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128 COVID 19 and chronic fatigue syndrome Is the worst yet to come There has been concern about possible long term sequelae resembling myalgic encephalomyelitis chronic fatigue syndrome in COVID 19 patients Clarifying the mechanisms underlying such a post COVID 19 fatigue syndrome is essential for the development of preventive and early treatment methods for this syndrome In the present paper by integrating insights pertaining to the glymphatic system and the nasal cerebrospinal fluid outflow pathway with findings in patients with chronic fatigue syndrome idiopathic intracranial hypertension and COVID 19 I provide a coherent conceptual framework for understanding the pathophysiology of post COVID 19 fatigue syndrome According to this hypothesis this syndrome may result from damage to olfactory sensory neurons causing reduced outflow of cerebrospinal fluid through the cribriform plate and further leading to congestion of the glymphatic system with subsequent toxic build up within the central nervous system I further postulate that patients with post COVID 19 fatigue syndrome may benefit from cerebrospinal fluid drainage by restoring glymphatic transport and waste removal from the brain Obviously further research is required to provide further evidence for the presence of this post viral syndrome and to provide additional insight regarding the relative contribution of the glymphatic lymphatic system to it Other mechanisms may also be involved If confirmed the glymphatic lymphatic system could represent a target in combating post COVID 19 fatigue syndrome Moreover further research in this area could also provide new insights into the understanding of chronic fatigue syndrome 1 |
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402 The Delta Variant Mutations in the Receptor Binding Domain of SARS CoV 2 Show Enhanced Electrostatic Interactions with the ACE2 Mutations in the receptor binding domain RBD in SARS CoV 2 are shown to enhance its replication transmissibility and binding to host cells Recently a new strain is reported in India that includes a mutation T478K and L452R in the RBD that is possibly increasing the infection rate Here using Molecular Mechanics MM and Monte Carlo MC sampling we show that the double mutant variant of SARS CoV 2 induced conformational change in ACE2 E37 which enhanced the electrostatic interactions by the formation of a salt bridge with SARS CoV 2 R403 In addition we observed that the double mutated structure induced a significant change in the salt bridge electrostatic interaction between RBD T500 and ACE2 D355 Where that this interaction lost more than 70 of its value compared to its value in WT protein 0 |
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679 Developmentally appropriate transitional care during the Covid 19 pandemic for young people with juvenile onset rheumatic and musculoskeletal diseases the rationale for a position statement The importance of developmentally appropriate transitional care in young people with juvenile onset rheumatic and musculoskeletal disease is well recognised The Paediatric Rheumatology European Society PReS European League Against Rheumatism EULAR Taskforce has developed international recommendations and standards for transitional care and a growing evidence base supports the positive benefits of such care However there is also evidence that universal implementation has yet to be realised In 2020 against this background the COVID 19 pandemic arrived with significant impact on all our lives young and old patient public and professional alike The unfortunate reality of the pandemic with potential for unfavourable outcomes on healthcare provision during transition was acknowledged by the PReS working groups in a position statement to support healthcare professionals young people and their caregivers The aim of this review is to present the literature which provides the rationale for the recommendations in the PReS Position Statement The following areas are specifically addressed the prime importance of care coordination the impact of the pandemic on the various aspects of the transition process the importance of ensuring continuity of medication supply the pros and cons of telemedicine with young people ensuring meaningful involvement of young people in service development and the importance of core adolescent health practices such as routine developmental assessment psychosocial screening and appropriate parental involvement during transitional care 0 |
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212 Immune Based Prediction of COVID 19 Severity and Chronicity Decoded Using Machine Learning Expression of CCR5 and its cognate ligands have been implicated in COVID 19 pathogenesis consequently therapeutics directed against CCR5 are being investigated Here we explored the role of CCR5 and its ligands across the immunologic spectrum of COVID 19 We used a bioinformatics approach to predict and model the immunologic phases of COVID so that effective treatment strategies can be devised and monitored We investigated 224 individuals including healthy controls and patients spanning the COVID 19 disease continuum We assessed the plasma and isolated peripheral blood mononuclear cells PBMCs from 29 healthy controls 26 Mild Moderate COVID 19 individuals 48 Severe COVID 19 individuals and 121 individuals with post acute sequelae of COVID 19 PASC symptoms Immune subset profiling and a 14 plex cytokine