Cognitive function and impact on driving after SARS-COV-2 infection in a man with long-standing HIV infection: a case report.

A substantial number of individuals who experience COVID-19 infection experience prolonged physical and mental symptoms after resolution of their initial infection, and among them, many individuals experience cognitive difficulties including memory lapses and executive function difficulties, often referred to as "brain fog." The possible impact of COVID-19 infection on cognition in persons with HIV-related cognitive disorders is unknown. In this report, we describe post-COVID-19 cognitive and driving function in a 62-year-old man with HIV infection since the early 1990s.

Principles of vaccine development

Vaccines are biological products that protect against pathogens such as bacteria and viruses by eliciting an immune response. Antigens foster the response within the vaccine, generated either naturally or synthetically. Antigens are one of several components that comprise a vaccine and aid in its classification. The type of virulence factors can influence its classification as either live or nonlive. Types of vaccines may be classified based on their main content, such as protein-polysaccharide conjugate vaccines or nucleic acid vaccines. With the essential role vaccines serve and their developmental intricacies, it is understood that there is a federal entity that oversees vaccine development. In the United States the vaccine development process is regulated by the Food and Drug Administration (FDA). The beginning stages typically involve submitting an investigational new drug application (IND) for approval. Through submitting an IND, the FDA provides vaccine developers critical information regarding factors such as trial design and quality testing. Evaluation of vaccine safety and efficacy is performed during the clinical trial period. Foreign clinical, human challenge, and pediatric clinical studies are the most common types of studies recommended by the FDA. This review discusses the details regarding the general key features of vaccines and the overall federal regulation of vaccine development. © 2023 Elsevier Inc. All rights reserved.

Catastrophic Antiphospholipid Syndrome as a Complication of COVID-19 Infection.

COVID-19 infection has been found to precipitate hypercoagulability and transiently increase antiphospholipid antibodies. However, it is yet to be determined how likely these transient changes contribute to thrombotic events and antiphospholipid syndrome. We present a case in which antiphospholipid antibodies were detected in the presence of significant thromboses. The patient was subsequently treated for suspected catastrophic antiphospholipid syndrome following COVID-19 infection.

A Review on Catastrophic Evolution of SARS-CoV to SARS-CoV2: A Global Pandemic

The coronaviruses, belonging to the family Coronaviridae, have caused a massive pandemic in December 2019 after their previous outbreaks as SARS-CoV and MERS. The outbreak is believed to have originated from the seafood and live market in the Hubei province of China. The Rhinolophus species are the natural hosts of this virus. This virus caused pneumonia and took away many lives be-fore it was recognized as the novel Coronavirus. Very little information is available about the biology and nature of the novel Coronavirus. This article reviews multiple aspects encompassing its origin, epi-demiology, pathogenesis, symptoms, and the global statistics of spread. Acute respiratory distress syndrome (ARDS) is the key symptom of this condition. Angiotensin-converting enzyme 2 (ACE2) helps in the penetration of the virus into the target cells. Deeper research and understanding are essential for the identification of antibodies that inhibit ACE2 and can prevent viral replication. Drug design and control of disease are crucial. In countries like India, where plant diversity is extensive, it is prudent to focus on plant-based alternative drugs. Many attempts have been made to review and curate the drug discovery attempts using immuno-informatic and bioinformatic tools.Copyright © 2021 Bentham Science Publishers.

Digital Tools and methods to Enhance Learning: The Digitools Project

The use of distance education using digital tools in higher education has increased over the last decade, particularly during the COVID-19 pandemic. COVID-19 has resulted in schools shutting down all across the world. This paper aims to present a brief summary of the Digitools Project and a multicultural analysis of the use of e-learning during Covid-19 in six countries. The methodology used was a survey by questionnaire involving teachers, librarians and students. The analysis of the questionnaire results allowed us to identify which dimensions to assess the sustainability of eLearning namely the organizational, socio-cultural and technological context. It also made it possible to assess the perceived usefulness, perceived ease of use, intention to use, actual use and perceived satisfaction. Furthermore, personal, technological and organizational dimensions are also valued for e-learning usage. After reviewing the state of the art, there was a need to define a strategic training plan for the acquisition of basic and advanced skills for eLearning's implementation and usage. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Effect of Parenteral Corticosteroids in Mortality from Severe Covid-19 / Efecto de los Corticoides Parenterales en la Mortalidad por Covid-19 Severo

