The qualitative content validity of this questionnaire was confirmed by 8 environmental health experts. Cronbach's alpha was used to determine the reliability of the questionnaire. Data analysis was done using SPSS software V. 25. Results: Based on the results of this study, personal protective equipment was used continuously in 100% of the centers. In 93% of the centers, sodium hypochlorite and formaldehyde were used to disinfect the equipment, and in 94% of the cases, the frequency of disinfection of the equipment was after each patient. Disinfection of toilets was done daily in 62% of the centers and every two days in the rest. In 72% of the examined dental centers, had no local hood installed or turned on above the units, but in 92% of the offices, there was proper ventilation of public spaces. In addition, according to the results, in 99% of clinics, waste management was carried out in accordance with national laws and regulations and based on the rules and methods of the executive management of medical waste and related waste and related instructions, and also in 100% of clinics, water consumption was healthy and desirable. Conclusion: Overall, environmental health measures in dental offices were at an optimal level in most cases and in accordance with the instructions of the Ministry of Health. Not installing a hood or not turning it on above the units and improper ventilation of the dentist's office were the most critical problems of the centers, which need to be given more attention and corrective measures should be taken according to the instructions of the Ministry of Health. [ABSTRACT FROM AUTHOR]

AbstractCities manifesting the world's most consuming ecosystem are responsible for a large part of the world's environmental problems. Knowledge of the ecological conditions prevailing in any regions is essential for achieving development. Ecological Footprint Index (EFI) is of great interest for assessing urban communities as a way to measure the levels of sustainability. In this research, the ecological footprint method, which is a quantitative model, was used to analyze the data and measure the sustainability of urban areas. To this goal, an attempt was made to study the EFI and biological capacity of the urban ecosystem of Sari City by using a descriptive-analytical method and relying on library resources. Ecological footprint in the consumption sector, including housing, services, and transportation, was calculated in 4 areas of Sari City. According to the results of data analysis, the ecological footprint of consumption in the mentioned city was equal to 0.94 global hectares and its biological capacity was 0.59 global hectares per person. Comparison of the biological capacity and ecological footprint of this city showed that it had an ecological deficit and was thus ecologically unstable. Among the footprints calculated in the consumption sector, transportation with the ecological footprint of 46.46969 ha had the most ecological footprint. Also, analyses of the ecological footprints in the 4 regions of Sari City showed that Region 1 had a more footprint than other regions, indicating that it followed a higher consumption pattern, but in general, all areas of Sari City were in an ecologically unstable situation according to the research results.Keywords: ecological footprint, sustainable development, urbanization capacity, SariIntroduction:Rapid population growth and consequent expansions of cities, as well as the urbanization process exceeding management and development of urban services, have led to an increasing use of natural resources and energy. The amount of ecological footprint of a society depends on the following factors: population size, average standard of living, average productivity of land ecosystem, efficiency of harvesting, processing, water resources, and use of other resources. By measuring and controlling each of these variables, the effects of resource utilization can be determined, the degree of sustainability of the urban system in relation to the natural ecosystem can be studied, and finally, appropriate policies and strategies can be applied to reduce the effects of ecological footprint and increase urban sustainability. It is important to note that analysis of ecological footprint varies according to the type of community, country, and the amount of technology used in that community. In other words, ecological footprint varies based on the level of development and land use in each country. Generally, the study of ecological footprint shows that the developed countries have a greater impact on natural areas. Methodology:Various social, economic, cultural, political, and environmental aspects, etc. have affected human life. One of the