Impact of coronavirus disease 2019 on the HIV testing and health care delivery at a university hospital in Taiwan, 2020-2021

Background: To contain the coronavirus disease 2019 (Covid-19) pandemic, non-pharmacologic interventions, including lockdown and social distancing, may have adverse impact on access to HIV testing and care. This study investigated the impact of Covid-19 on HIV testing and care at a major hospital in Taiwan in 2020-2021. Method(s): The numbers of clients seeking anonymous HIV voluntary counseling and testing were compared 2 years before (2018-2019) and 2 years after Covid-19 outbreak (2020-2021). People living with HIV (PLWH) who sought care at the hospital during 2018-2021 were included to examine the status of HIV care delivery and disposition. Result(s): The annual number of HIV screening tests performed had significantly decreased from 2507 to 2794 in 2018 and 2019, respectively, to 2161 and 1737 in 2020 and 2021, respectively. The rate of discontinuation of HIV care among PLWH was 3.7% in 2019, which remained unchanged in 2020 (3.7%) and 2021 (3.8%). The respective percentage of annual plasma HIV RNA testing <2 times increased from 8.4% to 7.8% in 2018 and 2019 to 7.0% and 10.7% in 2020 and 2021, so was that of annual syphilis testing <2 times (10.1% and 8.8%-7.9% and 12.0%). The rates of plasma HIV RNA <200 copies/ml ranged from 97.0% to 98.1% in 2018-2021. Conclusion(s): During the Covid-19 pandemic, access to HIV counseling and testing was significantly limited. While the number of HIV-related testing decreased, the impact of Covid-19 on the continuity of antiretroviral therapy and viral suppression among PLWH appeared to be minimal in Taiwan. Copyright © 2022

Mental Health of Healthcare Workers in Indonesia, Philippines, and Taiwan During COVID-19 Pandemic: a Cross-Sectional Survey.

OBJECTIVE: This study aims to determine factors associated with hesitation and motivation to work among healthcare workers (HCWs) in Indonesia, Philippines, and Taiwan during the COVID-19 pandemic. METHODS: HCWs aged ≥20 years working in five hospitals in Indonesia, Philippines, and Taiwan were invited to participate in a self-administered mental health survey between 30 January 2021 and 31 August 2021. The 33-item questionnaire measured HCWs' perceived stress, level of motivation and hesitation to work, attitude and confidence regarding work, attitude on the policies by the hospital and government, and discrimination against the occupation. Each item was rated in a 4-point Likert scale from 0 (never) to 3 (always). Sociodemographic and occupational factors were also considered in data analysis. RESULTS: Of 1349 participants, 671 (49.7%) were from Indonesia, 365 (27.1%) from Philippines, and 313 (23.2%) from Taiwan. Overall, 20.8% of participants showed motivation to work and only 4.7% showed hesitation to work. Compared with HCWs in their 20s, HCWs in their 30s, 40s, and 50s had significantly lower hesitation to work (adjusted odds ratio [AOR] = 0.42, 0.33, and 0.11, respectively; p = 0.01, 0.02, and 0.03, respectively). Similarly, compared with HCWs in their 20s, HCWs in their 30, 40s, 50s, 60s, and 70s had significantly higher motivation to work (AOR = 1.71, 2.98, 5.92, 5.40, and 7.15, respectively; p = 0.01, <0.001, <0.001, <0.001, and 0.02, respectively). Clinical staff had lower motivation to work than non-clinical staff (AOR = 0.60, p = 0.01). Those who worked in high-risk areas had lower hesitation to work than those who worked in low-risk areas (AOR = 0.51, p = 0.03). Overall, higher hesitation to work was associated with 'wanting to leave job/study' (AOR = 4.54, p = 0.03) and 'feeling isolated' (AOR = 4.84, p = 0.01), whereas lower hesitation to work was associated with 'being confident about the future of medical practice' (AOR = 0.33, p = 0.02) and 'burden of child care including lack of nursery' (AOR = 0.30, p = 0.04). Higher motivation to work was associated with 'feeling of being protected by hospital' (AOR = 2.23, p = 0.001), 'confident in my country's pandemic prevention policy' (AOR = 2.19, p = 0.001), 'feeling of elevated mood' (AOR = 4.14, p = 0.004), and 'being confident about the future of medical practice' (AOR = 2.56, p < 0.001), whereas lower motivation to work was associated with 'exhausted mentally' (AOR = 0.35, p = 0.03). CONCLUSION: Various stress-related factors contribute to hesitation and motivation to work among HCWs in Indonesia, Philippines, and Taiwan during the COVID-19 pandemic. Proactive and practical strategies should be implemented to protect HCWs from the negative behavioural and emotional effects of the COVID-19 pandemic.

Sequential Bell's Palsy and Guillain-Barre Syndrome in a Child Following COVID-19 Vaccination: A Case Report

Case Diagnosis: A 10-year-old boy with postvaccination Guillain-Barre Syndrome (GBS) and Bell's Palsy Case Description or Program Description: A 10-year-old white Hispanic boy without significant past medical history presented to the emergency room (ER) with new right facial droop two weeks following his second dose of the Pfizer COVID-19 vaccine. He was diagnosed with Bell's Palsy and received a five-day course of steroids. He returned to the ER ten days later with a four-day history of bilateral lower extremity pain, weakness, and progressively worsening gait. His examination was notable for less than antigravity strength throughout the major muscle groups of both lower limbs, in which he also had impaired light touch sensation and areflexia. Setting(s): Pediatric unit of acute care hospital Assessment/Results: Cerebrospinal fluid analysis was notable for elevated protein levels. In the setting of areflexia in the bilateral lower limbs, a presumptive diagnosis of GBS was made and a 5-day course of intravenous immunoglobulin (IVIg) was initiated, with improvement. At time of discharge, he was able to ambulate independently without use of an assistive device. Discussion (relevance): Both GBS and Bell's palsy have been reported following vaccinations. This case is unique in that both occurred sequentially in a pediatric patient within 1 month of the second dose of the Pfizer COVID-19 vaccine. Conclusion(s): Neurological complications of the COVID-19 vaccine include both Bell's Palsy and GBS, which as in this case, may occur sequentially. Prompt initiation of IVIg, steroids, and rehabilitation may result in good recovery.

