COVID-19 and Its Impact on Common Diseases in the Allergy Clinics

Coronavirus disease 2019 (COVID-19) is a highly contagious viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has various effects on asthma, allergic rhinitis, atopic dermatitis, and urticaria and may change the course of the disease depending on the severity of the infection and control status of the disease. Conversely, these diseases may also impact the course of COVID-19. Patients with chronic urticaria and atopic dermatitis may have COVID-19-induced disease exacerbations and biological treatments reduce the risk of exacerbations. Poor asthma control is linked to severe COVID-19 while allergic asthma is associated with lower risk of death and a lower rate of hospitalization due to COVID-19 compared with nonallergic asthma. The use of intranasal corticosteroids is associated with lower rates of hospitalization due to COVID-19 in patients with allergic rhinitis, whereas the effect of inhaled corticosteroids is confounded by asthma severity. These observations reinforce the importance of keeping allergic diseases under control during pandemics. The use of biologicals during COVID-19 is generally regarded as safe, but more evidence is needed. The pandemic substantially changed the management of allergic disorders such as home implementation of various biologicals, allergen immunotherapy, food introduction, and increased use of telemedicine and even home management of anaphylaxis to reduce emergency department burden and reduce risk of infection. Physicians need to be aware of the potential impact of COVID-19 on allergic diseases and educate their patients on the importance of continuing prescribed medications and adhering to their treatment plans to maintain optimal control of their disease.

Comparative efficacy of self-administered dentifrices for the management of dentine hypersensitivity - A systematic review and network meta-analysis

OBJECTIVES

This systematic review with network meta-analysis synthesises available randomised controlled trials evidence concerning efficacy of self-administered dentifrices for management of dentine hypersensitivity (DH) pain.

STUDY SELECTION

Following systematic review registration (CRD42019154064), three data bases (MEDLINE, Embase, CENTRAL) were searched to December 2022 for parallel randomised controlled trials conducted in adults diagnosed with DH, using at least two recognised stimuli, assessing the short-term efficacy of home-use dentifrice treatment in reducing pain. Thirty-two studies and 4,638 participants were included. A Network meta-analysis (NMA) approach was used to compare relative effectiveness between interventions.

CONCLUSIONS

Twice daily application of self-applied dentifrice containing formulations of stannous, potassium +/- stannous, or arginine can be recommended for the reduction of dentine hypersensitivity pain. There is a need for standardised methodology guideline development to improve the conduct, analysis and reporting of DH clinical studies.

CLINICAL RELEVANCE

This is the first comprehensive NMA to be performed, that follows guidelines for conduct of DH trials to determine the efficacy of self-applied dentifrices for the management of dentine hypersensitivity. Indirect comparisons can be made between formulations that have not been compared to one another in randomised controlled trials.

Accuracy of Three Commercial Home-Use Hemoglobin A1c Tests

Background: The COVID-19 pandemic and the rapid expansion of telemedicine have increased the need for accurate and reliable capillary hemoglobin A1c (HbA1c) testing. Nevertheless, validation studies of commercially available products suitable for home use have been in short supply. Methods: Three commercial home-use capillary blood sample HbA1c tests (Home Access, CoreMedica, and A1cNow+) were evaluated in 219 participants with type 1 or type 2 diabetes (4-80 years years of age, HbA1c 5.1%-13.4% [32-123 mmol/mol]) at four clinical sites. Comparisons were made between HbA1c measurements from the commercial tests and paired venous samples for which HbA1c was measured at two central reference laboratories. The primary outcome was percentage of commercial HbA1c values within 5% of the corresponding reference values. Results: HbA1c values were within 5% (relative difference) of paired reference values for 82% of Home Access samples, 29% of CoreMedica samples, and 46% of A1cNow+ samples. Absolute differences were within 0.3% of the reference value for 75% of Home Access samples, 28% of CoreMedica samples, and 44% of A1cNow+ samples and exceeded 0.5% for 8%, 55%, and 37%, respectively. Conclusions: None of the commercial home-use HbA1c tests produced the National Glycohemoglobin Standardization Program goal of ≥90% measurements within 5% of a DCCT venous reference. However, the Home Access product performed substantially better than the CoreMedica or A1cNow+ products. Telemedicine is likely to persist as a mainstay of diabetes care well after the COVID-19 era. As such, accurate home-based HbA1c assessment represents an urgent need for the diabetes community.

Competitive motivation increased home use and improved prosthesis self-perception after Cybathlon 2020 for neuromusculoskeletal prosthesis user

Background

Assistive technologies, such as arm prostheses, are intended to improve the quality of life of individuals with physical disabilities. However, certain training and learning is usually required from the user to make these technologies more effective. Moreover, some people can be encouraged to train more through competitive motivation.

Methods

In this study, we investigated if the training for and participation in a competitive event (Cybathlon 2020) could promote behavioral changes in an individual with upper limb amputation (the pilot). We defined behavioral changes as the active time while his prosthesis was actuated, ratio of opposing and simultaneous movements, and the pilot’s ability to finely modulate his movement speeds. The investigation was based on extensive home-use data from the period before, during and after the Cybathlon 2020 competition.