Introducción. La infección causada por el SARS-CoV-2 puede producir un cuadro inflamatorio severo, sepsis, falla respiratoria, disfunción orgánica, y muerte. Es plausible fisiopatológicamente, que los corticoides sean una opción terapéutica razonable para Covid-19. Sin embargo, la evidencia del efecto benéfico de los corticoides sobre la mortalidad no es categórica. Objetivo: determinar si existe evidencia que avale el uso de corticoides parenterales en Covid-19 grave y Síndrome de Distrés Respiratorio Agudo (SDRA). Material y método: Este estudio se desarrolló en concordancia con la guía PRIMA. Según la estrategia PICO, nuestra Población fueron los pacientes con Covid-19 grave y/o SRDA; la Intervención, el uso de corticoides parenterales; el Comparador, los pacientes con Covid-19 severo con tratamiento estándar (sin corticoides); y el Outcome, la mortalidad y otros resultados clínicos. La búsqueda se realizó en las bases de datos PubMed, Medline, Cochrane, Embase, y LILACS usando los términos relacionados con nuestra pregunta PICO, entre el de 01 enero al 31 de agosto del 2020. Se logró recopilar un total de 287 artículos, de los que finalmente se seleccionaron 9 que cumplieron con los criterios PICO y de selección. Resultados: Según nuestro estudio, los corticoides parenterales reducen la mortalidad en pacientes con Covid-19 severo y SRDA[OR 0.83 (IC 95% 0.63-1.08)]. Conclusión: la revisión sistemática muestra que los corticoides parenterales podrían disminuir la mortalidad de pacientes con Covid-19 severo y ARDS.

Introduction. Infections caused by SARS-CoV-2 may produce a severe inflammatory response,sepsis, respiratory failure, organ dysfunction, and death. From a pathophysiological point of view, it is plausible that glucocorticoids could be a reasonable therapeutic option for Covid-19. However, the evidence supporting the benefit of corticosteroids on mortality and other clinical outcomes is no tconclusive. Objective: determinate if there exist evidence supporting corticosteroids therapy in patients with severe Covid-19 and Acute Respiratory Distress Syndrome (ARDS). Material and method: This study was performed in concordance with PRISMA guidelines. According to the PICO strategy, Population were patients with severe Covid-19 and/or ARDS; Intervention, parenteral corticosteroid administration; Comparator, patients with severe Covid-19 and/or ARDS with standard treatment (without corticosteroids); and Outcome, mortality and other clinical outcomes. Search strategy was performed in the data bases PubMed, Medline, Cochrane, Embase, and LILACS, using terms related with the PICO question; from January 1 to august 31 (2020). A total of 287 articles were initially retrieved. Of these, we finally selected only 9 article which fulfilled with PICO and selection criteria. Results: According to our study, parenteral corticosteroids reduce mortality in patients with Severe Covid-19 and/or ARDS [OR 0.83 (IC 95% 0.63-1.08)]. Conclusion: the systematic review shows that parenteral corticosteroids could reduce the mortality of patients with severe Covid-19 and ARDS.

A review of neurological side effects of COVID-19 vaccination.

Following the COVID-19 virus epidemic, extensive, coordinated international research has led to the rapid development of effective vaccines. Although vaccines are now considered the best way to achieve collective safety and control mortality, due to the critical situation, these vaccines have been issued the emergency use licenses and some of their potential subsequence side effects have been overlooked. At the same time, there are many reports of side effects after getting a COVID-19 vaccine. According to these reports, vaccination can have an adverse event, especially on nervous system. The most important and common complications are cerebrovascular disorders including cerebral venous sinus thrombosis, transient ischemic attack, intracerebral hemorrhage, ischemic stroke, and demyelinating disorders including transverse myelitis, first manifestation of MS, and neuromyelitis optica. These effects are often acute and transient, but they can be severe and even fatal in a few cases. Herein, we have provided a comprehensive review of documents reporting neurological side effects of COVID-19 vaccines in international databases from 2020 to 2022 and discussed neurological disorders possibly caused by vaccination.