aspects of rapid urban development is increasing urban population and thus increasing use of the ecological resources of cities. The mismatch between the exploitation level of resources and ecological potential of a city has caused urban instability, which needs to be determined by measuring the ecological potential of exploitation so as to increase urban sustainability. In recent decades, there has been a large increase in the population of Sari City, which has caused its ecological instability due to the excessive use of land and ecological resources. Therefore, it is necessary to determine its ecological potential and level of utilization of resources. The present study tried to measure the ecological footprint, consumption, housing, and transportation in Sari City and determine its ecological status and sustainability. Thus, in addition to recognizing the current situation, the future of this city can be predicted and its problems can be solved in terms of each of the mentioned ecological indicators, as well as providing the necessary measures to prevent its possible natural hazards. Discussion:Ecological footprint is a computational tool for measuring population demand on nature. It is mainly used to assess ecological potential, ultimate ecological capacity, and sustainable development. The ecological footprint of a country or region involves the areas of bio-production (land and sea) that will be needed to consolidate current consumptions by using the dominant technology. The Ecological Footprint Index (EFI) includes several special functions in the areas of bio-production, such as land, agriculture, and forestry, both for wood production and carbon sequestration in geospatial pastures and water areas. The key concept for calculating ecological footprint and bioavailability by this index is using the same unit of hectare globally; thus, it is easy to evaluate and compare the studied areas with other areas globally. The ecological footprint method is a prelude to planning and one of the important and essential tools, which helps to achieve sustainability. The results of this research indicated that the ecological footprint of housing in Sari City was 1 hectare worldwide. Of 13980,29 hectares, 2071,55, 3840,81, 1602,64, and 620,66 hectares showed the global ecological footprints of the housing sector in the 1st, 2nd, 3rd, and 4th regions of Sari City, respectively. Among the 4 districts of the city, District 2 had the highest footprint in the housing sector with an ecological footprint of 3840,81 hectares; in other words, the citizens living in this district needed more lands to meet the needs of their housing sector. The ecological footprint of transportation is estimated with regard to urban areas. It is calculated by the sum of the ecological footprints of the Earth and the energy consumptions, including gasoline, diesel, CNG. Conclusion:Due to the nature of this research, library and field methods were used based on quantitative and qualitative data and information. At first, the ecological footprint indicators were developed for Sari City based on library methods. Then, the field information required for each indicator were collected and analyzed. Finally, the status of each indicator and the general situation of the city were determined in terms of ecological footprint and degree of sustainability. The ecological footprint in the city of Sari was 46969,24 hectares worldwide, of which 13955,3, 10736,77, 10563,51, and 11713,66 hectares were the global footprints of Zones 1, 2, 3 and 4, respectively. Ecological sustainability offers solutions that initially require revision in relation to agriculture, housing, energy, urban design, transportation, economy, family, consumer resources, forestry, deserts, and the core values of our lives. The study of the bodies and functions of cities, urban planning and designing, ecological design, ecological village, ecological city, and other forms of environmental designs are essential for achieving and promoting urban sustainability. According to the results obtained from the roles of the various parameters in the stability of Sari City, the most important issue for promoting this city was achieving sustainable development by preventing the pattern of consumerism and replacing it with productivity, as well as taking advantage of the opportunities with regard to the strengths and weaknesses. References:- Abedi, Z. (2017). From Ecological Footprint to Sustainable City. International Conference on Urban Economics.- Ahmad, M., Ahmed, Z., Yang, X., Hussain, N., & Sinha, A. (2021). Financial development and environmental degradation: Do human capital and institutional quality make a difference? Gondwana Research.