Exposure of pediatric emergency patients to imaging exams, nowadays and in times of covid-19: an integrative review / Exposição de pacientes da emergência pediátrica a exames de imagem, na atualidade e em tempos de covid-19: uma revisão integrativa

ABSTRACT Objective: To analyze literature data about unnecessary exposure of pediatric emergency patients to ionizing agents from imaging examinations, nowadays and during times of COVID-19. Data sources: Between April and July 2020, articles were selected using the databases: Virtual Health Library, PubMed and Scientific Electronic Library Online. The following descriptors were used: [(pediatrics) AND (emergencies) AND (diagnostic imaging) AND (medical overuse)] and [(Coronavirus infections) OR (COVID-19) AND (pediatrics) AND (emergencies) AND (diagnostic imaging)]. Inclusion criteria were articles available in full, in Portuguese or English, published from 2016 to 2020 or from 2019 to 2020, and articles that covered the theme. Articles without adherence to the theme and duplicate texts in the databases were excluded. Data synthesis: 61 publications were identified, of which 17 were comprised in this review. Some imaging tests used in pediatric emergency departments increase the possibility of developing future malignancies in patients, since they emit ionizing radiation. There are clinical decision instruments that allow reducing unnecessary exam requests, avoiding over-medicalization, and hospital expenses. Moreover, with the COVID-19 pandemic, there was a growing concern about the overuse of imaging exams in the pediatric population, which highlights the problems pointed out by this review. Conclusions: It is necessary to improve hospital staff training, use clinical decision instruments and develop guidelines to reduce the number of exams required, allowing hospital cost savings; and reducing children's exposure to ionizing agents.

RESUMO Objetivo: Analisar dados da literatura sobre exposição desnecessária de pacientes da emergência pediátrica a agentes ionizantes dos exames de imagem, na atualidade e em tempos de COVID-19. Fontes de dados: Entre abril e julho de 2020 ocorreu a seleção dos artigos, utilizando-se as bases de dados: Biblioteca Virtual em Saúde, PubMed e Scientific Electronic Library Online. Utilizaram-se os descritores: [(pediatrics) AND (emergencies) AND (diagnostic imaging) AND (medical overuse)] e [(Coronavirus infections) OR (COVID-19) AND (pediatrics) AND (emergencies) AND (diagnostic imaging)]. Incluíram-se artigos disponíveis na íntegra, em português ou inglês, publicados no período de 2016 a 2020 ou de 2019 a 2020, e artigos que contemplassem o tema. Excluiu-se artigos sem aderência com a temática e textos duplicados. Síntese dos dados: Identificaram-se 61 publicações, sendo 17 utilizadas para a elaboração desta revisão. Alguns exames de imagem utilizados nos Setores de Urgência e Emergência (SUEs) pediátricos, por emitirem radiação ionizante, aumentam a possibilidade de desenvolver malignidades futuras nas crianças. Destarte, há instrumentos de decisão clínica que possibilitam diminuir requisições de exames desnecessários, evitando a sobremedicalização e os gastos hospitalares. Ademais, com a pandemia da COVID-19, cresceu a preocupação com o uso excessivo de exames de imagem na população pediátrica, o que reafirma a problematização deste estudo. Conclusões: Veem-se como necessárias a capacitação da equipe hospitalar, a utilização de instrumentos de decisão clínica e a confecção de protocolos que possam avaliar a singularidade da criança. Isso permitirá reduzir o número de exames requeridos, possibilitando economia de custos hospitalares e redução da exposição de crianças a agentes ionizantes.

Pregnancy outcomes of COVID-19 positive pregnant women at the Cantonal Hospital Zenica, Bosnia and Herzegovina.

Aim To investigate clinical presentation of COVID-19 infection in pregnancy, its course during pregnancy, effects on pregnancy outcomes for both mothers and newborns as well as the potential for vertical transmission. Methods This retrospective observational study included all identifi ed COVID-19-positive pregnant women admitted to the Cantonal Hospital in Zenica at any stage of pregnancy or labour from 30 April 2020 to April 30 2021. Maternity and newborns were followed until discharge from the hospital. Results Twenty-four pregnant women were positive for COVID-19. There were 79.2% asymptomatic cases, 12.5% had mild symptoms, while 8.3% had more severe forms of the disease. The main follow-up morbidities were high BMI 33.3%, anaemia 16.7%, thrombocytopenia 12.5%, hypertensive disorders 4.2% and diabetes 4.2%. The rate of premature births was 33.3%, while 8.3% pregnant women had premature rupture of the amniotic sac. Caesarean section was done for 75% women while 25% delivered vaginally. Previous caesarean section (54.2%) was the most common indication for operative completion of labour. Twentythree (92%) live babies were born, of which 8 (33.3%) were admitted to the neonatal intensive care unit. Two (8%) intrauterine foetal deaths were recorded that occurred before admission to our hospital. Two infants (8.7%) had a positive PCR test for COVID-19. Conclusion COVID-19 viral disease in pregnancy is usually presented as an asymptomatic or mild disease. It is associated with high rates of preterm birth, admission of newborns to the intensive care unit and intrauterine foetal death. Vertical transmission is possible but the newborns were asymptomatic.

Computational modeling predicts potential effects of the herbal infusion "horchata" against COVID-19.

Bioactive plant-derived molecules have emerged as therapeutic alternatives in the fight against the COVID-19 pandemic. In this investigation, principal bioactive compounds of the herbal infusion "horchata" from Ecuador were studied as potential novel inhibitors of the SARS-CoV-2 virus. The chemical composition of horchata was determined through a HPLC-DAD/ESI-MSn and GC-MS analysis while the inhibitory potential of the compounds on SARS-CoV-2 was determined by a computational prediction using various strategies, such as molecular docking and molecular dynamics simulations. Up to 51 different compounds were identified. The computational analysis of predicted targets reveals the compounds' possible anti-inflammatory (no steroidal) and antioxidant effects. Three compounds were identified as candidates for Mpro inhibition: benzoic acid, 2-(ethylthio)-ethyl ester, l-Leucine-N-isobutoxycarbonyl-N-methyl-heptyl and isorhamnetin and for PLpro: isorhamnetin-3-O-(6-Orhamnosyl-galactoside), dihydroxy-methoxyflavanone and dihydroxyphenyl)-5-hydroxy-4-oxochromen-7-yl]oxy-3,4,5-trihydroxyoxane-2-carboxylic acid. Our results suggest the potential of Ecuadorian horchata infusion as a starting scaffold for the development of new inhibitors of the SARS-CoV-2 Mpro and PLpro enzymes.

Comprehensive Laboratory Data Analysis to Predict the Clinical Severity of Coronavirus Disease 2019 in 1,952 Patients in Daegu, Korea.

Background: Laboratory parameter abnormalities are commonly observed in COVID-19 patients; however, their clinical significance remains controversial. We assessed the prevalence, characteristics, and clinical impact of laboratory parameters in COVID-19 patients hospitalized in Daegu, Korea. Methods: We investigated the clinical and laboratory parameters of 1,952 COVID-19 patients on admission in nine hospitals in Daegu, Korea. The average patient age was 58.1 years, and 700 (35.9%) patients were men. The patients were classified into mild (N=1,612), moderate (N=294), and severe (N=46) disease groups based on clinical severity scores. We used chi-square test, multiple comparison analysis, and multinomial logistic regression to evaluate the correlation between laboratory parameters and disease severity. Results: Laboratory parameters on admission in the three disease groups were significantly different in terms of hematologic (Hb, Hct, white blood cell count, lymphocyte%, and platelet count), coagulation (prothrombin time and activated partial thromboplastin time), biochemical (albumin, aspartate aminotransferase, alanine aminotransferase, lactate, blood urea nitrogen, creatinine, and electrolytes), inflammatory (C-reactive protein and procalcitonin), cardiac (creatinine kinase MB isoenzyme and troponin I), and molecular virologic (Ct value of SARS-CoV-2 RdRP gene) parameters. Relative lymphopenia, prothrombin time prolongation, and hypoalbuminemia were significant indicators of COVID-19 severity. Patients with both hypoalbuminemia and lymphopenia had a higher risk of severe COVID-19. Conclusions: Laboratory parameter abnormalities on admission are common, are significantly associated with clinical severity, and can serve as independent predictors of COVID-19 severity. Monitoring the laboratory parameters, including albumin and lymphocyte count, is crucial for timely treatment of COVID-19.

Performance Comparison of Five SARS-CoV-2 Antibody Assays for Seroprevalence Studies.

Background: Seroprevalence studies of coronavirus disease 2019 (COVID-19) cases, including asymptomatic and past infections, are important to estimate the scale of the disease outbreak and to establish quarantine measures. We evaluated the clinical performance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody assays available in Korea for use in seroprevalence studies. Methods: The sensitivity, specificity, cross-reactivity, and interference of five SARS-CoV-2 antibody assays were evaluated using the following: 398 serum samples from confirmed COVID-19 patients, 510 negative control samples from before 2018 (pre-pandemic), 163 serum samples from patients with SARS, Middle East respiratory syndrome (MERS), and other viral infections, and five samples for the interference study. Results: The sensitivities of the five assays ranged from 92.2% to 98%, and their specificities, including cross-reactivity and interference, ranged from 97.5% to 100%. The agreement rates were excellent (kappa >0.9). Adjustment of the cutoff values could be considered through ROC curve analysis. The positive predictive values of the individual assays varied from 3.5% to 100% at a 0.1% prevalence but were as high as ≥95% when two assays were combined. Conclusions: The prevalence of COVID-19 in Korea is considered to be exceptionally low at present; thus, we recommend using a combination of two or more SARS-CoV-2 antibody assays rather than a single assay. These results could help select SARS-CoV-2 antibody assays for COVID-19 seroprevalence studies in Korea.

Prevalence of a Single-Nucleotide Variant of SARS-CoV-2 in Korea and Its Impact on the Diagnostic Sensitivity of the Xpert Xpress SARS-CoV-2 Assay.

The sensitivity of molecular diagnostics could be affected by nucleotide variants in pathogen genes, and the sites affected by such variants should be monitored. We report a single-nucleotide variant (SNV) in the nucleocapsid (N) gene of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), i.e., G29179T, which impairs the diagnostic sensitivity of the Xpert Xpress SARS-CoV-2 assay (Cepheid, Sunnyvale, CA, USA). We observed significant differences between the threshold cycle (Ct) values for envelope (E) and N genes and confirmed the SNV as the cause of the differences using Sanger sequencing. This SNV, G29179T, is the most prevalent in Korea and is associated with the B.1.497 virus lineage, which is dominant in Korea. Clinical laboratories should be aware of the various SNVs in the SARS-CoV-2 genome and consider their potential effects on the diagnosis of coronavirus disease 2019.

Clinical Evaluation of the Rapid STANDARD Q COVID-19 Ag Test for the Screening of Severe Acute Respiratory Syndrome Coronavirus 2.

Standard tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detect the presence of viral RNA using real-time reverse transcription (rRT)-PCR. Recently, convenient, rapid, and relatively inexpensive SARS-CoV-2 antigen (Ag) detection methods have been developed. The STANDARD Q COVID-19 Ag test (SD Biosensor, Inc., Suwon, Korea) is a rapid immunochromatography test that qualitatively detects the nucleocapsid protein of SARS-CoV-2 using gold conjugated antibodies. We evaluated its performance in comparison with that of Allplex 2019-nCoV Assay (Seegene, Seoul, Korea) in a retrospective case-control study using residual samples. The sensitivity and specificity of the STANDARD Q COVID-19 Ag test were 89.2% (58/65) and 96.0% (96/100), respectively. Cycle threshold (Ct) values for the three target SARS-CoV-2 genes (envelope, RNA-dependent RNA polymerase, and nucleocapsid genes) included in Allplex 2019-nCoV Assay were significantly lower in Ag test-positive patients than in Ag test-negative patients (P<0.001). The Ag test sensitivity was higher in samples with Ct≤30 and those collected one to five days post symptom onset. In conclusion, the STANDARD Q COVID-19 Ag test can serve as an alternative in high-prevalence settings, when the low sensitivity is compensated or when rRT-PCR tests are limited.

Generalized models and the impacts of population density on COVID-19 transmission / Modelos generalizados y los impactos de la densidad de población en la transmisión del COVID-19 / Modelos generalizados e os impactos da densidade populacional na transmissão da COVID-19

Objective: to analyze epidemic curves based on mathematical models for the state of Mato Grosso do Sul and the impacts of population density on COVID-19 transmission. Method: the linear, polynomial and exponential regression model was used to make the numerical adjustment of the respective curves empirical. Result: it was found that the models used describe very well the empirical curves in which they were tested. In particular, the polynomial model is able to identify with reasonable reliability the appearance of the inflection point in the accumulated curves, which corresponds to the maximum point of the respective daily curves. The analysis indicates a weak positive correlation between infection, mortality, lethality and deaths from COVID-19 with population density, as revealed by the correlation and analysis of R2 . Conclusion: the models are very effective in describing the COVID-19 and epidemic curves in the estimation of important epidemiological parameters, such as peak case curves and daily deaths, allowing practical and efficient monitoring of the evolution of the epidemic.

Objetivo: analizar curvas epidémicas basadas en modelos matemáticos para el estado de Mato Grosso do Sul y los impactos de la densidad de población en la transmisión de COVID-19. Método: se utilizó el modelo de regresión lineal, polinomial y exponencial para hacer el ajuste numérico valor de las respectivas curvas empíricas. Resultados: se encontró que los modelos utilizados describen muy bien las curvas empíricas en las que fueron probados. En particular, el modelo polinomial es capaz de identificar con razonable fiabilidad la aparición del punto de inflexión en las curvas acumuladas, que corresponde al punto máximo de las respectivas curvas diarias. El análisis indica una correlación positiva débil entre la infección, la mortalidad, la letalidad y las muertes por COVID-19 con la densidad de población, según lo revelado por la correlación y el análisis de R2 .Conclusión: los modelos son muy efectivos para describir el COVID-19 y curvas epidémicas en la estimación de parámetros epidemiológicos importantes, como las curvas de casos máximos y las muertes diarias, lo que permite un seguimiento práctico y eficaz de la evolución de la epidemia.