Impact of various buffers and weak bases on lysosomal and intracellular pH: Implications for infectivity of SARS-CoV-2.

Acidification of the cellular lysosome is an important factor in infection of mammalian cells by SARS-CoV-2. Therefore, raising the pH of the lysosome would theoretically be beneficial in prevention or treatment of SARS-CoV-2 infection. Sodium bicarbonate, carbicarb, and THAM are buffers that can be used clinically to provide base to patients. To examine whether these bases could raise lysosomal pH and therefore be a primary or adjunctive treatment of SARS-CoV-2 infection, we measured lysosomal and intracellular pH of mammalian cells after exposure to each of these bases. Mammalian HEK293 cells expressing RpH-LAMP1-3xFLAG, a ratiometric sensor of lysosomal luminal pH, were first exposed to Hepes which was then switched to sodium bicarbonate, carbicarb, or THAM and lysosomal pH measured. In bicarbonate buffer the mean lysosomal pH was 4.3 ± 0.1 (n = 20); p = NS versus Hepes (n = 20). The mean lysosomal pH in bicarbonate/carbonate was 4.3 ± 0.1 (n = 21) versus Hepes (n = 21), p = NS. In THAM buffer the mean lysosomal pH was 4.7 ± 0.07 (n = 20) versus Hepes (4.6 ± 0.1, n = 20), p = NS. In addition, there was no statistical difference between pHi in bicarbonate, carbicarb or THAM solutions. Using the membrane permeable base NH4Cl (5 mM), lysosomal pH increased significantly to 5.9 ± 0.1 (n = 21) compared to Hepes (4.5 ± 0.07, n = 21); p < 0.0001. Similarly, exposure to 1 mM hydroxychloroquine significantly increased the lysosomal pH to (5.9 ± 0.06, n = 20) versus Hepes (4.3 ± 0.1, n = 20), p < 0.0001. Separately steady-state pHi was measured in HEK293 cells bathed in various buffers. In bicarbonate pHi was 7.29 ± 0.02 (n = 12) versus Hepes (7.45 ± 0.03, [n = 12]), p < 0.001. In cells bathed in carbicarb pHi was 7.27 ± 0.02 (n = 5) versus Hepes (7.43 ± 0.04, [n = 5]), p < 0.01. Cells bathed in THAM had a pHi of 7.25 ± 0.03 (n = 12) versus Hepes (7.44 ± 0.03 [n = 12]), p < 0.001. In addition, there was no statistical difference in pHi in bicarbonate, carbicarb or THAM solutions. The results of these studies indicate that none of the buffers designed to provide base to patients alters lysosomal pH at the concentrations used in this study and therefore would be predicted to be of no value in the treatment of SARS-CoV-2 infection. If the goal is to raise lysosomal pH to decrease the infectivity of SARS-CoV-2, utilizing lysosomal permeable buffers at the appropriate dose that is non-toxic appears to be a useful approach to explore.

Severe Liver Injury Secondary to COVID-19-Induced Rhabdomyolysis in McArdle Disease.

Severe liver injury is an uncommon condition caused by non-traumatic rhabdomyolysis. This rare correlation is more commonly seen in the aspartate aminotransferase (AST) than in the alanine transaminase (ALT) level elevation. We report a case of a 27-year-old male with a history of McArdle disease who presented with generalized muscle aches associated with dark urine. His workup showed SARS-CoV-2 positive, severe rhabdomyolysis (creatinine kinase [CK] > 40000 U/L) and acute kidney injury (AKI) followed by severe liver injury (AST/ALT: 2122/383 U/L). He was started on aggressive intravenous hydration. After multiple boluses, he became overloaded, fluids were re-adjusted and continued, his renal function, CK, and liver enzymes improved, and the patient was discharged; during his visit at the post-discharge, the patient was asymptomatic and no clinical or laboratory abnormalities were found. The glycogen storage diseases are challenging, but prompt and accurate assessment is determinant in recognizing potential life-threatening complications of SARS-CoV-2. The failure to identify complicated rhabdomyolysis could lead to the patient's rapid deterioration, ending in multiorgan failure.

