Tachykinins and the potential causal factors for post-COVID-19 condition.

The most prevalent symptoms of post-COVID-19 condition are pulmonary dysfunction, fatigue and muscle weakness, anxiety, anosmia, dysgeusia, headaches, difficulty in concentrating, sexual dysfunction, and digestive disturbances. Hence, neurological dysfunction and autonomic impairments predominate in post-COVID-19 condition. Tachykinins including the most studied substance P are neuropeptides expressed throughout the nervous and immune systems, and contribute to many physiopathological processes in the nervous, immune, gastrointestinal, respiratory, urogenital, and dermal systems and participate in inflammation, nociception, and cell proliferation. Substance P is a key molecule in neuroimmune crosstalk; immune cells near the peripheral nerve endings can send signals to the brain with cytokines, which highlights the important role of tachykinins in neuroimmune communication. We reviewed the evidence that relates the symptoms of post-COVID-19 condition to the functions of tachykinins and propose a putative pathogenic mechanism. The antagonism of tachykinins receptors can be a potential treatment target.

Was Icu Right for You? An Exploratory Qualitative Study of Patients >=65 Yrs and Next of Kin in Covid-19: The Escalate Study

Introduction The decision to admit an older patient to the intensive care unit (ICU) should reflect shared goals of care. Resource limitations during the Covid-19 pandemic highlighted challenges in selecting candidates for escalation. Patients and next of kin (NoK) who have experienced ICU are well-placed to reflect on whether the admission was right for them. Objective To explore older patients' (>65 years) and their loved ones' views on escalation decision making. Methods Qualitative study involving semi-structured interviews with patients, NoK of survivors and NoK of deceased who experienced UK ICU admission with Covid-19 respiratory failure between March 2020 and February 2021. A preliminary questionnaire was used to maximise sample diversity of age, sex, ethnicity, survival, decision regret and impact of event scores. Interview data were collected via video conferencing or telephone. Transcripts were analysed using framework analysis. Results 30 participants were interviewed. Results Five themes were identified: 'Inevitability' - a sense that the illness and its management are out of the control of the patient or their loved one;'Disconnect' - differences between hospital and lay person narratives;challenges to bridging that gap included effective communication aided by technology;'Acceptance' - of the consequences, good or bad, of an intensive care admission as unalterable;'Beyond comprehension' - participants had not contemplated ill health or ICU prior to admission and even with the benefit of hindsight struggled to describe which potential outcomes would be acceptable or unacceptable if they needed to be involved in similar decision-making around escalation in the future;'Covid-19' - unique impact of a pandemic. Conclusion This study, which includes bereaved NoK as well as patients and NoK of survivors, adds perspective to inform decision making regarding treatment escalation of older people.

Qualitative Research in a Technological Age: Friend or Foe

Introduction: Familiarity with information technology is increasingly widespread. COVID-19 has increased the use of video conferencing social media within the UK population, including by older people1 This evolving scene has the potential to change how research is conducted.2 Social media has been employed for recruitment to qualitative research,3,4 but mostly in a young cohort. Recruitment through interfaces such as Twitter has the potential to access a larger number of participants, but may not reach all groups, such as older people. Video conferencing (VC) is increasingly used for qualitative interviewing.5 It simulates in-person communication while avoiding the need to travel but requires access to costly equipment and confidence in engaging with the technology. Objective: To explore the experience of using technology in a critical care-based qualitative research study. Methods: The ESCAlation of the eLderly (Age-65years) to criTical carE with COVID-19 (ESCALATE) study uses semi-structured interviews with patients and loved ones to explore views on escalation of older people to critical care during the COVID-19 pandemic. Recruitment took place using two routes: UK-wide social media advertising;and postal invitations via local databases with telephone follow up. For the former, the study was advertised directly via the social media platform Twitter using a specifically created study account (@covidescalate), showing a brief advert and link to a questionnaire and contact form. Relevant charities were invited to disseminate the advertisement. In-person interviews were avoided to maximise participant and interviewer safety in the context of the COVID-19 pandemic. Participant preference for mode of interview (VC or telephone) was established. If participants stated in advance that they were not familiar with video technology or found during the interview that they were unable to manage a VC, interviews were conducted by telephone. Results: There was partial uptake by charities and limited 'retweeting' overall. Only one responder meeting eligibility criteria responded via social media advertising, compared with 44 from local postal/telephone recruitment. Ten interviews were conducted via VC and 12 via telephone, where participants were not familiar with VC. There was no difference in interview duration with VC lasting around 45 minutes and telephone calls lasting around 42 minutes. The researchers found that it was more difficult to pick up on social and non-verbal cues without visual contact but all questions in the topic guide were covered using both media. There was no difference between choice of VC vs. telephone according to participant ethnicity (BAME vs Caucasian) or sex. In one case, several participants from one family joined the VC from different locations. Conclusion: In the ESCALATE study, video conferencing and telephone interviews were both valuable interviewing methods. Social media recruitment was of limited use but this may reflect the participant demographic and research team experience and could still be useful for recruiting certain groups in other studies. Information technology has the potential to increase engagement with research but our experience demonstrates that it must be used flexibly and with consideration.

