Ai based motion analysis software for sport and physical therapy assessment / Software de análisis de movimiento basado en ia para la evaluación del deporte y la fisioterapia / Software de análise de movimento baseado em ia para avaliação de esporte e fisioterapia

ABSTRACT Introduction: As the World Health Organization declared the novel coronavirus as a pandemic in March 2020, physical therapy is more difficult to execute, and social distancing is mandatory in the healthcare sector. Objective: In physical therapy, an online video analysis software that provides real-time graphic and numerical information about the patient's movement executions without direct personal contact would mean a significant improvement in eHealth treatment. Methods: We have developed a software layer on top of OpenPose human body position estimation software that can extract the time series of angles of arbitrary body parts using the output coordinates from OpenPose processing the data recorded by two cameras simultaneously. To validate the procedure of determining the joint angles using the Openpose software we have used the Kinovea software. Results: The comparison of the determined maximal knee angle in our and the Kinovea software, which is widely used in biomechanical measurements, was not significantly different (2.03±1.06°, p<0.05) Conclusion: This indicates, that the developed software can calculate the appropriate joint angles with the accuracy that physiotherapy treatments require. As, to our knowledge no such software yet exists, with the help of this software development, therapists could control and correct the exercises in real-time, and also from a distance, and physical therapy effectiveness could be increased. Level of Evidence II; Experimental, comparative.

RESUMEN Introducción: Como la Organización Mundial de la Salud declaró el nuevo coronavirus como una pandemia en marzo de 2020, la fisioterapia es más difícil de ejecutar, el distanciamiento social es obligatorio en el sector de la salud. Objetivo: En la práctica de fisioterapia un software de análisis de vídeo online que proporcione información gráfica y numérica en tiempo real sobre las ejecuciones de movimiento del paciente sin contacto personal directo supondría una mejora significativa en el tratamiento de la eSalud. Métodos: Fue desarrollado una capa de software sobre el software de estimación de posición del cuerpo humano OpenPose que puede extraer la serie temporal de ángulos de partes arbitrarias del cuerpo utilizando las coordenadas de salida de OpenPose procesando los datos registrados por dos cámaras simultáneamente. Para validar el procedimiento de determinación de los ángulos articulares mediante el software Openpose fue utilizado el software Kinovea. Resultados: La comparación del ángulo máximo de rodilla determinado en nuestro software y Kinovea, que es ampliamente utilizado en mediciones biomecánicas, no fue significativamente diferente (2,03±1,06°, p<0,05). Conclusión: Esto indica que el software desarrollado puede calcular los ángulos articulares adecuados con la precisión que requieren los tratamientos de fisioterapia. Dado que aún no existe dicho software, con la ayuda de este desarrollo de software, los terapeutas podrían controlar y corregir los ejercicios en tiempo real, y también a distancia, y se podría aumentar la eficacia de la fisioterapia. Nivel de Evidencia II; Experimental, comparativo.

RESUMO Introdução: Como a Organização Mundial da Saúde declarou o novo coronavírus como pandemia em março de 2020, a fisioterapia é mais difícil de executar, o distanciamento social é obrigatório no setor de saúde. Objetivo: Na prática da fisioterapia, um software de análise de vídeo online que fornece informações gráficas e numéricas em tempo real sobre as execuções de movimento do paciente sem contato pessoal direto significaria uma melhora significativa no tratamento eHealth. Métodos: Desenvolveu-se uma camada de software em cima do software de estimativa de posição do corpo humano OpenPose que pode extrair as séries temporais de ângulos de partes do corpo arbitrárias usando as coordenadas de saída do OpenPose processando os dados gravados por duas câmeras simultaneamente. Para validar o procedimento de determinação dos ângulos articulares utilizando o software Openpose utilizou-se o software Kinovea. Resultados: A comparação do ângulo máximo do joelho determinado em nosso e no software Kinovea, amplamente utilizado em medidas biomecânicas, não foi significativamente diferente (2,03±1,06°, p<0,05) Conclusão: Isso indica que o software desenvolvido pode calcular os ângulos articulares adequados com a precisão que os tratamentos de fisioterapia exigem. Como esse software ainda não existe, com a ajuda do desenvolvimento desse software, os terapeutas puderam controlar e corrigir os exercícios em tempo real, e também à distância, aumentando a eficácia da fisioterapia. Nível de Evidência II; Experimental, comparativo.

Effects of physical exercise on mood and sleep quality of college students under the covid-19 epidemic / Impacto del ejercicio físico en el estado de ánimo y la calidad del sueño de estudiantes universitarios en el contexto del covid-19 / Impacto do exercício físico no humor e na qualidade do sono de estudantes universitários no contexto do covid-19

ABSTRACT Introduction: The management of university campuses in the context of COVID-19 makes the mental health of college students draw much attention. Objective: To explore the effects of physical exercise under COVID-19 on sleep quality and mood of college students. Methods: 1983 college students from The Civil Aviation University of China were selected, and their physical exercise state, sleep quality, and emotional state were measured by a questionnaire. Results: Physical exercise has a significant positive effect on college students' mood and sleep quality, and sleep quality has a considerable impact on their mood. There is no gender difference in mood and sleep quality. The amount of physical exercise has a significant difference in sleep quality and mood. Compared with the students who do a lot of physical exercises, those who do a lot of physical exercises have higher sleep quality and more vital stronger emotional control ability. Conclusion: This study can provide a reference for universities to carry out mental health education during the particular period of epidemic prevention and control. Level of evidence II; Diagnostic Studies—Investigating a Diagnostic Test.