Results

Relevant behavioral changes were found from both quantitative and qualitative analyses. The pilot’s home use of his prosthesis nearly doubled in the period before the Cybathlon, and remained 66% higher than baseline after the competition. Moreover, he improved his speed modulation when controlling his prosthesis, and he learned and routinely operated new movements in the prosthesis (wrist rotation) at home. Additionally, as confirmed by semi-structured interviews, his self-perception of the prosthetic arm and its functionality also improved.

Conclusions

An event like the Cybathlon may indeed promote behavioral changes in how competitive individuals with amputation use their prostheses. Provided that the prosthesis is suitable in terms of form and function for both competition and at-home daily use, daily activities can become opportunities for training, which in turn can improve prosthesis function and create further opportunities for daily use. Moreover, these changes appeared to remain even well after the event, albeit relevant only for individuals who continue using the technology employed in the competition.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12984-022-01024-4.

Economic Impact of Home-Use versus Office-Use Diphenylcyclopropenone in Extensive Alopecia Areata

Introduction

Diphenylcyclopropenone (DPCP) is the medication of choice for the treatment of severe alopecia areata (AA) according to AA treatment guidelines. Precise initiation and application are important factors for successful treatment. However, it is difficult for patients who live far away to visit their doctor weekly.

Methods

We conducted a retrospective cohort study to assess the cost, effectiveness, and side effects of DPCP treatment between office-use DPCP (O-DPCP) and home-use DPCP (H-DPCP) in severe AA patients. A cost-effectiveness analysis was performed from the perspective of healthcare providers and patients using real-world data and the national cost statistics for hospital services comparing O-DPCP and H-DPCP in patients with severe AA at 24, 36, and 48 weeks.

Results

Two groups of 41 patients treated with O-DPCP and H-DPCP were enrolled. There was no significant difference in the proportion of patients who showed a favorable outcome (≥50% improvement) with minimal side effects between both groups at 24 (O-DPCP 43.9% vs. H-DPCP 26.8%, p = 0.11), 36 (O-DPCP 58.5% vs. H-DPCP 43.9%, p = 0.19), or 48 weeks (O-DPCP 63.4% vs. H-DPCP 56.1%, p = 0.49). The cost of H-DPCP was half of the cost of O-DPCP.

Discussion/Conclusion

H-DPCP is a cost-effective and time-efficient alternative treatment option for severe AA patients.

Home-Use and Real-Time Sleep-Staging System Based on Eye Masks and Mobile Devices with a Deep Learning Model

Purpose

Sleep is an important human activity. Comfortable sensing and accurate analysis in sleep monitoring is beneficial to many healthcare and medical applications. From 2020, owing to the COVID‑19 pandemic that spreads between people when they come into close physical contact with one another, the willingness to go to hospital for receiving care has reduced; care-at-home is the trend in modern healthcare. Therefore, a home-use and real-time sleep-staging system is developed in this paper.

Methods

We developed and implemented a real-time sleep staging system that integrates a wearable eye mask for high-quality electroencephalogram/electrooculogram measurement and a mobile device with MobileNETV2 deep learning model for sleep-stage identification. In the experiments, 25 all-night recordings were acquired, 17 of which were used for training, and the remaining eight were used for testing.

Results

The averaged scoring agreements for the wake, light sleep, deep sleep, and rapid eye movement stages were 85.20%, 87.17%, 82.87%, and 89.30%, respectively, for our system compared with the manual scoring of PSG recordings. In addition, the mean absolute errors of four objective sleep measurements, including sleep efficiency, total sleep time, sleep onset time, and wake after sleep onset time were 1.68%, 7.56 min, 5.50 min, and 3.94 min, respectively. No significant differences were observed between the proposed system and manual PSG scoring in terms of the percentage of each stage and the objective sleep measurements.

Conclusion

These experimental results demonstrate that our system provides high scoring agreements in sleep staging and unbiased sleep measurements owing to the use of EEG and EOG signals and powerful mobile computing based on deep learning networks. These results also suggest that our system is applicable for home-use real-time sleep monitoring.

Self-health monitoring and wearable neurotechnologies

Brain-computer interfaces and wearable neurotechnologies are now used to measure real-time neural and physiologic signals from the human body and hold immense potential for advancements in medical diagnostics, prevention, and intervention. Given the future role that wearable neurotechnologies will likely serve in the health sector, a critical state-of-the-art assessment is necessary to gain a better understanding of their current strengths and limitations. In this chapter we present wearable electroencephalography systems that reflect groundbreaking innovations and improvements in real-time data collection and health monitoring. We focus on specifications reflecting technical advantages and disadvantages, discuss their use in fundamental and clinical research, their current applications, limitations, and future directions. While many methodological and ethical challenges remain, these systems host the potential to facilitate large-scale data collection far beyond the reach of traditional research laboratory settings.

BCI in practice

Brain-computer interfaces are systems that use signals recorded from the brain to enable communication and control applications for individuals who have impaired function. This technology has developed to the point that it is now being used by individuals who can actually benefit from it. However, there are several outstanding issues that prevent widespread use. These include the ease of obtaining high-quality recordings by home users, the speed, and accuracy of current devices and adapting applications to the needs of the user. In this chapter, we discuss some of these unsolved issues.