The end is just the beginning: Involving bereaved next of kin in qualitative research

Introduction: Almost half the UK population die in hospital and more than two thirds of these are aged 75 years or more.1 Older people make up an increasing proportion of patients admitted to critical care and often have poorer outcomes, especially in the context of COVID-19.2 Loved ones are an essential support network for older patients but their ability to provide support was compromised by visiting restrictions during COVID-19. Little is known about the experiences of older patients in ICU and there is limited literature on the experiences of bereaved relatives.3 Bereaved relatives may be the only way to access the experiences of patients who do not survive, but there are a number of barriers to including bereaved relatives in research. Researchers may feel inhibited from imposing what might be seen as an additional burden on families during the aftermath of a bereavement. The ongoing ESCAlation of the eLderly (age >65years) to criTical carE with COVID-19) (ESCALATE) study includes semi-structured interviews with bereaved loved ones as well as patients and NoK of survivors in the UK. Objectives: To describe successful involvement of bereaved next of kin in critical care-based research Methods: This qualitative research uses semi-structured interviews and thematic analysis. Patient and public involvement from an intensive-care focused charity and local palliative care team advice was sought in order to develop recruitment strategies such as detailed, sympathetically worded participant information packs.4 In keeping with the literature,5 the window for recruitment and interview was approximately one year following bereavement. Following ethical approval, participants were recruited via postal invitations with follow up telephone calls if no response after a minimum of one week. Results: Recruitment was limited by only 40% of bereaved NoK (next of kin) having postal addresses recorded on the hospital systems. 9 /40 bereaved NoK contacted by letter responded and as well as completing a questionnaire, consented to be interview. A further 5/11 contacted by follow-up telephone call agreed to participate (consistent with response rates for patients and NoK of survivors). All of the interviewed bereaved participants completed the interview according to the interview topic guide, with each interview lasting around 45 minutes. More than half were female, and three quarters were Black, Asian or Minority Ethnic. Bereaved relatives were keen to share their experience and some even volunteered additional information with the interviewers, such as resources they had created for their local community and personal diaries. Participants reported that they were happy to be interviewed if it would help others in a similar position. Conclusion: Bereaved relatives of critical care patients are willing to engage in qualitative research. Recruitment is challenging due to practical constraints, but we suggest could be improved through meticulous documentation of contact details and involvement of bereavement services in research. By seeking the views of bereaved loved ones, we can improve care for critically unwell patients at end of life.

Economic Crises and Private Rates of Returns to University Education: A Conceptual Framework, Stylized Facts from Three Middle-Income Countries, and COVID-19 Implications

In this study, we develop a conceptual framework that explains the reasons behind a widening of the gaps in private rates of return to university education during an economic crisis such as COVID-19. Next, we report stylized facts on the private rates of return to university education before and after economic crises in Indonesia, Pakistan, and South Africa. We further conduct panel regression analysis to assess the statistical significance of the relationship between private returns and crises in the three countries. We conclude by speculating on COVID-19 implications and future research.

Coronavirus disease-19: The multi-level, multi-faceted vasculopathy.

BACKGROUND AND AIMS: The new coronavirus disease (COVID-19) is a systemic disease. Mounting evidence depict signs and symptoms involving multiple organs, most of which supported by pathological data. A plausible link to these manifestations is vascular and endothelial dysfunction/damage. However, much of the current knowledge relies on opinion and incipient evidence. We aim to objectively appraise current evidence on the association between COVID-19 and vascular disease, specifically endotheliitis and vasculitis. METHODS: Two researchers independently entered the search terms COVID-19 OR SARS-CoV-2 AND vasculitis, endotheliitis OR endothelium in the following online platforms: MedRxiv and LitCovid (PubMed). The search period was set from November 1, 2019 to August 28, 2020. Manuscripts with unavailable full texts, not in English, mainly on pre-clinical data, presenting only study designs or not directly related to the topics of this review were excluded. Retrospective and prospective studies, especially longitudinal ones, were given priority to the purpose of this review. Since there was paucity of prospective controlled evidence, case reports/series were also considered. RESULTS: A total of 318 manuscripts were initially found. Sixty-seven (21%) were excluded: 59 (18.5%) met exclusion criteria and 8 (2.5%) were duplicates. One hundred and forty-two manuscripts (44,6%) did not provide original data and were also excluded: 35 (11%) were comments, 108 (33.9%) reviews; 1 (0.3%) position paper. One hundred and seven (33.6%) studies were considered for the present scoping review: 81 (25,5%) case reports/series; 18 (5.7%) prospective; 8 (2.5%) retrospective. Viral inclusions in endothelial cells, mononuclear cell infiltrates in the intima of small vessels and markers of endothelial cell apoptosis were demonstrated. Specificities of COVID-19 may lead to diverse vascular manifestations in different levels of the vascular bed. CONCLUSIONS: Evidence indicates that COVID-19 targets vasculature and endothelium. However, high quality data is still lacking and studies with prospective designs and appropriately matched controls are needed.

A systamatic review on effect of covid on children

After the 2019 pandemic Coronavirus (COVID-19), caused by Extreme Acute RESS 2 coronavirus syndrome was identified (SARS-CoV-2), our ways of managing ourselves socially and on a regular basis have changed unprecedentedly. The sudden isolation from education, social life and recreational sports has had great impacts on children and teenagers. In certain cases, domestic abuse has also increased. Due to heightened anxiety, changes in their diet and school dynamics, fear or even lack of a component of the issue1,2, stress has a direct effect on their mental health. Our purpose is to address the need to supervise and treat persons in various areas and to alert public health and government agents. We hope that effective and prompt action will minimise harm to your mental health as a result of the side effects of this pandemic.