RESUMEN Introducción: la gestión del campus universitario en el contexto del COVID-19 hace que la salud mental de los estudiantes universitarios llame mucho la atención. Objetivo: explorar los efectos del ejercicio físico bajo COVID-19 sobre la calidad del sueño y el estado de ánimo de estudiantes universitarios. Métodos: se selecciona estudiantes universitarios 1983 de la universidad de aviación Civil de China, y se midió su estado de ejercicio físico, calidad del sueño y estado emocional mediante un cuestionario. Resultados: el ejercicio físico tiene un efecto positivo significativo en el estado de ánimo y la calidad del sueño de los estudiantes universitarios, y la calidad del sueño tiene un efecto significativo en su estado de ánimo. No hay diferencia de género en cuanto al estado de ánimo y la calidad del sueño. La cantidad de ejercicio físico tiene una diferencia significativa en la calidad del sueño y el estado de ánimo. En comparación con los estudiantes que hacen mucho ejercicio físico, los estudiantes que hacen mucho ejercicio físico tienen una mayor calidad de sueño y una mayor capacidad de control emocional. Conclusión: este estudio puede servir de referencia para que las universidades realicen educación en salud mental durante el período especial de prevención y control de epidemias. Nivel de Evidência II; Estudios diagnósticos: investigación de una prueba diagnóstica.

RESUMO Introdução: A gestão do campus universitário no contexto do COVID-19 faz com que a saúde mental dos universitários chame muita atenção. Objetivo: Explorar os efeitos do exercício físico sob o COVID-19 sobre a qualidade do sono e o humor dos estudantes universitários. Métodos: Foram selecionados 1983 estudantes universitários da Universidade de Aviação Civil da China, e seu estado de exercício físico, qualidade do sono e estado emocional foram medidos por um questionário. Resultados: O exercício físico tem um efeito positivo significativo no humor e na qualidade do sono dos estudantes universitários, e a qualidade do sono tem um efeito significativo em seu humor. Não há diferença de gênero no humor e na qualidade do sono. A quantidade de exercício físico tem diferença significativa na qualidade do sono e no humor. Em comparação com os alunos que fazem muito exercício físico, os alunos que fazem muito exercício físico têm maior qualidade de sono e maior capacidade de controle emocional. Conclusão: Este estudo pode fornecer referência para que as universidades realizem a educação em saúde mental durante o período especial de prevenção e controle de epidemias. Nível de evidência II; Estudos de Diagnóstico — Investigando um Teste de Diagnóstico.

Sedentary behavior among medical students: repercussions of the coronavirus pandemic / Conduta sedentária entre estudantes de medicina: repercussões da pandemia do coronavírus

ABSTRACT Introduction: In order to face COVID-19, social restriction measures were adopted that influenced the population's living habits, increasing sedentary lifestyle. Considering the high complexity and dedication required by the Medicine course, it becomes relevant to investigate the effect of the pandemic on the practice of physical exercise and sedentary behavior of these students. Objective: Identify changes in physical activity and sedentary behavior self-reported by medical students in the city of Salvador, Bahia, before and during the self-confinement imposed by the COVID-19 pandemic. Methods: Longitudinal, prospective, quantitative study carried out with regularly enrolled medical students over 18 years of age. A virtual, structured, anonymous, self-completed questionnaire was applied, containing sociodemographic and academic aspects. In addition, the International Physical Activity Questionnaire (IPAQ) was applied in its short version, considering the period before and during the pandemic. Through this, the level of physical activity, sedentary behavior and time spent walking and performing moderate and vigorous activities were measured. Results: 268 medical students were included, predominantly women (65.7%), white (50.0%) and mixed race (38.8%), aged 24.2 ± 5.5 years, single (90.7%), attending the clinical cycle (59.0%), in private institutions (78.4%). No statistically significant differences were identified in the level of physical activity and in the time spent with moderate and vigorous activities. However, there was a reduction in walking time (p<0.00001) and an increase in sedentary behavior (p=0.001) during the COVID-19 pandemic, with the greatest impact among women (p=0.0009). Conclusion: The repercussions of the COVID-19 pandemic have been shown to increase the sedentary behavior of medical students, especially among women, and to reduce activity time spent with walking. Longitudinal studies are needed to analyze the medium and long-term consequences of this change in the healthy lifestyle habits of medical students. Level of evidence II; Comparative prospective study.

Resumen Introducción: Frente al COVID-19 se adoptaron medidas de restricción social que influyeron en los hábitos de vida de la población, aumentando el sedentarismo. Considerando la alta complejidad y la dedicación exigida por la carrera de Medicina, se torna relevante investigar el efecto pandémico sobre la práctica de ejercicio físico y la conducta sedentaria de estos estudiantes. Objetivos: Identificar los cambios en la actividad física y en la conducta sedentaria auto-reportados por los estudiantes de Medicina de la ciudad de Salvador, Bahía, Brasil, antes y durante el auto-confinamiento impuesto por la pandemia de COVID-19. Métodos: Estudio longitudinal, prospectivo, cuantitativo, realizado con estudiantes de medicina regularmente matriculados, mayores de 18 años. Foi aplicado um questionário virtual, estruturado, anónimo, autocompletado, contendo aspectos sociodemográficos e académicos. Além disso, foi aplicado o International Physical Activity Questionnaire (IPAQ), em sua versão curta, considerando o período antes e durante a pandemia. A través de éste, se midió el nivel de actividad física, el comportamiento sedentario y el tiempo dedicado a caminar, así como las actividades moderadas y vigorosas. Resultados: Se incluyeron 268 estudiantes de medicina, predominantemente mujeres (65,7%), blancas (50,0%) y morenas (38,8%), de 24,2 ± 5,5 años de edad, solteras (90,7%), en el ciclo clínico (59,0%), en instituciones privadas (78,4%). No se identificaron diferencias estadísticamente significativas en el nivel de actividad física y el tiempo dedicado a actividades moderadas y vigorosas. Sin embargo, hubo una reducción en el tiempo de caminata (p<0,00001) y un aumento en la conducta sedentaria (p=0,001) durante la pandemia COVID-19, siendo mayor el impacto entre las mujeres (p=0,0009). Conclusión: Las repercusiones de la pandemia COVID-19 se manifestaron en el aumento de la conducta sedentaria entre los estudiantes de medicina, especialmente entre las mujeres, además de la reducción del tiempo de actividad dedicado a caminar. Son necesarios estudios longitudinales para analizar las consecuencias a medio y largo plazo de este cambio en los hábitos de vida saludables de los estudiantes de medicina. Nivel de evidencia II; Estudio Prospectivo Comparativo.