Authentication of NIfTI Neuroimages Using Lifting Wavelet Transform, Arnold Cat Map, Z-Transform, and Hessenberg Decomposition

The technological progress in digital medical imaging has enabled the diagnosis of various ailments, and thus upgraded the global healthcare system. In the era of coronavirus 2019 (COVID-19), telemedicine plays the crucial role of supporting remote medical consultation in rural locations. During the remote consultation, numerous medical images are sent to each radiologist via the Internet. There has been a surge in the number of attacks on digital medical images worldwide, which severely threatens authenticity and ownership. To mitigate the threat, this paper proposes a robust and secure watermarking approach for NIfTI images. Our approach painstakingly incorporates a watermark into the chosen NIfTI image slice, aiming to accurately fit the watermark, while preserving the medical information contained in the slice. Specifically, the original image was converted through the lifting wavelet transform (LWT), realizing excellent modification during insertion. Next, Z transform was applied over the low-low (LL) band, and the Hessenberg decomposition (HD) was performed on the transformed band, which contains the maximum energy of the image. Afterwards, Arnold Cat map was employed to scramble the watermark, before inserting it into the slice. Simulation results show that our approach strikes a perfect balance between security, imperceptibility, and robustness against various attacks, as suggested by metrics like peak signal-to-noise ratio (PSNR), normalized correlation (NC), structural similarity index measure (SSIM), and universal image quality index Q.

An Effective and Efficient Algorithm for Detecting Exact Deletion Breakpoints from Viral Next-Generation Sequencing Data

The COVID-19 pandemic has caused serious damage to the health, life and, economic stability of human beings all over the world. In order to combat this disease, researchers from all over the world, including computer scientists, are beginning to engage in cross-regional cooperation to conduct research on SARS-CoV-2. One of the latest reports pointed out that the sequence deletion of the specific region of the SARS-CoV-2 genomic is related to its viral infectivity. In addition, the sequence deletion of this specific region is also found in Hepatitis B Virus (HBV), and Hepatocellular carcinoma (HCC). Through next-generation sequencing (NGS) technology, the sequence data of biological genomes can be quickly obtained, but the number of short reads generated by NGS is often as high as one million big data. It is a challenge to detect the information necessary to provide the exact sequence deletion breakpoint from these NGS data, especially in the sequence data of highly variable viral genomes. In our previous research, we proposed VirDelect, a bioinformatics tool that can detect exact breakpoints in Viral NGS data. In this paper, a new method, One-base Alignment Plus (OAP), is proposed to enhance further the core VirDelect algorithm, in order to improve the sequence deletion detection correctness. We use the simulated data of SARS-CoV-2 and HBV with different deletion lengths and the real data of HBV to conduct experiments and evaluate the correctness. The experimental results showed that VirDelect+OAP was able to find deletions that VirDelect could not find in the simulation data, and in the real data, the correctness of VirDelect+OPA was raised effectively. © 2020 IEEE.

Study-abroad in Japan under COVID-19: Emerging parallels with a course on environmental pollution

The Coronavirus hit Japan during our study-abroad semester in Kyoto. Here we present similarities in Japanese societal response to chemical pollutants throughout the long twentieth century and to COVID-19, as they became apparent to us through a chemistry course on Japanese industrial pollution. © 2020, Japan Focus. All rights reserved.

The Impact of High-Flow Nasal Cannula Use on Patient Mortality and the Availability of Mechanical Ventilators in COVID-19.

Rationale: How to provide advanced respiratory support for coronavirus disease (COVID-19) to maximize population-level survival while optimizing mechanical ventilator access is unknown.Objectives: To evaluate the use of high-flow nasal cannula for COVID-19 on population-level mortality and ventilator availability.Methods: We constructed dynamical (deterministic) simulation models of high-flow nasal cannula and mechanical ventilation use for COVID-19 in the United States. Model parameters were estimated through consensus based on published literature, local data, and experience. We had the following two outcomes: 1) cumulative number of deaths and 2) days without any available ventilators. We assessed the impact of various policies for the use of high-flow nasal cannula (with or without "early intubation") versus a scenario in which high-flow nasal cannula was unavailable.Results: The policy associated with the fewest deaths and the least time without available ventilators combined the use of high-flow nasal cannula for patients not urgently needing ventilators with the use of early mechanical ventilation for these patients when at least 10% of ventilator supply was not in use. At the national level, this strategy resulted in 10,000-40,000 fewer deaths than if high-flow nasal cannula were not available. In addition, with moderate national ventilator capacity (30,000-45,000 ventilators), this strategy led to up to 25 (11.8%) fewer days without available ventilators. For a 250-bed hospital with 100 mechanical ventilators, the availability of 13, 20, or 33 high-flow nasal cannulas prevented 81, 102, and 130 deaths, respectively.Conclusions: The use of high-flow nasal cannula coupled with early mechanical ventilation when supply is sufficient results in fewer deaths and greater ventilator availability.