Treatment patterns and visual acuity change of AMD patients, before, during and after the COVID-19 pandemic lockdowns: A large cohort

PURPOSE

To evaluate the impact of the changes in treatment patterns before, during and after the COVID-19 pandemic on best-corrected visual acuity (BCVA) in previously treated neovascular age-related macular degeneration (nAMD) patients.

METHODS

A multi-centre, retrospective, observational study of consecutive nAMD patients during 2019-2021. Data collected included demographics, BCVA, dates of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections and clinic visits.

RESULTS

A total of 1652 eyes of 1652 nAMD patients were included, out of which 850 eyes were assessed in 2019 (pre-COVID-19), 630 eyes were assessed in 2020 (COVID-19) and 974 eyes were assessed in 2021 (post-COVID-19). During the COVID-19 period, the mean number of anti-VEGF injections was significantly lower than the corresponding pre-COVID-19 and post-COVID-19 periods (5.55 compared to 6.13 and 6.60, respectively p < 0.01). A constant lower ratio of injections per patient/month was observed during COVID-19 compared to previous and following years, with a notable decline during March-April, reaching a ratio of 0.4 in 2020 versus 0.65 in 2019 and 0.62 in 2021 (p < 0.01). Baseline BCVA (0.825, p < 0.001), number of injections (-0.007, p < 0.001), gender (-0.027, p = 0.037) and age (0.004, p < 0.001) were shown to be significant predictors of final BCVA.

CONCLUSION

During the COVID-19 period, patients were treated with significantly less intravitreal anti-VEGF injection compared to the previous year with compensation in the following year. These changes in treatment patterns did not have a significant impact on BCVA outcomes. Age, gender, baseline BCVA and number of injections are predictors of final visual outcomes.

To reappraise or not to reappraise? Emotion regulation strategies moderate the association of loneliness during COVID-19 with depression and anxiety

BACKGROUND

The COVID-19 pandemic resulted in heightened feelings of loneliness due to lockouts and social restrictions.

OBJECTIVE

In the present study, we examined the association of loneliness during the pandemic with anxiety and depression, while exploring the moderating role of the tendency to use two emotion-regulation strategies (expressive suppression, cognitive reappraisal).

DESIGN

We chose to examine these associations in a sample of older adults, because they faced higher risk for loneliness and health problems during the COVID-19 pandemic.

METHODS

Specifically, 174 Israeli veterans and ex-prisoners of wars from the 1973 Yom Kippur war (mean age = 69) completed self-report scales tapping loneliness, depression, anxiety, and emotion regulation strategies at the beginning of the COVID-19 outbreak (April-May 2020).

RESULTS

Findings revealed a stronger association between loneliness and depression among participants who had a greater tendency of using suppression. The tendency to use suppression did not significantly moderate the link between loneliness and anxiety. Additionally, a weaker association between loneliness and depression was found among participants who has a greater tendency of using reappraisal. However, these participants showed a stronger association between loneliness and anxiety.

CONCLUSIONS

These findings highlight the complexity of reappraisal and adds to the growing body of work on emotion regulation.

Orthodontists' use of remote monitoring platforms pre-, amid, and post-COVID-19: a survey study

BACKGROUND

Did the COVID-19 pandemic affect orthodontists' use of remote monitoring platforms? The goal of this research was to examine orthodontists' experiences implementing remote monitoring platforms before, during, and after the initial COVID-19 lockdown.

METHODS

In this descriptive cross-sectional survey study, an electronic, anonymous questionnaire consisting of a series of 31 short-answer and multiple-choice questions was administered to an international sampling of practicing orthodontists. The target population in the study included currently practicing orthodontists who were graduates of an accredited orthodontic residency program. Participants were recruited in 2021 through collaboration with the American Association of Orthodontists (AAO) Partners in Research Program and the Harvard School of Dental Medicine Orthodontic Alumni Association. Descriptive analysis was conducted, reporting frequency (N and %) distributions for each question. The questionnaire aimed to describe whether orthodontists incorporated remote monitoring platforms into their practices, their experiences doing so, and if the COVID-19 pandemic influenced their use of these resources.

RESULTS

Orthodontists' use of remote monitoring platforms was negligible prior to the pandemic; however, a quarter of surveyed orthodontists began using a remote monitoring platform during COVID-19 and nearly all respondents plan to continue using remote monitoring for the foreseeable future. Approximately half of orthodontists believe most patients' treatment progress can be monitored to the standard of care between in-person orthodontic appointments using remote monitoring platforms. Half of the orthodontists who do not currently use a remote monitoring platform in their practice are interested in learning more about how to implement one.

CONCLUSIONS

The COVID-19 pandemic led to an increase in the interest and adoption of remote monitoring platforms in orthodontic practices. Most orthodontists had not incorporated remote monitoring platforms into their practices prior to the COVID-19 pandemic. However, this study revealed that a subset of orthodontists utilized the pandemic as motivation to incorporate remote monitoring into their practices and an additional group of orthodontists were interested in incorporating one in the future. Remote monitoring platforms garnered interest and importance with the arrival of the COVID-19 pandemic and may only have an increasing role in the field in years to come.

The influence of the COVID-19 pandemic on the adoption and impact of AI ChatGPT: Challenges, applications, and ethical considerations

DESIGN/METHODOLOGY/APPROACH

This article employs qualitative thematic modeling to gather insights from 30 informants. The study explores various aspects related to the impact of the COVID-19 pandemic on AI ChatGPT technologies.

PURPOSE

The purpose of this research is to examine how the COVID-19 pandemic has influenced the increased usage and adoption of AI ChatGPT. It aims to explore the pandemic's impact on AI ChatGPT and its applications in specific domains, as well as the challenges and opportunities it presents.

FINDINGS

The findings highlight that the pandemic has led to a surge in online activities, resulting in a heightened demand for AI ChatGPT. It has been widely used in areas such as healthcare, mental health support, remote collaboration, and personalized customer experiences. The article showcases examples of AI ChatGPT's application during the pandemic.

STRENGTH OF STUDY

This qualitative framework enables the study to delve deeply into the multifaceted dimensions of AI ChatGPT's role during the pandemic, capturing the diverse experiences and insights of users, practitioners, and experts. By embracing the qualitative nature of inquiry and this research offers a comprehensive understanding of the challenges, opportunities, and ethical considerations associated with the adoption and utilization of AI ChatGPT in crisis contexts.

PRACTICAL IMPLICATIONS

The insights from this research have practical implications for policymakers, developers, and researchers. This reserach emphasize the need for responsible and ethical implementation of AI ChatGPT to fully harness its potential in addressing societal needs during and beyond the pandemic.

SOCIAL IMPLICATIONS

The increased reliance on AI ChatGPT during the pandemic has led to changes in user behavior, expectations, and interactions. However, it has also unveiled ethical considerations and potential risks. Addressing societal and ethical concerns, such as user impact and autonomy, privacy and security, bias and fairness, and transparency and accountability, is crucial for the responsible deployment of AI ChatGPT.

ORIGINALITY/VALUE

This research contributes to the understanding of the novel role of AI ChatGPT in times of crisis, particularly in the era of COVID-19 pandemic. It highlights the necessity of responsible and ethical implementation of AI ChatGPT and provides valuable insights for the development and application of AI technology in the future.

Plasma steroid concentrations reflect acute disease severity and normalise during recovery in people hospitalised with COVID-19

OBJECTIVE

Endocrine systems are disrupted in acute illness, and symptoms reported following coronavirus disease 2019 (COVID-19) are similar to those found with clinical hormone deficiencies. We hypothesised that people with severe acute COVID-19 and with post-COVID symptoms have glucocorticoid and sex hormone deficiencies.

DESIGN/PATIENTS

Samples were obtained for analysis from two UK multicentre cohorts during hospitalisation with COVID-19 (International Severe Acute Respiratory Infection Consortium/World Health Organisation [WHO] Clinical Characterization Protocol for Severe Emerging Infections in the UK study), and at follow-up 5 months after hospitalisation (Post-hospitalisation COVID-19 study).

MEASUREMENTS

Plasma steroids were quantified by liquid chromatography-mass spectrometry. Steroid concentrations were compared against disease severity (WHO ordinal scale) and validated symptom scores. Data are presented as geometric mean (SD).

RESULTS

In the acute cohort (n = 239, 66.5% male), plasma cortisol concentration increased with disease severity (cortisol 753.3 [1.6] vs. 429.2 [1.7] nmol/L in fatal vs. least severe, p < .001). In males, testosterone concentrations decreased with severity (testosterone 1.2 [2.2] vs. 6.9 [1.9] nmol/L in fatal vs. least severe, p < .001). In the follow-up cohort (n = 198, 62.1% male, 68.9% ongoing symptoms, 165 [121-192] days postdischarge), plasma cortisol concentrations (275.6 [1.5] nmol/L) did not differ with in-hospital severity, perception of recovery, or patient-reported symptoms. Male testosterone concentrations (12.6 [1.5] nmol/L) were not related to in-hospital severity, perception of recovery or symptom scores.