The calcium-sensing receptor in inflammation: Recent updates.

The Calcium-Sensing Receptor (CaSR) is a member of the class C of G-proteins coupled receptors (GPCRs), it plays a pivotal role in calcium homeostasis by directly controlling calcium excretion in the kidneys and indirectly by regulating parathyroid hormone (PTH) release from the parathyroid glands. The CaSR is found to be ubiquitously expressed in the body, playing a plethora of additional functions spanning from fluid secretion, insulin release, neuronal development, vessel tone to cell proliferation and apoptosis, to name but a few. The present review aims to elucidate and clarify the emerging regulatory effects that the CaSR plays in inflammation in several tissues, where it mostly promotes pro-inflammatory responses, with the exception of the large intestine, where contradictory roles have been recently reported. The CaSR has been found to be expressed even in immune cells, where it stimulates immune response and chemokinesis. On the other hand, CaSR expression seems to be boosted under inflammatory stimulus, in particular, by pro-inflammatory cytokines. Because of this, the CaSR has been addressed as a key factor responsible for hypocalcemia and low levels of PTH that are commonly found in critically ill patients under sepsis or after burn injury. Moreover, the CaSR has been found to be implicated in autoimmune-hypoparathyroidism, recently found also in patients treated with immune-checkpoint inhibitors. Given the tight bound between the CaSR, calcium and vitamin D metabolism, we also speculate about their roles in the pathogenesis of severe acute respiratory syndrome coronavirus-19 (SARS-COVID-19) infection and their impact on patients' prognosis. We will further explore the therapeutic potential of pharmacological targeting of the CaSR for the treatment and management of aberrant inflammatory responses.

Effects of varying pandemic restrictions on the health-related behaviours of Australian children.

AIM: To explore the effects of COVID-19 pandemic restrictions varying in severity and duration on health-related behaviours in children aged 5-17 years. METHODS: We used data from the Royal Children's Hospital National Child Health Poll, an online cross-sectional survey of Australian caregivers. The survey assessed 1222 caregivers' perceived changes in health-related behaviours (physical activity, sleep, screen-time, diet, outdoor activity, family and peer connectedness) of 2011 children aged 5-17 years in a typical week from June to September 2020 (when jurisdictions experienced varying restriction severity and duration) compared to retrospective reports of behaviour before March 2020 (pre-pandemic). To compare the effects of varying restriction severity in Victoria, New South Wales (NSW) and other states and territories on health-related behaviours binary logistic regression was used, adjusting for caregiver demographics and weighted to reflect Australia's parent population. RESULTS: Compared to pre-pandemic, Victoria's restrictions had a greater impact on child health-related behaviours compared to NSW restrictions and an even stronger impact compared to other states and territories which experienced few or no restrictions. A greater proportion of Victorian children reported more recreational screen time (71.3%) than NSW (53.9%) and other states and territories (34.5%) and less physical activity (57.2%) than NSW (30.3%) and other states and territories (26.5%). Victorian children reported less outdoor activity (62.6%) than NSW (32.0%) and other states and territories (25.2%), and less social connectedness (68.0%) than NSW (35.4%) and other states and territories (27.3%). CONCLUSIONS: More severe and longer COVID-19 pandemic restrictions are associated with greater impacts and predominantly more negative impacts to children's health-related behaviours. These should be mitigated through policies and programs to encourage healthier life-styles.

Emerging technologies for COVID (ET-CoV) detection and diagnosis: Recent advancements, applications, challenges, and future perspectives.