RESUMO Introdução: Foram adotadas medidas de restrição social para o enfrentamento da COVID-19 que influenciaram nos hábitos de vida da população, aumentando o sedentarismo. Considerando a alta complexidade e a dedicação exigida pelo curso de Medicina, torna-se relevante investigar o efeito da pandemia na prática de exercício físico e conduta sedentária desses estudantes. Objetivos: Identificar alterações na atividade física e na conduta sedentária autorrelatadas por acadêmicos de Medicina na cidade de Salvador, Bahia, antes e durante o autoconfinamento imposto pela pandemia de COVID-19. Métodos: Estudo longitudinal, prospectivo, quantitativo, realizado com estudantes de Medicina, maiores de 18 anos, regularmente matriculados. Foi aplicado um questionário virtual, estruturado, anônimo, de autopreenchimento, contendo aspectos sociodemográficos e acadêmicos. Além disso, foi aplicado o International Physical Activity Questionnaire (IPAQ), em sua versão curta, considerando o período antes e durante a pandemia. Através deste, foram mensurados nível de atividade física, conduta sedentária e tempo de realização de caminhada, além de atividades moderadas e vigorosas. Resultados: Foram incluídos 268 estudantes de Medicina, predominantemente mulheres (65,7%), da raça branca (50,0%) e parda (38,8%), com idade de 24,2 ± 5,5 anos, solteiros (90,7%), cursando o ciclo clínico (59,0%), em instituições privadas (78,4%). Não foram identificadas diferenças estatisticamente significantes no nível de atividade física e no tempo despendido com atividades moderadas e vigorosas. Entretanto, houve redução no tempo de caminhada (p<0,00001) e aumento da conduta sedentária (p=0,001) durante a pandemia de COVID-19, sendo o impacto maior entre as mulheres (p=0,0009). Conclusão: Foram demonstradas as repercussões da pandemia de COVID-19 no aumento da conduta sedentária dos estudantes de Medicina, principalmente entre as mulheres, além da redução do tempo de atividade despendido com caminhadas. Estudos longitudinais são necessários para analisar as consequências a médio e longo prazo dessa alteração nos hábitos de vida saudáveis de estudantes de Medicina. Nível de evidência II; Estudo Prospectivo Comparativo.

Global research trends related to coronavirus disease 2019 and the aged: a bibliometric analysis

ABSTRACT BACKGROUND: A bibliometric analysis covering only the production of original studies or considering world production until 2022 has yet to be conducted. The creation and advancement of vaccines have also influenced research priorities, demonstrating the need for a new approach to this subject. OBJECTIVES: To analyze worldwide scientific production related to coronavirus disease 2019 (COVID-19) and the aged and to describe what has already been produced. DESIGN AND SETTING: Bibliometric analysis with a quantitative approach. METHOD: The search terms "COVID-19," "SARS-CoV-2," "Aged," and "Elderly" were used to retrieve articles from the Web of Science database. A total of 684 articles were included in the analysis. Data were imported into RStudio Desktop Software and linked to R Software. The Bibliometrix R package and VOSviewer software were used for analysis. RESULTS: Most articles were published in 2020. These were produced by 4,937 authors and published in 379 journals. The keyword most used by the authors was "COVID-19." Publications from 77 countries were obtained. China had the highest article production ranking, and Spain collaborated the most. The articles addressed the implications of the pandemic on the aged, the relationship between vaccination in the aged, and the implications for the disease itself. CONCLUSION: Further research should be conducted, mainly concerning vaccines and vaccination of the aged, owing to the need for and importance of immunization in this risk group, including assessing the long-term effects of vaccines.

Impact of COVID-19 social distancing recommendations on pulmonary function, nutritional status, and morbidity in patients with cystic fibrosis / Impacto das recomendações de distanciamento social por COVID-19 sobre a função pulmonar, estado nutricional e morbidade em pacientes com fibrose cística

ABSTRACT Objective: To evaluate the impact of COVID-19 social distancing recommendations on nutritional status, pulmonary function, and morbidity in patients with cystic fibrosis (CF). Methods: A retrospective cohort study including patients older than six years with a diagnosis of CF was performed. Demographic and clinical data, anthropometric measurements, pulmonary function, days of antibiotic use, and length of hospital stay were recorded. Variables were recorded at three time points relative to the baseline for implementation of social distancing measures: T-1 (14 months before implementation), T0 (baseline), and T1 (14 months after implementation). Delta (Δ) was calculated for each period: Δ1 (pre-pandemic T0-T-1) and Δ2 (pandemic T1-T0). Results: The study included 25 patients, with a mean age of 11.7±4.3 years. The mean forced expiratory volume in the first second (FEV1) was 85.6±23.6%, and body mass index (BMI) was 17.5±3.0 kg/m2. When comparing the two periods (Δ1 and Δ2), there was a significant increase in the FEV1/forced vital capacity (FVC) ratio (p=0.013) and in the forced expiratory flow between 25 and 75% of vital capacity (FEF25-75%) (p=0.037) in the pandemic period. There was also a significant reduction (p=0.005) in the use of antibiotics in the pandemic period compared with the pre-pandemic period. The Δ1 and Δ2 values did not differ significantly for BMI, FEV1, or length of hospital stay. Conclusions: COVID-19 social distancing recommendations had a positive impact (decrease) on morbidity (use of antibiotics) and small airway obstruction (FEF25-75%) in patients with CF.