CONCLUSIONS

Circulating glucocorticoids in patients hospitalised with COVID-19 reflect acute illness, with a marked rise in cortisol and fall in male testosterone. These findings are not observed 5 months from discharge. The lack of association between hormone concentrations and common post-COVID symptoms suggests steroid insufficiency does not play a causal role in this condition.

Prevalence of Oral Manifestations in COVID-19-Diagnosed Patients at a Tertiary Care Hospital in Kerala

Background

COVID-19, a pandemic since 2019, is still causing significant healthcare burden across the world. Although the disease primarily presents with respiratory symptoms, a multitude of signs and symptoms may be manifested elsewhere in the body.

Aim

This study was to estimate the prevalence of oral manifestations in COVID-19 diagnosed patients and thereby understand the effects of corona virus disease on oral health.

Materials & methods

A total of 472 patients were evaluated using a questionnaire and further examined visually using a mouth mirror and a light source.The patients were evaluated for erythema, ulcers, macule, papule, vescicles, bullae or any other abnormal changes within the oral cavity.

Results

103 patients (21%) were found to have oral lesions and 41 (39.8%) of them presented with palatal enanthem which was macular in nature. Candidiasis was noted in 19 (18.4%) patients, ulcer in 4 (3.8%), mucositis in 5 (4.8%), angular cheilitis in 3 (2.9%), white coating on tongue in 25 (24.2%) & depapillated tongue with glossitis in 6 (5.8%). Multivariate analysis was done using logistic regression.Tobacco chewing, malignancies and altered taste sensation were found to be independently associated with oral lesions.

Conclusion

The study thus confirms the presence of oral lesions in diagnosed COVID-19 patients prompting healthcare professionals on a multidisciplinary approach towards this novel disease.

Association between COVID 19 exposure and expression of malignant pathological features in oral squamous cell carcinoma: A retrospective cohort study

OBJECTIVES

To analyze the relationship between the clinical and pathological characters of OSCC and COVID 19 exposure.

MATERIALS AND METHODS

A retrospective cohort study in patients with OSCC with or without COVID 19 was performed. A total of 200 OSCC patients treated with surgery from 2019 to 2023 were included. Clinical and pathological features were analysed between two groups. Characters with statistical difference were further analysed by performing univariate analysis and logistic regression analysis.

RESULTS

The expression of Ki67 (n = 57, 71.3 %, P < 0.001) and CyclinD1 (n = 64, 80 %, P < 0.001) in OSCC with the exposure history of COVID 19 is higher than that in patients never exposed to COVID 19. COVID 19 exposure history is an independent influencing factor for higher expression of Ki67 (OR = 4.04, 95 % CI: 1.87-8.72, P < 0.001) and CyclinD1 (OR = 5.45, 95 % CI: 2.56-11.60, P < 0.001).

CONCLUSION

COVID 19 may suggest more invasive malignant biological behavior of cancer cells in OSCC.

Otologic disease trends in Japan post-COVID-19 outbreak: A retrospective time-series analysis

OBJECTIVE

To evaluate the potential impact of coronavirus disease 2019 (COVID-19) and vaccinations on otologic diseases, including facial nerve paralysis (including Ramsay Hunt syndrome), vestibular neuritis, sudden sensorineural hearing loss, and Meniere's disease.

METHODS

In this retrospective study, we conducted a time-series analysis employing a causal impact algorithm on a large-scale inpatient database in Japan. We compared the actual number of hospitalized patients with otologic diseases to two predictions: one without any covariates and another with a covariate accounting for the reduction in the number of hospitalized patients due to lockdown measures. Additionally, we performed Granger causality tests to ensure the robustness of our findings.

RESULTS

No significant increase was noted in the number of hospitalized patients with otologic diseases following the onset of the COVID-19 pandemic in the causal impact analysis. Similarly, no notable surge was observed in hospitalizations for these diseases following the introduction of the COVID-19 vaccine. The Granger causality tests results aligned with the causal impact analysis findings.

CONCLUSION

Our findings indicate that COVID-19 and vaccinations had minimal discernible effects on hospitalization of patients with otologic diseases, suggesting that otologic diseases may not be significantly impacted by COVID-19 and vaccinations, which could have implications for public health policies and the allocation of healthcare resources during a pandemic. Further research and monitoring of long-term effects are warranted to validate these findings and guide healthcare decision-making.

Impact of COVID-19 Treatment on Real-World Outcomes in Inflammatory Bowel Disease

BACKGROUND

While there are multiple safe and effective agents for COVID-19 treatment, their impact in inflammatory bowel disease (IBD) remains uncertain.

AIMS

Our objective was to assess the effects of these therapies on both IBD and COVID outcomes.

METHODS

A single-center retrospective study of adult patients with IBD who contracted COVID-19 between 12/2020 and 11/2022 was performed. Patients were stratified by COVID-19 treatment (antivirals and/or intravenous antibodies) vs no therapy. The primary outcome was the development of severe COVID-19 infection, defined by need for supplemental oxygen, corticosteroids and/or antibiotics, or hospitalization. Secondary outcomes included rates of withholding advanced IBD therapy (defined as biologic agents or small molecules) and of post-COVID-19 IBD flare.

RESULTS

Of 127 patients with COVID-19 infection, 70% were on advanced therapies, 35% received COVID-19 treatment, and 15% developed severe COVID-19. Those treated for COVID-19 were more likely to be on corticosteroids [odds ratio (OR) 4.61, 95% confidence interval (CI) 1.72-12.39, p = 0.002] or advanced IBD therapies (OR 2.78, 95% CI 1.04-7.43, p = 0.041). After adjusting for age, race, sex, corticosteroid use, obesity, COVID-19 vaccination status, and severe COVID-19 infection, those treated for COVID-19 were more likely to have IBD therapy held (OR 6.95, 95% CI 1.72-28.15, p = 0.007). There was no significant difference in rates of post-COVID-19 IBD flares or severe COVID-19 infection. There were no COVID-related deaths.

CONCLUSIONS

Patients with IBD on advanced therapies were frequently treated for acute COVID-19. Although COVID-19 treatment was associated with temporary withholding of IBD therapy, it did not result in increased IBD flares.

In Silico Evaluation of NO-Sartans against SARS-CoV-2

INTRODUCTION

Numerous clinical trials are currently investigating the potential of nitric oxide (NO) as an antiviral agent against coronaviruses, including SARS-CoV-2. Additionally, some researchers have reported positive effects of certain Sartans against SARS-CoV-2.

METHOD

Considering the impact of NO-Sartans on the cardiovascular system, we have compiled information on the general structure, synthesis methods, and biological studies of synthesized NOSartans. In silico evaluation of all NO-Sartans and approved sartans against three key SARS-CoV- -2 targets, namely Mpro (PDB ID: 6LU7), NSP16 (PDB ID: 6WKQ), and ACE-2 (PDB ID: 1R4L), was performed using MOE.

RESULTS

Almost all NO-Sartans and approved sartans demonstrated promising results in inhibiting these SARS-CoV-2 targets. Compound 36 (CLC-1280) showed the best docking scores against the three evaluated targets and was further evaluated using molecular dynamics (MD) simulations.

CONCLUSION

Based on our in silico studies, CLC-1280 (a Valsartan dinitrate) has the potential to be considered as an inhibitor of the SARS-CoV-2 virus. However, further in vitro and in vivo evaluations are necessary for the drug development process.

Effects of the COVID-19 Pandemic on the Medical Use of Elderly Patients with Hypertension: A Nationwide Cohort Study in Korea

Background

The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare services, including chronic disease management, for vulnerable groups, such as older individuals with hypertension. This study aimed to evaluate hypertension management in South Korea's elderly population during the pandemic using treatment consistency indices such as the continuity of care (COC), modified, modified continuity index (MMCI), and most frequent provider continuity (MFPC).

Methods

This study used the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort (K-COV-N cohort) from the National Health Insurance Service between 2017 and 2021. The research included a total of 4,097,299 hypertensive patients aged 65 years or older. We defined 2018 and 2019 as the baseline period before the COVID-19 pandemic and 2020 and 2021 as the COVID-19 period and calculated the indices of medical continuity (number of visits, COC, MMCI, and MFPC) on a yearly basis.

Results

The number of visits decreased during the COVID-19 period compared to the baseline period (59.64±52.75 vs. 50.49±50.33, P<0.001). However, COC, MMCI, and MFPC were not decreased in the baseline period compared to the COVID-19 period (0.71±0.21 vs. 0.71±0.22, P<0.001; 0.97±0.05 vs. 0.96±0.05, P<0.001; 0.8±0.17 vs. 0.8±0.17, P<0.001, respectively).