‏- Ahmed, Z. and Wang, Z. (2019). Investigating the impact of human capital on the ecological footprint in India: An empirical analysis. Environmental Science and Pollution Research, Vol. 26, No. 26, pp. 26782-26796.‏- Ahmed, Z., Asghar, M. M., Malik, M. N., & Nawaz, K. (2020). Moving towards a sustainable environment: The dynamic linkage between natural resources, human capital, urbanization, economic growth, and ecological footprint in China. Resources Policy, Vol. 67, No. 101677.‏- Alvarado, R., Ortiz, C., Jiménez, N., Ochoa-Jiménez, D., & Tillaguango, B. (2021). Ecological footprint, air quality and research and development: The role of agriculture and international trade. Journal of Cleaner Production, Vol. 288, No. 125589.‏- Bautista-Puig, N., Aleixo, A. M., Leal, S., Azeiteiro, U., & Costas, R. (2021). Unveiling the Research Landscape of Sustainable Development Goals and Their Inclusion in Higher Education Institutions and Research Centers: Major Trends in 2000–2017. Frontiers in Sustainability, Vol. 2, No. 12.‏- Casoli, E., Piazzi, L., Nicoletti, L., Jona-Lasinio, G., Cecchi, E., Mancini, G., & Ardizzone, G. (2020). Ecology, distribution, and demography of erect bryozoans in Mediterranean coralligenous reefs. Estuarine, Coastal, and Shelf Science, Vol. 235, No. 106573.- Danish, R. and Khan, S. U. D. (2020). Determinants of the ecological footprint: Role of renewable energy, natural resources, and urbanization. Sustainable Cities and Society, Vol. 54, No. 101996.‏- Destek, M. A. and Sarkodie, S. A. (2019). Investigation of environmental Kuznets curve for ecological footprint: The role of energy and financial development. Science of the Total Environment, Vol. 650, pp. 2483-2489.‏- Du, Y. W., Wang, Y. C., & Li, W. S. (2022). Emergy ecological footprint method considering uncertainty and its application in evaluating marine ranching resources and environmental carrying capacity. Journal of Cleaner Production, No. 130363.- Huang, Y., Haseeb, M., Usman, M., & Ozturk, I. (2022). Dynamic association between ICT, renewable energy, economic complexity and ecological footprint: Is there any difference between E-7 (developing) and G-7 (developed) countries? Technology in Society, Vol. 68, No. 101853.- Khakpour, B., Rahnama, M., & Damavandi, H. (2015). Application of ecological footprint method in assessing the sustainability of urban development (Case study: Sari City). First National Conference on Geography, Tourism, Natural Resources, and Sustainable Development.- Li, P., Zhang, R., & Xu, L. (2021). Three-dimensional ecological footprint based on ecosystem service value and their drivers: A case study of Urumqi. Ecological Indicators, Vol. 131, No. 108117.‏- Lin, D., Hanscom, L., Murthy, A., Galli, A., Evans, M., Neill, E., & Wackernagel, M. (2018). Ecological footprint accounting for countries: Updates and results of the National Footprint Accounts, 2012–2018. Resources, Vol. 7, No. 3, p. 58.‏- Liu, W., Yan, Y., Wang, D., & Ma, W. (2018). Integrate carbon dynamics models for assessing the impact of land use intervention on carbon sequestration ecosystem service. Ecological Indicators, Vol. 91, pp. 268-277.‏- Saberifar, R. (2007). Sustainable Urban Development, Peak Noor. Humanities, Vol. 5, No. 2, pp. 108-115.- Salehi, I. (2007). The Role of Urban Planning Rules and Regulations in Realizing a Good City and Sustainable Urban Development (Case Study: Tehran). Journal of Environmental Studies, 32(40), 51-62.- Tan, F. and Lu, Z. (2016). Assessing regional sustainable development through an integration of nonlinear principal component analysis and Gram Schmidt orthogonalization. Ecological Indicators, Vol. 63, pp. 71-81.‏- Taqvaee, M. and Safarabadi, A. (2013). Sustainable urban development and some effective factors for the study of the city of Kermanshah. Journal of Urban Sociological Studies (Urban Studies), Vol. 3, No. 6, pp. 1-22.- Wu, J. and Bai, Z. (2022). Spatial and temporal changes of the ecological footprint of China's resource-based cities in the process of urbanization. Resources Policy, Vol. 75, pp. 102-491.- Yang, X., Li, N., Mu, H., Zhang, M., Pang, J., & Ahmad, M. (2021). Study on the long-term and short-term effects of globalization and population aging on ecological footprint in OECD countries. Ecological Complexity, Vol. 47, No. 100946.‏- Yu, H., Liu, X., Kong, B., Li, R., & Wang, G. (2019). Landscape ecology development supported by geospatial technologies: A review. Ecological Informatics, Vol. 51, pp. 185-192.‏- Zafar, M. W., Zaidi, S. A. H., Khan, N. R., Mirza, F. M., Hou, F., & Kirmani, S. A. A. (2019). The impact of natural resources, human capital, and foreign direct investment on the ecological footprint: The case of the United States. Resources Policy, Vol. 63, No. 101428.‏