RESUMO Objetivo: Avaliar o impacto das recomendações de medidas de distanciamento social por COVID-19 sobre estado nutricional, função pulmonar e morbidade em pacientes com fibrose cística (FC). Métodos: Estudo de coorte, retrospectivo, que incluiu pacientes com diagnóstico de FC e idade superior a seis anos. Foram registrados os dados demográficos, antropométricos, clínicos, de função pulmonar e o total de dias de uso de antibiótico e de hospitalizações. As variáveis foram registradas em três momentos relativos ao início das recomendações de distanciamento social: T-1 (14 meses antes), T0 (início das recomendações) e T1 (14 meses depois). Foram calculados deltas (Δ) para cada um dos períodos: Δ1 (pré-pandemia T0-T-1) e Δ2 (pandemia T1-T0). Resultados: Vinte e cinco pacientes, com média de idade de 11,7±4,3 anos, sendo 76% homozigotos para Δf508 e 28% colonizados por Pseudomonas aeruginosa, foram incluídos. A média do volume expiratório forçado no primeiro segundo (VEF1) foi de 85,6±23,6 (% do previsto) e o índice de massa corporal (IMC) foi de 17,5±3,0 kg/m2. Ao compararmos os períodos (Δ1 e Δ2), houve aumento significativo do VEF1/CVF (p=0,013) e do FEF25-75% (p=0,037) no período das recomendações de distanciamento. Também se observou redução significativa (p=0,005) do uso de antibióticos no período da pandemia em comparação ao período anterior a ela. Não houve diferenças significativas nos deltas para o IMC, VEF1 e dias de hospitalização. Conclusões: As recomendações de distanciamento social por COVID-19 tiveram impacto positivo (redução) sobre a morbidade (uso de antibióticos) e a obstrução de vias aéreas de menor calibre (FEF25-75%) em pacientes com FC.

New records of Coronatella (Crustacea, Branchiopoda, Chydoridae) from Colombia with the first report of Coronatella undata and of the male of Coronatella monacantha / Novos registros de Coronatella (Crustacea, Branchiopoda, Chydoridae) na Colômbia com o primeiro relato de Coronatella undata e o macho de Coronatella monacantha

Biological samples obtained from a small temporary pond of northern Colombia yielded the first record Coronatella undata Sousa, Elmoor-Loureiro and Santos, 2015 and of the male of C. monacantha (Sars, 1901) for Colombia. In this study, the morphology of female of Coronatella undata and female and male of C. monacantha was described and compared to other species within the genus. C. undata was originally described from Brazil and, among the species of the Coronatella monacantha complex, seems to be closely related to C. acuticostata (Sars, 1903). C. undata shows some similarities with C. monacantha, but it can be identified by important diagnostic characters such as: 1) posterior-ventral corner of valve with two denticles, 2) seta on exopodite of trunk limb II rudimentary, 3) filter comb of trunk limb II with six setae, 4) ODL seta of trunk limb I shorter than longest seta of IDL. C. monacantha is the most reported species in the Neotropical region and the male most resemble C. paulinae Sousa, Elmoor-Loureiro & Santos, 2015 in relation to (i), length/wide of postabdomen ratio (ii) basal spine almost straight and (iii)) long basal spine reaching the mid-length of basal spine. However, they can be separated by (i) number of lateral seta on the antennule, (ii) postanal angle, (iii) position of gonopore (iv) presence of a denticle on posterior-ventral corner of valve.

Amostras biológicas obtidas de uma pequena lagoa temporária do norte da Colômbia proporcionaram o primeiro registro de Coronatella undata Sousa, Elmoor-Loureiro e Santos, 2015 e do macho de Coronatella monacantha (Sars, 1901) na Colômbia. Neste estudo, foi descrita a morfologia de fêmeas de C. undata e de fêmeas e machos de C. monacantha, comparando-a com outras espécies do gênero. Coronatella undata foi descrita originalmente no Brasil e, entre as espécies do complexo C. monacantha, parece estar intimamente relacionada com Coronatella acuticostata (Sars, 1903). Coronatella undata apresenta algumas semelhanças com C. monacantha, mas pode ser identificada por seus principais caracteres, tais como: 1) ângulo posterior ventral da valva com dois dentículos; 2) cerda rudimentar no exopodito do ramo do tronco II; 3) filtro da gnatobase do apêndice torácico II com seis cerdas; 4) cerda ODL do membro do tronco I mais curta que a cerda mais longa do IDL. Coronatella monacantha é a espécie mais relatada na região neotropical, e o macho se assemelha mais a Coronatella paulinae Sousa, Elmoor-Loureiro & Santos em relação à/ao: (i) razão comprimento / largura do pós-abdômen, (ii) espinho basal quase reto e (iii) espinho basal longo com a metade do comprimento do espinho basal. No entanto, eles podem ser separados pelo/pela: (i) número de cerdas laterais na antênula, (ii) ângulo postanal, (iii) posição do gonóporo e (iv) presença de dentículo no canto ventral posterior da valva.