Objetivo: analisar as curvas epidêmicas com base em modelos matemáticos para o estado de Mato Grosso do Sul e os impactos da densidade populacional na transmissão da COVID-19. Método: o modelo de regressão linear, polinomial e exponencial foi utilizado para fazer o ajuste numérico das respectivas curvas empíricas. Resultados: verificou-se que os modelos utilizados descrevem muito bem as curvas empíricas nas quais foram testados. Em particular, o modelo polinomial é capaz de identificar com razoável confiabilidade o aparecimento do ponto de inflexão nas curvas acumuladas, que corresponde ao ponto máximo das respectivas curvas diárias. A análise indica uma correlação positiva fraca entre infecção, mortalidade, letalidade e mortes por COVID-19 com a densidade populacional, conforme revelado pela correlação e análise de R 2. Conclusão: os modelos são muito eficazes na descrição das curvas epidêmicas de COVID19 e na estimativa de parâmetros epidemiológicos importantes, como curvas de casos de pico e óbitos diários, permitindo um monitoramento prático e eficiente da evolução da epidemia

Factores de riesgo en población rural andina con COVID-19: un estudio de cohorte retrospectivo / Risk factors in rural Andean population with COVID-19: a retrospective cohort study

Resumen Objetivo: Determinar los factores de riesgo en adultos con COVID-19 en población rural andina durante 2020. Métodos: En este estudio de cohorte retrospectivo multicéntrico, incluimos a 184 pacientes adultos (≥18 años) con pruebas serológicas y moleculares para CO VID-19 de tres hospitales de la sierra peruana (Ancash y Apurímac) incluidos con sospecha clínica entre abril y junio. Se utilizó análisis descriptivos y regresión logística univariable para explorar los factores de riesgo asociados a los pacientes con COVID-19. Resultados: Del total de pacientes, 14 (7.6%) tuvieron SARS-CoV-2. En los pacientes infectados 12 (85.7%) fueron varones con promedio de edad de 47.3±21 años. Las comorbilidades estuvieron presentes en cerca de la tercera parte de pacientes, siendo la hipertensión y diabetes las más frecuentes (ambas 14.3%), y la sinto matología más frecuentes fueron fiebre y cefalea (57.2%). La regresión univariable mostró mayores probabilidades de infección con SARS-CoV-2 en la población rural andina asociada con la edad avanzada (OR: 1.1 IC95% 0.7-1.8; p=0,019), comorbilidades previas (OR: 1.7, IC95% 0.32-9.39; p=0,006), y sintomatología previa (OR: 49.8, IC95% 5.6-436.9; p=0,0011). Conclusiones: Los posibles factores de riesgo como la edad avanzada, las comorbilidades y sintomatología previas están relacionados con el desarrollo de CO VID-19 en población rural andina de Perú.

Abstract Objective: To determine the risk factors in adults with COVID-19 in the rural Andean population during 2020. Methods: This multicenter retrospective cohort study included 184 adult patients (≥18 years) with COVID-19's serological and molecular tests from three Hospitals in the Peruvian mountains (Ancash and Apurímac) included with clinical suspicion between April and June. Descriptive analysis and univariate logistic regression were used to explore the risk factors associated with patients with COVID-19. Results: Of total of patients, 14 (7.6%) had a SARS-CoV-2. In infected patients 12 (85.7%) were men with an average age of 47.3±21 years. Comorbidities were present in about a third of patients, with hypertension and diabetes being the most frequent (both 14.3%), and the most frequent symptoms were fever and hea dache (57.2%). Univariate regression showed higher probabilities of infection with SARS-CoV-2 in the rural Andean population associated with advanced age (OR: 1.1 95% CI 0.7 - 1.8; p = 0.019), previous comorbidities (OR: 1.7, 95%CI 0.32 - 9.39; p = 0.006), and previous symptoms (OR: 49.8, 95%CI 5.6 - 436.9; p = 0.0011). Conclusions: Possible risk factors such as advanced age, comorbidities and previous symptoms are related to the development of COVID-19 in the rural Andean population of Peru.

Clinical course, biomarkers, management and outcomes of patients hospitalised due to COVID-19 in Colombia / Curso clínico, biomarcadores, manejo y desenlaces de pacientes hospitalizados por COVID-19 en Colombia

Abstract Objective: To analyse the clinic characteristics, risk factors and evolution of the first cohort of hospitalised patients with confirmed infection by COVID-19 in 5 Colombian institutions. Materials and methods: Is a retrospective observational study of consecutive hospitalized patients with a diagnosis of COVID-19 confirmed from March 01 to May 30, 2020 in Colombia. Results: A total of 44 patients were included. The median age was 62 years. 43.2% had a history of smoking, while 69.8% were overweight or obese. 88.6% had at least one comorbidity and 52.3% had three or more comorbidities. Hypertension and dyslipidaemia were the most frequent comorbidities (40.9% and 34.1%, respectively). The 30-day mortality rate was 47.7% with a median of 11 days. The composite outcome occurred in the 36.4%. The biomarkers associated with mor tality risk included troponin higher than 14 ng/L (RR: 5.25; 95% CI 1.37-20.1, p = 0.004) and D-dimer higher than 1000 ng/ml (RR: 3.0; 95% CI 1.4-6.3, p = 0.008). Conclusions: The clinical course of SARS-CoV-2 infection in hospitalized Colombian was characterised by a more advanced stage of the infection.

Resumen Objetivo: Analizar las características, clínicas, factores de riesgo, y la evolución de pacientes hospitalizados con infección confirmada por COVID-19 en 5 Institu ciones de Colombia. Material y método: Es un estudio observacional retrospectivo de pacientes consecutivos hospitalizados con diagnóstico de COVID-19 confirmado entre 01 de Febrero de 2020 y 30 de Mayo de 2020 en Colombia. Resultados: Un total de 44 pacientes fueron incluidos. La mediana de edad fue de 62 años y la mayoría del sexo masculino. El 43.2% tenían historia de tabaquismo, mientras que el 69.8% tenían sobrepeso u obesidad. El 88.6% tenían al menos una comorbilidad y el 52.3% tenían tres o más comorbilidades. La hipertensión arterial fue la comorbilidad más frecuente (40.9%), seguido de la dislipidemia (34.1%). La tasa de letalidad a 30 días fue de 47.7% y ocurrió con una mediana de 11 días. El 36.4% presentó el desenlace compuesto. Los biomarcadores asociados con el riesgo de muerte fue troponina > 14 ng/mL (RR:5.25, IC95% 1.37-20.1, p=0.004) y dímero D mayor a 1000 mg/dL (RR: 3.0, IC95% 1.4-6.3, p=0.008). Conclusiones: El curso clínico de la infección por SARS-CoV-2 en colombianos hospitalizados fue un estadio más avanzado de la infección.

Trombosis de senos venosos cerebrales una manifestación extrapulmonar de COVID-19: Reporte de caso / Cerebral venous sinus thrombosis, an extrapulmonary manifestation of COVID-19: A case report

Resumen La trombosis de senos venosos cerebrales es un evento infrecuente en la población pediátrica y sus manifestaciones clínicas pueden variar dependiendo de la localización y extensión de la lesión, etiología o grupo etario (1); así mismo, la asociación de esta patología con virus es poco común, sin embargo, se han repor tado casos de trombosis de senos venosos en pacientes adultos con SARS-CoV-2 en relación con los mecanismos de lesión endotelial y respuesta inflamatoria que desencadena mecanismos procoagulantes. A continuación se presenta el primer caso reportado en Colombia de un caso de trombosis venosa cerebral en un lactante previamente sano, que debuta con un cuadro infeccioso gastrointestinal que resuelve y una semana después se presenta con cefalea y paralisis del VI par craneal derecho. Se documentó por angioto mografía trombosis del seno venoso sagital con extensión a senos transversos; los laboratorios fueron negativos para otras causas sistémicas y con prueba de anticuerpos para coronavirus positiva.

Abstract Cerebral venous sinus thrombosis is infrequent in the pediatric population and its clinical manifestations may vary depending on the anatomical location and the extent of the lesion, etiology or age group(1). The association of this pathology with viruses is uncommon, however, cases in adults with SARS-Cov2 have been reported triggered by procoagulant mechanisms due to endothelial injury and inflammatory response. The following article is the first reported case in Colombia of cerebral venous thrombosis in a previously healthy child, who debuted with gastrointestinal infectious disease and a week later with headache and sixth right cranial nerve palsy . The diagnosis of sagittal venous sinus thrombosis with extension to transverse sinuses was documented in a computed tomography angiography; laboratories for systemic diseases were negative and antibodies for coronavirus were positive.

Infección por COVID-19 previo al inicio de la epidemia en Colombia / COVID-19 infection prior to the beginning of the epidemic in Colombia

Resumen La identificación del nuevo Coronavirus tipo 2 en marzo de 2020 en Colombia ha generado paradigmas e incógnitas en la epidemiología nacional con respecto a la llegada aproximada del virus y sus mecanismos de diseminación local en los departamentos y ciudades principales. Presentamos el caso de un paciente con COVID-19 que tuvo su inicio de síntomas dos semanas antes de la declaración del primer caso en Colombia, lo que sugiere circulación del virus y transmisión local en Colombia previo a la declaración de la epidemia.

Abstract The identification of Coronavirus type 2 in March 2020 in Colombia has generated paradigms and unknows in the national epidemiology regarding the approxi mate arrival of the virus and its mechanisms of local dissemination in the main departments and cities. We present the case of a patient with COVID-19 that had its onset of symptoms two weeks before the declaration of the first case in Colombia, wich moves the circulation of the virus and local transmission in Colombia prior the declaration of the epidemic.

Período pós-parto e infecção pelo novo coronavírus: revisão de escopo / Postpartum period and infection by the new coronavirus: a scoping review / Periodo posparto e infección por el nuevo coronavirus: revisión del alcance

Objetivo: mapear as evidências disponíveis na literatura acerca dos manejos e desfechos da infecção pelo novo coronavírus no puerpério. Método: revisão de escopo conforme o Institute Joanna Briggs, desenvolvida em quatro fontes de dados eletrônicas. A extração, análise e síntese dos dados foi realizada por quatro pesquisadores independentes. Resultados: Nove publicações foram revisadas de 188 localizadas. Seis foram os países produtores das evidências, todas obtidas e publicadas em 2020. Vinte e um casos de COVID-19 no puerpério estiveram tratados nestas publicações, sendo 15 (71,4%) relativos a evoluções graves/exacerbação da doença e seis (28,6%) diagnosticados após a alta hospitalar. Conclusão: O mapeamento aponta para a ocorrência da infecção ou seu agravamento no período pós-parto, com indicativas ao monitoramento de sinais e sintomas, exploração diagnóstica e tratamento acurado e necessidade de acompanhamento próximo das mulheres diagnosticadas com COVID-19, sintomáticas ou não, no período pós-parto.

Objective: to map the evidence available in the literature about management and outcomes of postpartum infection by the new coronavirus. Method: scoping review conducted in four electronic sources, following Joanna Briggs Institute guidelines. Data were extracted, analyzed and summarized by four researchers independently. Results: nine of the 188 publications located were reviewed. The evidence, all obtained and published in 2020, was produced in six countries. These publications considered 21 cases of postpartum COVID-19, 15 (71.4%) of which related to severe developments / exacerbation of the disease and six (28.6%) diagnosed after hospital discharge. Conclusion: the mapping points to the occurrence of infection or worsening of the disease in the postpartum period, indicating the need for monitoring of signs and symptoms, diagnostic exploration and accurate treatment and the need for close monitoring of postpartum women diagnosed with COVID-19, whether symptomatic or not.

Objetivo: mapear las evidencias disponibles en la literatura sobre el manejo y los resultados de la infección por el nuevo coronavirus en el período posparto. Método: revisión del alcance según el Instituto Joanna Briggs, desarrollada en cuatro fuentes de datos electrónicas. La extracción, el análisis y la síntesis de los datos fueron realizados por cuatro investigadores independientes. Resultados: se revisaron nueve publicaciones de 188 encontradas. Fueron seis los países que produjeron las evidencias, obtenidas y publicadas en 2020. En estas publicaciones se trataron 21 casos de COVID-19 en el período posparto, 15 (71,4%) de los cuales estaban relacionados con evoluciones graves/exacerbación de la enfermedad y seis (28,6%) diagnosticados tras el alta hospitalaria. Conclusión: el mapeo apunta hacia la ocurrencia de la infección o su agravamiento en el posparto, con indicaciones de seguimiento de indicios y síntomas, exploración diagnóstica, tratamiento preciso y la necesidad de un seguimiento cercano a las mujeres diagnosticadas con COVID-19, sintomáticas o no, en el período posparto.

Evaluation of the potential for transmission of coronavirus disease via saliva: a systematic review and meta-analysis

Aim: One of the main factors that play a pivotal role in the transmission of COVID-19 from human to human is saliva; according to the subject's importance, the present study aimed to evaluate the potential of transmission via the saliva of coronavirus disease. Methods: PubMed, ISI, Embase, Scopus, Medicine have been used until September 2020 to search for articles. Therefore, EndNote X9 used to manage electronic resources. A 95% confidence interval (CI) effect size, fixed effect model, Inverse-variance methods have been calculated. The positive rate of SARS-CoV2 assessed with meta analysis. To deal with potential heterogeneity, random effects were used, and I2 showed heterogeneity. I2 values above 50% signified moderate-to-high heterogeneity. The Meta-analysis has been evaluated with Stata/MP v.16 (the fastest version of Stata) statistical software. Results: According to the study's purpose, in the initial search with keywords, 19 articles were found, the full text of 3 studies was reviewed, and finally, three studies were selected. The positive rate of SARS-CoV2 was 86% (86%; 95% CI 67 %-100%). Conclusion: saliva can be a non-invasive specimen type for diagnosis of COVID-19. Dentists should be aware that saliva plays a major role in the transmission of COVID-19 from human to human, and failure to follow prevention protocols can contaminate them

Endodontic treatment during COVID-19 pandemic - Economic perception of dental professionals

Aim: This study evaluated, by the application of questionnaires, the impact of the COVID-19 pandemic on the clinical routine and inspection by the competent authorities, on the flow of patients in the office, as well as on possible changes in Endodontic treatment costs and the amounts charged to patients. Methods: This cross-sectional study was conducted from May 2nd, 2020 to May 6th, 2020, using an online questionnaire with a convenience sample. The inclusion criterion was professionals who perform endodontic treatments in daily clinical practice and who professional setting is private practice. The questionnaire brought questions about the impact on costs and the amount charged to the patient. Results: A total of 1042 questionnaires were answered from all the different states of Brazil, by professional who usually perform Endodontic treatment, and who is working in private practice. A total of 1010 (96.9%) respondents affirm it was necessary to modify the protective equipment in endodontic treatment due to pandemic and longer intervals between appointments was cited by 922 (88.5%), economically affecting the dental practice. There was no association between routine changes and economic impacts with gender, professional experience, area of residence or education level. Conclusion: In conclusion, most dental professionals recognized changes in the routine of endodontic treatment during the COVID-19 pandemic. They have a perception of increase in endodontic costs, and reduction in the volume of patients

Information sources of Brazilian undergraduate dental students during the COVID-19 outbreak: a cross-sectional study