Johannes Leiner,1,2 Sven Hohenstein,2 Vincent Pellissier,2 Sebastian König,1,2 Claudia Winklmair,3 Irit Nachtigall,4 Andreas Bollmann,1,2,5 Ralf Kuhlen3,5,6 On behalf of the scientific advisory board of the Initiative of Quality Medicine (IQM)1Heart Centre Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany; 2Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany; 3Initiative of Quality Medicine, Berlin, Germany; 4Department of Infectious Diseases and Infection Prevention, HELIOS Hospital Emil-von-Behring, Berlin, Germany and Charité - Universitaetsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; 5Helios Health Institute, Berlin, Germany; 6Helios Health, Berlin, GermanyCorrespondence: Ralf Kuhlen, Initiative Qualitaetsmedizin e.V, Alt-Moabit 104, Berlin, 10559, Germany, Tel +49 30 7262 152 - 0, Email ralf.kuhlen@initiative-qualitaetsmedizin.deIntroduction: Reliable surveillance systems to monitor trends of COVID-19 case numbers and the associated healthcare burden play a central role in efficient pandemic management. In Germany, the federal government agency Robert-Koch-Institute uses an ICD-code-based inpatient surveillance system, ICOSARI, to assess temporal trends of severe acute respiratory infection (SARI) and COVID-19 hospitalization numbers. In a similar approach, we present a large-scale analysis covering four pandemic waves derived from the Initiative of Quality Medicine (IQM), a German-wide network of acute care hospitals.Methods: Routine data from 421 hospitals for the years 2019– 2021 with a “pre-pandemic” period (01– 01-2019 to 03– 03-2020) and a “pandemic” period (04– 03-2020 to 31– 12-2021) was analysed. SARI cases were defined by ICD-codes J09-J22 and COVID-19 by ICD-codes U07.1 and U07.2. The following outcomes were analysed: intensive care treatment, mechanical ventilation, in-hospital mortality.Results: Over 1.1 million cases of SARI and COVID-19 were identified. Patients with COVID-19 and additional codes for SARI were at higher risk for adverse outcomes when compared to non-COVID SARI and COVID-19 without any coding for SARI. During the pandemic period, non-COVID SARI cases were associated with 28%, 23% and 27% higher odds for intensive care treatment, mechanical ventilation and in-hospital mortality, respectively, compared to pre-pandemic SARI.Conclusion: The nationwide IQM network could serve as an excellent data source to enhance COVID-19 and SARI surveillance in view of the ongoing pandemic. Future developments of COVID-19/SARI case numbers and associated outcomes should be closely monitored to identify specific trends, especially considering novel virus variants.Graphical Abstract: Keywords: initiative of quality medicine, Germany, COVID-19, SARI, inpatient, hospital network