In light of the constantly changing terrain of the COVID outbreak, medical specialists have implemented proactive schemes for vaccine production. Despite the remarkable COVID-19 vaccine development, the virus has mutated into new variants, including delta and omicron. Currently, the situation is critical in many parts of the world, and precautions are being taken to stop the virus from spreading and mutating. Early identification and diagnosis of COVID-19 are the main challenges faced by emerging technologies during the outbreak. In these circumstances, emerging technologies to tackle Coronavirus have proven magnificent. Artificial intelligence (AI), big data, the internet of medical things (IoMT), robotics, blockchain technology, telemedicine, smart applications, and additive manufacturing are suspicious for detecting, classifying, monitoring, and locating COVID-19. Henceforth, this research aims to glance at these COVID-19 defeating technologies by focusing on their strengths and limitations. A CiteSpace-based bibliometric analysis of the emerging technology was established. The most impactful keywords and the ongoing research frontiers were compiled. Emerging technologies were unstable due to data inconsistency, redundant and noisy datasets, and the inability to aggregate the data due to disparate data formats. Moreover, the privacy and confidentiality of patient medical records are not guaranteed. Hence, Significant data analysis is required to develop an intelligent computational model for effective and quick clinical diagnosis of COVID-19. Remarkably, this article outlines how emerging technology has been used to counteract the virus disaster and offers ongoing research frontiers, directing readers to concentrate on the real challenges and thus facilitating additional explorations to amplify emerging technologies.

Cytokine Storm, Immunomodulators and Mucormycosis in COVID-19: Bench To Bed Side

The world is undergoing its biggest health crisis named coronavirus disease, which is associated with increased proinflammatory cytokine storm, which ultimately leads to various medical complications including acute respiratory distress syndrome. The treatment protocol was always controversial due to the excessive use of corticosteroids in aggressive pneumonia and associated hyperinflammatory conditions.The excessive use, misuse, and rampant use of steroids may lead to various coinfection like mucormycosis which is referred to as black fungus that manifests within the skin and also affects the lungs and brain which may be more fatal. It is necessary to have early diagnosis and management to tackle the severity of post covid coinfection. Copyright © RJPT All right reserved.

Antiviral potential of anthraquinones from Polygonaceae, Rubiaceae and Asphodelaceae: Potent candidates in the treatment of SARS-COVID-19, A comprehensive review.

Medicinal plants are being used as an alternative source of health management to cure various human ailments. The healing role is attributed to the hidden dynamic groups of various phytoconstituents, most of which have been recorded from plants and their derivatives. Nowadays, medicinal plants have gained more attention due to their pharmacological and industrial potential. Aromatic compounds are one of the dynamic groups of secondary metabolites (SM) naturally present in plants; and anthraquinones of this group are found to be attractive due to their high bioactivity and low toxicity. They have been reported to exhibit anticancer, antimicrobial, immune-suppressive, antioxidant, antipyretic, diuretic and anti-inflammatory activities. Anthraquinones have been also shown to exhibit potent antiviral effects against different species of viruses. Though, it has been reported that a medicinal plant with antiviral activity against one viral infection may be used to combat other types of viral infections. Therefore, in this review, we explored and highlighted the antiviral properties of anthraquinones of Polygonaceae, Rubiaceae and Asphodelaceae families. Anthraquinones from these plant families have been reported for their effects on human respiratory syncytial virus and influenza virus. They are hence presumed to have antiviral potential against SARS-CoV as well. Thus, anthraquinones are potential candidates that need to be screened thoroughly and developed as drugs to combat COVID-19. The information documented in this review could therefore serve as a starting point in developing novel drugs that may help to curb the SARS-COVID-19 pandemic.

