Articles

<b>Background:</b> Tuberculosis (TB) in the elderly poses significant diagnostic and therapeutic challenges due to immunosenescence, comorbidities, and atypical clinical presentation. This study evaluates the epidemiological and clinical characteristics of TB in patients aged ≥65 years. <b>Methods:</b> A retrospective descriptive study was conducted including all TB cases reported between 2020 and 2024. Data from the National Tuberculosis Program were analyzed for demographic characteristics, clinical form, bacteriological confirmation, comorbidities, and treatment outcomes. <b>Results:</b> Of 1,335 TB cases, 352 (26.4%) occurred in individuals aged ≥65 years. Pulmonary TB accounted for 80.7% of cases. Men represented 63.4% of patients, and 56.8% lived in urban areas. Bacteriological confirmation was achieved in 82% of pulmonary cases, and treatment success exceeded 85%. Diabetes mellitus (26.5%) and arterial hypertension (31%) were the most common comorbidities. An increase in TB cases was observed in the post-COVID-19 period. A significant association was found between age and clinical form of TB (p < 0.001). <b>Conclusions:</b> Elderly individuals constitute a substantial proportion of TB cases and frequently present with chronic comorbidities. Despite diagnostic challenges, favorable treatment outcomes were achieved, highlighting the need for integrated and early management strategies in this population.

Mathematical modeling plays a central role in infectious disease epidemiology, shaping outbreak response strategies and informing public health policy. The COVID-19 pandemic demonstrated the value of these models but also exposed persistent limitations related to data fragility, lack of transparency, limited stakeholder engagement, and insufficient consideration of social and political contexts. Rather than critiquing modeling as a discipline, this perspective argues for a reorientation of infectious disease modeling toward a more responsive, equity-centered, and participatory paradigm. We propose a conceptual framework built on three interrelated principles: adaptability through real-time data integration, transparency via open-source and reproducible practices, and relevance through interdisciplinary and co-produced model design. Drawing on illustrative examples from COVID-19 and dengue control efforts, we highlight how integrating behavioral dynamics, local knowledge, and policy feedback can improve model usefulness and public trust. Reconceptualizing models as dynamic systems of inquiry rather than static forecasting tools can enhance decision-making and promote more equitable and effective responses to future public health emergencies.

Complexity Leadership Theory (CLT) is a new and revolutionary concept in addressing healthcare crises worldwide. Its relevance and applications were tested during the COVID-19 pandemic. However, no definite and encompassing research was done to apply it to nursing leadership. Thus, this study examines CLT integration into nursing leadership to address the challenges posed by the pandemic. Through a systematic review of literature from PubMed, Scopus, and Web of Science, relevant studies were analyzed to determine how complexity leadership theory was defined, conceptualized, and operationalized within nursing leadership context. The findings reveal that traditional hierarchical leadership models are insufficient in a dynamic crisis environment like the pandemic. Instead, CLT’s framework which encompasses adaptive, administrative, and enabling leadership facilitates innovation, resilience, and effective interprofessional collaboration. Nurse leaders employing these strategies are better positioned to manage resources limitation, foster shared decision-making, and implement technological advancements in rapidly changing healthcare settings. Overall, this study underscores the potential of complexity leadership theory to transform nursing leadership practices by promoting continuous learning and empowerment, thereby enhancing crisis response and preparedness for future pandemics.

COVID-19 vaccines have demonstrated efficacy in reducing the prevalence of serious illnesses. The relative risk of hospitalization and mortality for patients who get breakthrough infections after immunization versus those who develop reinfections after a prior spontaneous infection is examined in this correspondence. Based on a study on U.S. Veterans who were not vaccinated and experienced reinfections had a much higher risk of experiencing severe illness outcomes compared to those who had received immunizations and experienced breakthrough infections, even if the rates of reinfection and breakthrough infection were similar. Our findings highlight the value of immunization in reducing severe COVID-19 outcomes, even in the presence of reinfections.