Conclusion

COVID-19 had no significant impact on the continuity of care but affected the frequency of outpatient visits for older patients with hypertension. However, this study highlights the importance of addressing healthcare inequalities, especially in older patients with hypertension, during pandemics and advocates for policy changes to ensure continued care for vulnerable populations.

Feasibility and outcomes with subclavian vein access for crescent jugular dual lumen catheter for venovenous extracorporeal membrane oxygenation in COVID-19 related acute respiratory distress syndrome

INTRODUCTION

Femoral-femoral Veno-Venous ExtraCorporeal Life Support (V-V ECLS) has been associated with higher infections rates, vascular site bleeding complications, and restricted patient mobility. Jugular or bicaval dual lumen V-V ECLS conceptually overcomes some of these adverse factors, but experience has shown that jugular vein cannulation still limits mobility and has increased bleeding complications. Technique and outcomes of subclavian vein single-cannulation with Crescent jugular dual-lumen V-V ECLS is described.

METHOD

five patients with COVID-19 related acute respiratory distress syndrome (ARDS) underwent right subclavian vein V-V ECLS placement with the Crescent 32 French jugular dual-lumen V-V ECLS catheter. A standardized percutaneous technique was developed that allowed efficient insertion without need for any specialized imaging (i.e. transesophageal echocardiogram) and outcomes assessed.

RESULTS

Mean age of the five patients was 41.2 years, all obese with an average basal mass index of 45.2 kg/m2 and mean days to decannulation of 24.2 days. Outcomes discovered included; improved patient mobility allowing physical rehabilitation, no vascular access site related complications requiring surgery or endovascular intervention, and none had evidence of superior vena cava syndrome. One patient had subclavian/axillary vein thrombosis with resolution after 3 months of direct-acting oral anticoagulants, and one patient had blood cultures positive at day 37, nearing decannulation.

CONCLUSION

Subclavian vein access for crescent jugular dual lumen V-V ECLS catheter appears to be safe and feasible with added benefits of decreased bleeding and increased mobility over jugular or femoral-femoral access site for long term V-V ECLS support in COVID-19 related ARDS patients.

Interleukin 6 Antagonists in Severe COVID-19 Disease: Cardiovascular and Respiratory Outcomes

BACKGROUND

Inhibitors of interleukin 6 [IL-6] have been utilized to treat severe COVID-19 disease. Their immunosuppressive or immunomodulating impact may be beneficial in COVID-19.

OBJECTIVES

To discuss the role of IL-6 inhibitors and assess various trials conducted to evaluate the efficacy of IL-6 inhibitors in COVID-19 disease.

SUMMARY

Two of the most common causes of mortality in COVID-19-infected critically ill individuals are acute respiratory distress syndrome [ARDS] and multiorgan failure. Increased levels of inflammatory cytokines suggest that a cytokine storm, also known as cytokine release syndrome [CRS], is involved in the etiology of COVID-19. Most tissue damage, sepsis, and pulmonary and cardiovascular problems are caused mainly by the host defense system. Therefore, regulating this inflammatory cascade using immunomodulators is a prudent strategy. Although corticosteroids, as immunomodulators, are routinely used in COVID-19 management, interleukin [IL] inhibitors, especially IL-6 inhibitors, are also tested in many trials. Many studies have demonstrated that IL-6 inhibitors improve disease outcomes and decrease mortality, whereas others have shown that they are ineffective. In this paper, we briefly examined the role of IL-6 in COVID-19 pathogenesis and trials that support or refute the use of IL-6 inhibitors in treating COVID-19 disease.

RESULTS

Though mixed results are coming from trials regarding the adjuvant use of IL-6 inhibitors and standard anti-viral therapy with dexamethasone, a consensus favors using IL-6 inhibitors in severely ill COVID-19 patients regardless of the outcome.

[Tixagevimab-cilgavimab as pre-exposure prophylactic treatment against SARS-CoV-2 in kidney transplantation patients]

INTRODUCTION

It has been reported that after vaccination with RNAm or viral vectors from SARS-CoV-2 a significant number of solid organ transplant recipients do not develop an effective immune response. In this scenario, the use of tixagevimab-cilgavimab was approved by the European Medicines Agency for COVID-19 prophylaxis in immunocompromised patients in March 2022. We present our experience with a group of kidney transplant recipients who received prophylactic treatment with tixagevimab-cilgavimab.

MATERIAL AND METHODS

Prospective study from a cohort of kidney transplant recipients who had been previously vaccinated with 4 doses and did not achieve a satisfactory immune response to vaccination, presenting antibody titers lower than 260 BAU/mL when measured by ELISA. A total of 55 patients who received a single dose of 150mg of tixagevimab and 150mg of cilgavimab between May and September of 2022 were included in this study.

RESULTS

No immediate or severe adverse reactions, including worsening of kidney function, were observed after administering the drug or during follow up. All patients who had received the drug 3 months prior presented positive antibody titers (>260 BAU/mL). Seven patients were diagnosed with COVID, and one of those patients had to be admitted to the hospital and died 5 days later from infectious complications and a suspected diagnosis of bacterial coinfection.

CONCLUSIONS

In our experience, all kidney transplant recipients reached antibody titers higher than 260 BAU/mL 3 months after receiving prophylactic treatment with tixagevimab-cilgavimab with no severe or irreversible adverse reactions.

Correlation between pain and depressive symptoms in patients with confirmed endometriosis during COVID-19 pandemic

BACKGROUND

Endometriosis is a chronic, estrogen-dependent, inflammatory condition which affects women of reproductive age physically and psychologically in their everyday life. The most common symptom is chronic lower abdominal pain. Apart from physical pain, endometriosis often also leads to an unfulfilled desire to give birth. In general, these two main aspects alone lead to emotional stress for patients and often initiate depressive symptoms. To what extent endometriosis patients are additionally affected by the COVID pandemic and its effects is to be determined in this study.

METHODS

Patients who presented at our endometriosis center and met the study criteria were offered participation in the study. A link to an online questionnaire (SoSci-Survey) was sent by email. The online questionnaire evaluated depressive symptoms before and during the pandemic as well as the pain perception and perceived support during the pandemic. The data of 167 fully completed questionnaires were evaluated and analyzed using SPSS.

RESULTS

The analysis of the questionnaires revealed a significant association between pain levels and depressive symptomatology in endometriosis patients during the pandemic. Patients with more severe pain showed significantly higher depressive symptoms than patients with little or no pain. During the pandemic, patients showed higher depressive symptoms than before. In addition, it was found that those endometriosis patients who felt left alone with their pain due to the consequences of the COVID pandemic, or who felt they had to endure the pain alone, also had higher depressive symptoms.

CONCLUSION

In summary, it can be observed that endometriosis patients with a high pain burden had significantly higher depressive symptoms during the COVID pandemic. The consequences of the pandemic often led to the feeling of having to cope with the symptoms alone or having to endure pain alone, which in turn increased the depressive symptoms. As treating physicians, we should be aware of these connections and try to counteract them with targeted offers and support.

Association of COVID 19 pneumonitis and acute mesenteric ischemia

Key Clinical Message

D. dimer could be useful as an indicator in diagnosis of mesenteric ischemia in COVID patients. A two staged damage control emergency laparotomy is of good benefits in such patients.

Abstract

Bowel ischemia in COVID 19 patients is extremely rare condition results from migrating thrombus formed by a hypercoagulable inflammatory state that is frequently associated COVID 19 infection. A two staged damage control emergency laparotomy is of good benefits in general especially in those with active COVID 19 infection.

Bilateral central retinal vein occlusion following COVID-19 vaccination: Cause or coincidence?

AIM

To report a case of sequential bilateral ischemic central retinal vein occlusion (CRVO) following the third dose of anti-COVID 19 vaccination.

METHODS

Observational case report.

RESULTS

A 73-year-old Caucasian male patient, with no known medical history, complained of sudden vision loss in his right eye (RE) 18 days following the third dose of Pfizer-BioNTech anti-COVID 19 vaccination. Ten days later, he suffered from sudden vision loss in his left eye (LE).Best-corrected visual acuity was limited to counting fingers at 50cm in both eyes.Fundus examination of both eyes revealed signs of ischemic central retinal vein occlusion (CRVO) with diffuse superficial and deep retinal hemorrhages in all four quadrants. Diagnosis was confirmed of fluorescein angiography.Optical coherent tomography (OCT) showed an ischemic hyperreflectivity and disorganization of the inner retinal layers in both eyes with significantly increased central macular thickness, associated to intraretinal fluid accumulation in LE.An urgent systemic assessment was requested. A mild hypertension was discovered and the rest of the work up was unremarkable.

