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The aim of this study was to evaluate differences in the clinical manifestations and outcomes in hospitalized patients with COVID-19 in a single Romanian center during four pandemic waves determined by different SARS-CoV-2 variants of concern (VOCs). A retrospective study on 9049 consecutive hospitalized adult patients was performed between 27 February 2020 and 31 March 2023. The study interval was divided into waves based on national data on SARS-CoV-2 VOCs' circulation. Multivariate logistic regression models were built, predicting death and complications as functions of comorbidities, therapy, wave, severity form, and vaccination status, and adjusted for ages ≥65 years. Pulmonary (pneumothorax/pneumomediastinum, pulmonary embolism) and extrapulmonary complications (liver injury, acute kidney injury, ischemic/hemorrhagic stroke, myocardial infarction, and gastrointestinal bleeding) were present, more frequently in ICU hospitalized patients and with differences between waves. The highest in-hospital mortality was found in patients presenting pneumothorax/pneumomediastinum. All of the evaluated risk factors were significantly associated with death, except for obesity and the Omicron wave. Our study highlights the changing nature of COVID-19 and acknowledges the impacts of viral mutations on disease outcomes. For all four waves, COVID-19 was a severe disease with a high risk of poor outcomes. [ABSTRACT FROM AUTHOR]

Niels Kaj Jerne has proposed the "immune network theory" of interactions among anti‐idiotypic antibodies, able to interfere with humoral responses to certain antigens. After the occurrence of the primary generation of antibodies, against an antigenic epitope, idiotypes of these antibodies induce anti‐idiotypic antibodies that modulate the intensity of the first response, and so on. Adverse effects following SARS‐COV‐2 COVID‐19 vaccines are occasionally similar to the symptoms of COVID‐19 infection. Rare events linked to SARS‐CoV‐2 vaccines also resemble some rarely reported COVID‐19 complications. Safety data from product information by European Medicines Agency suggest that spectra do overlap for four main vaccines. The proposition is that vaccine events and COVID‐19 complications are related to anti‐idiotypic antibodies whose spatial shape can lead to interactions with ACE2 molecules, in individuals with a prolonged Spike protein synthesis. The vaccines target cells by their affinity to the vaccine vector, or to engulf lipid nanoparticles. Anti‐idiotypic antibodies shaped similarly to the Spike protein possibly interact with ACE2 molecules and cause diverse signs and symptoms. [ABSTRACT FROM AUTHOR]

A high body mass index (BMI) is a known risk factor for coronavirus infection in hospitalized patients. Our study examined the association between BMI and complications and the survival rate among COVID-19 patients. This retrospective analysis used data from a tertiary hospital in the Eastern Region of Saudi Arabia during two waves of the COVID-19 pandemic. The study included 600 participants, with the majority being between 41 and 60 years old (41.3%) and men comprising 63.5% of the sample. Approximately 42.5% of patients were obese, and 31.3% were overweight. The results showed that BMI was significantly linked to respiratory diseases (p = 0.013); end-stage renal disease (p = 0.021); and cardiovascular disease (p = 0.003) but not diabetes mellitus (p = 0.064). Death occurred in 10.8% of patients; 33.8% were admitted to the ICU; 13.8% needed mechanical ventilation; and 60.7% had lung infiltration. Obese patients with oxygen saturation levels below 93% were 2.45 times more likely to require mechanical ventilation than those in the normal-weight group. Overweight and obese patients were also more likely to require mechanical ventilation than normal-weight patients, with odds ratios of 3.66 and 2.81, respectively. The BMI categorized was not associated with survival rate in COVID-19-hospitalized patients using Kaplan-Meier survival plots (p = 0.061). However, the BMI categorized was associated with survival rate in COVID-19 ICU patients (p < 0.001). In addition, the overweight showed a statistically significant higher hazard ratio of 2.22 (p = 0.01) compared to normal-weight patients using a Cox regression model. A high BMI was identified as an independent risk factor for reduced oxygen saturation (<93%), the need for mechanical ventilation, lung infiltration, mortality, and longer ICU stays in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Introduction. COVID-19 pandemic is caused by SARS-CoV-2 and it has an important but often overlooked impact on surgical current activity. The reports about its implications in obstetrical and gynecological surgical side are accumulating. The purpose of our study was to reveal the surgical challenges during pandemic period. Methodology. We reviewed the main medical databases, such as PubMed, Medline and Web of Science, searching for publications about SARS-CoV-2 in surgery and we focused on reports about the challenges that medical staff had to endure during patients’ care. Results. Our research revealed more than 4500 publications about SARS-CoV-2 and medical staff. At onset, there was a lack of information. The virus spread so fast, and the medical professional providers had different challenges. At the beginning, everybody was discussing about the way of transmission among individuals. The deficit of equipment was a major reason of concern. The instructions of using correctly the PPE were contradictory. All the medical staff was stressed, and they must face more stressed patients with different pathologies. In time, the reasons of concern changed so that that surgical procedures can be performed in safety conditions for both surgeon and patient. The characteristic of each pandemic wave raised peculiar discussions. Conclusions. COVID-19 in gynecologic operating room represents a challenge because the physician has to perform usual surgical steps in special conditions. The literature experience and the personal one in COVID-19 hospital represent the subject of this report. [ABSTRACT FROM AUTHOR]