Aim: This cross-sectional study aimed to investigate where Brazilian dental students seek information about COVID-19 by a self-administered web-based questionnaire. Methods: A social network campaign on Instagram was raised to approach the target population. The dental students responded to a multiple-response question asking where or with whom they get information about COVID-19. The possible answers were government official websites or health and education institutions websites, TV Programs, professors, social media, scientific articles, health professionals, and family members. The data were analyzed by descriptive statistics, and the frequency distributions of responses were evaluated by gender, age, type of institution, and year of enrollment. Results: A total of 833 valid responses were received. The main source of information used by the dental students were government official websites or health and education institutions websites, which were reported by 739 (88.7%) participants. In the sequence, 477 (57.3%) participants chose health professionals while 468 (56.2%) chose scientific articles as information sources. The use of social media was reported by 451 (54.1%) students, while TV programs were information sources used by 332 (39.9%) students. The least used information sources were professors, reported by 317 (38.1%) students, and family members, chosen only by 65 (7.8%) participants. Conclusion: Brazilian dental students rely on multiple information sources to stay informed about COVID-19, mainly focusing their information-seeking behavior on governmental and health professional's websites

ACUTE SKIN FAILURE E LESÃO POR PRESSÃO EM PACIENTE COM COVID-19 / ACUTE SKIN FAILURE AND PRESSURE INJURY IN THE PATIENT WITH COVID-19

Objetivo:relatar o caso de um paciente crítico com COVID-19 e mostrar os principais achados relacionados à lesão considerada Acute skin failure (ASF), bem como realizar seu diagnóstico diferencial com lesão por pressão (LP) evitável. Método: estudo observacional do tipo relato de caso, desenvolvido em um hospital de São Paulo, na unidade de terapia intensiva (UTI) exclusiva a pessoas diagnosticadas com COVID-19. Os dados foram coletados de um único paciente, entre os meses de março e setembro de 2020. Resultados: paciente com complicações da COVID-19 evoluiu com lesão de pele, inicialmente definida como LP e posteriormente reclassificada como ASF. Os seguintes achados corroboraram o diagnóstico: ventilação mecânica invasiva prolongada, insuficiências respiratória, renal e cardíaca e sepse de foco respiratório. Além disso, outros fatores agravantes, como o uso de droga vasoativa, instabilidade hemodinâmica com intolerância ao mínimo reposicionamento, jejum prolongado e coagulopatia intravascular disseminada associada à infecção pelo coronavírus. Conclusão: o relato mostra que existem dificuldades para o diagnóstico diferencial entre ASF e LP na prática clínica. Trata-se de conceito novo, sendo fundamental que o profissional de saúde reconheça os principais fatores associados ao aparecimento da ASF, muitos dos quais também estão relacionados ao desenvolvimento das LP, ressaltando a necessidade de análise individualizada dessas lesões, e garantia da implementação de intervenções adequadas para prevenção e tratamento.

High risk coronavirus disease 2019: The primary results of the CoronaHeart multi-center cohort study

BACKGROUND: Patients with Coronavirus Disease 2019 (COVID-19) may present high risk features during hospitalization, including cardiovascular manifestations. However, less is known about the factors that may further increase the risk of death in these patients. METHODS: We included patients with COVID-19 and high risk features according to clinical and/or laboratory criteria at 21 sites in Brazil from June 10th to October 23rd of 2020. All variables were collected until hospital discharge or in-hospital death. RESULTS: A total of 2546 participants were included (mean age 65 years; 60.3% male). Overall, 70.8% were admitted to intensive care units and 54.2% had elevated troponin levels. In-hospital mortality was 41.7%. An interaction among sex, age and mortality was found (p = 0.007). Younger women presented higher rates of death than men (30.0% vs 22.9%), while older men presented higher rates of death than women (57.6% vs 49.2%). The strongest factors associated with in-hospital mortality were need for mechanical ventilation (odds ratio [OR] 8.2, 95% confidence interval [CI] 5.4­12.7), elevated C-reactive protein (OR 2.3, 95% CI 1.7­2.9), cancer (OR 1.8, 95 %CI 1.2­2.9), and elevated troponin levels (OR 1.8, 95% CI 1.4­2.3). A risk score was developed for risk assessment of in-hospital mortality. CONCLUSIONS: This cohort showed that patients with COVID-19 and high risk features have an elevated rate of in-hospital mortality with differences according to age and sex. These results highlight unique aspects of this population and might help identifying patients who may benefit from more careful initial surveillance and potential subsequent interventional therapies

Trends in urological emergencies in the Era of COVID-19

ABSTRACT Purpose: To evaluate trends in emergency room (ER) urological conditions during COVID-19 pandemic lockdown. Materials and Methods: Retrospective analyses of renal colic, hematuria, and urinary retention in ER's admissions of a tertiary hospital during the lockdown period (March 19 to May 4, 2020) in Israel. Patient's demographics and clinical characteristics were compared to those in corresponding periods during 2017-2019, with estimated changes in ER arrival and waiting times, utilization of imaging tests, numbers of hospitalizations, and urgent procedure rates. Results: The number of ER visits for renal colic, hematuria, and urinary retention decreased by 37%, from an average of 451 (2017-2019) to 261 patients (2020). Clinical severity was similar between groups, with no major differences in patient's age, vital signs, or laboratory results. The proportion of ER visits during night hours increased significantly during lockdown (44.8% vs. 34.2%, p=0.002). There was a decrease in renal colic admission rate from 19.8% to 8.4% (p=0.001) without differences in urgent procedures rates, while the 30-day revisit rate decreased from 15.8% to 10.3% during lockdown (p=0.02). Conclusions: General lockdown was accompanied by a significant decrease in common urological presentations to the ER. This change occurred across the clinical severity spectrum of renal colic, hematuria, and urinary retention. In the short term, it appears that patients who sought treatment did not suffer from complications that could be attributed to late arrival or delay in treatment. The long-term implications of abstinence from seeking emergent care are not known and require further investigation.

Após 18 meses de pandemia de COVID-19, OPAS pede prioridade para prevenção ao suicídio

No marco do Dia Mundial da Prevenção ao Suicídio, que acontece no dia 10 de setembro de cada ano, a Organização Pan-Americana da Saúde (OPAS) alertou que a pandemia de COVID-19 exacerbou os fatores de risco associados a comportamentos suicidas e pediu pela priorização da prevenção ao suicídio.

Diretora da OPAS pede que países priorizem mulheres grávidas e lactantes na vacinação contra COVID-19

Alertando que a COVID-19 representa um sério risco para mulheres grávidas na América Latina e no Caribe, a diretora da Organização Pan-Americana da Saúde (OPAS), Carissa F. Etienne, pediu aos países que priorizem gestantes e lactantes na vacinação contra a doença.

Posicionamento SOGESP - Vacinação contra covid-19 para gestantes e puérperas que tomaram a primeira dose de vacina Astrazeneca/Oxford

Parecer da Associação de Obstetrícia e Ginecologia de São Paulo – SOGESP sobre a vacinação contra covid-19 para gestantes e puérperas que tomaram a primeira dose de vacina Astrazeneca/Oxford.

OPAS alerta que apenas uma em cada quatro pessoas na América Latina e no Caribe foi totalmente vacinada contra COVID-19

A diretora da Organização Pan-Americana da Saúde (OPAS), Carissa F. Etienne, alertou que 75% da população da América Latina e do Caribe ainda não foi totalmente vacinada contra a COVID-19 e informou que a OPAS está acelerando sua campanha para expandir o acesso às vacinas em toda a região.

Covid-19 And Rheumatic Autoimmune Systemic Diseases: Role of Pre-Existing Lung Involvement and Ongoing Treatments.

BACKGROUND: The Covid-19 pandemic may have a deleterious impact on patients with autoimmune systemic diseases (ASD) due to their deep immune-system alterations. OBJECTIVE: To investigate the prevalence of symptomatic Covid-19 and its correlations with both organ involvement and ongoing treatments in a large series of Italian ASD patients during the first wave of pandemic. METHOD: Our multicenter telephone 6-week survey included 3,029 unselected ASD patients enrolled at 36 tertiary referral centers of northern, central, and southern Italian macro-areas with different diffusion of pandemic. Symptomatic SARS-CoV-2 infection was classified as definite Covid-19 (presence of symptoms plus positive oral/nasopharyngeal swabs) or highly suspected Covid-19 (highly suggestive symptoms, in absence of a swab testing). RESULTS: A significantly higher prevalence of definite plus highly suspected Covid-19 compared to Italian general population was detected in the whole ASD series (p=.000), as well as in patients from the three macro-areas (p=.000 in all). Statistically higher prevalence of Covid-19 was also found in connective tissue diseases compared to chronic arthritis subgroup (p=.000) and in ASD patients with pre-existing interstitial lung involvement (p=.000). Patients treated with either conventional disease modifying anti-rheumatic drugs (DMARDs) and/or biological DMARDs showed a significantly lower prevalence of Covid-19 (p=.000 in both). Finally, scleroderma patients undergoing low-dose aspirin showed significantly lower rate of Covid-19 compared to those without (p=0.003). CONCLUSION: The higher prevalence of Covid-19 in ASD patients along with the significant correlations with important clinical features and therapeutic regimens suggests the need to develop targeted prevention/management strategies during the current pandemic wave.

Impact of Sitagliptin in Non-Diabetic Covid-19 Patients.

OBJECTIVE: In Coronavirus disease 2019 (Covid-19), SARS-CoV-2 may use dipeptidyl peptidase 4 (DPP4) as an entry-point in different tissues expressing these receptors. DPP4 inhibitors (DPP4Is), also named gliptins like sitagliptin, have anti-inflammatory and antioxidant effects; thereby lessen inflammatory and oxidative stress in diabetic Covid-19 patients. Therefore, the present study aimed to illustrate the potential beneficial effect of sitagliptin in managing Covid-19 in non-diabetic patients. METHODS: A total number of 89 patients with Covid-19 were recruited from a single-center at the time of diagnosis. The recruited patients were assigned according to the standard therapy for Covid-19 and our interventional therapy into two groups; Group A: Covid-19 patients on the standard therapy (n=40) and Group B: Covid-19 patients on the standard therapy plus sitagliptin (n=49). The duration of this interventional study was 28 days according to the guideline in management patients with Covid-19. Routine laboratory investigations, serological tests, complete blood count (CBC), C-reactive protein (CRP), D-dimer, lactate dehydrogenase (LDH), and serum ferritin were measured to observed Covid-19 severity and complications. Lung computed tomography (CT) and clinical scores were evaluated. RESULTS: The present study illustrated that sitagliptin add-on standard therapy improved clinical outcomes, radiological scores, and inflammatory biomarkers than standard therapy alone in non-diabetic patients with Covid-19 (P<0.01). CONCLUSIONS: Sitagliptin add-on standard therapy in managing non-diabetic Covid-19 patients may have a robust beneficial effect by modulating inflammatory cytokines with subsequent good clinical outcomes.

SARS-CoV-2 Seroprevalence in a Rural and Urban Household Cohort during First and Second Waves of Infections, South Africa, July 2020-March 2021.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections may be underestimated because of limited access to testing. We measured SARS-CoV-2 seroprevalence in South Africa every 2 months during July 2020-March 2021 in randomly selected household cohorts in 2 communities. We compared seroprevalence to reported laboratory-confirmed infections, hospitalizations, and deaths to calculate infection-case, infection-hospitalization, and infection-fatality ratios in 2 waves of infection. Post-second wave seroprevalence ranged from 18% in the rural community children <5 years of age, to 59% in urban community adults 35-59 years of age. The second wave saw a shift in age distribution of case-patients in the urban community (from persons 35-59 years of age to persons at the extremes of age), higher attack rates in the rural community, and a higher infection-fatality ratio in the urban community. Approximately 95% of SARS-CoV-2 infections were not reported to national surveillance.

Implementation of Telehealth Services at the VA during COVID-19.

BACKGROUND: At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting non-urgent in-person appointments. Even though, the VA was an early adopter of telehealth in the late 1990's, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020. OBJECTIVE: We compare telehealth services use at one VA Medical Center, Greater Los Angeles across three clinics, primary care (PC), cardiology, and home-based primary care (HBPC), 12-months before and 12-months after onset of COVID-19 (March 2020). METHODS: We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect (VVC) encounters were examined for each clinic. Semi-structured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC, during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes. RESULTS: Prior to COVID-19, telehealth use was minimal at all three clinics, but at the onset of COVID-19, telehealth use increased substantially for all three clinics. Telephone was the main modality of patient choice. Compared to PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps to connect to video-conferencing, creating new scheduling grids, limited access to internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identifying staff telehealth champions, and developing workflows to help incorporate telehealth into treatment plans) were noted. CONCLUSIONS: Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic.

Exploring Well-being of Healthcare Workers during the COVID-19 Pandemic: A Prospective Longitudinal Study Protocol.

BACKGROUND: Healthcare workers (HCWs) have experienced several stressors associated with the COVID-19 pandemic. Structural stressors, including extended work hours, re-deployment, and changes in organizational mandates often intersect with interpersonal and personal stressors, such as caring for those with COVID-19 infections, worrying about infection to self, family and loved ones, working despite shortages of personal protective equipment, and encountering various difficult moral-ethical dilemmas. OBJECTIVE: The paper describes the protocol for a longitudinal study seeking to capture the unique experiences, challenges, and changes faced by HCWs during the COVID-19 pandemic. The study seeks to explore: (a) the impact of COVID-19 on the mental well-being of HCWs with a particular focus on moral distress, and (b) perceptions and satisfaction with delivery of care, and (c) how changes in work structure are tolerated among HCWs providing clinical services. METHODS: A prospective longitudinal design is employed to assess HCWs' experiences across domains of mental health (depression, anxiety, posttraumatic stress, and well-being), moral distress and moral reasoning, work-related changes and telehealth, organizational responses to COVID-19 concerns, and experiences with COVID-19 infections to self and to others. We recruited HCWs from across Canada through convenience snowball sampling to participate in either a short-form or long-form online survey at baseline. Respondents to the baseline survey are invited to complete a follow-up survey every three months, for a total of 18 months. RESULTS: A total of 1926 participants completed baseline surveys between June 26, 2020, and December 31, 2020, and 1859 participants provided their emails for contact to participate in follow-up surveys. As of July 2021, data collection is ongoing, with participants nearing the 6 or 9-month follow-up periods depending on their initial time of self-enrollment. CONCLUSIONS: The current protocol describes a study that will provide unique insights into the immediate and longitudinal impact of the COVID-19 pandemic on dimensions of mental health, moral distress, healthcare delivery, and workplace environment in HCWs. The feasibility and acceptability of implementing a short-form and long-form survey on participant engagement and data retention will also be discussed.

Knowledge, attitude and practice towards COVID-19 among healthcare workers in public health facilities, Eastern Ethiopia.