<b>Background:</b> Severe COVID-19 patients who received ventilator management were not very rare even when the omicron variant became dominant, but the clinical characteristics of these patients are still unclear. <b>Methods:</b> The clinical characteristics of severe COVID-19 patients requiring ventilator management were retrospectively investigated from January 2023 to December 2023. <b>Results:</b> Severe COVID-19 patients who received ventilator management accounted for 11 of 275 (4.2%) patients during the omicron variant period. Their mean age was 70.7 (51-85) years, and males were predominant. Ten of eleven (91.7%) patients were managed in the emergency department and had underlying diseases, including chronic lung/heart/kidney diseases and neurological diseases. However, only 4 of 11 (36.4%) had a clear history of vaccination. The patients showed a positive SARS-CoV-2 antigen titer of 3305.7 (12.9-20912). All 11 patients were treated with remdesivir and dexamethasone, and 5 (45.5%) also received sotrovimab. Pathogenic bacteria were isolated from 7 of 11 (63.6%) patients, and all 11 patients were treated with antibiotics. Only 3 of 11 (27.3%) patients were managed using extracorporeal membrane oxygenation (ECMO), but 9 of 11(81.8%) patients survived. <b>Conclusions:</b> These data suggest that severe COVID-19 patients who required ventilator management were less-vaccinated, elderly patients with underlying disease. These patients were treated successfully using antiviral agents, steroids, neutralizing antibodies, and antibiotics, with a few also treated using ECMO in the omicron era.

<b>Background:</b> The COVID-19 pandemic posed significant psychological challenges to frontline healthcare workers (HCWs), including anxiety, stress, and emotional strain. <b>Aim</b>: This study investigates the psychological impact on HCWs during the pandemic and explores coping strategies employed to manage distress. <b>Methods</b>: An integrative review was conducted using 24 studies published between January and December 2020. These studies were analyzed to identify common psychological outcomes and coping mechanisms among HCWs. <b>Results</b>: Healthcare workers experienced significant psychological distress during the COVID-19 pandemic, including anxiety, stress, insomnia, and depression. Anxiety was the most commonly reported issue, particularly among women, younger healthcare workers, and frontline staff. Stress levels were heightened by high workloads, exposure to COVID-19 patients, and inadequate protective measures. Coping strategies and self-care behaviors, such as seeking social support and utilizing institutional resources, varied in effectiveness across populations. <b>Conclusion</b>: The findings highlight the urgent need for targeted mental health support and resilience programs for HCWs, ensuring they are better equipped to face future health crises.

An increasing number of adverse events are raising concern in the pharmaceutical supply chain due to contaminated active pharmaceutical ingredients (APIs). Most of the active pharmaceutical ingredients are not currently under the scope of environmental regulations, despite their negative impact on human health and the environment. API's life cycle plays a significant role in identifying potential supply chain sources and determining their impact on the environment. The Covid-19 pandemic's intermittent manufacturing interruptions and the increase in the frequency of drug shortages over the past ten years have sparked worries about how resilient the world's drug supply chains are. Many clinical trials were conducted on patients with COVID-19 during the SARS-CoV-2 pandemic and resulted in millions of deaths globally by 2022.

<i><b>Background:</b></i> COVID-19-related pneumonia was initially rare, though influenza-related pneumonia is well known as a severe complication of influenza. However, COVID-19-related pneumonia may be increasing since the omicron variant of COVID-19 appeared. <i><b>Methods:</b></i> The clinical differences between COVID-19-related and influenza-related pneumonia patients were retrospectively investigated in patients hospitalized from January 2022 to December 2023. <i><b>Results:</b></i><i><b> </b></i>COVID-19-related and influenza-related pneumonias were found in 46 of 285 (15.8%) and 6 of 12 (50.0%) patients, respectively (p<0.001). Their mean ages were 75.5 (45-93) years and 53.8 (19-73) years in COVID-19-related and influenza-related pneumonia cases, respectively (p=0.002). Aspiration pneumonia was more common in COVID-19-related pneumonia (28/46=60.9%) than in influenza-related pneumonia patients, and it was treated by sulbactam/ampicillin (31/46=67.4%). The influenza-related pneumonia patients were more often infected in the work place (2/6=33.3%) and not vaccinated (4/6=66.7%), compared with COVID-19-related patients. Death occurred in 7 of 46 (15.2%) COVID-19 patients, but none of 6 influenza-infected patients died. <i><b>Conclusions:</b></i> These data suggest that COVID-19-related pneumonia presented as aspiration pneumonia in older patients, although influenza-related pneumonia was more common in younger and non-vaccinated patients and might be associated with immune mechanisms during the omicron variant surge era.

Respiratory virus co-infections have been suggested to happen frequently and exacerbate patients’ conditions, but little is known about the detailed rates and the combinations of viruses during the COVID-19 pandemic period. A total of 255 symptomatic patients who underwent multiplex PCR tests were analyzed, and it was found that 6 (6/255=2.4%) patients were infected with multiple viruses. The patients ranged in age from 1 to 38 years, and one female patient was pregnant. Of the 6 patients, 4 had fever, and 5 had human rhinovirus/enterovirus and another virus. These data suggested that the rate of respiratory virus co-infection was low, and the combination of SAS-CoV-2 and other viruses was rare even during the COVID-19 pandemic.