New records of Coronatella (Crustacea, Branchiopoda, Chydoridae) from Colombia with the first report of Coronatella undata and of the male of Coronatella monacantha

Abstract Biological samples obtained from a small temporary pond of northern Colombia yielded the first record Coronatella undata Sousa, Elmoor-Loureiro and Santos, 2015 and of the male of C. monacantha (Sars, 1901) for Colombia. In this study, the morphology of female of Coronatella undata and female and male of C. monacantha was described and compared to other species within the genus. C. undata was originally described from Brazil and, among the species of the Coronatella monacantha complex, seems to be closely related to C. acuticostata (Sars, 1903). C. undata shows some similarities with C. monacantha, but it can be identified by important diagnostic characters such as: 1) posterior-ventral corner of valve with two denticles, 2) seta on exopodite of trunk limb II rudimentary, 3) filter comb of trunk limb II with six setae, 4) ODL seta of trunk limb I shorter than longest seta of IDL. C. monacantha is the most reported species in the Neotropical region and the male most resemble C. paulinae Sousa, Elmoor-Loureiro & Santos, 2015 in relation to (i), length/wide of postabdomen ratio (ii) basal spine almost straight and (iii)) long basal spine reaching the mid-length of basal spine. However, they can be separated by (i) number of lateral seta on the antennule, (ii) postanal angle, (iii) position of gonopore (iv) presence of a denticle on posterior-ventral corner of valve

Resumo Amostras biológicas obtidas de uma pequena lagoa temporária do norte da Colômbia proporcionaram o primeiro registro de Coronatella undata Sousa, Elmoor-Loureiro e Santos, 2015 e do macho de Coronatella monacantha (Sars, 1901) na Colômbia. Neste estudo, foi descrita a morfologia de fêmeas de C. undata e de fêmeas e machos de C. monacantha, comparando-a com outras espécies do gênero. Coronatella undata foi descrita originalmente no Brasil e, entre as espécies do complexo C. monacantha, parece estar intimamente relacionada com Coronatella acuticostata (Sars, 1903). Coronatella undata apresenta algumas semelhanças com C. monacantha, mas pode ser identificada por seus principais caracteres, tais como: 1) ângulo posterior ventral da valva com dois dentículos; 2) cerda rudimentar no exopodito do ramo do tronco II; 3) filtro da gnatobase do apêndice torácico II com seis cerdas; 4) cerda ODL do membro do tronco I mais curta que a cerda mais longa do IDL. Coronatella monacantha é a espécie mais relatada na região neotropical, e o macho se assemelha mais a Coronatella paulinae Sousa, Elmoor-Loureiro & Santos em relação à/ao: (i) razão comprimento / largura do pós-abdômen, (ii) espinho basal quase reto e (iii) espinho basal longo com a metade do comprimento do espinho basal. No entanto, eles podem ser separados pelo/pela: (i) número de cerdas laterais na antênula, (ii) ângulo postanal, (iii) posição do gonóporo e (iv) presença de dentículo no canto ventral posterior da valva.

Conducting Goals of Care Conversations: Lessons From the COVID-19 Pandemic.

Objective: Internal medicine (IM) residents discuss a patient's goals of care (GOC) as part of their initial consultation. Residents have described inexperience, general discomfort, limited formal teaching, and prognostic uncertainty as barriers to effective GOC conversations. The early COVID-19 pandemic resulted in rapid changes to the healthcare system on the individual, patient, and systemic level that might exacerbate and/or introduce new barriers to IM residents' GOC conversations. This qualitative study examines how the early COVID-19 pandemic challenged IM residents' ability to have effective GOC conversations. Methods: Using a constructivist grounded theory approach, participants (n=11) completed a semi-structured interview. Data collection and analysis occurred simultaneously using an open coding, constant comparison process. Interviews were completed until no new themes were identified. Results: Residents self-described their GOC conversations in 5 steps: normalization of the conversation, introduction of expected clinical course, discussion of possible care plans, exploration of the patient's values, and occasionally providing a recommendation. Residents described limited structured teaching around GOC conversations and instead relied on observed role-modelling and self-practice to hone their skillset. Residents described an increased sense of urgency to have GOC conversations due to the uncertainty of clinical course and potential for rapid deterioration of patients with COVID-19. Residents identified restrictive visitor policies as a significant barrier that contributed to feelings of dehumanization. Residents felt that these limitations affected their GOC conversations and potentially resulted in discordant care plans which contributed to moral distress. Conclusion: The early COVID-19 pandemic resulted in several barriers that challenged residents' ability to conduct effective GOC conversations. This is on the background of previously reported discomfort and limited formal training in conducting GOC conversations. Based on our findings, we present a conceptual model involving teaching validated GOC frameworks, positive role-modelling, and experiential learning to support GOC conversation education in post-graduate medical education.

Immunity testing against COVID-19 from blood by an IoT-enabled and AI-controlled multiplexed microfluidic platform.

Developing herd immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is pivotal for changing the course of the coronavirus disease 2019 (COVID-19) pandemic. However, the uncertainty of vaccine-induced immunity development and inequitable distribution of vaccines hinders the global vaccination effort. Therefore, routine serodiagnosis and ensuring effective vaccination on a time-to-time basis are essential for developing sustainable immunity against SARS-CoV-2. Herein, an AI-driven multiplexed point-of-care testing (POCT) platform capable of utilizing a microfluidic lab-on-a-chip (LOC) device has been proposed for analyzing bodily fluid response against SARS-CoV-2. The developed platform has been successfully utilized for the quantification of SARS-CoV-2 S-protein, N-protein, IgM, and IgG from human blood samples with limits of detection (LODs) as low as 0.01, 0.02, 0.69, and 0.61 ng/mL respectively. Finally, a data-receptive web-based dashboard system has been developed and demonstrated to provide real-time, territory-specific analysis of herd immunity progress from the test results. Thus, the proposed platform could be an imperative tool for healthcare authorities to analyze and restrain ongoing COVID-19 outbreaks or similar pandemics in the future by ensuring effective immunization.

