Multisystem Inflammatory Syndrome in Children

Multisystem inflammatory syndrome in children (MIS-C) is an uncommon but emerging syndrome related to SARS-CoV-2 infection. While the presentation of MIS-C is generally delayed after exposure to the virus that causes coronavirus 2019, both MIS-C and Kawasaki disease (KD) share similar clinical features. Multisystem inflammatory syndrome in children poses a diagnostic and therapeutic challenge given the lack of definitive diagnostic tests and a paucity of evidence regarding treatment modalities. We review the clinical presentation, diagnostic evaluations, and management of MIS-C and compare its clinical features to those of KD.

Utilization of Patient-Centered Digital Tools to Improve Adherence Rates for Outpatient Screening Colonoscopies in a Metropolitan Hospital

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Screening through stool testing or colonoscopy is the standard of care for all ages 50 to 75 years, but national rates of procedures remain sub-optimal. Digital applications i.e., frequent automated text-based reminders and assess through personal healthcare apps on smartphones, can be effective tools to overcome barriers to screening colonoscopy adherence thus improving the outcomes. Method(s): We performed a retrospective study on a prospectively maintained database on CRC screening adherence rates from July 2019 to March 2022 in outpatient settings of a metropolitan hospital. Only screening colonoscopies (SC) scheduled during the study time period were included. Demographics and health-care resources utilization were reviewed. Primary comparison was between SC performance rates, prior to and after implementation of: a digital navigation program (DNP) developed by a private company that consisted of generating automated messages containing bowel-prep instructions, appointment reminders, driving instructions, short informative procedure videos;and EPIC EMR generated personal health app called MyChart. All participants were offered access to DNP through a digital platform and MyChart app set up on their smartphones. Result(s): Total of 3584 SC were scheduled during the study period. Overall age was 6069.6 years and majority were males at 55%;Hispanics were 49% with Not Hispanics at 24%. Pre-intervention period (n51057), 48% of SC performed and 52% cancelled;and in post-intervention period (n52527), 85% SC performed with 15% cancelled (p< .001) with a percent change of 74% increase in procedures. In postintervention group< DNP enrolled 930 patients of which 87% presented for procedure. Patients who did not present, received additional reminders. Bowel prep between groups showed no significant difference in quality (Table). Conclusion(s): Our study highlights a significant increase in performance rates of scheduled screening colonoscopies with a 74% increase after implementation of a DNP and MyChart app utilization. Usefulness of digital applications in improving screening colonoscopy adherence and reducing no show rates, has been well studied in literature with promising results, but implementation on a larger scale is lacking. Especially after COVID-19 pandemic, use of technology to increase adherence to CRC screening and surveillance seems more warranted.

Consumer Profile Comparisons: Traditional food local entrepreneurs

The study aims to explore consumer profiles in Sabah and Selangor states. Twenty (20) informants from selected business categories are being identified and interviewed using a semi-structured question and online video and phone recording due to the Covid 19 pandemic. Two (2) themes have been identified: Food category and Business criteria. Under the food category: categories of food and type of food. While under the business criteria: experience, customer, and type of business. Entrepreneurs from both states must adapt to the changes due to the Covid-19 pandemic by implementing new methods to sustain their business life.

Examining Local Traditional Food Entrepreneurs in Selangor and Sabah States during Covid 19 Pandemic

The study aims to explore local entrepreneurs' profile criteria during covid 19 pandemic in Sabah and Selangor states. Two (2) themes have been identified for this study which are 1) Food category and 2) Business criteria. Twenty (20) informants from selected business categories are being identified and interviewed using a semi-structured question and online video and phone recording due to the Covid 19 pandemic. The finding shows that entrepreneurs from both states share similarities in food categories and customer backgrounds. They also implement technology such as online delivery applications to sustain their business during the Covid-19 pandemic.