Effectiveness of Pulmonary Rehabilitation among COVID-19 Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: Many COVID-19 patients presented with detrimental features, such as impaired respiratory function, physical capacity, and overall poor quality of life. The present study evaluates the effectiveness of pulmonary rehabilitation on COVID-19 patients. METHODS: We searched PubMed, Scopus, ScienceDirect, and Google Scholar from 2019 to 2021. The protocol was registered in PROSPERO with the registration number CRD42021273618. We performed statistical analyses via random effects and expressed the outcomes as standardized mean difference (SMD) for continuous variables, with 95% confidence intervals (CI). RESULTS: We included six trials involving 432 patients. The primary outcome showed a significant improvement in physical function (SMD 0.83, 95% CI -0.58 to 1.09; p < 0.001; four trials, 266 participants; high-quality evidence). There was significant difference in anxiety (SMD -0.80, 95% CI -1.23 to -0.37; p = 0.003), physical activity intensity levels (SMD -1.27, 95% CI -2.23 to -0.32; p = 0.009), sleep quality (MD -0.05, 95% CI -0.83 to -0.16; p = 0.004), peripheral muscle performance of lower limbs (SMD 0.90, 95% CI -0.60 to 1.20; p < 0.001), and dyspnoea outcomes (SMD -0.55, 95% CI -0.87 to -0.23; p = 0.007). CONCLUSIONS: Pulmonary rehabilitation is an effective adjuvant therapy that minimizes COVID-19 severity in the intervention group compared to the conventional treatment. The findings of this study will need to be considered in the framework of the clinical outcome as observed in the intervention outcome. Additionally, safer data on guideline rehabilitation would be needed to examine whether pulmonary rehabilitation would be a fruitful intervention to reduce COVID-19 severity.

The SARS-CoV-2 differential genomic adaptation in response to varying UVindex reveals potential genomic resources for better COVID-19 diagnosis and prevention.

Coronavirus disease 2019 (COVID-19) has been a pandemic disease reported in almost every country and causes life-threatening, severe respiratory symptoms. Recent studies showed that various environmental selection pressures challenge the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infectivity and, in response, the virus engenders new mutations, leading to the emergence of more virulent strains of WHO concern. Advance prediction of the forthcoming virulent SARS-CoV-2 strains in response to the principal environmental selection pressures like temperature and solar UV radiation is indispensable to overcome COVID-19. To discover the UV-solar radiation-driven genomic adaption of SARS-CoV-2, a curated dataset of 2,500 full-grade genomes from five different UVindex regions (25 countries) was subjected to in-depth downstream genome-wide analysis. The recurrent variants that best respond to UV-solar radiations were extracted and extensively annotated to determine their possible effects and impacts on gene functions. This study revealed 515 recurrent single nucleotide variants (rcntSNVs) as SARS-CoV-2 genomic responses to UV-solar radiation, of which 380 were found to be distinct. For all discovered rcntSNVs, 596 functional effects (rcntEffs) were detected, containing 290 missense, 194 synonymous, 81 regulatory, and 31 in the intergenic region. The highest counts of missense rcntSNVs in spike (27) and nucleocapsid (26) genes explain the SARS-CoV-2 genomic adjustment to escape immunity and prevent UV-induced DNA damage, respectively. Among all, the most commonly observed rcntEffs were four missenses (RdRp-Pro327Leu, N-Arg203Lys, N-Gly204Arg, and Spike-Asp614Gly) and one synonymous (ORF1ab-Phe924Phe) functional effects. The highest number of rcntSNVs found distinct and were uniquely attributed to the specific UVindex regions, proposing solar-UV radiation as one of the driving forces for SARS-CoV-2 differential genomic adaptation. The phylogenetic relationship indicated the high UVindex region populating SARS-CoV-2 as the recent progenitor of all included samples. Altogether, these results provide baseline genomic data that may need to be included for preparing UVindex region-specific future diagnostic and vaccine formulations.

Telehealth application in Sudan: requirements and potential benefits.

Telehealth (TH) is defined as the entire spectrum of activities used to deliver care remotely. It could either be provider-to-patient or provider-to-provider communications. TH can take place synchronously (via telephone and video), asynchronously (via patient portal messages, e-consults), and through virtual agents (chat) and wearable devices. It has been used to support access to specialised medical advice in remote areas in many countries all over the world. We discuss the potential use of TH Clinics in Sudan and propose guidance for establishing such services. The current pandemic of SARS-COVID-19 has increased the pressure on most health systems. This has challenged and urged for significant changes in the way we provide health care for both COVID and non-COVID cases. There is a great potential for improvement in services in many countries including Sudan with the use of TH.