Fulminant Vaccine-Induced Immune Thrombotic Thrombocytopenia After ChAdOx1 nCoV-19 (AZD1222) Vaccine Administration in a Woman With Obesity: A Case Report.

Vaccine-induced immune thrombotic thrombocytopenia (VITT), also known as thrombosis with thrombocytopenia syndrome, is a rare complication of ChAdOx1 nCoV-19 (AZD1222) vaccine administration. The overall incidence of VITT worldwide is one case per 100 000 exposures. Because of the high mortality rate from VITT, thorough monitoring is crucial to predict the risk of occurrence. The underlying risk factors for VITT are not fully understood. Potential risk factors include sex (female) and young age (less than 50 years), but further research must be conducted to confirm these assumptions. We report the case of a woman with obesity, which is a risk factor for deep vein thrombosis in the legs and for pulmonary embolism, who experienced fulminant VITT after AZD1222 vaccine administration. Keywords: Vaccine-induced immune thrombotic thrombocytopenia, AZ vaccine, Obesity, Risk factor.

Cytotoxic lesion of corpus callosum after COVID-19 vaccination: case report.

PURPOSE: Cytotoxic lesions of corpus callosum (CLOCCs) are associated with many disease entities. Serious neurological complications after coronavirus disease 2019 (COVID-19) vaccination are rare. CASE REPORT: A 20-year-old man presented with severe headache for 2 days. He had received the first dose of ChAdOx1nCoV-19 COVID-19 vaccine 5 days ago. Persistent dull headache occurred on the third day after vaccination and intensified gradually to awaken him from sleep at night. No neck stiffness was observed. Brain magnetic resonance angiography (MRA) 9 days after vaccination revealed an oval-shaped diffusion-weighted restriction lesion at the splenium of corpus callosum with a mildly high signal intensity on T2-weighted images (T2WI) and low signal intensity on apparent diffusion coefficient (ADC) imaging but without enhancement after contrast injection. A COVID-19 polymerase chain reaction test was negative. A blood test revealed slight leukocytopenia, thrombocytopenia, and hyponatremia. Further autoimmune and hematological studies were normal. A cerebrospinal fluid study revealed normal intracranial pressure. The patient's headache improved gradually. Follow-up brain MRA 5 weeks after vaccination revealed complete disappearance of the diffusion-weighted restriction lesion of the splenium. CONCLUSION: CLOCCs are rare transient adverse effect of COVID-19 vaccination possibly related to a cytokine storm. The splenic lesion might disappear spontaneously with a good prognosis.

Respiratory rate­oxygenation (ROX) index for predicting high-flow nasal cannula failure in patients with and without COVID-19.

BACKGROUND: The predictive value of the respiratory rate­oxygenation (ROX) index for a high-flow nasal cannula (HFNC) in patients with COVID-19 with acute hypoxemic respiratory failure (AHRF) may differ from patients without COVID-19 with AHRF, but these patients have not yet been compared. We compared the diagnostic accuracy of the ROX index for HFNC failure in patients with AHRF with and without COVID-19 during acute emergency department (ED) visits. METHODS: We performed a retrospective analysis of patients with AHRF treated with an HFNC in an ED between October 2020 and April 2022. The ROX index was calculated at 1, 2, 4, 6, 12, and 24 h after HFNC placement. The primary outcome was the failure of the HFNC, which was defined as the need for subsequent intubation or death within 72 h. A receiver operating characteristic (ROC) curve was used to evaluate discriminative power of the ROX index for HFNC failure. RESULTS: Among 448 patients with AHRF treated with an HFNC in an ED, 78 (17.4%) patients were confirmed to have COVID-19. There was no significant difference in the HFNC failure rates between the non-COVID-19 and COVID-19 groups (29.5% vs. 33.3%, p = 0.498). The median ROX index was higher in the non-COVID-19 group than in the COVID-19 group at all time points. The prognostic power of the ROX index for HFNC failure as evaluated by the area under the ROC curve was generally higher in the COVID-19 group (0.73-0.83) than the non-COVID-19 group (0.62-0.75). The timing of the highest prognostic value of the ROX index for HFNC failure was at 4 h for the non-COVID-19 group, whereas in the COVID-19 group, its performance remained consistent from 1 h to 6 h. The optimal cutoff values were 6.48 and 5.79 for the non-COVID-19 and COVID-19 groups, respectively. CONCLUSIONS: The ROX index had an acceptable discriminative power for predicting HFNC failure in patients with AHRF with and without COVID-19 in the ED. However, the higher ROX index thresholds than those in previous publications involving intensive care unit (ICU) patients suggest the need for careful monitoring and establishment of a new threshold for patients admitted outside the ICU.

Remission of severe forms of long COVID following monoclonal antibody (MCA) infusions: A report of signal index cases and call for targeted research.

OBJECTIVE: Long COVID has afflicted tens of millions globally leaving many previously-healthy persons severely and indefinitely debilitated. The objective here was to report cases of complete, rapid remission of severe forms of long COVID following certain monoclonal antibody (MCA) infusions and review the corresponding pathophysiological implications. DESIGN: Case histories of the first three index events (among others) are presented. Unaware of others with similar remissions, each subject independently completed personal narratives and standardized surveys regarding demographics/occupation, past history, and the presence and respective severity grading of 33 signs/symptoms associated with long COVID, comparing the presence/severity of those symptoms during the pre-COVID, long-COVID, post-vaccination, and post-MCA phases. SETTING: Patient interviews, e-mails and telephone conversations. SUBJECTS: Three previously healthy, middle-aged, highly-functioning persons, two women and one man (ages 60, 43, and 63 years respectively) who, post-acute COVID-19 infection, developed chronic, unrelenting fatigue and cognitive impairment along with other severe, disabling symptoms. Each then independently reported incidental and unanticipated complete remissions within days of MCA treatment. INTERVENTIONS: The casirivimab/imdevimab cocktail. MEASUREMENTS AND MAIN RESULTS: Irrespective of sex, age, medical history, vaccination status, or illness duration (18, 8 and 5 months, respectively), each subject experienced the same complete remission of their persistent disabling disease within a week of MCA infusion. Each rapidly returned to normal health and previous lifestyles/occupations with normalized exercise tolerance, still sustained to date over two years later. CONCLUSIONS: These index cases provide compelling clinical signals that MCA infusions may be capable of treating long COVID in certain cases, including those with severe debilitation. While the complete and sustained remissions observed here may only apply to long COVID resulting from pre-Delta variants and the specific MCA infused, the striking rapid and complete remissions observed in these cases also provide mechanistic implications for treating/managing other post-viral chronic conditions and long COVID from other variants.