BACKGROUND: On 13 March 2020, Ethiopia reported the first confirmed case of COVID-19 in Addis Ababa. COVID-19 is likely to overwhelm an already fragile health-care delivery system and reduce the availability of essential health services. This analysis of data from Somali region of Eastern Ethiopia on health workers knowledge, attitude and practice towards the prevention and control of COVID-19 may be used in planning health education programs about the emerging viral disease. OBJECTIVE: This study is aimed to investigate the knowledge, attitude and practice of health workers towards COVID-19 infection. METHODS: Cross-sectional study was conducted among healthcare workers in three public health facilities in Somali region, Eastern Ethiopia. A self-administered questionnaire was shared to the all-health workers working at the public health facilities. Multiple questions with nominal scale were used to assess Knowledge (15 questions) and practice (6 questions); whereas attitude was assessed using 14 Likert 5-scale questions in negative dimension. Mean scores were calculated and used as a cut point to dichotomize the outcome variables (good knowledge >13.7; good practice <18.8 and favorable attitude <10.5). T-test and ANOVA were used to analyze the mean score differences of knowledge, attitude and practice between the independent variables. Spearman's correlation was used to assess the relationship between mean knowledge and attitude scores. RESULTS: Of the 686 HCWs approached, a total of 434 HCWs responded (response rate = 63%). Mean age of participants was 27.6±5.3 years, and majorities (67.5%) of them were male. The mean knowledge score was 13.7± 2.6 and 73% of participants had sufficient knowledge. The mean attitude score was 10.5±4.1 and 55% of the participants) had a good attitude toward COVID-19. The mean practice score was 18.8± 5.8 and 62% of the participants better practiced COVID-19 precautionary measures. There was a negative correlation between knowledge scores, attitude scores (r=-0.295, P<0.001) and practice (r=-0.298, P<0.001). CONCLUSIONS: The overall level of knowledge and practice was relatively better than the attitude. This highlights the need to implement strategies that enhance the positive attitude and safe practice of the healthcare workers for better containment of the pandemic and essential healthcare services.

Surveillance for Adverse Events After COVID-19 mRNA Vaccination.

Importance: Safety surveillance of vaccines against COVID-19 is critical to ensure safety, maintain trust, and inform policy. Objectives: To monitor 23 serious outcomes weekly, using comprehensive health records on a diverse population. Design, Setting, and Participants: This study represents an interim analysis of safety surveillance data from Vaccine Safety Datalink. The 10 162 227 vaccine-eligible members of 8 participating US health plans were monitored with administrative data updated weekly and supplemented with medical record review for selected outcomes from December 14, 2020, through June 26, 2021. Exposures: Receipt of BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) COVID-19 vaccination, with a risk interval of 21 days for individuals after vaccine dose 1 or 2 compared with an interval of 22 to 42 days for similar individuals after vaccine dose 1 or 2. Main Outcomes and Measures: Incidence of serious outcomes, including acute myocardial infarction, Bell palsy, cerebral venous sinus thrombosis, Guillain-Barré syndrome, myocarditis/pericarditis, pulmonary embolism, stroke, and thrombosis with thrombocytopenia syndrome. Incidence of events that occurred among vaccine recipients 1 to 21 days after either dose 1 or 2 of a messenger RNA (mRNA) vaccine was compared with that of vaccinated concurrent comparators who, on the same calendar day, had received their most recent dose 22 to 42 days earlier. Rate ratios (RRs) were estimated by Poisson regression, adjusted for age, sex, race and ethnicity, health plan, and calendar day. For a signal, a 1-sided P < .0048 was required to keep type I error below .05 during 2 years of weekly analyses. For 4 additional outcomes, including anaphylaxis, only descriptive analyses were conducted. Results: A total of 11 845 128 doses of mRNA vaccines (57% BNT162b2; 6 175 813 first doses and 5 669 315 second doses) were administered to 6.2 million individuals (mean age, 49 years; 54% female individuals). The incidence of events per 1 000 000 person-years during the risk vs comparison intervals for ischemic stroke was 1612 vs 1781 (RR, 0.97; 95% CI, 0.87-1.08); for appendicitis, 1179 vs 1345 (RR, 0.82; 95% CI, 0.73-0.93); and for acute myocardial infarction, 935 vs 1030 (RR, 1.02; 95% CI, 0.89-1.18). No vaccine-outcome association met the prespecified requirement for a signal. Incidence of confirmed anaphylaxis was 4.8 (95% CI, 3.2-6.9) per million doses of BNT162b2 and 5.1 (95% CI, 3.3-7.6) per million doses of mRNA-1273. Conclusions and Relevance: In interim analyses of surveillance of mRNA COVID-19 vaccines, incidence of selected serious outcomes was not significantly higher 1 to 21 days postvaccination compared with 22 to 42 days postvaccination. While CIs were wide for many outcomes, surveillance is ongoing.

COVID-19: an opportunity to re-evaluate the implementation of a One Health approach to tackling emerging infections in Nigeria and other sub-Saharan African countries.

BACKGROUND: One Health (OH) has resurfaced in the light of the ravaging COVID-19 pandemic. It has been accepted by many local and global health authorities as a suitable approach for preventing and responding to infectious disease outbreaks including pandemics. MAIN BODY: One Health (OH) is a multisectoral and interdisciplinary framework for managing the animal, human, and ecosystem determinants of health. Globally, the majority of emerging infections in humans including SARS-Cov2-the causative agent of COVID-19-are transmitted from animals through environmental contacts in the last few decades. Yet, even when the biological and social interactions at the human, animal, and environmental interface that drive spillover of zoonotic diseases have been proven, OH strategies to address associated complex health challenges today are still rudimentary in many national health systems. Despite the disproportionate burden of infectious diseases in sub-Saharan Africa, OH is minimally incorporated into routine disease control and national health security programs. Challenges include poor policy support for OH in sub-Saharan Africa, and where some form of policy framework does exist, there are significant implementation bottlenecks. In this paper, we identified ideological, technical, operational, and economic barriers to OH implementation in Nigeria and sub-Saharan Africa, and highlighted possible recommendations across these domains. In order to yield sustainable benefits, a relevant OH policy approach in the sub-Saharan African health systems must derive from a buy-in of the critical mass of stakeholders in the society. CONCLUSION: The implementation of sustainable OH approaches as a countermeasure to recurring emerging infections is a developmental priority for sub-Saharan African countries. A deep understanding of the local context must be leveraged to develop integrative OH solutions that are bold, rooted in science, and proven to be compatible with the level of development in sub-Saharan Africa.

Taxi drivers and COVID-19 in Jamaica: Occupationally related income decline and health behaviour.

Income and employment are recognised as social determinants of health. Occupationally related exposures and working conditions impact health behaviours. Taxi drivers have been recognised as an occupationally COVID-19 at-risk group. COVID-19 threatens their lives and livelihoods. This study describes self-reported income changes attributed to the COVID-19 pandemic among taxi drivers. Associations between percentage change in income and reported prevention practices were ascertained. In May 2020, a cross-sectional study was done among 282 taxi drivers in the Kingston and St. Andrew Metropolitan Area in Jamaica. Multi-stage sampling was used to select taxi driver from seven hubs. Data collection utilised a 28-item questionnaire. Self-reported income before and during the COVID-19 pandemic was ascertained and correlations between relative changes in income and COVID-19 prevention practices were assessed. The median pre-COVID-19 monthly income was USD 1,428.57 (IQR = 1,467.26), about USD 51/day. Median monthly income since the COVID-19 outbreak was USD 500 (IQR = 472.37), about USD 18/day, representing a 65% reduction in income. There was a statistically significant association between the relative change in income and the practice of wearing mask while transporting passengers. Generally, as the relative change (decline) in income increased, reported compliance with mask wearing decreased (Spearman's rho = -0.15, p = 0.02). Taxi drivers have experienced marked decline in income due to the COVID-19 pandemic, with implications for health practices and the maintenance of desired health behaviours. Authorities should be cognisant of the economic impact and COVID-related consequences in the taxi industry, as they seek to develop COVID-19 occupationally related prevention and control programmes.

A review of pears (Pyrus spp.), ancient functional food for modern times.

BACKGROUND: Pears have been world-widely used as a sweet and nutritious food and a folk medicine for more than two millennia. METHODS: We conducted a review from ancient literatures to current reports to extract evidence-based functions of pears. RESULTS: We found that pears have many active compounds, e.g., flavonoids, triterpenoids, and phenolic acids including arbutin, chlorogenic acid, malaxinic acid, etc. Most of researchers agree that the beneficial compounds are concentrated in the peels. From various in vitro, in vivo, and human studies, the medicinal functions of pears can be summarized as anti-diabetic,-obese, -hyperlipidemic, -inflammatory, -mutagenic, and -carcinogenic effects, detoxification of xenobiotics, respiratory and cardio-protective effects, and skin whitening effects. Therefore, pears seem to be even effective for prevention from Covid-19 or PM2.5 among high susceptible people with multiple underlying diseases. CONCLUSION: For the current or post Covid-19 era, pears have potential for functional food or medicine for both of communicable and non-communicable disease.

Objective and Subjective Behavioral Measures in Myopic and Non-Myopic Children During the COVID-19 Pandemic.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic required a shift to electronic devices for education and entertainment, with children more confined to home, which may affect eye growth and myopia. Our goal was to assess behaviors during COVID-19 in myopic and non-myopic children. Methods: Parents completed a questionnaire for their children (ages 8.3 ± 2.4 years, n = 53) regarding visual activity in summer 2020, during the COVID-19 pandemic, as well as during school time and the summer before COVID-19. Children also wore an Actiwatch for 10 days in summer 2020 for objective measures of light exposure, activity, and sleep. Data were analyzed with repeated-measures analysis of variance. Results: Subjective measures showed that during COVID-19, children exhibited increased electronic device use and decreased activity and time outdoors (P < 0.05 for all), while time spent doing near work was not different than during a typical school or summer session before COVID-19 (P > 0.05). Objective measures during COVID-19 showed that myopic children exhibited lower daily light exposure (P = 0.04) and less activity (P = 0.04) than non-myopic children. Conclusions: Children demonstrated increased electronic device use and decreased activity and time outdoors during COVID-19, with myopic children exhibiting lower light exposure and activity than non-myopes. Long-term follow-up is needed to understand if these behavioral changes ultimately contribute to myopia progression. Translational Relevance: Children's behaviors changed during the COVID-19 pandemic, which may have implications in eye growth and myopia.

New-onset or Exacerbated Occupational Hand Eczema among Healthcare Workers During the COVID-19 Pandemic: A Growing Health Problem.

Hand hygiene is one of the cornerstones in ensuring effective infection control during the Coronavirus disease 2019 (COVID-19) outbreak. We aimed to investigate the prevalence of new-onset occupational HE during the COVID-19 outbreak in healthcare workers (HCWs) and the clinical course, clinical features, and risk factors of occupational hand eczema (HE). A total of 159 volunteer HCWs (female: n=112; male: n=47, mean age=35.55±7.03 years) working in a pandemic hospital were included. Participants were questioned in terms of daily hand hygiene, use of gloves, and signs and symptoms associated with HE before and during the COVID-19 pandemic. HCWs were divided into two groups classified as non-COVID and COVID, according to the unit they worked in. In our study, 55 participants reported new-onset signs and/or symptoms associated with HE during the COVID-19 pandemic. 59 participants described an increase in signs and/or symptoms associated with HE. The presence of newly-formed or increased signs and/or symptoms associated with HE was found to be 71.7%. A significant increase in dryness, itching, pain/burning, erythema, and scaling was observed (P<0.05). No difference was found between the COVID and non-COVID groups in terms of newly formed and/or increased signs and symptoms (P>0.05). The study included a limited number of participants, and the participants self-reported the signs and symptoms associated with HE. During the COVID-19 period, there has been a significant increase in the signs and symptoms of occupational HE as a result of increased hand hygiene practices in HCWs.

A Reminder of Skin Cancer During the COVID-19 Pandemic.

The year 2020 has been marked by the coronavirus disease 2019 (COVID-19) pandemic, caused by an RNA virus called SARS-COV2 (severe acute respiratory syndrome coronavirus). The fight against this epidemic has become the center of our daily clinical practice as well as of our private lives, in which avoiding infection has become one of our most important goals. Even though COVID-19 is a potentially lethal disease, especially for the elderly and people with chronic diseases, it did not cause all the other life-threatening diseases to vanish. On the contrary, many scheduled medical activities and procedures, especially preventive and non-urgent internal and surgical activities, had to be postponed due to COVID-19 crisis. This interruption in the health care system can negatively affect the diagnosis and management of our patients with other health issues, namely malignant skin tumors, of which melanoma is the most aggressive. In this letter, we as dermatovenereologists from the Croatian Referral Centre of The Ministry of Health for Melanoma needed to express our concern regarding the increasing number of patients with delayed diagnosis of skin cancer, with special emphasis on melanoma detection and treatment. In the last few months, a large number of our newly-diagnosed patients with melanoma, as well as those with non-melanoma skin cancers, reported that they had noticed a suspicious skin lesion a few months ago but decided not to seek help from dermatologist due to the worrisome epidemiologic situation. In the current environment, clinical skin examination may be viewed as less important and thus postponed, but neglecting melanoma throughout the virus outbreak may lead to increased rates of morbidity, mortality, and consequently a greater financial burden for the health system (1). There are several reasons for such a relaxed attitude towards skin health in our patients. Unlike cardiac, pulmonary, or digestive difficulties, which patients consider life-threatening and for which they seek emergency care despite the coronavirus pandemic, skin tumors do not cause great subjective or significantly noticeable objective symptoms. Moreover, all of the skin tumors and especially melanoma , mostly present as small changes of just a few millimeters in diameter in the early stage at which they are prognostically most favorable. For the average person with no medical education, such small lesions usually do not cause any concern as they have no awareness of the fact that small and inconspicuous skin lesions may be dangerous and potentially even lethal. According to the recommendations concerning patient management during COVID-19 pandemic, oncological examinations should still be performed regularly (2). In spite of that, the cancelation of appointments, especially by patients who are being monitored for high-risk lesions, is inevitable when COVID-19 is disrupting everyone's lives. With the pandemic evolving and no clear solutions in sight, now is the time to emphasize the importance of self-examination and teledermatology in early melanoma diagnosis. Even though diagnosing and managing pigmented skin lesions usually requires face-to-face examinations and dermoscopy as a crucial tool in early melanoma detection, in these times, and especially for people with a higher risk of SARS-COV2 infection, remote communication could prevent delays resulting in worse prognosis and could also eliminate the risk of infecting healthcare workers. Moreover, teledermatology can also be initiated by doctors asking patients to monitor lesions between clinical visits (3). However, we should not rely solely on this technology but should instead assess every patient individually and insist on a face-to-face examination for those at greater risk, with the aim that, if necessary, surgery be performed in timely manner. The collaboration between general practitioners and dermatologists represents an important aspect of achieving the most rational and effective health care in terms of performing triage of patients who can be assessed by teledermatology as well as referring to hospital centers those who need face-to-face examination and further treatment. During the first breakout of the epidemic in March 2020, the multidisciplinary team for melanoma from the Croatian National Referral Melanoma Centre provided recommendations for the management of patients with melanoma during COVID epidemic, designed according to the guidelines of the National Comprehensive Cancer Network (NCCN) (4) and considering the specifics of health care and clinical practice in the Republic of Croatia. Due to epidemic circumstances, preventive actions such as Euromelanoma and many other campaigns that included massive preventive skin examinations of the population and which were conducted for years by Croatian dermatologists throughout the country, could not be organized this year. This is particularly worrisome because on average about 800 patients are diagnosed with melanoma annually in Croatia, of which 60 during public health preventive actions. Despite these circumstances, we were able to maintain public awareness of the importance of early skin cancer recognition by sending the message through different media such as newspapers, television, and social media (Facebook and Instagram). We find that now more than ever it is essential to remind and teach the population about the importance of regular monthly skin self-examinations and recognition of atypical lesions. Clearly, a thorough dermatological examination includes full skin examination from head to toe. Herein we would also like to remind our readers that most skin cancers develop in the head and neck area, which is the most UV-exposed part of the body. Therefore, despite the epidemic conditions, the removal of patients' masks and thorough inspection of the face is mandatory. We find it most practical and efficient to perform the body and scalp examination first, followed by the face examination after the patient gets dressed. Prior to removal of the mask, we ask the patient not to talk during close examination. Even though this could make dermoscopic examination harder to perform, we strongly suggest wearing a protective shield and mask during close examination whenever possible. Between patients, the examining room should be disinfected and ventilated. As doctors, we live in uncertain times when we are heavily burdened by the currently unstoppable COVID epidemic, always awaiting new instructions from the state administration every day and wondering whether perhaps tomorrow we dermatologists will be assigned solely to the service of patients with COVID-19. In the end, we would like to once again remind you that despite the ravaging COVID pandemic and all the epidemiological measures that come with it, other diseases still exist. It is expected of us to draw attention to the still growing incidence of skin cancers and the serious consequences that can occur as a result of a delayed diagnosis.