The daily intake of trace elements through water resources and their adverse health effects is a critical issue. The purpose of this research was to assess the carcinogenic and non-carcinogenic risks of exposure to iron (Fe), copper (Cu), manganese (Mn), zinc (Zn), chromium (Cr), lead (Pb), and arsenic (As) in groundwater resources of Sari city, Iran. The concentrations of the trace elements in a total number of 66 samples from the groundwater sources were measured using inductively coupled plasma mass spectrometry (ICP-MS). The hazard index (HI) levels of exposure to the trace elements from the groundwater sources for adults, teenagers, and children were 0.65, 0.83, and 1.08, respectively. The carcinogenic risk values of Cr and As in the groundwater sources for children, teenagers, and adults were 0.0001, 0.00009, 0.00007, 0.0003, 0.0002, and 0.0001, respectively, causing a total carcinogenic risk value higher than the acceptable range, and removing Cr and As from the groundwater resources is recommended for safe community water supply. HIGHLIGHTS The most important goals of the current research are to (1) determine the concentration of heavy metals in the drinking water and (2) assess the carcinogenic and non-carcinogenic risks of heavy metals through water ingestion by adults, teenagers, and children in the study areas.; Total carcinogenic risk value of the heavy metals in drinking water was higher than the acceptable range.;

Aims: Endemic SARS-CoV-2 infections still burden the healthcare system and represent a considerable threat to vulnerable patient cohorts, in particular immunocompromised (IC) patients. This study aimed to analyze the in-hospital outcome of IC patients with severe SARS-CoV-2 infection in Germany. Methods: This retrospective, observational study, analyzed administrative data from inpatient cases (n = 146,324) in 84 German Helios hospitals between 1 January 2022 and 31 December 2022 with regard to in-hospital outcome and health care burden in IC patients during the first 12 months of Omicron dominance. As the primary objective, in-hospital outcomes of patients with COVID-19-related severe acute respiratory infection (SARI) were analyzed by comparing patients with (n = 2037) and without IC diagnoses (n = 14,772). Secondary analyses were conducted on IC patients with (n = 2037) and without COVID-19-related SARI (n = 129,515). A severe in-hospital outcome as a composite endpoint was defined per the WHO definition if one of the following criteria were met: intensive care unit (ICU) treatment, mechanical ventilation (MV), or in-hospital death. Results: In total, 12% of COVID-related SARI cases were IC patients, accounting for 15% of ICU admissions, 15% of MV use, and 16% of deaths, resulting in a higher prevalence of severe in-hospital courses in IC patients developing COVID-19-related SARI compared to non-IC patients (Odds Ratio, OR = 1.4, p < 0.001), based on higher in-hospital mortality (OR = 1.4, p < 0.001), increased need for ICU treatment (OR = 1.3, p < 0.001) and mechanical ventilation (OR = 1.2, p < 0.001). Among IC patients, COVID-19-related SARI profoundly increased the risk for severe courses (OR = 4.0, p < 0.001). Conclusions: Our findings highlight the vulnerability of IC patients to severe COVID-19. The persistently high prevalence of severe outcomes in these patients in the Omicron era emphasizes the necessity for continuous in-hospital risk assessment and monitoring of IC patients.

IntroductionAs the studies predicting mortality in severe acute respiratory illness (SARI) have inferred associations either from dichotomous outcomes or from time-event models, we identified some clinical-epidemiological characteristics and predictors of mortality by comparing and discussing two multivariate models.MethodsTo identify factors associated with death among all SARI hospitalizations occurred in Botucatu (Brazil)/regardless of the infectious agent, and among the COVID-19 subgroup, from March 2020 to 2022, we used a multivariate Poisson regression model with binomial outcomes and Cox proportional hazards (time-event). The performance metrics of both models were also analyzed.ResultsA total of 3,995 hospitalized subjects were included, of whom 1338 (33%) tested positive for SARS-CoV-2. We identified 866 deaths, of which 371 (43%) were due to the COVID-19. In the total number of SARI cases, using both Poisson and Cox models, the predictors of mortality were the presence of neurological diseases, immunosuppression, obesity, older age, and need for invasive ventilation support. However, the Poisson test also revealed that admission to an intensive care unit and the COVID-19 diagnosis were predictors of mortality, with the female gender having a protective effect against death. Likewise, Poisson proved to be more sensitive and specific, and indeed the most suitable model for analyzing risk factors for death in patients with SARI/COVID-19.ConclusionGiven these results and the acute course of SARI and COVID-19, to compare the associations and their different meanings is essential and, therefore, models with dichotomous outcomes are more appropriate than time-to-event/survival approaches.

Abstract is missing Short communication

IntroductionThe Indian Council of Medical Research has set up a nationwide network of 28 laboratories for simultaneous surveillance of influenza virus and SARS-CoV-2 in ILI/SARI patients, using an in-house developed and validated multiplex real-time RTPCR assay. The aim of this study was to ensure the quality of testing by these laboratories by implementing an external quality assessment program (EQAP).MethodsFor this EQAP, a proficiency test (PT) panel comprising tissue-culture or egg-grown influenza virus and SARS-CoV-2 was developed. The PT panel was distributed to all the participant laboratories, which tested the panel and submitted the qualitative results online to the EQAP provider. The performance of the laboratories was evaluated on qualitative criteria but cycle threshold (Ct) values were also gathered for each sample.ResultsOn a qualitative basis, all the laboratories achieved the criteria of 90% concordance with the results of the PT panel provider. Ct values of different samples across the laboratories were within ≤ ±3 cycles of the corresponding mean values of the respective sample. The results of this EQAP affirmed the quality and reliability of testing being done for simultaneous surveillance of influenza virus and SARS-CoV-2 in India.