The COVID-19 pandemic has had a significant impact on individuals worldwide, affecting not only their educational futures but also their mental health. This paper aims to explore college students' perceived barriers to accessing mental health services during the pandemic. The study finds that there is a significant difference between stigma-related and non-stigma-related barriers, with non-stigma items being rated higher on average. The most commonly reported non-stigma barriers include wanting to solve the problem independently, financial constraints, and the belief that the issue will resolve itself. Stigma-related barriers include feeling embarrassed or ashamed, concern about having a mental health problem on medical records, and fear of being seen as crazy or weak. This research sheds light on the challenges students face in seeking mental health care during the pandemic and highlights the need to address these barriers.

The study is a follow-up of the study "Coronavirus in pregnant patients and their clinical outcomes – results of a case-control study" conducted by R.Kadriu et al (2023) in which,in addition to the pregnant patients whose outcome is now being investigated,a control group of patients who were not pregnant,conducted with pregnant patients and a control group that were non-pregnant patients.This study was conducted 6 months after the discharge of the patients and their newborns,and highlights the impact of COVID-19 on their health as well as the health of the newborns. The aim of the study is to follow up the patients after 6 months of their hospitalization as COVID-19 patients and after their delivery.In the COVID study, none of the health indicators showed statistically significant differences between the population before and after hospitalization.Patient data were collected at the case level summarized in their respective groups.For secondary objectives, several comparative analyzes were performed regarding comorbidity-related parameters and available risk factors.A significance level (α) of 0.05 was used for statistical significance. While these results may be reassuring regarding the stability of health status, one should be aware of the limitations of the study, including sample size and specific population characteristics.

<b>Background</b>: The titers of SARS-COV-2 antigens are frequently used as markers of viral activity and threshold for release from quarantine and treatment. COVID-19 patients were treated with several antiviral agents, including remdesivir (RDV) and ensitrelvir (ESV), which is a novel anti-SARS-CoV-2 agent recently suggested to have strong antiviral activity. <b>Cases</b>: We present the cases of two patients whose SARS-CoV-2 antigens were successfully decreased by oral administration of ESV after they could not be decreased by RDV drip infusion. Case 1 was a 74-year-old man who was admitted with SARS-CoV-2 infection and had been infected by the virus a month earlier and relapsed twice. He had been treated with rituximab for diffuse B cell lymphoma and not received vaccination for SARS-CoV-2. RDV was administered intravenously two weeks earlier and again 4 days earlier, but it failed to control the infection, and he was transferred to our hospital (day 1). Intravenous RDV was restarted on day 1, but viral antigens remained high until day 5. The RDV was then switched to oral ESV, and viral antigen titers were successfully decreased on days 8, 10, and 12. Case 2 was an 81-year-old man who was admitted with SARS-CoV-2 infection on day 0. He had heart failure and diabetes mellitus, and had not received vaccination for SARS-CoV-2. Intravenous RDV was started on day 1, but viral antigens were still high until day 8. He was then switched from RDV to oral ESV, and viral antigen titers were successfully decreased on day 11. <b>Conclusions:</b> These cases suggest that ESV might be more effective than RDV for reducing viral activity, and it is easy to administer orally.

<b>Background: </b>Recently specific interactions and crosslinks between the gut microbiota and the lungs have been recognized, particularly with regard to respiratory immune and anti-microbial reactions. This is often known as the “gut-lung axis” or “a common mucosal immunological system”.<b> Objective: </b>The aim of the current systematic review was to evaluate evidence, from published clinical trials and cohort studies, if probiotics may have an effect in improving and managing COVID-19 symptoms.<b> Materials and methods: </b>The available studies were searched through a comprehensive search of electronic databases that included PubMed, Science Direct, Scirus, ISI Web of Knowledge, Google Scholar and CENTRAL (Cochrane Central Register of Controlled Trials), using a combination of the following keywords: “COVID-19" OR<i> </i>"SARS-CoV-2" AND "Microbiota" OR "Probiotics” OR “Gut Lung Axis”. The literature was reviewed until August 31, 2022<b>. Results: </b>Only 3 studies were included. One of them evaluated the efficacy of probiotics in COVID-19 patients to obtain complete remission of all signs and symptoms. The clinical trial proves that probiotics have a significant effect on complete remission of all signs and symptoms of COVID-19 patients with statistical significant difference. Only one clinical trial out of the 3 included studies had evaluated the need for O2 therapy during the study between the probiotics and control groups, but without statistical significant difference<b>. </b>No statistical significant difference between the probiotics group and placebo group was observed regarding fatal prognosis during the only clinical trial that measured death as an outcome<b>. Conclusion: </b>We couldn’t judge on these results as they are insufficient data for pooling and meta-analysis. However, what we can say is “Most probably Probiotics have no role in treatment of COVID-19 infection”.