Diagnostic Delays for Non-melanoma Skin Cancers in Renal Transplant Recipients during the COVID-19 Pandemic: What is Hiding Behind the Mask?

Dear Editor, The ongoing pandemic of coronavirus disease 2019 (COVID-19) was declared by the World Health Organization on March 11, 2020, and remains a global challenge. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), transmitted primarily through respiratory droplets and aerosols. Even though the COVID-19 vaccine has become available since December 2020, the main preventive measures still include social distancing, hand washing, and the use of protective face masks. By May 22, 2021, 3,437,545 deaths caused by SARS-CoV-2 have been registered by WHO, confirming the burden of this disease (1). Consequently, the pandemic has become a challenge for health care systems, as they had to be focused on the care of patients with COVID-19. During the first lockdown from March to May 2020, it was advised to postpone clinical visits whenever this could be done without risk. This recommendation was mainly aimed at older patients and those with chronic diseases, as it has been shown that they are at greater risk for complications from COVID-19. Renal transplant recipients (RTRs) are at a greater risk for infections and different cancers due to their permanent immunosuppressive therapy. The most common malignancies in RTRs are skin cancers, particularly non-melanoma skin cancers. It has been estimated that RTRs have a 65-250 times higher risk for cutaneous squamous cell carcinoma (SCC), 10 times higher risk for basal cell carcinoma, and 2-5 times higher risk for melanoma when compared with the general population (2-4). RTRs are at a higher risk for complications from COVID-19, not only because of their immunosuppressive therapy but also because of different comorbidities, such as hypertension, cardiovascular disease, and diabetes mellitus (5). Therefore, RTRs tend to limit their medical visits and postpone clinical examinations for skin cancer screenings. Moreover, during clinical visits the patients are commonly asked to keep their protective masks on, increasing the risk of overlooking their facial skin changes. Herein we present two RTRs who developed skin cancers during the COVID-19 pandemic, and the tumors were diagnosed with a significant delay. Patient 1 A 67-year-old woman with unknown primary kidney disease received a renal allograft from a deceased donor in 2014. The immunosuppressive protocol included antithymocyte globulin induction with tacrolimus, mycophenolate mofetil, and steroid maintenance. In January 2020, she had noticed a reddish squamous lesion on her right cheek, which enlarged slowly. Since there were no other symptoms, she postponed the dermatologic examination. Additionally, she further postponed the visit to her physician during the pandemic as she wanted to avoid social contact as much as possible. One year later, at the nephrologist's examination, she was asked to take off her face mask for a skin check, and two skin tumors on her right cheek were noticed (Figure 1). One lesion was located at the angle of her mandible and presented as a hypertrophic, sharply marginated lesion with central crusting and a diameter of 2 cm. The other lesion was at the right zygomatic region and appeared as a scaly, erythematous lesion with a diameter of 7 mm. The patient was referred to a dermatologist, and a biopsy of both lesions was indicated. The pathohistological analysis revealed cutaneous SCC in situ for the mandibular lesion and actinic keratosis for the zygomatic lesion. SCC in situ has been excised, and actinic keratosis was treated by cryosurgery. Patient 2 A 66-year-old woman received a renal allograft from a deceased donor in 2010 due to chronic glomerulonephritis without biopsy. The immunosuppressive protocol included basiliximab induction with tacrolimus, mycophenolate mofetil, and steroid maintenance. In June 2020, an erosion occurred at her left infraocular area and did not heal but instead gradually enlarged. The patient suspected that the "wound" developed due to the friction from the rim of her eyeglasses. Six months later, the nephrologist noticed the erosion which was 10×5 mm in size with a slightly elevated, pearl-colored margin (Figure 2). The patient was referred to a dermatologist who indicated tumor excision due to suspected basal cell carcinoma. The pathohistological analysis confirmed the clinical diagnosis. DISCUSSION Both presented patients did not inform their family physicians about their skin changes because they avoided all non-nephrological medical visits during the pandemic. The additional reason for the diagnostic delay was the fact that they kept the masks on their faces during most examinations, with the skin lesions behind the mask consequently remaining unnoticed. The problem of diagnostic delay of skin cancers during the COVID-19 pandemic has been recognized by several studies. Canadian authors compared the number of biopsies for skin cancers during the first 15 weeks in 2020 and during the same period in 2019. They found a decrease in the number of biopsies for non-melanoma skin cancers (NMSC) and melanoma of 18% and 27%, respectively (6). A multicenter study performed in northern-central Italy showed that the number of skin cancer (NMSC and melanoma) diagnoses fell by 56.7% in weeks 11 to 20 of 2020 compared with the average number noted in the same periods of 2018 and 2019 (7). Furthermore, a single-center retrospective study in Italy demonstrated that the number of advanced skin cancers surgically treated between May 18 and November 18, 2020, was significantly higher than in the same period in 2019. These findings led the authors to conclude that the surgical excisions were postponed due to the delay in follow-ups, which resulted in increased incidence of advanced skin cancers (8). RTRs are at particular risk of severe consequences from diagnostic delay with regard to skin cancers. Namely, skin cancers in RTRs are more aggressive and are associated with a higher incidence rate of metastases and recurrences than in the general population (9). Therefore, RTRs should be advised to regularly check their skin for potential skin cancer, which includes self-examinations and dermatologic follow-ups.

[Intracerebral haemorrhage twelve days after vaccination with ChAdOx1 nCoV-19].

The COVID-19-pandemic has had a huge impact on health and economics all over the world resulting in widespread vaccine development. Vaccine-induced immune thrombotic thrombocytropenia has been described, suggesting a link between the two adeno-vector vaccines ChAdOx1 nCoV-19 (Vaxzevria from AstraZeneca) and Ad26.COV2-S (Janssen from Johnson and Johnson). This rare clinical condition should be suspected in patients with headache, abdominal pain, suspected thrombosis or hemorrhage and thrombocytopenia within 3-30-day post vaccine. In this case report a previously healthy man had thrombocytopenia with fatal intracerebral haemorrhage which was suspected to be related to vaccine.

[Methods for collecting upper respiratory tract specimens for COVID-19 diagnostics].

The World Health Organization recommends a comprehensive testing strategy during the current COVID-19 pandemic. For suspected individuals in a community setup, it is recommended to collect an upper respiratory tract specimen to detect SARS-CoV-2. Different upper respiratory specimen collection techniques or a combination of these can be used to increase test sensitivity or decrease patient discomfort depending on the purpose as summarised in this review. However, it is essential that the specimen collection is performed correctly in order to ensure the diagnostic accuracy of testing.

A Midwestern Academic HIV Clinic Operation during the COVID-19 Pandemic: Implementation Strategy and Preliminary Outcomes.

During the COVID-19 pandemic, HIV clinics had to transform care delivery for people with HIV (PWH). We developed a multifaceted telehealth implementation strategy and monitored number of out of care patients (OOC), medical visit frequency (MVF), gap in care (GiC) and viral suppression (VS), and compared measures to baseline data. Between April and October 2020, 1559 visits were scheduled; 328 (21%) were missed, and 63 (4%) were new to care. Of the remaining 1168 follow-up visits, 412 (35%) were telehealth visits. As of October 2020, there were 53 patients OOC, MVF was 55% and GiC was 24% compared to 34, 69% and 14% at baseline, respectively. Overall VS rate remained high at 93% (97% for telehealth and 91% for in-person visits, p = 0.0001). Our implementation strategy facilitated quick provision of telehealth to a third of PWH receiving care in our clinic. While MVF decreased and GiC increased, VS rates remained high.

[Increase in the positivity of the galactomannan biomarker during the COVID-19 pandemic in the Fifth Region: Valparaíso]. / Aumento en la positividad del biomarcador galactomanano durante la pandemia de COVID-19 en la Quinta Región: Valparaíso.

BACKGROUND: The current pandemic due to SARS-CoV-2 has caused a high burden on health. Cases and series of invasive aspergillosis associated with COVID-19 patients (CAPA) on mechanical ventilation have been described. AIM: To describe the increase in the positivity of the galactomannan (GM) biomarker during the COVID-19 pandemic in the Fifth Region: Valparaíso. METHOD: Retrospective descriptive study. The GM results in both broncho-alveolar lavage (BAL) and serum and the BAL cultures that were sent to the Mycology Laboratory of the University of Valparaíso from January to September 2020 were reviewed; then they were compared with the examinations of the same period of 2019. RESULTS: There was a significant increase in GMs carried out in LBA during the pandemic, concentrating mainly between the months of July-September. CONCLUSIONS: There was a significant increase in GM carried out in LBA during the pandemic, concentrating mainly between the months of July-September.

[Routine immunization 2020 in Chile during the SARS-CoV-2 pandemic]. / Vacunación programática 2020 en Chile en tiempos de pandemia por SARS-CoV-2.

In March 2020, the World Health Organization (WHO) recommended that vaccination not be interrupted as long as countries could safely maintain this service in the context of the SARS-CoV-2 pandemic. WHO also warned about the risk of interruption of programmatic vaccination that generates an increase in the number of people susceptible to infections that are sought to be prevented with the use of vaccines and, therefore, an increase in the probability of disease outbreak. Along with increased morbidity and mortality in risk groups, vaccine-preventable disease outbreaks would put additional demand on the health system already burdened by COVID-19. In August 2020, WHO reported the interruption of essential health services in different countries as a result of the SARS-CoV-2 pandemic, which mainly affected routine and extramural vaccination. In Chile, routine vaccination coverage decreased during 2020 compared to the average coverage for the 2015-2019 period. The smallest decline was 0.39% for the hexavalent vaccine at 2 months of age and the largest decrease was 12.02% at 18 months for the same vaccine. The exception to the fall in coverage in 2020 was adult pneumococcal vaccination, which showed an increase of 0.8% compared to 2015-2019.

[Recommendations for the suspected diagnosis and management of Multisystemic Inflammatory Syndrome (MIS-C) in the context of a SARS-CoV-2 pandemic. April 2021]. / Recomendaciones para la sospecha diagnóstica y manejo del Síndrome Inflamatorio Multisistémico (SIM-COVID-19) en contexto pandemia SARS-CoV-2. Abril 2021.

Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) is a post-infectious complication described in children and adolescents with previous exposure to SARS-CoV-2. Because of its potential to evolve to severe disease -including cardiovascular impairment and multiple organ failure it requires a prompt diagnosis and appropriate management, including intensive care for most cases. These guidelines compile recent information from scientific literature, from our local clinical experiences during the past pandemic year, and have been discussed by experts. The recommendations provided are meant to help the clinical work of health teams attending the pediatric population.

Role of rehabilitation amidst the COVID-19 pandemic: a review.

COVID-19 remains globally a highly infectious disease targeting multiple organs. Rehabilitation is increasingly valued among the supportive care fields to combat COVID-19 as currently definitive curative treatment remains largely absent. This narrative review is to address rehabilitation related topics associated with the treatment of COVID-19 patients. Nosocomial spread remains a high risk for healthcare workers, with comparable high ratios of exposed workers suffering from the disease with more severe clinical course. Primary principle of rehabilitation is to protect rehabilitation physicians and cover all person-to-person interactions. Translating perspectives are encouraged through each multidisciplinary approach. Rehabilitation for the outpatient remains a potential beneficial approach. Artificial intelligence can potentially provide aid and possible answers to important problems that may emerge involving COVID-19. The real value of rehabilitation in COVID-19 may be very impactful and beneficial for patient's physical and mental health.

Who comes when the world goes Code Blue? A novel method of exploring job advertisements for COVID-19 in health care.

AIM: To explore the health workforce responses to COVID-19. DESIGN: Analysis of job advertisements. METHODS: We collected advertisements for healthcare jobs which were caused by and in response to COVID-19 between 4 March-17 April 2020 for the United States, Canada, United Kingdom, Australia and New Zealand. We collected information on the date of the advertisement, position advertised and location. We categorized job positions into three categories: frontline, coordination and decision support. RESULTS: We found 952 job advertisements, 72% of which were from the United States. There was a lag period between reported COVID-19-confirmed cases and job advertisements by several weeks. Nurses were the most advertised position in every country. Frontline workers were substantially more demanded than coordination or decision-support roles. Job advertisements are a novel data source which leverages a readily available information about how workforces respond to a pandemic. The initial phases of the response emphasise the importance of frontline workers, especially nurses.

Clinical features, comorbidities, complications and treatment options in severe and non-severe COVID-19 patients: A systemic review and meta-analysis.

OBJECTIVES: The aim of this analysis was to assess the prevalence of clinical features, comorbidities, complications and treatment options in the patients with COVID-19 and compare incidence of these clinical data in severe and non-severe patients. DESIGN: Systemic review and Meta-analysis. METHODS: PubMed, Embase, Scopus and Web of Sciences databases were searched to identify relevant papers until 20 July 2020. All studies comparing clinical data of severe and non-severe patients of COVID-19 were included. Heterogeneity across included studies was determined using Cochrane's Q test and the I2 statistic. Results were expressed as odds ratio with accompanying 95% confidence intervals. RESULTS: Twelve studies with 3,046 patients were included. The result showed the most prevalent clinical symptoms were fever 88.3%, cough 62.2%, fatigue 39.5% and dyspnoea 31.5%. Further meta-analysis showed incidence of fever, cough, fatigue and dyspnoea was higher in severe patients. The most prevalent comorbidities were hypertension 22.6%, diabetes 11.5%, cardiovascular disease 10.3% and cancer 2.5%. We found that compared with non-severe patients, the symptoms, existing comorbidities and complications are prevalent in severe COVID-19 patients. Future well-methodologically designed studies from other populations are strongly recommended.