CONCLUSION

To our knowledge, we report the first case of bilateral CRVO in a healthy patient after anti-COVID 19 vaccination. CRVO occurred few days following third shot of vaccine followed by a sequential CRVO in the fellow eye in a patient with recently diagnosed very mild hypertension and no thrombo-embolic risk factors, strongly suggesting a relationship between both events. Nowadays, CRVO should be kept in mind as a potential side effect of Covid-19 vaccination and should be added to the spectrum of their ophthalmic complications.

Determining the coverage and efficacy of the COVID-19 vaccination program at the community level in children aged 12 to 17 in Tehran

Background

The vaccination is one of the acceptable and recomended solution to prevent and control of COVID-19. The aim of this study was to determine the efficacy of sinopharm vaccination in children aged 12-17 in Tehran.

Methods

The case population study was performed from October 2021 to March 2022 among 1,500 children with positive PCR test reffered in Mofid Children's Hospital in Tehran. 64 children aged 12-17 years were included. The data were collected by the hospital information system (HIS), vaccination information registration systems and questionnaire with their families. The coverage and efficacy of vaccination determined with equels commented by WHO.

Results

Out of 64 children, 52 children were 12 to 15 years old (13.35±1.08), 12 children were 16 to 17 years old (16.55±0.52). 48.4% had received two doses of vaccine. The highest rate of positive PCR was observed in February 2022. Sinopharm vaccine coverage in this age group was 93.6% for the first dose and 81.1% for the second dose. Based on this information, 48.4% children in this study have received two complete doses of the COVID-19 vaccine. The efficacy of the vaccine was estimated as 94.4% (95% CI 90.2 to 97.7).

Conclusion

It seems the coverage of Sinopharm vaccination in the age group of 12-17 years in Tehran is favorable and has high efficacy in this age group. In order to obtain more accurate and comprehensive estimation, it is recommended to take a sample on a wider level of the community.

What our children lost and gained at the time of school closure during the Covid-19 pandemic: a study on psychological distress, behavioural concerns and protective factors of resilience among preschool children in Kerala, India

BACKGROUND

The pandemic has put at risk the social and emotional development of children on account of the paucity of arenas for social interaction. This study from Kerala, India was conducted to assess the resilience factors, behavioural concerns, psychological distress symptoms among the children aged 3 to 5 years. We also tried to look into the lost opportunities that could have aided the social and emotional development of children like peer interaction, child care hours.

METHODS

The cross-sectional study was conducted among the children aged 3 to 5 years. A total of 535 children attending the immunisation clinics were enrolled by consecutive sampling. Devereux Early Childhood Assessment P2 (DECA P2) questionnaire was used to assess the levels of resilient factors and behavioural concerns in the study population.

RESULTS

We observed a high proportion of children in the area of need category of protective factors under DECA P2. The proportion of children falling under area of concern was 64.5%, 49%, 68.4% for attachment/relationship, self-regulation, and initiative respectively. 24.9% study subjects have a behavioural concern score that puts them in the area of need category. The logistic regression model we created identified 'Male Gender,' 'Mothers could spend only less time for child care' and 'electronic devices used as pacifier' as significant predictors for belonging to Area of need Behavioural Concerns T score category.

CONCLUSION

A large proportion of children aged between 3 to 5 years with reported behavioural concerns and lack of protective factors for socioemotional development. This can be attributed partly to the ongoing pandemic and its associated restrictions. The increased child care hours invested by parents or grandparents could have sized down the full impact that the pandemic would have had on the socio emotional development of the child. Increased time spent using electronic devices coupled with dwindled opportunities for interaction with peers have been notable challenges.

Enhancing the optical properties of [P(MMA-co-AN)/ZrO2]TF by doping fluorescein dye, TD-DFT/DMOl3 simulations and COVID-19 main protease docking

Poly methyl methacrylate-co-acrylonitrile [P(MMA-co-AN)]HB hybrid blend was first synthesized by precipitation polymerization and characterized by static light scattering. With a thickness of 200 ± 5 nm, the hybrid nanocomposite of [P(MMA-co-AN)/ZrO2]HNC thin films were fabricated by spin coating method. X-Ray diffraction studies showed a monoclinic cell structure with an average crystalline size of 180 nm for the fabricated films. An improvement in the optical properties were figured out when fluorescein dye was doped in the hybrid nanocomposite. Where the optical energy gap was decreased from 4.31 to 4.025 eV for fluorescein doped hybrid nanocomposite. While a possible energy transfer between ZrO2 and fluorescein was investigated in the laser photoluminescence spectra. DFT-CASTEP simulations were deployed to calculate the theoretical optical properties for the molecules under consideration. The structural and optical simulations of [P(MMA-co-AN)/ZrO2]HNC were found to match the experimental data. Molecular docking studies of [P(MMA-co-AN)/ZrO2]Iso against the main protease of novel corona virus COVID 19 (PDB code 6LU7 Hormone) showed an interesting interaction.

[Cardiovascular prevention in primary care in crisis situations: multicenter comparative study before, during and after the SARS-COVID-19 pandemic]

OBJECTIVE

To assess whether the appearance of a crisis situation such as the one caused by the SARS-COV-2 pandemic, together with the organizational changes adopted in Primary Care, have influenced the implementation of cardiovascular preventive activities in patients aged 40 to 74 years.

DESIGN

Retrospective multicenter descriptive study for three years (2019-2022) in Primary Care.

SETTING

35 health centers of the Primary Care of the Northern Assistance Directorate of Madrid.

PARTICIPANTS

1008 patients of both sexes between 40 and 74 years with diagnosed of hypertension, Diabetes Mellitus and/or dyslipidemia.

METHOD

The variables analyzed from the computerized clinical history were lifestyle activities (consumption of tobacco, alcohol, consumption of Mediterranean diet and exercise) considering 3 of the 4 parameters optimal; examination data (blood pressure record) and analytical record (glycemia, hbA1c, total cholesterol, HDL, LDL)considering 4 of the 5 parameters optimal. Differences are analyzed between based pre-pandemic (03/15/2019-03/14/2020), pandemic (03/15/2020-03/14/2021), and transition (03/15/2022-03/14/2022).

STATISTICAL ANALYSIS

MC Nemar's test to compare the main variables between the study periods.

RESULTS

Data from 1008 patients are collected. The registration of preventive activities on lifestyle was 180 patients (17.9%) (IC95%: 0,155-0,204) in pre-pandemic, 29 patients (2.9%) (IC 95%: 0,019-0,041) in pandemic and 55 patients (5.5%) (IC 95%: 0,041-0,070) in the transition stage (p < 0.05). Exploration was registered in 393 patients (39%) (IC95%: 0,360-0,421) in the pre-pandemic, 133 patients 13,2% (IC 95%: 0,112-0,154) in the pandemic, and 218 patients (21,6%) (IC 95%: 0,191-0,243) in the transition (p < 0.05). The analytical record was 33 patients (3.3%) (IC955: 0,023-0,046), 10 patients (1%) (IC95%: 0,005-0,018) and 23 patients (2.3%) (IC95%: 0,015-0,034) respectively in each phase with one (P < 0.05).

CONCLUSIONS

Activities on lifestyle, physical examination, and laboratory test as part of the cardiovascular prevention strategy are scarce in the prepandemic period and decrease drastically during the pandemic, at the first level of care.

Investigation of Bucillamine as anti-COVID-19 drug: DFT study, molecular docking, molecular dynamic simulation and ADMET analysis

The novel coronavirus disease-2019 (COVID-19), caused by SARS-CoV-2, is a global health pandemic beginning in early December 2019 in Wuhan, Hubei province, China. The effective drug target among coronaviruses is the SARS-CoV-2 main protease (Mpro), because of its crucial role in processing viral polyproteins translated from the viral RNA. In this study, the bioactivity of the selected thiol drug named Bucillamine (BUC) was evaluated as a potential drug for COVID-19 treatment by using computational modeling strategies. First, the molecular electrostatic potential density (ESP) calculation was performed to estimate the chemically active atoms of BUC. Additionally, BUC was docked to the Mpro (PDB: 6LU7) to evaluate the protein-ligand binding affinities. Besides, the estimated ESP results by density functional theory (DFT) were used to illustrate the molecular docking findings. Moreover, the frontier orbitals analysis was calculated to determine the charge transfer between the Mpro and BUC. Then, the stability of protein-ligand complex was subjected to the molecular dynamic simulations. Finally, an in silico study was performed to predict drug-likeness and absorption, distribution, metabolism, excretion and toxicity profiles (ADMET) of BUC. These results propose that BUC can be a potential drug candidate against the COVID-19 disease progression.Communicated by Ramaswamy H. Sarma.