BackgroundOver time, COVID-19 testing has significantly declined across the world. However, it is critical to monitor the virus through surveillance. In late 2020, WHO released interim guidance advising the use of the existing Global Influenza Surveillance and Response System (GISRS) for the integrated surveillance of influenza and SARS-CoV-2.MethodsIn July 2021, we initiated a pan-India integrated surveillance for influenza and SARS-CoV-2 through the geographically representative network of Virus Research and Diagnostic Laboratories (VRDLs) across 26 hospital and laboratory sites and 70 community sites. A total of 34,260 cases of influenza-like illness (ILI) and Severe acute respiratory infection (SARI) were enrolled from 4 July 2021 to 31 October 2022.FindingsInfluenza A(H3) and B/Victoria dominated during 2021 monsoon season while A(H1N1)pdm09 dominated during 2022 monsoon season. The SARS-CoV-2 “variants of concern” (VoC) Delta and Omicron predominated in 2021 and 2022, respectively. Increased proportion of SARI was seen in extremes of age: 90% cases in < 1 year; 68% in 1 to 5 years and 61% in ≥ 8 years age group. Approximately 40.7% of enrolled cases only partially fulfilled WHO ILI and SARI case definitions. Influenza- and SARS-CoV-2-infected comorbid patients had higher risks of hospitalization, ICU admission, and oxygen requirement.InterpretationThe results depicted the varying strains and transmission dynamics of influenza and SARS-CoV-2 viruses over time, thus emphasizing the need to continue and expand surveillance across countries for improved decision making. The study also describes important information related to clinical outcomes of ILI and SARI patients and highlights the need to review existing WHO ILI and SARI case definitions.

The COVID‐19 pandemic has highlighted delayed reporting as a significant impediment to effective disease surveillance and decision‐making. In the absence of timely data, statistical models which account for delays can be adopted to nowcast and forecast cases or deaths. We discuss the four key sources of systematic and random variability in available data for COVID‐19 and other diseases, and critically evaluate current state‐of‐the‐art methods with respect to appropriately separating and capturing this variability. We propose a general hierarchical approach to correcting delayed reporting of COVID‐19 and apply this to daily English hospital deaths, resulting in a flexible prediction tool which could be used to better inform pandemic decision‐making. We compare this approach to competing models with respect to theoretical flexibility and quantitative metrics from a 15‐month rolling prediction experiment imitating a realistic operational scenario. Based on consistent leads in predictive accuracy, bias, and precision, we argue that this approach is an attractive option for correcting delayed reporting of COVID‐19 and future epidemics. [ABSTRACT FROM AUTHOR]

Background: We explored whether hospital‐based surveillance is useful in detecting severe acute respiratory infection (SARI) clusters and how often these events result in outbreak investigation and community mitigation. Methods: During May 2009–December 2020, physicians at 14 sentinel hospitals prospectively identified SARI clusters (i.e., ≥2 SARI cases who developed symptoms ≤10 days of each other and lived <30 min walk or <3 km from each other). Oropharyngeal and nasopharyngeal swabs were tested for influenza and other respiratory viruses by real‐time reverse transcriptase‐polymerase chain reaction (rRT‐PCR). We describe the demographic of persons within clusters, laboratory results, and outbreak investigations. Results: Field staff identified 464 clusters comprising 1427 SARI cases (range 0–13 clusters per month). Sixty percent of clusters had three, 23% had two, and 17% had ≥4 cases. Their median age was 2 years (inter‐quartile range [IQR] 0.4–25) and 63% were male. Laboratory results were available for the 464 clusters with a median of 9 days (IQR = 6–13 days) after cluster identification. Less than one in five clusters had cases that tested positive for the same virus: respiratory syncytial virus (RSV) in 58 (13%), influenza viruses in 24 (5%), human metapneumovirus (HMPV) in five (1%), human parainfluenza virus (HPIV) in three (0.6%), adenovirus in two (0.4%). While 102/464 (22%) had poultry exposure, none tested positive for influenza A (H5N1) or A (H7N9). None of the 464 clusters led to field deployments for outbreak response. Conclusions: For 11 years, none of the hundreds of identified clusters led to an emergency response. The value of this event‐based surveillance might be improved by seeking larger clusters, with stronger epidemiologic ties or decedents. [ABSTRACT FROM AUTHOR]