COVID-19 and Acute Coronary Syndromes: From Pathophysiology to Clinical Perspectives.

Acute coronary syndromes (ACS) are frequently reported in patients with coronavirus disease 2019 (COVID-19) and may impact patient clinical course and mortality. Although the underlying pathogenesis remains unclear, several potential mechanisms have been hypothesized, including oxygen supply/demand imbalance, direct viral cellular damage, systemic inflammatory response with cytokine-mediated injury, microvascular thrombosis, and endothelial dysfunction. The severe hypoxic state, combined with other conditions frequently reported in COVID-19, namely sepsis, tachyarrhythmias, anemia, hypotension, and shock, can induce a myocardial damage due to the mismatch between oxygen supply and demand and results in type 2 myocardial infarction (MI). In addition, COVID-19 promotes atherosclerotic plaque instability and thrombus formation and may precipitate type 1 MI. Patients with severe disease often show decrease in platelets count, higher levels of d-dimer, ultralarge von Willebrand factor multimers, tissue factor, and prolongation of prothrombin time, which reflects a prothrombotic state. An endothelial dysfunction has been described as a consequence of the direct viral effects and of the hyperinflammatory environment. The expression of tissue factor, von Willebrand factor, thromboxane, and plasminogen activator inhibitor-1 promotes the prothrombotic status. In addition, endothelial cells generate superoxide anions, with enhanced local oxidative stress, and endothelin-1, which affects the vasodilator/vasoconstrictor balance and platelet aggregation. The optimal management of COVID-19 patients is a challenge both for logistic and clinical reasons. A deeper understanding of ACS pathophysiology may yield novel research insights and therapeutic perspectives in higher cardiovascular risk subjects with COVID-19.

Medicinal chemistry strategies towards the development of effective SARS-CoV-2 inhibitors.

Novel therapies are urgently needed to improve global treatment of SARS-CoV-2 infection. Herein, we briefly provide a concise report on the medicinal chemistry strategies towards the development of effective SARS-CoV-2 inhibitors with representative examples in different strategies from the medicinal chemistry perspective.

SARS-CoV-2 infection of the central nervous system in a 14-month-old child: A case report of a complete autopsy.

Background: Neurological and other systemic complications occur in adults with severe COVID-19. Here we describe SARS-CoV-2 infection complicated by neuroinvasion in the post-mortem tissues of a child. Methods: We performed a complete autopsy of a 14-month-old child who died of COVID-19 pneumonitis. Histological sections of multiple organs were stained with haematoxylin and eosin. Luxol fast blue staining for myelin and immunohistochemistry were performed in selected areas of the brain. The presence of SARS-CoV-2 was investigated by immunostaining with anti-spike protein antibody and by RT-qPCR. Findings: Lesions included microthrombosis, pulmonary congestion, interstitial oedema, lymphocytic infiltrates, bronchiolar injury, collapsed alveolar spaces, cortical atrophy, and severe neuronal loss. SARS-CoV-2 staining was observed along the apical region of the choroid plexus (ChP) epithelium and in ependymal cells of the lateral ventricle, but was restricted to ChP capillaries and vessels in some regions. SARS-CoV-2 infection of brain tissue was confirmed by RT-qPCR in fragments of the ChP, lateral ventricle, and cortex. Interpretation: Our results show multisystemic histopathological alterations caused by SARS-CoV-2 infection and contribute to knowledge regarding the course of fatal COVID-19 in children. Furthermore, our findings of ChP infection and viral neurotropism suggest that SARS-CoV-2 may invade the central nervous system by blood-cerebrospinal fluid barrier disruption. Funding: Carlos Chagas Filho Foundation for Supporting Research in the State of Rio de Janeiro (FAPERJ); the National Council for Scientific and Technological Development (CNPq) and Coordination for the Improvement of Higher Education Personnel (CAPES), in addition to intramural grants from D'Or Institute for Research and Education. Resumo: Complicações sistêmicas e neurológicas foram descritas em adultos com COVID-19 grave. Neste trabalho, descrevemos a infecção por SARS-CoV-2, incluindo sua neuroinvasão, nos tecidos post-mortem de uma criança. Métodos: Realizamos a autópsia completa de uma criança de 14 meses que morreu de pneumonite por COVID-19. Cortes histológicos de múltiplos órgãos foram corados com Hematoxilina e Eosina. A coloração de Luxol Fast Blue para mielina e imuno-histoquímica foram realizadas em áreas selecionadas do cérebro. A presença de SARS-CoV-2 foi investigada por imunomarcação com anticorpo anti-proteína spike e por RT-qPCR. Achados: As lesões incluíram microtrombose, congestão pulmonar, edema intersticial, infiltrados linfocíticos, lesão bronquiolar, colapso dos espaços alveolares, atrofia cortical e perda neuronal grave. A presença de SARS-CoV-2 foi observada ao longo da região apical do epitélio do plexo coróide (PC) e nas células ependimárias do ventrículo lateral, mas ficou restrita aos capilares e vasos do PC em outras regiões. A infecção do tecido cerebral por SARS-CoV-2 foi confirmada por RT-qPCR em fragmentos do PC, ventrículo lateral e cortex cerebral. Interpretação: Nossos resultados mostram alterações histopatológicas multissistêmicas causadas pela infecção por SARS-CoV-2 e contribuem para ampliar o conhecimento sobre a evolução da COVID-19 fatal em crianças. Além disso, nossos achados sobre a infecção no PC e neurotropismo viral sugerem que o SARS-CoV-2 pode invadir o sistema nervoso central pela ruptura da barreira sangue-líquido cefalorraquidiano. Financiamento: Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ); Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ) e Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), além de financiamento intramural do Instituto D'Or de Pesquisa e Educação.

Efficacy and safety of hydroxychloroquine as pre-and post-exposure prophylaxis and treatment of COVID-19: A systematic review and meta-analysis of blinded, placebo-controlled, randomized clinical trials.

BACKGROUND: Hydroxychloroquine (HCQ) is an anti-malarial and immunomodulatory drug considered a potential candidate for drug repurposing in COVID-19 due to their in vitro antiviral activity against SARS-CoV-2. Despite the potential antiviral effects and anti-inflammatory profile, the results based on clinical studies are contradictory. Therefore, the quality of the decision-making process from meta-analyses summarizing the available evidence selecting studies with different designs and unblinded trials is limited. The aim of this study was to synthesize the best evidence on the efficacy and safety of HCQ as pre-and post-exposure prophylaxis and treatment of non-hospitalized and hospitalized patients with COVID-19. METHODS: Searches were performed in PubMed, Web of Science, Embase, Lilacs, the website ClinicalTrials.gov and the preprint server medRxiv from January 1, 2020 to May 17, 2021. The following elements were used to define eligibility criteria: (1) Population: individuals at high-risk of exposure to SARS-CoV-2 (pre-exposure), individuals who had close contact with a positive or probable case of COVID-19 (post-exposure), non-hospitalized patients with COVID-19 and hospitalized patients with COVID-19; (2) Intervention: HCQ; (3) Comparison: placebo; (4) Outcomes: incidence of SARS-CoV-2 infection, need for hospitalization, length of hospital stay, need for invasive mechanical ventilation (MV), death, and adverse events; and (5) Study type: blinded, placebo-controlled, randomized clinical trials (RCTs). Risk of bias was judged according to the Cochrane guidelines for RCTs. Treatment effects were reported as relative risk (RR) for dichotomous variables and mean difference (MD) for continuous variables with 95% confidence intervals (CI). We used either a fixed or random-effects model to pool the results of individual studies depending on the presence of heterogeneity. The GRADE system was used to evaluate the strength of evidence between use of HCQ and the outcomes of interest. FINDINGS: Fourteen blinded, placebo-controlled RCTs were included in this meta-analysis. Four trials (1942 patients: HCQ = 1271; placebo = 671) used HCQ as a prophylactic medication pre-exposure to COVID-19, two (1650 patients: HCQ = 821; placebo = 829) as a prophylactic medication post-exposure to COVID-19, three (1018 patients: HCQ = 497; placebo = 521) as treatment for non-hospitalized patients, and five (1138 patients: HCQ = 572; placebo = 566) as treatment for hospitalized patients with COVID-19. We found no decreased risk of SARS-CoV-2 infection among individuals receiving HCQ as pre-exposure (RR = 0.90; 95% CI 0.46 to 1.77) or post-exposure (RR = 0.96; 95% CI 0.72 to 1.29) prophylaxis to prevent COVID-19. There was no significant decreased risk of hospitalization for outpatients with SARS-CoV-2 infection (RR = 0.64; 95% CI 0.33 to 1.23) and no decreased risk of MV (RR = 0.81; 95% CI 0.49 to 1.34) and death (RR = 1.05; 95% CI 0.62 to 1.78) among hospitalized patients with COVID-19 receiving HCQ. The certainty of the results on the lack of clinical benefit for HCQ was rated as moderate. Moreover, our results demonstrated an increased risk for any adverse events and gastrointestinal symptoms among those using HCQ. INTERPRETATION: Available evidence based on the results of blinded, placebo-controlled RCTs showed no clinical benefits of HCQ as pre-and post-exposure prophylaxis and treatment of non-hospitalized and hospitalized patients with COVID-19. FUNDING: There was no funding source.

Extreme Heat at Outdoor COVID-19 Vaccination Sites.

Extreme heat is an increasing climate risk due to climate change and the urban heat island (UHI) effect and can jeopardize points of dispensing (PODs) for COVID-19 vaccination distribution and broader public health emergency preparedness (PHEP) response operations. These PODs were often located on large parking lot sites with high heat severity and did not take heat mitigation or management strategies into account for unacclimated workers and volunteers. To investigate the personal heat exposure of workers, volunteers, and clients at three PODs in Tucson, Arizona, we collected ambient air temperatures, wet bulb globe temperatures (WBGT), surface temperatures, and thermal images. We also made qualitative observations and compared data against daily meteorological records. Ambient air temperatures at all three PODs exceeded the meteorological recorded high. WBGT on average were 8°F (4.4°C) higher in full sun locations than shaded locations such as tents. Evaporative cooling decreased ambient air temperatures by 2°F (1.2°C) when placed one per tent, but decreased ambient air temperatures by 7°F (3.9°C) when placed en masse in a larger tent. Vehicle surface temperatures exceeded recommended safe limits of 140°F (60°C) at all three sites, with a maximum temperature recorded at 170.9°F (77.2°C). Public health professionals should consider heat resilience, including heat mitigation and management measures, in POD and PHEP response operations to reduce exposure. This includes considering the UHI effect in the siting of PODs, applying heat mitigation strategies in the design of PODs such as the adaptive use of solar panels for shading, and improving heat safety guidance for workers and volunteers.

Towards antiviral polymer composites to combat COVID-19 transmission.

Polymer matrix composite materials have the capacity to aid the indirect transmission of viral diseases. Published research shows that respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19), can attach to polymer substrata as a result of being contacted by airborne droplets resulting from infected people sneezing or coughing in close proximity. Polymer matrix composites are used to produce a wide range of products that are "high-touch" surfaces, such as sporting goods, laptop computers and household fittings, and these surfaces can be readily contaminated by pathogens. This article reviews published research on the retention of SARS-CoV-2 and other virus types on plastics. The factors controlling the viral retention time on plastic surfaces are examined and the implications for viral retention on polymer composite materials are discussed. Potential strategies that can be used to impart antiviral properties to polymer composite surfaces are evaluated. These strategies include modification of the surface composition with biocidal agents (e.g., antiviral polymers and nanoparticles) and surface nanotexturing. The potential application of these surface modification strategies in the creation of antiviral polymer composite surfaces is discussed, which opens up an exciting new field of research for composite materials.

Psychiatric emergency visit trends and characteristics in a mental health epicenter in Istanbul during COVID-19 lockdown.

BACKGROUND: We aimed to explore the impact of the preventive measures and partial lockdown to the psychiatric emergency department (PED) visits during COVID-19 pandemic in a mental health epicenter in Istanbul. METHODS: A total of 5839 patients admitted to PED during the lockdown period (LP) between March 30 and May 31, 2020, were enrolled in this retrospective cohort study. Data of these patients were compared to those of patients in the same period in 2019 between April 1 and June 2, 2019 (non-LP). We also investigated the monthly number of PED visits and hospitalizations between March 1 and December 31, 2020, and compared it to the same period in 2019. RESULTS: The volume of PED visits and hospitalizations in LP decreased by 12% and 41.6%, respectively. The rates of patients presenting anxiety and depressive disorders and bipolar disorders were found to significantly increase in LP than non-LP (p < 0.001; p < 0.001; p < 0.01, respectively). Depressive disorders, prior history of mental illness, and aggressive behavior were found to predict frequent PED visits while decrease in age and male gender found to predict hospitalizations. Regarding suicide attempt, younger patients and those with new-onset mental disorders were found to be at high risk in LP. Patients diagnosed with COVID-19 in PED visits were mostly with psychotic and bipolar disorders. CONCLUSION: Policy-makers should focus on studies on mental health services to reorganize and enhance such services, which are crucial to prevent and manage adverse mental health consequences of the pandemic and congestion in PEDs.

COVID-19 manifestations in people with Parkinson's disease: a USA cohort.

BACKGROUND: With the explosion of COVID-19 globally, it was unclear if people with Parkinson's disease (PD) were at increased risk for severe manifestations or negative outcomes. OBJECTIVES: To report on people with PD who had suspected or confirmed COVID-19 to understand how COVID-19 manifested in PD patients. METHODS: We surveyed PD patients who reported COVID-19 to their Movement Disorders specialists at Columbia University Irving Medical Center and respondents from an online survey administered by the Parkinson's Foundation that assessed COVID-19 symptoms, general clinical outcomes and changes in motor and non-motor PD symptoms. RESULTS: Forty-six participants with PD and COVID-19 were enrolled. Similar to the general population, the manifestations of COVID-19 among people with PD were heterogeneous ranging from asymptomatic carriers (1/46) to death (6/46). The most commonly reported COVID-19 symptoms were fever/chills, fatigue, cough, weight loss, and muscle pain. Worsening and new onset of motor and non-motor PD symptoms during COVID-19 illness were also reported, including dyskinesia, rigidity, balance disturbances, anxiety, depression, and insomnia. CONCLUSION: We did not find sufficient evidence that PD is an independent risk factor for severe COVID-19 and death. Larger studies with controls are required to understand this further. Longitudinal follow-up of these participants will allow for observation of possible long-term effects of COVID-19 in PD patients.

Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature.