<b>Background</b>: Coronavirus disease 2019 (COVID-19) is a newly emerging human disease caused by a novel coronavirus, causing a global pandemic crisis<b>.</b> Probiotics and/or colchicine may be considered as options for treatment since they have anti-viral, anti-inflammatory, and immunomodulatory effects. The aim of the current review was to assess the effectiveness of probiotic supplements and colchicine on symptoms, duration, and progression of mild and moderate cases of COVID-19 infection<b>.</b> <b>Re</b><b>view</b><b>:</b> A randomized, double-blind, placebo-controlled trial in the United States with 182 participants who were randomly assigned to receive daily oral probiotic (Lactobacillus rhamnosus) LGG or placebo for 28 days. The study indicated that LGG is well-tolerated and is associated with a delay in the onset of COVID-19 infection, a reduction in the incidence of symptoms, and alterations in the structure of the gut microbiome when administered as post-exposure prophylaxis within seven days of exposure. Colchicine may lessen mortality and the need for mechanical ventilation in mild-to-moderate COVID-19 patients, according to a systematic review and meta-analysis. <b>Conclusion: </b>Probiotics and/or colchicine may be viable treatment options for COVID-19 patients. To examine the efficacy of probiotics and colchicine in the treatment of COVID-19, it is necessary to conduct additional clinical trials and provide clinicians with evidence, as there are currently insufficient studies to support this conclusion.

The pulmonary characteristics of <i>Staphylococcus </i><i>aure</i><i>u</i><i>s</i> (<i>S</i><i>.</i><i> </i><i>aureus</i>) co-infection with respiratory viruses, such as SARS-CoV-2 and influenza virus, are still unclear.<b> </b><b>Case series</b>: Two patients with methicillin-susceptible <i>S</i><i>.</i><i> </i><i>aureus</i><i> </i>(MSSA) infection in the lungs co-infected with either SARS-CoV-2 or influenza virus are reported. Case 1 was a 66-year-old woman who was admitted with SARS-CoV-2 infection. Her chest X-ray and computed tomography (CT) showed multiple cavity formations with infiltration shadows, and MSSA was detected from her sputum and blood, suggesting COVID-19-related bacterial pneumonia and pulmonary embolism. No catheters had been used, but she had skin eruptions and a history of SARS-CoV-2 vaccination. Ampicillin/sulbactam (ABPC/SBT) was administered, and she finally improved. Case 2 was an 87-year-old man with a history of atopic dermatitis who was admitted with moderate pneumonia, and influenza virus co-infection was found. He showed multiple cavitary shadows, and MSSA was isolated from both his sputum and blood. He was diagnosed with influenza-related bacterial pulmonary embolism. No catheters had been used, but he had a history of influenza vaccination. He was also treated by ABPC/SBT and finally improved. <b>Conclusions:</b> These cases suggest that MSSA showed affinity to the lungs when co-infected with either SARS-CoV-2 or influenza virus, and it presented as septic emboli without catheter use. We should consider MSSA infection when patients have SARS-CoV-2 or influenza virus co-infection, and multiple cavity formation and skin disorders are seen, even though they were vaccinated and no catheters were used.

<b>Background:</b> There is paucity of data on health-related quality of life (HRQoL) among Health Information Managers/Health Record Officers (HROs) in the Nigeria health system. Hence, this study investigated the impact of the COVID-19 pandemic on health-related quality of life (QoL) among HROs in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria. <b>Methods:</b> A cross-sectional study was conducted in the University Hospital, where a total of 52 health record officers were purposively sampled. Relevant data were collected using the Short Form survey (SF-36v2) questionnaire. One-way ANOVA was used to determine mean group differences across the nine and the two QoL (physical and mental) summary domains based on respondents’ socio-demographics, while level of significance was set at 0.05. <b>Results: </b>All the QoL sections of the instrument used yielded an α-Cronbach’s score of > 0.70. Analysis of some QoL physical component dimensions showed that; Bodily pain (BP) was found to be significantly (P=0.032) associated with marital status, Physical functioning (PF) with gender (P=0.023), and general health (GH) with age group (P=00.025) and highest level of education (P=0.023). On the other hand, mental health component analysis revealed that Social Functioning (SF) was associated with age group (P=014), Role limitation (RE) with marital status (P=0.048), highest level of education (P=0.048) and years of service (P=0.015) etc. <b>Conclusion:</b> The QoL among HROs studied was generally above average, and demographic characteristics such as age, gender and marital status significantly influence QoL. Health managers and stakeholders should consider some of the factors identified in managing HROs.