Concentration Measurements of Ethanol in Water Based on RFID-UHF Flexible Sensor for Sterilization Against SARS-CoV

In this work, we present a UHF-RFID-based noninvasive sensor to measure the concentration of ethanol in water using the volume fraction of liquids in mixture solutions. The sensing system operates at the UHF band (860-928 MHz). The concentration of ethanol in water affects the dielectric properties of the solution and therefore the antenna sensitivity of the RFID tag. This sensor operates by measuring the change in permittivity of a solution because of the change in concentration of ethanol in water. We propose a flexible RFID-Tag sensor a low-cost alternative to identify the possible sensitivity of tag changes and is able to detect a variation of 25% in ethanol in 9 ml of deionized water (DI-Water). The solution is useful in avoiding counterfeit ethanol solutions that may be toxic. The experimental setup is inexpensive, portable, quick, and contactless. We present results for ethanol solutions ranging from 25% to 100% in a small tube container. © 2022 IEEE.

[Anaphylaxis and COVID-19 vaccines]. / L'anaphylaxie et les vaccins COVID-19.

Vaccines against COVID-19 are an essential global intervention to control the current pandemic situation. Anaphylactic reactions have rapidly been reported after SARS-CoV2 RNA vaccines. This risk is now measured at 2.5-11/1,000,000 in the context of vaccine safety surveillance programs and only one case was documented to be due to polyethylene glycol. Suggestions for its role are indirect. The COVID-19 vaccination is rolling out vastly and surveillance programs are key to monitor severe adverse reactions, such as anaphylaxis. It is important to restore confidence about vaccination with COVID-19 mRNA and other vaccines and current data confirm their safety with no greater mortality than previous vaccines. Anaphylaxis is a complication that should be recognized immediately, be treated with epinephrine and which is not limiting and allows re-vaccination of some patients with pre-medication. It is important to recognize populations at risk such as women, patients with a history of allergies and anaphylaxis and to recognize the rare patients who have mast cell activating diseases. Anaphylaxis due to vaccine is extremely rare and specific cases should receive individualized investigation and care, highlighting the key role of allergists in the vaccination programmes.

A prospective study of transdiagnostic psychiatric symptoms associated with burnout and functional difficulties in COVID-19 frontline healthcare workers.

OBJECTIVE: Frontline healthcare workers (FHCWs) responding to the COVID-19 pandemic develop posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms. Such symptoms are associated with burnout, occupational and relational difficulties. In the current study, we examined the prospective association between acute transdiagnostic COVID-19-related PTSD, MDD, and GAD symptoms at pandemic outset, and burnout and functional difficulties several months later in FHCWs in New York City. METHODS: Wave 1 symptoms of COVID-19-related PTSD, MDD, and GAD, were assessed in 787 FHCWs from April 14 to May 11th, 2020. Burnout and occupational difficulties were assessed at wave 1 and wave 2, approximately 7 months later. RESULTS: After adjusting for wave 1 burnout, wave 1 MDD symptoms, particularly sleep difficulties, loss of interest, and feeling tired/having little energy, collectively explained 42% incremental variance in this outcome. After adjusting for wave 1 work difficulties, MDD and PTSD symptoms, particularly feeling tired/having little energy, loss of interest, and negative expectations of self/world, collectively explained 42% incremental variance in this outcome. After adjusting for wave 1 relationship difficulties, MDD, GAD, and PTSD symptoms, particularly depressed mood, irritability, and appetite disturbance, explained 26% incremental variance in this outcome. CONCLUSIONS: Results highlight psychiatric symptoms assessed during the acute phase of the COVID-19 pandemic that may help predict burnout and work and relationship difficulties in FHCWs. Early interventions aimed at ameliorating transdiagnostic symptoms of MDD, PTSD, and GAD may help mitigate risk for burnout and functional difficulties in this population.