Suburban Population of Bobcats (Lynx rufus) in Connecticut, USA, Tested Negative for SARS-CoV-2, November 2021-February 2022

A SARS-CoV-2 genomic and serologic survey was performed in a population of bobcats (Lynx rufus) inhabiting the state of Connecticut, USA. Wild animal populations are becoming established in densely populated cities with increased likelihood of direct or indirect contact with humans, as well as with household cats and dogs. Wild-caught bobcats (n=38) tested negative for SARS-CoV-2 genomic RNA by reverse-transcription quantitative PCR and for virus-neutralizing antibodies by ELISA, suggesting that either the species is not susceptible to SARS-CoV-2 or that the surveyed population has not yet been exposed to a source of infectious virus. However, this limited survey cannot rule out that human-to-bobcat or unknown reservoir-to-bobcat transmission of the virus occurs in nature.

Exploratory Study on Micronuclei and Metanuclear Abnormalities in Exfoliated Buccal Cells of COVID-19 Suspected Patients

Context

SARS-CoV-2 virus causes COVID-19 by infecting nasal and oral cavities primarily by attaching its spike proteins to ACE 2 receptors expressed in epithelial cells.

Aim

This study was done to evaluate the micronucleated cell count, metanuclear abnormalities, and genotoxic factor in exfoliated buccal mucosal cell among the COVID-19 suspected patients.

Settings and Design

This cross-sectional study was conducted at AIIMS, Mangalagiri, between August and October 2022.

Methods

One hundred COVID-19 suspected patients were recruited for this study after obtaining informed and written consent; buccal smear was obtained and stained for papanicolaou test (PAP). The PAP-stained slides were analyzed for micronuclei (MN), pyknotic, karyolytic, and karyorrhexic cell count, respectively. Based on their reverse transcription-polymerase chain reaction (RT-PCR) report, the patients were grouped into COVID-19 positive and negative groups.

Statistical Analysis

The genotoxicity factor was calculated using the micronucleated cell count from both the groups using mean and standard deviation.

Results

The MN, micronucleated cell, pyknotic, karyolitic, and karyorrhexic cell count in COVID-19 positive patients were 24.12, 15.24, 3.08, 2.88 and 4.40, respectively, than COVID-19 negative patients 5.69, 8.17, 1.08, 1.00 and 2.43, respectively. The genotoxicity factor for SARS-CoV-2 was 2.68 which is a positive genotoxic effect on buccal mucosal cells.

Conclusion

SARS-CoV-2 increases the expression of micronucleated cells, pyknotic cells, karyolytic cells, and karyorhexic cells and concludes SARS-CoV-2 is having cytogenotoxic effect on the buccal mucosal cells. This can be used as a reliable marker in identifying the early carcinogenic effects of virus causing COVID-19.

Relating D-Dimer, blood sugars, haemoglobin and liver function among COVID patients with T2DM

It is of interest to evaluate the correlation of D-Dimer, blood sugars, haemoglobin and liver function tests with novel coronavirus in patients with T2DM with and without symptoms. We recruited 200 patients with T2DM and COVID 19 with and without symptoms admitted in Rajarajeshwari Medical College and Hospital, Karnataka. Blood sugars, HbA1c, D-Dimer and also the incidence of T2DM and COVID 19 with and without symptoms were evaluated in all study subjects. There was a significant increased levels of biochemical parameters in T2DM and COVID 19 with symptoms when compared to T2DM and COVID 19 without symptoms (P<0.05). The D-Dimer levels was positively correlated with CT values, (r=0.518, P<0.05). Based on the study findings, the novel coronavirus enhances the insulin resistance, hyper-glycemia, abnormality in the liver and thrombolysis. Additionally, we also suggest that the subjects with T2DM and COVID 19 with and without symptoms require continuous monitoring of D-DIMER and LFT.

Monkeypox and the eye

KEYWORDS monkey pox, Orthopoxviruses, transmission, communicable disease, conjunctivitides, blepharitides, scleritides, keratitides, uveitides, acquired blindness, pandemic, COVID 19

Predictors of face mask use during the COVID-19 pandemic in Indonesia: Application of the health belief model, psychological distress and health motivation

Background

High infection rates of COVID-19 in Indonesia require attention, especially transmission and prevention behaviors. One way to lower infection rates is the use of face masks. However, people's adherence to its usage when in public is still low. This necessitates the exploration of predictors of the use of masks to increase community compliance. This study further aims to investigate the predictors of face mask use by applying the Health Belief Model, anxiety, stress, depression, and health motivation.

Methods

A total of 255 respondents from Jakarta, Bandung, Tangerang, and Banten filled out an online questionnaire. Furthermore, hierarchical multiple regression was used to detect predictors associated with face mask use.

Results

The results showed that the high perceived benefits and health motivation were higher in individuals who used a face mask when in public, while those who have high perceived barriers likely do not use masks. The respondent's level of psychological distress, including depression, anxiety, and stress were not associated with face mask use.

Conclusions

These findings highlight the importance of personal appraisal regarding COVID-19 and its prevention behaviors. Comfortable mask design, and emphasizing the benefits of using masks in the community improve compliance.

"We literally worked in parking lots, cars, garages, and separately set up party tents": qualitative study on the experiences of GPs in the frame of the SARS-CoV-2 pandemic in Austria

BACKGROUND

Primary care is internationally recognised as one of the cornerstones of health care. During the COVID-19 pandemic, primary care physicians were assigned a variety of tasks and thus made a significant contribution to a country's pandemic response. They were expected to perform a variety of tasks, such as diagnosing and treating people with COVID-19, maintaining health care for all other patients, as well as several public health tasks, such as diagnostic testing and vaccination, protecting patients and staff from infection, and serving as community trusted persons. In Austria, there are no structured levels of care, no definition of the role of the general practitioner during a pandemic is given, and no specific support structures are present. The aim of this study was to assess the views and experiences of primary care physicians regarding supportive and hindering factors for pandemic preparedness in Austria.

METHODS

Qualitative study using semi-structured interviews. A total of 30 general practitioners were interviewed, with particular attention to an equitable distribution in small, medium and large primary care facilities. Qualitative content analysis was performed.

RESULTS

Interviewees described a wide range of infection control, organisational and communication measures that they had implemented. They made changes to practise equipment, found makeshift solutions when supplies were scarce, and established communication and information pathways when official communication lines were inadequate.

CONCLUSION

General practitioners took on essential tasks and showed a high level of understanding of their role in the pandemic response. This was achieved mainly at an informal level and with high personal commitment. Their functioning in the absence of structural regulations and support shows that they had a clear intrinsic understanding of their responsibilities. To ensure reliability and sustainability and to reduce their burden, it will be necessary to clarify the role and tasks of a general practitioner and to provide the necessary support. This concerns both infrastructural support and communication and information strategies. As part of the reform to strengthen primary care, primary care needs to be seen, valued and involved in decision-making processes.

Breastfeeding success and perceived social support in lactating women with a history of COVID 19 infection: a prospective cohort study

BACKGROUND

Given the limited availability of research on the association between COVID-19 infection and breastfeeding success, the primary objective of this study is to conduct a comprehensive evaluation of this relationship.

METHODS

This prospective cohort study included 260 women who were on the postnatal ward of an academic hospital affiliated with Tehran University of Medical Sciences during the COVID-19 pandemic (between March and August 2021). Among these women, 130 had tested positive for COVID-19 in pregnancy, while the remaining 130 were considered healthy. The study aimed to assess various factors, including sociodemographic characteristics and the results of four validated questionnaires: The Bristol Breastfeeding Questionnaire, The Multidimensional of Perceived Social Support (MPSS), The Breastfeeding Self-Efficacy Scale (BSES), and The Postpartum Partner Support Scale (PPSS). These questionnaires were administered to each participant to gather relevant data. After eight weeks, a telephone follow-up was carried out to assess the success of breastfeeding. The evaluation focused on determining if exclusive breastfeeding was maintained or not. Data was collected by questioning mothers about their infants' feeding habits in the past 24 h. Exclusive breastfeeding refers to the exclusive use of breast milk without the introduction of other liquids or solid foods.

RESULTS

Women with a previous COVID-19 infection (case group) had a lower mean infant gestational age (P < 0.001) and a higher prevalence of cesarean section (P = 0.001) compared to the control group. The proportion of women who exclusively breastfed was higher in the control group (98.5%) than in women with a history of COVID-19 infection (89.2%) (P = 0.011). Furthermore, the case group reported lower scores in perceived social support and the Breastfeeding Self-Efficacy Scale, in contrast to the control group. Notably, there was a significant correlation between breastfeeding success and women's breastfeeding self-efficacy score.

CONCLUSIONS

The findings of this study offer valuable insights for healthcare professionals, enabling them to promote early initiation of breastfeeding in mothers with a history of COVID-19 infection, while ensuring necessary precautions are taken.