Background:</b> The COVID-19 pandemic disrupted routine osteoporosis care due to clinic closures and limited in-person consultations. Telehealth emerged as an alternative model enabling remote care delivery and monitoring. However, previous reviews on telehealth either did not include the pandemic period or had a limited focus in scope. Evidence synthesized specifically for osteoporosis care during the pandemic is needed but lacking. <b>Methods:</b> We systematically searched PubMed, MEDLINE, EMBASE, PsycINFO, Web of Science, and CINAHL for studies on telehealth for osteoporosis published between January 2021 and March 2023. Five studies met the inclusion criteria of: osteoporosis population, telehealth intervention, and COVID-19 pandemic timeframe. Data was extracted on study characteristics, COVID-19 outcomes, osteoporosis status, telehealth purpose, patient satisfaction, and clinical outcomes. <b>Result:</b> The five studies showed telehealth was used for monitoring data, delivering test results, adjusting medications, and assessments. Osteoporosis prevalence among telehealth users ranged 30-100%. High patient satisfaction was reported with telehealth versus in-person care. No major differences occurred in medication delays or fractures between telehealth and in-person groups. <b>Conclusion:</b> This review found telehealth enables effective osteoporosis care and monitoring during the pandemic, with high patient and provider satisfaction. However, more robust randomized controlled trials are needed to establish stronger evidence around telehealth's impacts on clinical osteoporosis outcomes. <b>Implications:</b> Though promising, further high-quality studies will help clarify telehealth's role in improving osteoporosis care and outcomes. Findings inform guidelines on integrating telehealth into routine management. Evidence on user perspectives optimizes telehealth implementation policies.

Background:</b> The World Health Organization (WHO) has declared COVID-19 a public health emergency of international concern. In this context, effective and affordable diagnostic procedures are essential for identifying and managing cases. Complete blood counts (CBC) are among the most common and readily available diagnostic tests. The current study aimed to evaluate the efficacy of CBC in diagnosing COVID-19 and identifying cases. <b>Patients and Methods:</b> A case-control study was conducted on 173 patients at Ain Shams University Hospitals over a period of three months. Patients were allocated into two groups according to COVID-19 PCR results: Group 1 included patients with COVID-19 positive PCR, and Group 2 included patients with COVID-19 negative PCR. <b>Results:</b> The study found that differential CBC had significant value in diagnosing COVID-19 disease. Many COVID-19 patients had lymphopenia and leucopenia compared to non-COVID-19 suspected patients. The low values of leukocytes, neutrophils, lymphocytes, and eosinophils with a CBC test were found to be valuable in the initial diagnosis of COVID-19. <b>Conclusion:</b> The definitive diagnosis of COVID-19 requires RT-PCR analysis, which is time-consuming and less accessible. Thus, the initial diagnosis and treatment of patients may be delayed. This study suggests that CBC, which is easily available and affordable, can be valuable in the early identification of COVID-19 cases, allowing for prompt treatment and management.

The pandemic of the SARS-CoV2 (COVID-19) that was declared by the World Health Organization (WHO) on 11 March 2020 is still ongoing. One of the early recommendations from CDC and other international agencies is the seasonal influenza vaccination to decrease the effects and burden of COVID-19 pandemic. This review suggests that during COVID-19 pandemic vaccination against seasonal influenza should be conducted all over the year, even for young age groups, because of several reasons. First, the complications of seasonal influenza, especially pneumonia, could increase the burden on the saturated healthcare systems worldwide. Second, the resemblance of symptoms and signs of both seasonal influenza and COVID-19 will difficult diagnosing and isolation of COVID-19 patients. Third, it has been postulated that there is a cross immunity between seasonal influenza and COVID-19.

Authors describe autoptic findings of two cases whose COVID-19 diagnosis was supported by laboratory data. Both patients were Caucasian individuals of middle age (one male, 47 years old; the other a female aging 36 years) that were considered as previously healthy. Clinically they died from cardiorespiratory insufficiency while being treated in intensive care units. None of them was intubated and blood oxygen levels (SpO2) decreased below 90% only during the agonal phase. Myopericardial changes were visible from a macroscopic point of view, with hemorrhagic and necrotic areas involving pericardium. Fresh hemorrhage and severe hyperemia were both signs of vascular damage and extravasation leading to acute myocardial injuries. Lymphocytic presence was disparate and not constant.