OBJECTIVE: To report a unique case and literature review of post COVID-19 vaccination associated transverse myelitis and with abnormal MRI findings. BACKGROUND: Coronavirus disease have been reported to be associated with several neurological manifestations such as stroke, Guillain-Barré syndrome, meningoencephalitis amongst others. There are only a few reported cases of transverse myelitis with the novel coronavirus (n-CoV-2). Here, we identify a post COVID-19 vaccination patient diagnosed with acute transverse myelitis. METHOD: A retrospective chart review of a patient diagnosed with post SARS-CoV-2 vaccination acute transverse myelitis, and a review of literature of all the reported cases of other post vaccination and transverse myelitis, from December 1st, 2010 till July 15th, 2021, was performed. CONCLUSION: To our knowledge, this is the one of early reported case of transverse myelitis and with post SARS-CoV-2 vaccination, who responded well to plasmapheresis. Further studies would be recommended to identify the underlying correlation between COVID-19 vaccination and transverse myelitis.

Exploring volatility of carbon price in European Union due to COVID-19 pandemic.

The European Union (EU) Emissions Trading System is the most important means for the EU to achieve carbon neutrality, but it has been severely affected by the outbreak of COVID-19 in Europe, and carbon price have fluctuated sharply. Research on the driving factors of carbon price during this period will help maintain the stability of the carbon emissions trading market and promote the realization of carbon neutrality. This study selected the EU carbon allowance futures price as the research object and applied the Bai-Perron structural break test to analyze the factors that influences carbon price fluctuations using the Johansen cointegration technique and the Newey-West regression estimation. Studies have shown that the outbreak of COVID-19 and the "€750 billion green recovery plan" both had a significant impact on EU carbon price. Carbon price has also undergone significant structural changes. Under the influence of these two factors, the relationship between the level of economic development and carbon price displayed a short-term negative correlation. At the same time, oil price and interbank dismantling rates were also important factors affecting carbon price, while the impact of the clean development mechanism on carbon price was not significant. The study confirmed the effectiveness of the EU's "green recovery plan" in stabilizing the carbon market during the COVID-19 pandemic and will provide a reference for the formulation of economic recovery policies of countries around the world.

Detection of SARS-CoV-2 in the indoor air of intensive care unit (ICU) for severe COVID-19 patients and its surroundings: considering the role of environmental conditions.

There is ambiguity about the airborne transmission of the SARS-CoV-2. While a distance of 6 feet is considered a safe physical distance, new findings show that the virus can be transmitted more than that distance and cause infection. In hospitals, this may cause the virus to be transmitted from the treatment wards of COVID-19 patients to adjacent wards and infect medical staff, non-COVID-19 patients, and patient companions. The aim of this study was to investigate the presence of coronavirus in the air of ICU and adjacent wards. The low volume sampler (LVS) with two separate inlets for PM2.5 and PM10 was applied to collect indoor air of intensive care unit (ICU) with confirmed COVID- 19 patients and its surroundings. The samples were collected on 0.3µ PTFE filter fitted to the holder. Sampling was done at flow rate of 16.7 l/min for 24 h. The SRAS-CoV-2 virus was isolated using a SinaPure™ Virus Extraction Kit (SINACLON, Iran). The presence of SARS-CoV-2 genome was assessed using a commercially available SARS-CoV-2 Test Kit (Pishtaz-Iran), according to the manufacturer's instructions using One Step plus Real-Time PCR system tool (Applied Biosystems, USA). A total of sixteen samples were taken, and the positive test rate for SRAS-CoV-2 was 12.5 % (2/16). All samples from surrounding (rest room and hallway) were negative, but two air samples from indoor of ICU (next to the patient bed and nursing station) were found to be positive. The results support the possibility of transmitting the SRAS-CoV-2 through the air at a greater distance than what is known as a safe physical distance. Therefore, in addition to maintaining a safe physical distance, other precautions including wearing a face mask, preventing air recirculation, and maximizing the use of natural ventilation should be considered, especially in crowded and enclosed environments.

Early reversible leukoencephalopathy and unilateral sixth cranial nerve palsy in mild COVID-19 infection.

OBJECTIVES: To provide new insights into neurological manifestations of COVID-19. We describe a patient with mild COVID-19 associated with diplopia from right sixth cranial nerve palsy and early diffuse leukoencephalopathy, successfully treated with intravenous methylprednisolone. METHODS: The patient was evaluated for diplopia that occurred 1 day after the onset of fever, myalgia, and headache. A complete neurological workup, including neurological examination, cerebrospinal fluid (CSF) analysis with viral polymerase chain reaction (PCR), serum autoimmune encephalitis, and anti-nerve antibodies and brain magnetic resonance imaging (MRI), was performed. RESULTS: Clinical examination revealed incomplete right sixth cranial nerve palsy. Brain MRI showed diffuse confluent fluid-attenuated inversion recovery (FLAIR) hyperintense white matter abnormalities, while CSF analysis showed mild hyperproteinorrachia (61 mg/dL) without pleocytosis. The patients were treated with high-dose intravenous methylprednisolone with rapid improvement of neurological symptoms and resolution of CSF and MRI abnormalities. DISCUSSION: Our report shows that COVID-19 may predominantly present with neurological symptoms; furthermore, it argues the notion of leukoencephalopathy as a typical feature of a severe case of the disease. Mechanisms underpinning neurological symptoms in COVID-19 still need to be elucidated; nonetheless, early recognition and prompt management may ensure their improvement or even complete recovery and are therefore recommended.

Fatal pulmonary thromboembolism in asymptomatic COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has claimed the lives of millions of people globally. AIMS: This study aims to identify the pathological findings at autopsy of asymptomatic COVID-19 death, to compare the incidence of acute bilateral pulmonary thromboembolism (ABPTE) in asymptomatic COVID-19 deaths versus non-COVID-19 deaths and to explore the possible pathogenesis of thrombosis in COVID-19. We also consider the place of COVID-19 in the death certification of 4 cases who died from ABPTE. METHODS: This study primarily reviewed post-mortem reports of 6 asymptomatic COVID-19 deaths. Post-mortem reports for the years 2019 and 2020 were also reviewed to establish the incidence of ABPTE. Each post-mortem report was reviewed for gross examination, histology and toxicology findings. A literature review on COVID-19 autopsy findings, COVID-19 pathogenesis, thrombosis in COVID-19 and asymptomatic SARS-CoV-2 infection was also conducted using PubMed. RESULTS: Of the 6 asymptomatic COVID-19 deaths, 4 died as a result of ABPTE, 1 died of ischaemic and hypertensive cardiac disease caused by coronary artery disease and ventricular hypertrophy and the remaining case died of heart failure due to dilated cardiomyopathy caused by subendocardial fibrosis. There were 2 cases of bilateral pulmonary thromboembolism (BPTE) in 2019 out of 140 post-mortems. Excluding the 4 cases of ABPTE described already, there was 1 case of ABPTE in 2020 out of 156 post-mortems. A literature review on the pathogenesis of thrombosis in COVID-19 highlighted the significant role that the endothelium plays. CONCLUSIONS: Massive pulmonary thromboembolism may be a significant cause of death in asymptomatic COVID-19 infection.

Determining the Religious Coping Styles of Adolescents in Turkey During COVID-19.

We sought to evaluate the religious coping styles of adolescents during the coronavirus disease 2019 (COVID-19) pandemic and its restrictions. The study was conducted online during the 2020 academic year among students in three randomly selected high schools in a city center located in Eastern Turkey. The students studying in the chosen high schools who agreed to participate were included in the study (n = 514). We found that most adolescents were anxious, had been affected in terms of health and life satisfaction, and felt sad due to isolation. Almost all subjects attached importance to their religious beliefs. The adolescents' mean Religious Coping Scale score was 2.23 ± 0.50, their mean Positive Religious Coping subscale score was 2.91 ± 0.73, and their mean Negative Religious Coping subscale score was 1.54 ± 0.52. Specifically, male adolescents of ages 15-17 whose incomes were less than their expenditures and who lived in a broken family had the highest level of negative religious coping. In light of these findings, adolescents can be supported by teaching them to develop positive religious coping styles during the COVID-19 pandemic.

Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center.

INTRODUCTION: Increased morbimortality in patients with COVID-19 infection who had undergone surgery has raised concerns about bariatric surgery safety during the current COVID-19 pandemic. Currently, there is scarce literature on safety outcomes after bariatric surgery during the COVID-19 pandemic. OBJECTIVES: To determine the risk of symptomatic COVID-19 infection and associated complications during the first 30 days after bariatric surgery. MATERIALS AND METHODS: Prospective observational cohort study including all patients who consecutively underwent primary bariatric surgery between August and December 2020. RESULTS: A total of 189 patients were included. Median age and BMI were 36 (17-70) years and 38 (35-41) kg/m2, respectively. Forty percent of patients were women (n = 76), 59.3% (n = 112) underwent sleeve gastrectomy (SG), and 40.7% (n = 77) underwent Roux-en-Y gastric bypass (RYGB). All surgeries were performed laparoscopically. The median length of postoperative stay was 2 (0-5) days. Postoperative COVID-19 infection was detected in two patients (1.1%): one patient was readmitted without the need of intermediate or ICU care, and the other was managed as an outpatient. Major complications occurred in three patients (1.6%); none of them was COVID-19 related. Two patients required an unplanned reoperation. No patient required intermediate or ICU care, no severe COVID-19 complications were observed, and no mortality was reported. CONCLUSION: Bariatric surgery can be safely performed during the ongoing pandemic, albeit a low risk of COVID-19 symptomatic infection. Rigorous perioperative COVID-19 institutional protocols are required to perform bariatric surgery safely during the current pandemic.

Intravitreal Dexamethasone Implant in Patients Who Did Not Complete Anti-VEGF Loading Dose During the COVID-19 Pandemic: a Retrospective Observational Study.

INTRODUCTION: To compare the functional and anatomic outcomes between eyes in patients with diabetic macular edema (DME) who underwent a complete anti-vascular endothelial growth factor (VEGF) loading dose with aflibercept and those who were switched to dexamethasone intravitreal (DEX) implant after an incomplete anti-VEGF treatment regimen during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This was a retrospective and comparative study conducted on patients with DME. Main outcome measures were mean change in best corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline to month 4. RESULTS: Forty-three eyes (23 eyes in the anti-VEGF group and 20 eyes in the DEX group) were included. Mean BCVA significantly improved from 37.7 ± 25.3 and 35.7 ± 22.0 letters at baseline to 45.4 (23.9) (mean adjusted BCVA improvement 7.6 ± 20.8 letters, p = 0.033) and 46.1 ± 26.0 (mean adjusted BCVA improvement 10.6 ± 15.9 letters, p = 0.049) at month 4 in the anti-VEGF and DEX groups, respectively, with no significant differences between study groups (mean adjusted BCVA difference 2.8 letters, 95% CI - 9.4 to 14.9 letters, p = 0.648). There were no statistically significant differences in the proportion of eyes that achieved a BCVA improvement of ≥ 5, ≥ 10, and ≥ 15 letters between groups. CRT was significantly reduced from baseline to month 4 in both DEX (mean adjusted CRT reduction 167.3 ± 148.2 µm, p = 0.012) and anti-VEGF groups (mean adjusted CRT reduction 109.9 ± 181.9 µm, p < 0.001), with no differences between them (mean adjusted CRT difference 56.1 µm, 95% CI - 46.0 to 158.2 µm, p = 0.273). Of 20 eyes in the DEX group, 16 (80.0%) and 9 (45.0%) eyes achieved a CRT reduction of ≥ 20% from baseline at 2 months and at 4 months, respectively. CONCLUSIONS: Our results seem to suggest that DEX implant can significantly improve both functional and anatomic clinical outcomes in patients who were unable to complete anti-VEGF loading dose during the COVID-19 pandemic.

Glucose control in home-isolated adults with type 1 diabetes affected by COVID-19 using continuous glucose monitoring.

PURPOSE: This study is aimed at evaluating changes in metrics of glucose control in home-isolated patients with type 1 diabetes and COVID-19 using a continuous glucose monitoring (CGM) system. METHODS: We included adults aged 18-45 years with type 1 diabetes, using CGM, followed by telemedicine at a Southern Italian University Hospital. Thirty-two home-quarantined subjects with SARS-CoV-2 positive swab constituted the COVID-19 group. Thirty age-matched diabetic individuals without COVID-19 formed the control group. The effects of COVID-19 on glycemic control in patients infected were assessed at different time points [2 weeks before-COVID-19 (Time 1), 2 weeks during-COVID-19 (Time 2) and 2 weeks after COVID-19 (Time 3)] and compared with those without infection. RESULTS: A significant reduction of TIR (Time 1 vs Time 2, %, 60.1 ± 16.6 vs 55.4 ± 19.2, P = 0.03), associated with a significant increase of TAR level 2 (10.1 ± 7.3 vs 16.7 ± 12.9, P < 0.001), GMI (7.1 ± 0.6 vs 7.5 ± 0.8, P < 0.001), CV (37.3 ± 7.1 vs 39.6 ± 7.0, P = 0.04), mean glucose values (mg/dL, 160.2 ± 26.5 vs 175.5 ± 32.6, P = 0.001) and standard deviation (59.2 ± 13.1 vs 68.6 ± 17.7, P = 0.001) was observed in patients with COVID-19. No significant change of glycemic metrics was found in the NO COVID-19 group across the time. CONCLUSION: Young home-isolated patients with type 1 diabetes and COVID-19 showed a worsening of glucose control during COVID-19, as compared with age-matched diabetic subjects without the infection.

Influencing factors for mental health of general practitioners in Hebei Province under the outbreak of COVID-19: A cross-sectional study.

OBJECTIVE: This study aimed to understand the mental health status of general practitioners (GPs) in Hebei Province during the outbreak of coronavirus disease 2019, analyse influencing factors, and establish and evaluate the risk prediction model. METHODS: During February 25-29, 2020, a self-designed questionnaire was used to conduct an online survey of GPs in Hebei Province. The survey included a questionnaire on GPs' basic information, a questionnaire on GPs' working hardware and software facilities, and a questionnaire on GPs' mental health condition. A total of 1040 participants returned the completely filled valid questionnaire, and the answers were analyzed using the χ2 test, Wilcoxon rank-sum test and logistic regression with SPSS 20.0 software. Based on the results of binary logistic regression analysis, a risk prediction model was established, and the receiver operating characteristic curve was used to evaluate the model. RESULTS: The results showed that 44.2% (460/1040) of GPs expressed anxiety after the outbreak. Absence of prescreening clinics, fever clinics or isolated observation rooms in primary medical institutions; persons in the administrative area required to be isolated; low sleep quality of GPs and less than 6 hours of sleep per day of GPs were risk factors affecting the mental health status of GPs. Also, epidemic-related training and adequate protective equipment were the protective factors for the mental health status of GPs. CONCLUSION: The government should strengthen the infrastructure construction of community institutions, equip them with sufficient epidemic protection equipment, ensure the rest time of GPs and strengthen mental health training to ensure the mental and physical health of GPs.

Case report: hepatitis in a child infected with SARS-CoV-2 presenting toll-like receptor 7 Gln11Leu single nucleotide polymorphism.