Insulin and early debridement keys to survival in-COVID 19 associated mucormycosis patients(CAM)- An experience from tertiary care hospital In India

Introduction

Amid the second wave of COVID 19 India witnessed a surge of mucormycosis cases. This worsened the already existing health emergency. India a diabetic capital had all the favourable factors to support the growth of black fungus. This study was conducted with objectives of ascertaining patient characteristics, clinical type of mucormycosis, predisposing factors, predictors of survival and long term outcome of survivors.

Materials and methods

An ambispective study of COVID 19 associated mucormycosis patients admitted in mucor ward of tertiary care hospital between May 2021- August 2021 was done. Study was approved by Institute Ethical Committee. Demographic characteristics, presence of risk factors, clinical sign and symptoms, mode of diagnosis, treatment given, final outcome and long term follow up for a period of 1 year from discharge was done.

Results

367 CAM patients were included in the study. 72.5%(n = 266) were men and 27.5% (n = 101) were females. Mean age group was 51.3 years (SD 12.4 years). Most important comorbidity was diabetes( n = 320,87.2%), followed by cardiovascular disease (n = 68, 18.5%) and hypertension (n = 58,15.8%). Other predisposing factors were use of oxygen (n = 367,100%), antibiotics( n = 213,58%) and steroids (n = 272, 74.1%). Dexamethasone was the most commonly used steroid (n = 218,59.4%). Rhino orbital cerebral mucormycosis was the most common type. 83.7% patients (n = 307) survived and 16.3% (n = 60) succumbed to illness. Kaplan Meir survival analysis curve showed use of insulin (p = 0.025), early debridement ( p < 0.05) significantly increased survival rate. Similarly patients with lesions involving, face (p < 0.05) and nose (p = 0.014) had much better outcome as compared to disseminated forms. Only 96 patients remained in follow up. Of these patients no significant alteration in metabolic profile was noted and they remained euglycemic on oral hypoglycaemics.

Conclusion

Early debridement and insulin use are keys to improved survival. Oxygen, Steroids and antibiotics are the risk factors for mucormycosis. Diabetes is the most important comorbidity.

SLEEP QUALITY OF SCHOOLCHILDREN - RESIDENTS OF RADIOACTIVELY CONTAMINATED AREAS DURING THE COVID-19 PANDEMIC

OBJECTIVE

to assess the sleep characteristics of middle school children during the COVID-19 pandemic.

MATERIALS AND METHODS

Cross-sectional study of sleep characteristics of children - residents of radioactively contaminated areas of Zhytomyr and Rivne regions, who underwent a routine examination in June-July 2020, after their stay from March to June 2020 in conditions of home isolation due to quarantine restrictions during the COVID-19 pandemic. Ninety six students of comprehensive public schools, aged 10-16, took part in the study. Sleep characteristics were assessed using the Pittsburgh Sleep Quality Index (PSQI-U indicator), translated into Ukrainian.

RESULTS AND DISCUSSION

During the period of the introduction of restrictive measures due to the COVID-19 pandemic, certain disturbances of sleep characteristics were observed, the imprint of which was a moderately increased total PSQI-U indicator, which was (3.89 ± 3.20) points. It was established that 19.79 % of children had insufficient total sleep time, and 2.08 % had significant sleep deprivation. The quality of their sleep was described as «rather bad» by 32.29 %, and as «very bad» by 4.17 %; 35.42 % of children complained about sleep disturbances, 67.71 % of children had signs of daytime dysfunction, 18.75 % had symptoms of insomnia. In the logistic regression model, quite significant prognostic factors of insomnia were: female gender (OR = 2.487; 95 % CI: 1.407-4.397); subjective determination of the negative impact of the pandemic on health, regardless of whether the respondent had COVID-19 or not (OR = 1.166; 95 % CI: 1.112-1.222), as well as living in the city (OR = 1.183; 95 % CI: 1.065-315).

CONCLUSIONS

The introduction of restrictive quarantine measures as a result of the COVID-19 pandemic led to a violation of the daily routine of schoolchildren, which modified the characteristics of sleep. In almost a third of the examined children, the duration and quality of night sleep was insufficient for the physiological restoration of the body's reserves. A late choice of the start of sleep and violations of his hygiene had a critical impact on these indicators.

Vaccination against COVID-19 and socioeconomic inequalities: A cross-sectional study in Ecuador

Background

Equity in vaccination against COVID-19 is a public health concern. The objective of this study was to analyze socioeconomic inequalities related to vaccination for the first and second doses from primary series against COVID-19 in Ecuador.

Methods

Secondary database study in 12,743,507 respondents from 15 years and over. The COVID-19 section of the National Survey of Employment, Unemployment and Underemployment (ENEMDU) was analyzed. Socioeconomic characteristics and vaccination against COVID-19 were associated with the at least one dose and second dose. Poisson regressions for complex samples were obtained.

Results

As of the date of the survey, 87.3% of the sample (95% CI 86.7%-87.8%) had received at least one vaccine against COVID-19. A lower probability of having received at least one vaccine against COVID-19 was found in rural areas (PR 0.82, 95% CI 0.74-0.91), indigenous population (PR 0.43, 95% CI 0.29-0.64), no level of education (PR 0.25, 95% CI 0.14-0.43), and the lowest economic income (PR 0.42, 95% CI 0.35-0.52). A significantly lower probability of vaccination with two or more doses was found in rural vs urban area (PR 0.88, 95% CI 0.80-0.96), women vs men (PR 0.85, 95% CI 0.77-0.91), indigenous population vs white (PR 0.44, 95% CI 0.33-0.59) and individuals in the lowest income quartile vs highest income quartile (PR 0.48, 95% CI 0.42-0.55). Underemployment, population economically inactive (PR 0.77, 95% CI 0.67-0.88 and PR 0.71, 95% CI 0.61-0.83) and individuals with no level of education (PR 0.39, 95% CI 0.27-0.58) also were less likely to complete the primary phase of vaccination compared with individuals in the highest income quartile, employment and postgraduate level of education.

Conclusions

There were socioeconomic inequalities with the primary series of vaccine against COVID-19, with a greater disadvantage for rural residents, women, indigenous populations, lower economic income and lower levels of education.

Significant exercise limitations after recovery from MIS-C related myocarditis

BACKGROUND

Myocarditis is one of the presentations of multisystemic inflammatory syndrome in children (MIS-C) following coronavirus disease 2019 (COVID-19). Although the reported short-term prognosis is good, data regarding medium-term functional capacity and limitations are scarce. This study aimed to evaluate exercise capacity as well as possible cardiac and respiratory limitations in children recovered from MIS-C related myocarditis.

METHODS

Fourteen patients who recovered from MIS-C related myocarditis underwent spirometry and cardiopulmonary exercise testing (CPET), and their results were compared with an age-, sex-, weight- and activity level-matched healthy control group (n = 14).

RESULTS

All participants completed the CPET with peak oxygen uptake (peak [Formula: see text]), and the results were within the normal range (MIS-C 89.3% ± 8.9% and Control 87.9% ± 13.7% predicted [Formula: see text]). Five post-MIS-C patients (35%) had exercise-related cardio-respiratory abnormalities, including oxygen desaturation and oxygen-pulse flattening, compared to none in the control group. The MIS-C group also had lower peak exercise saturation (95.6 ± 3.5 vs. 97.6 ± 1.1) and lower breathing reserve (17.4% ± 7.5% vs. 27.4% ± 14.0% of MVV).

CONCLUSIONS

Patients who recovered from MIS-C related myocarditis may present exercise limitations. Functional assessment (e.g., CPET) should be included in routine examinations before allowing a return to physical activity in post-MIS-C myocarditis. Larger, longer term studies assessing functional capacity and focusing on physiological mechanisms are needed.

Influenza viral infection is a risk factor for severe illness in COVID-19 patients: a nationwide population-based cohort study

In order to prepare for the twindemic of influenza and SARS-CoV-2 infection, we investigated the association between influenza infection and subsequent severity of SARS-CoV-2 infection. A population-based nationwide cohort study was performed using data from the National Health Insurance Service (NHIS) in the Republic of Korea. This study included 274,126 individuals who underwent SARS-CoV-2 PCR testing between 20 January 2020 and 1 October 2020. Among these patients, 28,338 tested positive for SARS-CoV-2, and 4,003 of these individuals had a history of influenza. The control group was selected through 1:1 propensity score matching. In the group of 4,003 COVID-19-positive individuals with no history of influenza, 192 (4.8%) experienced severe illness from COVID-19 infection. In the group of 4,003 COVID-19-positive individuals with a history of influenza, 260 (6.5%) had severe illness from COVID-19, and the overall adjusted odds ratio (aOR) was 1.29 (95% confidence interval 1.04-1.59). Among the 4,003 COVID-19-positive individuals with a history of influenza, severe COVID-19 infection was experienced by 143 of 1,760 (8.1%) with an influenza history within 1 year before the onset of COVID-19, 48 of 1,129 (4.3%) between 1 and 2 years, and 69 of 1,114 (6.2%) between 2 and 3 years before COVID-19 onset, and the aORs were 1.54 (1.20-1.98), 1.19 (0.84-1.70), and 1.00 (0.73-1.37), respectively. In conclusion, individuals who had an influenza infection less than 1 year before COVID-19 infection were at an increased risk of experiencing severe illness from the SARS-CoV-2 infection. To control the public health burden, it is essential that effective public health control measures, which include influenza vaccination, hand washing, cough etiquette, and mask use are in place.