Cities manifesting the world's most consuming ecosystem are responsible for a large part of the world's environmental problems. Knowledge of the ecological conditions prevailing in any regions is essential for achieving development. Ecological Footprint Index (EFI) is of great interest for assessing urban communities as a way to measure the levels of sustainability. In this research, the ecological footprint method, which is a quantitative model, was used to analyze the data and measure the sustainability of urban areas. To this goal, an attempt was made to study the EFI and biological capacity of the urban ecosystem of Sari City by using a descriptive-analytical method and relying on library resources. Ecological footprint in the consumption sector, including housing, services, and transportation, was calculated in 4 areas of Sari City. According to the results of data analysis, the ecological footprint of consumption in the mentioned city was equal to 0.94 global hectares and its biological capacity was 0.59 global hectares per person. Comparison of the biological capacity and ecological footprint of this city showed that it had an ecological deficit and was thus ecologically unstable. Among the footprints calculated in the consumption sector, transportation with the ecological footprint of 46.46969 ha had the most ecological footprint. Also, analyses of the ecological footprints in the 4 regions of Sari City showed that Region 1 had a more footprint than other regions, indicating that it followed a higher consumption pattern, but in general, all areas of Sari City were in an ecologically unstable situation according to the research results. [ABSTRACT FROM AUTHOR]

The main pathogens of severe respiratory infection in children are respiratory viruses, and the current molecular technology allows for a rapid and simultaneous detection of a wide spectrum of these viral pathogens, facilitating the diagnosis and evaluation of viral coinfection. Methods: This study was conducted between March 2020 and December 2021. All children admitted to the ICU with a diagnosis of SARI and who were tested by polymerase chain reaction on nasopharyngeal swabs for SARS-CoV-2 and other common respiratory viral pathogens were included in the study. Results: The result of the viral panel identified 446 children, with one infected with a single virus and 160 co-infected with two or more viruses. This study employed descriptive analyses, where a total of twenty-two coinfections among SARI-causing viruses were identified. Thus, the five most frequent coinfections that were selected for the study are: hRV/SARS-CoV-2 (17.91%), hRV/RSV (14.18%), RSV/SARS-CoV-2 (12.69%), hRV/BoV (10.45%), and hRV/AdV (8.21%). The most significant age group was 38.1%, representing patients aged between 24 and 59 months (61 individuals). Patients older than 59 months represented a total of 27.5%, comprising forty-four patients. The use of oxygen therapy was statistically significant in coinfections with Bocavirus, other CoVs, Metapneumovirus, and RSV. Coinfections with SARS-CoV-2 and the other different coinfections presented a similar time of use of oxygen therapy with a value of (p > 0.05). In the year 2020, hRV/BoV was more frequent in relation to other types of coinfections, representing a total of 35.1%. The year 2021 presented a divergent profile, with hRV/SARS-CoV-2 coinfection being the most frequent (30.8%), followed by hRV/RSV (28.2%). Additionally, 25.6% and 15.4% represented coinfections between RSV/SARS-CoV-2 and hRV/AdV, respectively. We saw that two of the patients coinfected with hRV/SARS-CoV-2 died, representing 9.52% of all deaths in the study. In addition, both hRV/hBoV and hRV/RSV had death records for each case, representing 8.33% and 6.67% of all deaths, respectively. Conclusion: Coinfections with respiratory viruses, such as RSV and hBoV, can increase the severity of the disease in children with SARI who are admitted to the ICU, and children infected with SARS-CoV-2 have their clinical condition worsened when they have comorbidities. [ABSTRACT FROM AUTHOR]