BACKGROUND: Covid-19 has the respiratory tract as the main target of infection, and patients present mainly dyspnea, pneumonia, dry cough, and fever. Nevertheless, organs outside the respiratory tract had been reported in recent studies, including the gastrointestinal tract and liver. The host innate immune system recognizes pathogen-associated molecular patterns (PAMPs) through their pattern recognition receptor (PRRs). Toll-like receptor 7 (TLR-7) is a pattern recognition receptor recognizing ssRNA (SARS-CoV-2 is an ssRNA). Polymorphisms are characterized by two or more alternative forms of a distinct phenotype in the same population. Polymorphisms in tlrs genes can negatively influence the immune response to infectious diseases. There are several references in the literature to non-synonymous single nucleotide (rs) polymorphisms related to several genes. Some of them are important for the innate immunity, as rs 179008 (tlr-7), rs3775291 (tlr3), rs8177374 (tir domain-containing adaptor protein, tirap), rs1024611 (monocyte chemoattractant protein-1, mcp-1) and rs61942233 (2'-5'-oligoadenylate synthase-3, oas-3). CASE PRESENTATION: We identified a 5-year-old-male child with gastrointestinal symptoms and fever presenting acholic stool and jaundice, who was positive for SARS-CoV-2 IgM, IgA, and IgG and presenting the Gln11Leu rs 179008 in tlr-7. The child presented high levels of aspartate aminotransferase, alanine aminotransferase, bilirubin, C-reactive protein, D-dimer, gamma-glutamyl transferase, alkaline phosphatase, and was negative for serological tests for hepatitis A, B, C, E, HIV 1 and 2, herpes virus, cytomegalovirus, Epstein-Barr virus, and negative for RTqPCR for Influenza A and B, RSV and SARS-CoV-2. We also investigated other SNPs in the tlr-3 (rs3775291), tirap (rs8177374), mcp-1 (rs1024611), and oas-3 (rs61942233) genes, and no mutation was detected. After an interview with the child's caregivers, any possible accidental ingestion of drugs or hepatotoxic substances was ruled out. CONCLUSION: To our knowledge, this is the first report of a SARS-CoV-2 caused hepatitis in a male child that has the tlr-7 Gln11Leu rs 179008, which could impair an efficient initial immune response. The knowledge of the patient's immune deficiency could improve the treatment to correct this deficiency with specific medications.

A lab-on-a-chip platform for integrated extraction and detection of SARS-CoV-2 RNA in resource-limited settings.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the unprecedented global pandemic of coronavirus disease-2019 (COVID-19). Efforts are needed to develop rapid and accurate diagnostic tools for extensive testing, allowing for effective containment of the infection via timely identification and isolation of SARS-CoV-2 carriers. Current gold standard nucleic acid tests require many separate steps that need trained personnel to operate specialist instrumentation in laboratory environments, hampering turnaround time and test accessibility, especially in low-resource settings. We devised an integrated on-chip platform coupling RNA extraction based on immiscible filtration assisted by surface tension (IFAST), with RNA amplification and detection via colorimetric reverse-transcription loop mediated isothermal amplification (RT-LAMP), using two sets of primers targeting open reading frame 1a (ORF1a) and nucleoprotein (N) genes of SARS-CoV-2. Results were identified visually, with a colour change from pink to yellow indicating positive amplification, and further confirmed by DNA gel electrophoresis. The specificity of the assay was tested against HCoV-OC43 and H1N1 RNAs. The assay based on use of gene N primers was 100% specific to SARS-CoV-2 with no cross-reactivity to HCoV-OC43 nor H1N1. Proof-of-concept studies on water and artificial sputum containing genomic SARS-CoV-2 RNA showed our IFAST RT-LAMP device to be capable of extracting and detecting 470 SARS-CoV-2 copies mL-1 within 1 h (from sample-in to answer-out). IFAST RT-LAMP is a simple-to-use, integrated, rapid and accurate COVID-19 diagnostic platform, which could provide an attractive means for extensive screening of SARS-CoV-2 infections at point-of-care, especially in resource-constrained settings.

Utility of thermal image scanning in screening for febrile patients in cold climates.

BACKGROUND: Infrared thermography (IRT) for fever screening systems was introduced in not only general hospitals, but also orthopedic hospitals as a countermeasure against the spread of coronavirus disease 2019 (COVID-19). Despite the widespread use of IRT, various results have shown low and high efficacies, so the utility of IRT is controversial, especially in cold climates. The aims of this study were to investigate the utility of IRT in screening for fever in a cold climate and to devise suitable fever screening in orthopedic surgery for COVID-19. METHODS: A total of 390 orthopedic surgery patients were enrolled to the outdoor group and 210 hospital staff members were enrolled to the indoor group. Thermographic temperature at the front of the face in the outdoor group was immediately measured after entering our hospital from a cold outdoor environment. Measurements for the indoor group were made after staying in the hospital (environmental temperature, 28 °C) for at least 5 h. Body temperature was then measured using an axillary thermometer >15 min later in both groups. RESULTS: In the outdoor group, mean thermographic temperature was significantly lower than axillary temperature and IRT could not detect febrile patients with axillary temperatures >37.0 °C. Mean thermographic temperature was significantly lower in the outdoor group than in the indoor group. Sensitivity was 11.5% for the outdoor group, lower than that for the indoor group. CONCLUSIONS: We verified that IRT was not accurate in a cold climate. IRT is inadequate as a screening method to accurately detect febrile individuals, so we believe that stricter countermeasures for second screening need to be employed to prevent nosocomial infections and disease clusters of COVID-19, even in orthopedic hospitals.

Impact of mental health on disease activity in mastocytosis during COVID-19 pandemic.

BACKGROUND: Mast cell-related symptoms might be influenced by mental health status in mastocytosis. In this study, we aimed to investigate the influence of mental health problems developed during the COVID-19 pandemic on the course of mastocytosis. METHODS: Mental health status in 60 adult patients with mastocytosis was prospectively evaluated with the total Depression-Anxiety-Stress Scale (tDASS-21) and Fear of COVID-19 Scale (FCV-19S) in the lockdown period (LP) and the return to normal period (RTNP) during the pandemic. The disease course was assessed from emergency and outpatient medical reports, including Scoring Mastocytosis (SCORMA) index and serum baseline tryptase levels, by telephone interviews and clinical visits. RESULTS: The mean FCV-19S and median tDASS-21 scores were significantly higher in LP than RTNP (p < 0.001) and there was a positive correlation between FCV-19S and tDASS-21 in LP (r = 0.820, p < 0.001) and in RTNP (r = 0.572 p= <0.001). Disease-related symptoms including skin lesions, flushing and anaphylaxis attacks increased in 22 patients in LP, and in this group, mean FCV-19S and median tDASS-21 were higher than those without symptom exacerbation (p < 0.001). During the study period, four (6.7%) patients who experienced COVID-19 recovered without any requirement for hospitalization and had not experienced symptom exacerbation. CONCLUSIONS: Fear of COVID-19 can be a reason for mental health changes, including depression, anxiety and stress which may further increase mast cell-related symptoms. Therefore, psychological support is important to control the severity of mast cell-related symptoms in mastocytosis during a pandemic.

Characterization of humoral response to COVID mRNA vaccines in multiple sclerosis patients on disease modifying therapies.

Little is known about COVID-19 mRNA vaccine humoral immune responses in patients with central nervous system autoimmune demyelinating diseases, multiple sclerosis (MS) and neuromyelitis optica (NMO), who are on B-cell depleting therapies (BCDT) and other disease modifying therapies (DMTs). We conducted a single center prospective study to identify the clinical and immunological features associated with vaccine-induced antibody response in 53 participants before and after COVID-19 mRNA vaccination. This is the first report on the anti-spike RBD and anti-nucleocapsid antibody response, along with pre- and post-vaccine absolute lymphocyte counts (ALC) and flow cytometry analysis of CD19 and CD20 lymphocytes in patients with MS and NMO. We tested the hypothesis that patients on BCDT may have impaired COVID-19 vaccine humoral responses. Among patients on BCDT, 36.4% demonstrated a positive antibody response to spike RBD, in comparison to 100% in all other groups such as healthy controls, untreated MS, and patients on non-B cell depleting DMTs (p < 0.0001). Immunological data revealed lower baseline (pre-vaccination) levels of IgM in patients on BCDT (p = 0.003). Low CD19 and CD20 counts and a shorter interval from the last B cell depleting therapy infusion to the first vaccine dose were associated with a negative spike RBD antibody response (non-seroconverter) in patients on BCDT. Age, body mass index (BMI) and total treatment duration did not differ between seroconverters and non-seroconverters.

Single-dose oral ivermectin in mild and moderate COVID-19 (RIVET-COV): A single-centre randomized, placebo-controlled trial.

INTRODUCTION: Ivermectin is an antiparasitic drug which has in-vitro efficacy in reducing severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral load. Hence, Ivermectin is under investigation as a repurposed agent for treating COVID-19. METHODS: In this pilot, double blind, randomized controlled trial, hospitalized patients with mild-to-moderate COVID-19 were assigned to a single oral administration of an elixir formulation of Ivermectin at either 24 mg or 12 mg dose, or placebo in a 1:1:1 ratio. The co-primary outcomes were conversion of RT-PCR to negative result and the decline of viral load at day 5 of enrolment. Safety outcomes included total and serious adverse events. The primary outcomes were assessed in patients who had positive RT-PCR at enrolment (modified intention-to-treat population). Safety outcomes were assessed in all patients who received the intervention (intention-to-treat population). RESULTS: Among the 157 patients randomized, 125 were included in modified intention-to-treat analysis. 40 patients each were assigned to Ivermectin 24 mg and 12 mg, and 45 patients to placebo. The RT-PCR negativity at day 5 was higher in the two Ivermectin arms but failed to attain statistical significance (Ivermectin 24 mg, 47.5%; 12 mg arm, 35.0%; and placebo arm, 31.1%; p-value = 0.30). The decline of viral load at day 5 was similar in each arm. No serious adverse events occurred. CONCLUSIONS: In patients with mild and moderate COVID-19, a single oral administration of Ivermectin did not significantly increase either the negativity of RT-PCR or decline in viral load at day 5 of enrolment compared with placebo.

Colorectal cancer surgery in Asia during the COVID-19 pandemic: A tale of 3 cities.

PURPOSE: The COVID-19 pandemic has put tremendous strain on healthcare systems. Surgical societies worldwide have advised minimizing non-essential surgeries in order to preserve hospital resources. Given the medical resources and COVID-19 incidence between countries across the world differ, so should colorectal practices. No formal guidelines have emerged from Asia. We wanted to find out what the current practice was in Asian colorectal centres outside China. INTRODUCTION: The COVID-19 pandemic has significantly impacted surgical practice worldwide. At the time of the writing of this paper, there are over 4.2 million cases reported with deaths exceeding 290 000 patients.1 With an abrupt disruption to worldwide supply chains, societal lockdowns and surge of cases into many hospitals, resource allocation was diverted and prioritised for all COVID-19 related services. METHODS: A questionnaire survey of current colorectal practice was carried out involving 3 major colorectal cancer centres, one each from 3 major cities: Singapore, Taichung and Daegu. Components of the survey include infrastructure and manpower, case selection, surgical approach, operating room management and endoscopy practice. RESULTS: All 3 centres continued to provide standard-of-care colorectal cancer surgery despite the COVID-19 pandemic. Two centres deferred surgery for benign colorectal conditions. Minimally Invasive Surgery (MIS) was still the preferred approach when indicated but with protocolized precautions undertaken. Other services such as pelvic exenteration, TATME and pelvic lymph node dissection were still offered if oncologically indicated. Elective diagnostic endoscopy services have also continued in two centres. CONCLUSION: Elective colorectal services continue to take place in the 3 surveyed Asian hospitals with heightened precautions. Provided there is adequate resource, colorectal cancer services should still continue to prevent consequences of neglecting or delaying cancer treatment. Practice should hence be tailored to the local resource of individual centres accordingly.

A coordinated strategy to develop and distribute infographics addressing COVID-19 vaccine hesitancy and misinformation.

BACKGROUND: Visual communication strategies are becoming increasingly prevalent for conveying information to health professionals as well as to the general public. The potential of social media for rapid knowledge dissemination using infographics was recognized early in the coronavirus disease (COVID-19) pandemic by health professionals. OBJECTIVE: The purpose of this study was to describe a coalition of health professionals' approach to developing infographics about COVID-19 vaccines and the reach and engagement of those infographics when shared through social media. METHODS: Infographics were created by a core team within the coalition following a stepwise approach. Each underwent a multistep review process, readability evaluation, and translation into Spanish. Infographics were then shared through multiple social media platforms. They were grouped into 1 of 3 categories for this analysis: COVID-19 vaccine series, myth debunkers, or other. RESULTS: All infographics had greater outreach, impressions, and engagement on Twitter than they did on other platforms. When comparing the 3 groups, no 1 infographic type was consistently performing higher than the others. CONCLUSION: Each infographic reached thousands to tens of thousands of people. We do not know whether those who viewed these infographics changed their perspective on vaccination, so we are unable to draw a conclusion about their impact on vaccine hesitancy based on this study alone.

Spike-directed vaccination elicits robust spike-specific T-cell response, including to mutant strains.

Although most studies describing coronavirus disease 2019 vaccine responses have focused on antibodies, there is increasing evidence that T cells play a critical role. Here the authors evaluated T-cell responses in seronegative donors before and after vaccination to define responses to the severe acute respiratory syndrome coronavirus 2 reference strain as well as to mutations in the variant strains Alpha/B.1.1.7 and Beta/B.1.351. The authors observed enhanced T-cell responses to reference and variant spike strains post-vaccination.

Change in hospitalizations and 30-day mortality of patients with acute myocardial infarction during the first COVID-19 lockdown - A pure social isolation effect?

BACKGROUND: The COVID-19 pandemic has had diverse effects on population health and psychology in relation to non-COVID-19 diseases, as well as on COVID-19 infection. Fewer patients with acute myocardial infarction (AMI) sought medical attention during the first lockdown of the pandemic. METHODS AND RESULTS: We conducted a retrospective cohort study of Clalit Health Services patients treated in multiple hospitals for AMI. We examined the numbers and characteristics of the patients and 30-day mortality during three 5-week phases of the first wave of the COVID-19 pandemic in Israel: pre-lockdown (N = 702), lockdown (N = 584), and lockdown-lift (N = 669). We compared data for the same period in 2018 and 2019. We stratified the data by ST-elevation myocardial infarction (STEMI) and non-STEMI. AMI hospitalizations during the lockdown were 17% lower than in the pre-lockdown period (rate ratio-0.83, 95% CI 0.74-0.93), and 22% and 31% lower than in the corresponding periods in 2018 and 2019, respectively. The reduction was mainly attributed to non-STEMI hospitalizations (26% lower than the pre-lockdown period in 2020). Hospitalizations due to both STEMI and non-STEMI were moderately reduced during the post-lockdown period compared to the corresponding periods in 2018 and 2019. Thirty-day mortality rate was similar for all the periods assessed. CONCLUSIONS: The number of hospitalized patients with AMI during the first COVID-19 lockdown and post-lockdown periods was significantly reduced, without significant changes in 30-day mortality rates.