Performance of an AI algorithm during the different phases of the COVID pandemics: what can we learn from the AI and vice versa

Background

Artificial intelligence (AI) has proved to be of great value in diagnosing and managing Sars-Cov-2 infection. ALFABETO (ALL-FAster-BEtter-TOgether) is a tool created to support healthcare professionals in the triage, mainly in optimizing hospital admissions.

Methods

The AI was trained during the pandemic's "first wave" (February-April 2020). Our aim was to assess the performance during the "third wave" of the pandemics (February-April 2021) and evaluate its evolution. The neural network proposed behavior (hospitalization vs home care) was compared with what was actually done. If there were discrepancies between ALFABETO's predictions and clinicians' decisions, the disease's progression was monitored. Clinical course was defined as "favorable/mild" if patients could be managed at home or in spoke centers and "unfavorable/severe" if patients need to be managed in a hub center.

Results

ALFABETO showed accuracy of 76%, AUROC of 83%; specificity was 78% and recall 74%. ALFABETO also showed high precision (88%). 81 hospitalized patients were incorrectly predicted to be in "home care" class. Among those "home-cared" by the AI and "hospitalized" by the clinicians, 3 out of 4 misclassified patients (76.5%) showed a favorable/mild clinical course. ALFABETO's performance matched the reports in literature.

Conclusions

The discrepancies mostly occurred when the AI predicted patients could stay at home but clinicians hospitalized them; these cases could be handled in spoke centers rather than hubs, and the discrepancies may aid clinicians in patient selection. The interaction between AI and human experience has the potential to improve both AI performance and our comprehension of pandemic management.

Toxic effects of aging mask microplastics on E. coli and dynamic changes in extracellular polymeric matter

Contamination of disposable medical masks has become a growing problem globally in the wake of Covid-19 due to their widespread use and improper disposal. Three different mask layers, namely the outer layer, the meltblown (MB) filler layer and the inner layers release three different types of microplastics, whose physical and chemical properties change after prolonged environmental weathering. In this study, physical and chemical changes of mask microplastics before and after aging were characterized by different characterization techniques. The toxic effect and mechanism of aged mask microplastics on Escherichia coli (E. coli) were studied by measuring the growth inhibition of mask microplastics, the change in ATPase activity, the change in malondialdehyde content and reactive oxygen species production, and the release of the chemical composition of exopolymeric substances (EPS). The microplastics of the aged MB filter layer had the most significant inhibitory effect on E. coli growth, reaching 19.2 % after 36 h. Also, under the influence of mask microplastics, ATPase activity of E. coli was inhibited and a large amount of EPS was released. The chemical composition of EPS has also changed. This study proposed the possible toxicity mechanism of mask microplastics and the self-protection mechanism of E. coli, and provided a reference for future research on the toxic effects of mask microplastics on environmental organisms.

Langerhans Cell Hyperplasia Mimicking Langerhans Cell Histiocytosis: A Rare Complication of COVID-19 Vaccination

Langerhans cell histiocytosis (LCH) is a rare disorder characterized by the abnormal proliferation of Langerhans cells, a type of immune cell that is normally present in the skin and various other tissues. LCH can affect people of any age but is most commonly diagnosed in children. We report a case of a patient with LCH who developed ipsilateral axillary lymphadenopathology post-COVID-19 vaccination. Lymph node biopsy showed diffuse Langerhans cell hyperplasia which mimicked LCH. Clinically and radiologically, it looked to be a reactive lymph node. The patient was kept on follow up only and after 1 year of follow up the size of lymph nodes regressed confirming to be reactive in nature rather than neoplastic. To the best of our knowledge, this is the second case of Langerhans cell hyperplasia post-COVID-19 vaccination being reported in the literature.

Performance in prognostic capacity and efficiency of the Thoracic Care Suite GE AI tool applied to chest radiography of patients with COVID-19 pneumonia

OBJECTIVE

Rapid progression of COVID-19 pneumonia may put patients at risk of requiring ventilatory support, such as non-invasive mechanical ventilation or endotracheal intubation. Implementing tools that detect COVID-19 pneumonia can improve the patient's healthcare. We aim to evaluate the efficacy and efficiency of the artificial intelligence (AI) tool GE Healthcare's Thoracic Care Suite (featuring Lunit INSIGHT CXR, TCS) to predict the ventilatory support need based on pneumonic progression of COVID-19 on consecutive chest X-rays.

METHODS

Outpatients with confirmed SARS-CoV-2 infection, with chest X-ray (CXR) findings probable or indeterminate for COVID-19 pneumonia, who required a second CXR due to unfavorableclinical course, were collected. The number of affected lung fields for the two CXRs was assessed using the AI tool.

RESULTS

One hundred fourteen patients (57.4±14.2 years, 65-57%-men) were retrospectively collected. Fifteen (13.2%) required ventilatory support. Progression of pneumonic extension ≥0.5 lung fields per day compared to pneumonia onset, detected using the TCS tool, increased the risk of requiring ventilatory support by 4-fold. Analyzing the AI output required 26s of radiological time.

CONCLUSIONS

Applying the AI tool, Thoracic Care Suite, to CXR of patients with COVID-19 pneumonia allows us to anticipate ventilatory support requirements requiring less than half a minute.

An Accountable Care Organization Maintains Access for Appendicitis During the COVID-19 Pandemic

INTRODUCTION

It has been reported that pediatric patients experienced a delay in treatment for acute appendicitis during the pandemic, resulting in increased rates of complicated appendicitis. We investigated the association of the COVID-19 pandemic and the incidence and severity of acute appendicitis among pediatric Medicaid patients using a population-based approach.

METHODS

The claims database of Partners For Kids, a pediatric Medicaid accountable care organization (ACO) in Ohio, was queried for cases of acute appendicitis from April to August 2017-2020. The monthly rate of acute appendicitis/100,000 covered lives was calculated each year and compared over time. Rates of complicated appendicitis were also compared. Diagnosis code validation for classification as complicated or uncomplicated appendicitis was performed for patients treated at our hospital.

RESULTS

During the study period, 465 unique cases of acute appendicitis were identified. Forty percent (186/465) were coded as complicated. No significant difference in the incidence of acute appendicitis cases was observed across the 4 y, either in an overall comparison or in pairwise comparisons (P > 0.15 for all). The proportion of acute appendicitis cases that were coded as complicated did vary significantly over the 4-year study period (P = 0.005); this was due to this proportion being significantly higher in 2018 than in either 2019 (P = 0.005 versus 2018) or 2020 (P = 0.03 versus 2018).

CONCLUSIONS

The COVID-19 pandemic was not associated with reduced access to treatment for acute appendicitis among patients in a pediatric Medicaid ACO. This suggests that an ACO may promote continued healthcare access for their covered population during an unexpected crisis.

Comparative study of 'the clinical profile of COVID-19-positive patients with and without vaccination profile'

Background

More than 4.5 million people have perished from the COVID-19 virus, which has so far been linked to more than 200 million reported cases. Vaccination is an ultimatum for survival from this disease. Hence, this research was designed to study the course of disease in vaccinated and unvaccinated group and to understand the significance of blood markers, to study lung involvement (HRCT), number of hospitalised days, number of O2 days, and number of days of ventilator support in both the groups in hospitalised patients.

Material and Methods

A cohort study was conducted among COVID-19-positive patients tested either with rapid antigen test or RT-PCR test hospitalised in Kullolli Institute of Health Services. Patients who had received at least one dose of vaccination were included in the analysis. Data were analysed by using unpaired t-test, between the two groups of survived and non-survived patients. Chi-square test and/or Fisher's exact tests were used to check the association.

Results

In the study, only 71 (18.6%) patients were vaccinated. There were 49 (69.01%) patients out of 71, representing a massive number of vaccinations for people over the age of 50. There were 40 patients with co-morbid conditions, 31 (77.50%) of whom were vaccinated. CRP levels were significantly severe in non-survived patients of non-vaccinated group (Fisher's exact = 8.938, P = 0.024). d-Dimer levels, serum ferritin levels, and HRCT scores were significantly related to the outcome (survival/non-survival). Patients who did not survive have higher levels of these parameters. In the vaccinated group, these associations were not significantly associated. Vaccination did not show statistically significant benefits in patients with co-morbid conditions.