Quantifying the impact of lockdown measures on air pollution levels: A comparative study of Bhopal and Adelaide.

This research study presents an in-depth comparison of air quality in Bhopal, India, and Adelaide, Australia, focusing on the impact of COVID-19 restrictions. Utilizing air quality data from 2019 to 2022, the research analyzed the concentrations of pollutants like PM2.5, PM10, NO2, and O3, during pre-lockdown, lockdown, and post-lockdown periods. The findings demonstrate a significant reduction in PM2.5and PM10 levels during lockdown in cities such as Delhi and Haryana in India, and various Chinese cities, while also highlighting complex sources of air pollution like bushfires in regions like Sydney, Australia. In contrast, the study revealed nuanced trends in Bhopal and Adelaide, influenced by local geographical, climatic, and anthropogenic factors. Bhopal exhibited a notable decrease in PM10 and PM2.5levels, but inconsistent patterns in NO2 and CO, while Adelaide experienced marginal changes. The study emphasizes the temporary effectiveness of lockdowns and underscores the need for region-specific, sustainable air quality management strategies. Future implications include considerations for regional specificities, broader atmospheric chemistry, and international collaboration. The research provides valuable insights for urban air quality policy formulation, stressing a data-driven, long-term approach.

Safety and timeliness of telemedicine initiation of continuous kidney replacement therapy.

BACKGROUND: During the COVID-19 pandemic, some continuous kidney replacement therapy (CKRT) initiations were transitioned to telemedicine to improve the timeliness of initiation, and minimize COVID-19 transmission. While telemedicine would appear acceptable for many clinical settings, safety and timeliness of telemedicine CKRT initiation is undescribed. METHODS: We conducted a single-center retrospective cohort study of pediatric patients on CKRT from January 2021-September 2022. Information on patient characteristics and CKRT therapy was extracted from the electronic health record. Multidisciplinary team provider attitudes and perspectives were assessed using survey. RESULTS: During the study period, there were 101 CKRT circuit initiations in patients not previously receiving CKRT, with 33% (33/101) initiated by telemedicine. There were no differences in patient characteristics, including age, weight at initiation, severity of illness, nor degree of fluid overload between the in-person and telemedicine initiation cohorts. CKRT telemedicine initiations were timelier, occurring on average 3.0 h after decision to initiate therapy compared to 5.8 h for all in-person CKRT starts (p < 0.001) and 5.5 h for night and weekend in-person starts (p < 0.001). Complications did not differ between telemedicine and in-person starts (15% vs. 15%, p = 0.99) and initial circuit life was similar. There were no differences in likelihood of death or duration of CKRT therapy. Telemedicine initiations were widely acceptable to multidisciplinary providers. CONCLUSION: In appropriately selected patients, telemedicine initiation of CKRT is a timely and safe option. Further standardization of telemedicine initiation of CKRT should be considered to improve the timely delivery of CKRT and may improve nephrology workforce wellness. A higher resolution version of the Graphical abstract is available as Supplementary information.

Cost analysis of telemedicine use in paediatric nephrology-the LMIC perspective.

BACKGROUND: The overall cost of managing chronic diseases is a significant barrier to accessing complete and timely healthcare, especially in rural and geographically isolated areas. This cost disparity becomes more pronounced in the case of children and more so in under-resourced regions of the world. In the era of COVID-19, as the need for physical distancing increased, there was a transition in approach to healthcare provision to telemedicine consultations. This study evaluates the cost saving using teleconsultations in a paediatric nephrology clinic. METHODS: This prospective cohort study was conducted at AIIMS Jodhpur, a tertiary care centre in western Rajasthan from March 2021 to October 2022. All consecutive paediatric (29 days-18 years) patients attending telemedicine services for kidney-related illness were enrolled. Basic demographic details were collected. Cost analysis was done after 6 months, regarding perceived cost savings for the patient and family by using telehealth for follow-up during 6 months starting from enrolment. RESULTS: A total of 112 patients were enrolled; 266 teleconsultations attended; 109 patients who could be followed up saved INR 457,900 during 6 months of follow-up. The average cost saving was INR - 1577/patient/visit. Patients saved 4.99% of the family income (median 2.16% (IQR 0.66-5.5)). The highest expenditure per visit was incurred for food and transport. The median distance from the residence to the clinic was 122.5 km (IQR 30-250). Over the 6-month study period, patients saved a travel distance of 83,274 km (743 km/patient). CONCLUSIONS: The use of telemedicine as a follow-up method helps save significant costs and distances travelled by patients. A higher-resolution version of the Graphical abstract is available as Supplementary information.

Use of the Seraph® 100 Microbind® Affinity Blood Filter in an adolescent patient with disseminated adenoviral disease.