Persisting COVID-19 vaccination hesitancy in the South Bronx

Background. Minority groups have the lowest vaccination rates when compared to the overall population. We aim to study the attitudes and perceptions of COVID-19 vaccination, about six months after vaccine rollout in the South Bronx. Methods. Cross-sectional anonymized online survey evaluating knowledge, attitude and perception about COVID-19 vaccination using SurveyMonkey™ was conducted in South Bronx community from April - June 2021. Results. Of the 281 participants, 67% were Latinx and 16% were African American (AA);69% (195) were fully vaccinated (FV) and 31% (86) with vaccine hesitancy (VH). The common reasons for hesitancy were "concerns about side effects" (38%), "vaccine is not safe" (27%) and "vaccine was approved too fast" (26%) (p< .001). VH were more likely to rely online/mobile apps (30%) and friends and family (23%) as compared to FV. VH were more likely to be AA, younger age (< 35 yrs), high school or lower education, single, unemployed, without comorbidities, not current on other eligible vaccines, and did not believe "vaccine is necessary to end the pandemic." Majority of participants from both cohorts trusted their primary care providers. Mistrust with healthcare and pharmaceutical companies was higher in VH (p=0.009). Both groups preferred to continue wearing mask and practice social distancing despite vaccination status. Conclusion. Persisting vaccine hesitancy is concerning in minority communities. Identifying the target population and implementation of innovative methods to improve COVID-19 vaccination acceptance leveraging primary care providers would be a possible solution.

Academic Impact on Emergency Medicine Training Programs During COVID-19 Pandemic

Background: Rapid spread of the Novel Coronavirus Disease (COVID-19) resulted in a global pandemic. As front-line health care workers, this crisis significantly affected emergency medicine residents and their respective programs. We sought to explore the impact of COVID-19 on the education and training of emergency medicine residents across the United States and Puerto Rico. Methods: A survey was sent out to Accreditation Council for Graduate Medical Education (ACGME) accredited United States and Puerto Rico emergency medicine residency programs (264 programs at the time) via email correspondence to the Program Directors and the Program Coordinators. The survey stratified program type (practice setting, length of training, institution type, moonlighting allowed) and impact of COVID-19 on residents (off-service rotations, weekly conferences, effect on research, and resident wellness initiatives). Comparison was made by United States and Puerto Rico regions divided by Northeast, South, Midwest, and West, as these closely correlated with the differences in areas of COVID-19 spread and saturation. REDCap was used as the platform for data capture. Results: A total of 134 emergency medicine residency programs completed the survey. Northeast (44%), South (26%), Midwest (17%) and West (13%) programs by regions were reviewed. Overall, the majority of programs were in an urban setting (70%), and academic practice comprised 58%, followed by community at 40% (p=NS). The curriculum was a 3-year format for 71% of the programs (p=0.002). Overall half of the programs stated their institution was declared a site of pandemic emergency status by the ACGME, with 70% in Northeast and 39% of the Midwest, followed by the West and South regions (p=0.011). The impact of COVID-19 on off-service rotations for the emergency medicine residencies was not significant;Northeast had a high impact in 34% of the programs, moderate impact for Midwest (35%) and minimal impact in the South (34%) and West (29%) programs. Weekly lectures were switched to virtual format and smaller groups. Of note, clinical research for prospective studies was negatively impacted throughout all the regions (p=0.034), however retrospective studies were not affected. Additionally, 88% of programs reported changes since the start of COVID-19 to assure residents with new initiatives and activities such as improving wellness and reducing burnout and stress. Conclusions: The COVID-19 pandemic impacted the training of emergency medicine residents in various aspects. Northeast programs were more affected compared to the other regions. Weekly didactic sessions largely transitioned to a virtual format and/or small group sessions. Off-service rotations overall were not significantly affected. Retrospective clinical research continued while there was a substantial disruption in prospective research projects. Finally, a positive outcome was the increased awareness to changes in improving resident well-being overall.

Viewpoint: Sars-cov-2 (the cause of covid-19 in humans) is not known to infect aquatic food animals nor contaminate their products

This paper is in response to the need for clear communication regarding the risk of transmission of the novel Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes COVID-19 in humans and the general societal concern of potential contamination, of aquatic animals used as food or their products, with the virus. SARS-CoV-2 belongs to the family Coronaviridae and genus Betacoronavirus. Betacoronaviruses are only reported to infect mammals. Currently there is no evidence to suggest that SARS-CoV-2 can infect aquatic food animals (e.g. finfish, crustaceans, molluscs, amphibians) and therefore these animals do not play an epidemiological role in spreading COVID-19 to humans. Aquatic food animals and their products, like any other surface, may potentially become contaminated with SARS-CoV-2, especially when handled by people who are infected with the virus. Nevertheless, with proper food handling and sanitation, the likelihood of contamination of aquatic animals or their products with SARS-CoV-2 should be negligible. The COVID-19 pandemic may negatively affect livelihoods, food security and nutrition for populations that rely on aquatic animals as a source of food or income. On a positive side, however, COVID-19 outbreaks may lead to an increase in local community utilization of aquatic food animals or their products due to limited transportation or limited supplies of alternative sources of animal proteins. © Asian Fisheries Society.