Conclusion

Vaccination has enormous life-saving potential. Regardless of the type of vaccine used, the immunisation provides life-saving protection against a disease that has killed millions.

Fear of the unknown, anxiety, and social isolation in Iranian patients with Covid-19, the grounded theory

BACKGROUND

Coronavirus 2019 (COVID-19) pandemic has incurred a health challenge. Patients suffer from many physical and mental disorders. To accurately identify the experience of patients with Covid-19 in the Iranian society.

MATERIALS AND METHODS

This qualitative research was conducted using the grounded theory. The data of this grounded theory study were collected using 32 semi-structured interviews with participants and field notes including the patients with Covid-19, nurses, physicians, and the patients' families. Data analysis was performed using Corbin and Strauss (2008) approach for concepts, context, process, and categories' integration.

RESULTS

Qualitative analysis of data led to the extraction of 54 sub-categories and 7 final categories. "Isolation, fear of death, and fear of infection of relatives and family members" were identified as the main issue. The context to this concern was the "unfamiliarity with the virus due to its ambiguous nature that was obtained with a wide range of symptoms." Facing this issue, the patients used the strategy of "adherence to health protocol in the coronavirus infection process" that was recognized as the central variable.

CONCLUSION

The ambiguous and complex nature of the emerging virus, the appearance of different symptoms in different people, and the fear of infecting others, death and anxiety due to unknown complications of the disease make patients go through the most difficult experience of their lives. That requires ongoing training on up-to-date prevention and treatment protocols, along with the emergence of mutated viruses and new symptoms.

The hidden effects of COVID-19 on HIV services in Zanzibar: country report

The COVID-19 pandemic has had a major effect on HIV-related healthcare services. Zanzibar has experienced several interruptions of HIV services in the areas of testing and counselling, prevention of mother-to-child transmission of HIV, key population, care and treatment services as well due to the hospital operating at a reduced capacity and the strict visit restrictions with health care allocations to COVID 19 pandemic. The community HIV initiatives, such as index testing and ARVs medicine refills, were used to mitigate the consequences of the epidemic and can be applied in future emergencies. This report tries to reveal COVID-19's unnoticed consequences on HIV services in Zanzibar.

Histopathological changes in lungs of patients with fatal COVID 19 infection: A series of 15 cases

Introduction

The predominant pathology noted in the lungs of patients dying of COVID-19 is reported to be diffuse alveolar damage (DAD). Other studies have identified microthrombi to be a prominent finding of lung injury in patients affected by COVID-19. We describe the lung histopathological findings in fifteen cases of COVID-19 who died from the disease with the aim of reporting the microscopic changes in the lungs of patients dying from this disease.

Materials and Methods

Lung tissues from fifteen consecutive autopsy cases of COVID-19 were studied for gross and microscopic features. The case history of the deaths was noted, and the information was analyzed. The lung damage seen was graded on a semiquantitative scale on the basis of the percentage of tissue involved.

Results

Gross examination of the lungs showed multiple foci of consolidation mainly in the lower lobes of the lungs as the most commonly encountered finding. The other significant pattern was congested and edematous lungs with areas of consolidation. Microscopic assessment of lung sections showed 8 out of the 15 cases showing changes of the exudative phase of diffuse alveolar damage, whereas two cases were in the proliferative phase. Hyaline membranes were one of the common findings along with intra-alveolar edema and interstitial edema. Four cases showed changes in organizing phase. Other findings were microthrombi formation, fungal abscesses, dilated and collapsed alveoli, intra-alveolar hemorrhage, and acute neutrophilic pneumonia.

Conclusion

DADand interstitial pneumonitis were the most striking features in our autopsy study. Features of different phases of diffuse alveolar damage were seen to coexist in the same patient indicating the temporal heterogeneity of the ongoing lung injury in these patients.

Implications of COVID-19 Infection on Arteriovenous Fistula Thrombosis

Objective: This study aims to identify and analyze implications of COVID-19 positivity on AVF occlusion, subsequent treatment patterns, and ESRD patient outcomes. Our aim is to provide a quantitative context for vascular access surgeons in order to optimize surgical decision making and minimize patient morbidity. Methods: The de-identified national TriNetX database was queried to extracted all adult patients who had a known AVF between January 1, 2020 and December 31, 2021. From this cohort individuals who also were diagnosed with COVID-19 prior to creation of their AVF were identified. Cohorts were propensity score matched according to age at AVF surgery, gender, ethnicity, diabetes mellitus, nicotine dependence, tobacco use, use of anticoagulant medications, and use of platelet aggregation inhibitors, hypertensive diseases, hyperlipidemia, and prothrombotic states. Results: After propensity score matching there were 5170 patients; 2585 patients in each group. The total patient population had 3023 (58.5%) males and 2147 (41.5%) females. The overall rate of thrombosis of AV fistulas was 300 (11.6%) in the cohort with COVID-19 and 256 (9.9%) in the control group (OR 1.199, CI 1.005-1.43, P =.0453). Open revisions of AVF with thrombectomy were significantly higher in the COVID-19 cohort compared to the non-COVID-19 group (1.5% vs .5% P = .0002, OR 3.199, CI 1.668-6.136). Regarding the time from AVF creation to intervention, the median days for open thrombectomy in COVID-19 patients was 72 vs 105 days in controls. For endovascular thrombectomy, the median was 175 vs 168 days for the COVID-19 and control cohorts respectively. Conclusion: As for this study, there were significant differences in rates of thrombosis and open revisions of recent created AVF, however endovascular interventions remained remarkably low. As noted in this study, the persistent prothrombotic state of patients with a history of COVID-19 may persist beyond the acute infectious period of the disease.

Retrospective analysis of clinico-laboratory parameters, outcome and predictors of scrub typhus co- infection in covid-19 affected children

The objective of this study was to describe clinico-laboratory parameters, outcome and predictors of scrub typhus co- infection in COVID-19 affected children. Ours was a retrospective analysis done in a tertiary care pediatric COVID facility. COVID-19 positive children in the age group of 1 month to 12 years who were tested for scrub typhus co-infection between May to August 2020 were included in the study. In all positive cases, clinical, laboratory, treatment and outcome data were analyzed. Relevant data were compared between scrub typhus confirmed, and suspected but negative patients. All six patients with co-infection had fever for >5 days and four had features of cerebral involvement. These had lymphocytic pleocytosis in cerebrospinal fluid (CSF) analysis and two had eschar. Screening for scrub typhus in persistently febrile children residing in highly endemic areas is highly recommended.

The early impact of COVID-19 pandemic on mobile stroke unit care delivery: A worldwide survey

OBJECTIVE

To report COVID -19 pandemic impact on mobile stroke units (MSUs) a world-wide survey of MSU programs.

METHODS

Contact information of MSU program was obtained through the Pre-hospital Stroke Treatment Organization. Anonymous electronic questionnaire was developed and sent through the email to one representative of each program on May 15, 2020.

RESULTS

Of 26 programs queried, 20 responded and completed survey based on the data or personal impression. Eighteen programs were in the regions with pandemic lockdown. Six either suspended or reduced MSU availability at some point. The reasons given for change in availability were as follows: decreased personnel availability (5 programs), risk of exposure (5 programs), and financial concerns (1 program). Staff availability was a concern among 8 programs. MSU activations were reported to be unchanged by 10 programs, but 9 programs experienced decline in activation, 1 program had more activations. Sixteen programs reported change in MSU protocol including introduction of screening questionnaire, PPE, reducing patient contact, and cleaning protocols. Nine reported that the crew was under greater stress. Only 2 respondents felt that the pandemic delayed stroke care on MSU and the remainder did not.

CONCLUSION

Overall Stroke care delivery had no major disruptions despite COVID 19 pandemic posed challenges to MSU Operations.

Experiences with SARS-CoV-2 (Covid-19) in Trinidad and Tobago, a small island developing state: realities and opportunities

The COVID-19 pandemic has exerted significant global challenges that are expressed in a variety of socio-politico-economic scenarios, depending upon individual countries' preparedness and resilience. The impact COVID-19 in Small Island Developing States (SIDS), most of which are categorized as Lower and Middle-Income Countries, has been pronounced. Furthermore, many of these SIDS possess specific vulnerabilities to global threats. This paper contextualizes the experience of Trinidad and Tobago from some perspectives of geoeconomics, healthcare, and international relations. In many ways, the experience is similar to that of other SIDS with the inherent nuances of a post-colonial world. Trinidad and Tobago was ranked number one by the Oxford University COVID-19 Government Response Tracker (OxCGRT) "Lockdown rollback checklist: Do countries meet WHO recommendations for rolling back lockdown?". Despite the significant political support to combat the disease, by the end of 2022, the country had recorded over four thousand deaths and just over 50% of the population is vaccinated. This paper seeks to discuss the successes and challenges faced by this twin island state.