BACKGROUND: The Seraph® 100 Microbind® Affinity Blood Filter (Seraph® 100) is an adjunctive pathogen adsorption device with emergency use authorization for use with extracorporeal therapies to treat COVID-19 infection. CASE: Here, we describe the use of Seraph® 100 in a 17-year-old chronically immunosuppressed patient status post deceased donor kidney transplant who presented initially for hematuria, dysuria, and fevers, and was found to have disseminated adenovirus (ADV) infection complicated by nephritis, viral pneumonia, elevated transaminases, and bone marrow suppression. Despite halting immunosuppression for 2 weeks, she remained febrile to 40.2 °C, with serum ADV counts > 10 million copies/mL (> log 7). Due to concerns about nephrotoxicity from cidofovir treatment, she underwent 2 intermittent treatments with Seraph® 100 to reduce viral load. Fever curve, blood counts, and transaminases stabilized in the days following treatment, and the patient was able to resume her prior immunosuppression regimen without a rebound in viral counts. CONCLUSIONS: This adolescent kidney transplant patient with disseminated ADV infection tolerated in-line treatment with Seraph® 100 without major clinical adverse events related to the adsorber, and had resolution of her ADV infection and good clinical recovery.

Factors Affecting Healthcare Provider Referral to Heart Function Clinics: A Mixed-Methods Study.

BACKGROUND: Heart failure (HF) care providers are gatekeepers for patients to appropriately access lifesaving HF clinics. OBJECTIVE: The aim of this study was to investigate referring providers' perceptions regarding referral to HF clinics, including the impact of provider specialty and the coronavirus disease pandemic. METHODS: An exploratory, sequential design was used in this mixed-methods study. For the qualitative stage, semistructured interviews were performed with a purposive sample of HF providers eligible to refer (ie, nurse practitioners, cardiologists, internists, primary care and emergency medicine physicians) in Ontario. Interviews were conducted via Microsoft Teams. Transcripts were analyzed concurrently by 2 researchers independently using NVivo, using a deductive-thematic approach. Then, a cross-sectional survey of similar providers across Canada was undertaken via REDCap (Research Electronic Data Capture), using an adapted version of the Provider Attitudes toward Cardiac Rehabilitation and Referral scale. RESULTS: Saturation was achieved upon interviewing 7 providers. Four themes arose: knowledge about clinics and their characteristics, providers' clinical expertise, communication and relationship with their patients, and clinic referral process and care continuity. Seventy-three providers completed the survey. The major negative factors affecting referral were skepticism regarding clinic benefit (4.1 ± 0.9/5), a bad patient experience and believing they are better equipped to manage the patient (both 3.9). Cardiologists more strongly endorsed clarity of referral criteria, referral as normative and within-practice referral supports as supporting appropriate referral versus other professionals ( P s < .02), among other differences. One-third (n = 13) reported the pandemic impacted their referral practices (eg, limits to in-person care, patient concerns). CONCLUSION: Although there are some legitimate barriers to appropriate clinic referral, greater provider education and support could facilitate optimal patient access.

Epidemiology of systemic vasculitis.

PURPOSE OF REVIEW: Epidemiology of vasculitides exhibit geographic variation and data from some parts of the world are still scarce. Increased recognition of these rare diseases and improvement in diagnosis and patient care may lead to changes in their epidemiology. In this review, we aimed to highlight the most recent work on the epidemiology of systemic vasculitis. RECENT FINDINGS: New data from countries where information on the epidemiology of giant cell arteritis, Takayasu arteritis and Behçet syndrome were limited have revealed that these conditions are not as rare as previously believed. The incidence rates during the coronavirus disease 2019 pandemic highlight the link between Kawasaki disease and respiratory pathogens. The use of different classification criteria hampers the comparison of true incidence and prevalence rates in antineutophil cytoplasmic antibody (ANCA)-associated vasculitis and its subtypes between geographies and over time. SUMMARY: Recent studies have highlighted the epidemiology of vasculitides in different parts of the world and changing trends. Standardization of study design and disease definitions is needed to improve the reliability and comparability of the results.

COVID-19 Vaccine Policy Implementation and Differential Vaccine Uptake Trajectories in Chicago Communities.

BACKGROUND: Since the onset of the COVID-19 pandemic, multiple public health interventions have been implemented to respond to the rapidly evolving pandemic and community needs. This article describes the scope, timing, and impact of coordinated strategies for COVID-19 vaccine uptake in Chicago for the first year of vaccine distribution. METHODS: Using a series of interviews with public health officials and leaders of community-based organizations (CBOs) who participated in the implementation of the citywide COVID-19 vaccine outreach initiatives, we constructed a timeline of vaccine outreach initiatives. The timeline was matched to the vaccine uptake rates to explore the impact of the vaccine outreach initiatives by community area. Finally, we discussed the nature of policy initiatives and the level of vaccine uptake in relation to community characteristics. RESULTS: The Chicago Department of Public Health (CDPH) implemented myriad vaccine outreach strategies, including mass vaccination sites, improved access, and community-level vaccine campaigns. Protect Chicago+ was the primary vaccine outreach effort initiated by the CDPH, which identified 15 highly vulnerable community areas. More than 2.7 million (67%) Chicagoans completed the vaccine regimen by December 2021. Black (51.3%) Chicagoans were considerably less likely to be vaccinated than Asian (77.6%), White (69.8%), and Hispanic (63.6%) Chicago residents. In addition, there were significant spatial differences in the rate of COVID-19 vaccine completion: predominantly White and Hispanic communities, compared with Black communities, had higher rates of vaccine completion. CONCLUSIONS: The community outreach efforts to improve COVID-19 vaccine uptake in Chicago have shown the importance of community-engaged approaches in pandemic responses. Despite citywide efforts to build community infrastructure, Black communities had relatively lower levels of vaccine uptake than other communities. Broader social restructuring to mitigate disinvestment and residential segregation and to ameliorate medical mistrust will be needed to prepare for future pandemics and disasters.