The daily intake of trace elements through water resources and their adverse health effects is a critical issue. The purpose of this research was to assess the carcinogenic and non-carcinogenic risks of exposure to iron (Fe), copper (Cu), manganese (Mn), zinc (Zn), chromium (Cr), lead (Pb), and arsenic (As) in groundwater resources of Sari city, Iran. The concentrations of the trace elements in a total number of 66 samples from the groundwater sources were measured using inductively coupled plasma mass spectrometry (ICP-MS). The hazard index (HI) levels of exposure to the trace elements from the groundwater sources for adults, teenagers, and children were 0.65, 0.83, and 1.08, respectively. The carcinogenic risk values of Cr and As in the groundwater sources for children, teenagers, and adults were 0.0001, 0.00009, 0.00007, 0.0003, 0.0002, and 0.0001, respectively, causing a total carcinogenic risk value higher than the acceptable range, and removing Cr and As from the groundwater resources is recommended for safe community water supply. [ABSTRACT FROM AUTHOR]

Background: Severe acute respiratory tract infection (SARI) is a major global health threat. This study aimed to examine risk factors associated with poor outcomes in patients with SARI. Methods: All patients who met World Health Organization's (WHO) SARI case definition and were admitted to Salmaniya Medical Complex from January 2018 to December 2021 were included. Epidemiological and virological data were obtained and analyzed. Results: Of 1159 patients with SARI included, 731 (63.1%) patients were below 50 years, and 357 (30.8%) tested positive for viral pathogens. The most prevalent virus was Flu‐A (n = 134, 37.5%), SARS‐CoV2 (n = 118, 33%), RSV (n = 51, 14.3%), Flu B (n = 49,13.7%), other viruses (n = 3, 0.8%), and combined infection (n = 2, 0.6%). Six hundred fifty‐eight (56.8%) patients had comorbidities, mainly diabetes (n = 284, 43%) and heart disease (n = 217, 33%). 183 (16%) patients were admitted to ICU, 110 (9%) needed mechanical ventilation, and 80 (7%) patients died. The odds of ICU admission were higher for patients with hematological (OR 5.9, 95% CI 3.1–11.1) and lung diseases (OR 2.7, 95% CI 1.6–4.6). The odds of mechanical ventilation were higher among patients with lung disease (OR 3.1, 95% 1.7–5.5). The mortality odds were higher among patients above 50 (OR 2.4, 95% CI 1.4–4.1) and chronic kidney disease (OR 2.5, 95% CI 1.1–5.2). Conclusions: Being 50 years or above or having kidney, lung, or heart diseases was associated with worse SARI outcomes. Efforts and actions in developing better strategies to vaccinate individuals at high risk and early diagnosis and treatment should help in reducing the burden of SARI. [ABSTRACT FROM AUTHOR]

The potential for influenza viruses to cause public health emergencies is great. The World Health Organisation (WHO) in 2005 concluded that the world was unprepared to respond to an influenza pandemic. Available surveillance guidelines for pandemic influenza lack the specificity that would enable many countries to establish operational surveillance plans. A well-designed epidemiological and virological surveillance is required to strengthen a country’s capacity for seasonal, novel, and pandemic influenza detection and prevention. Here, we describe the protocol to establish a novel mechanism for influenza and SARS-CoV-2 surveillance in the four identified districts of Tamil Nadu, India. This project will be carried out as an implementation research. Each district will identify one medical college and two primary health centres (PHCs) as sentinel sites for collecting severe acute respiratory infections (SARI) and influenza like illness (ILI) related information, respectively. For virological testing, 15 ILI and 10 SARI cases will be sampled and tested for influenza A, influenza B, and SARS-CoV-2 every week. Situation analysis using the WHO situation analysis tool will be done to identify the gaps and needs in the existing surveillance systems. Training for staff involved in disease surveillance will be given periodically. To enhance the reporting of ILI/SARI for sentinel surveillance, trained project staff will collect information from all ILI/SARI patients attending the sentinel sites using pre-tested tools. Using time, place, and person analysis, alerts for abnormal increases in cases will be generated and communicated to health authorities to initiate response activities. Advanced epidemiological analysis will be used to model influenza trends over time. Integrating virological and epidemiological surveillance data with advanced analysis and timely communication can enhance local preparedness for public health emergencies. Good quality surveillance data will facilitate an understanding outbreak severity and disease seasonality. Real-time data will help provide early warning signals for prevention and control of influenza and COVID-19 outbreaks. The implementation strategies found to be effective in this project can be scaled up to other parts of the country for replication and integration.