panel were run on all patients from each group B cells were significantly elevated compared to healthy control individuals P 0 001 as was the CD14 CD16 CCR5 monocytic subset P 0 001 CD4 and CD8 positive T cells expressing PD 1 as well as T regulatory cells were significantly lower than healthy controls P 0 001 and P 0 01 respectively CCL5 RANTES IL 2 IL 4 CCL3 IL 6 IL 10 IFN γ and VEGF were all significantly elevated compared to healthy controls all P 0 001 Conversely GM CSF and CCL4 were in significantly lower levels than healthy controls P 0 01 Data were further analyzed and the classes were balanced using SMOTE With a balanced working dataset we constructed 3 random forest classifiers a multi class predictor a Severe disease group binary classifier and a PASC binary classifier Models were also analyzed for feature importance to identify relevant cytokines to generate a disease score Multi class models generated a score specific for the PASC patients and defined as S1 IFN γ IL 2 CCL4 MIP 1β Second a score for the Severe COVID 19 patients was defined as S2 IL 6 sCD40L 1000 VEGF 10 10 IL 10 IL 2 IL 8 Severe COVID 19 patients are characterized by excessive inflammation and dysregulated T cell activation recruitment and counteracting activities While PASC patients are characterized by a profile able to induce the activation of effector T cells with pro inflammatory properties and the capacity of generating an effective immune response to eliminate the virus but without the proper recruitment signals to attract activated T cells 1 |
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193 Descriptive analysis of long COVID sequelae identified in a multidisciplinary clinic serving hospitalised and non hospitalised patients There are emerging data of long term effects of coronavirus disease 2019 COVID 19 comprising a diversity of symptoms The aim of this study was to systematically describe and measure pulmonary and extra pulmonary post COVID 19 complications in relation to acute COVID 19 severity Patients attending a standard of care 3 months post hospitalisation follow up visit and those referred by their general practitioner because of persistent post COVID 19 symptoms were included Patients underwent symptomatic quality of life pulmonary lung function and high resolution computed tomography HRCT cardiac high resolution ECG physical 1 min sit and stand test 1 MSTST handgrip strength cardiopulmonary exercise testing CPET and cognitive evaluations All 34 hospitalised and 22 out of 23 non hospitalised patients had 1 complaint or abnormal finding at follow up Overall 67 of patients were symptomatic Medical Research Council MRC 2 or COPD assessment test CAT 10 with no difference between hospitalised i versus i non hospitalised patients Pulmonary function forced expiratory volume in 1 s FEV sub 1 sub or diffusing capacity of the lung for carbon monoxide i D i sub LCO sub 80 of predicted was impaired in 68 of patients i D i sub LCO sub was significantly lower in those hospitalised compared to non hospitalised 70 1 18 0 i versus i 80 2 11 2 predicted p 0 02 Overall 53 had an abnormal HRCT predominantly ground glass opacities with higher composite computed tomography CT scores in hospitalised i versus i non hospitalised patients 2 3 0 1 4 8 and 0 0 0 0 0 3 p 0 001 1 MSTST was below the 25th percentile in almost half of patients but no signs of cardiac dysfunction were found Cognitive impairments were present in 59 66 of hospitalised and 31 44 of non hospitalised patients p 0 08 Three months after COVID 19 infection patients were still symptomatic and demonstrated objective respiratory functional radiological and cognitive abnormalities which were more prominent in hospitalised patients Our study underlines the importance of multidimensional management strategies in these patients 1 |
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213 Post acute COVID 19 syndrome PCS and health related quality of life HRQoL A systematic review and meta analysis There is an established literature on the symptoms and complications of COVID 19 but the after effects of COVID 19 are not well understood with few studies reporting persistent symptoms and quality of life We aim to evaluate the pooled prevalence of poor quality of life in post acute COVID 19 syndrome PCS and conducted meta regression to evaluate the effects of persistent symptoms and intensive care unit ICU admission on the poor quality of life We extracted data from observational studies describing persistent symptoms and quality of life in post COVID 19 patients from March 10 2020 to March 10 2021 following PRISMA guidelines with a consensus of two independent reviewers We calculated the pooled prevalence with 95 confidence interval CI and created forest plots using random effects models A total of 12 studies with 4828 PCS patients were included We found that amongst PCS patients the pooled prevalence of poor quality of life EQ VAS was 59 95 CI 42 75 Based on individual factors in the EQ 5D 5L questionnaire the prevalence of mobility was 36 10 67 personal care 8 1 21 usual quality 28 2 65 pain discomfort 42 28 55 and anxiety depression 38 19 58 The prevalence of persistent symptoms was fatigue 64 54 73 dyspnea 39 5 20 60 anosmia 20 15 24 arthralgia 24 3 14 36 headache 21 3 47 sleep disturbances 47 7 89 and mental health 14 5 4 29 Meta regression analysis showed the poor quality of life was significantly higher among post COVID 19 patients with ICU admission p 0 004 and fatigue p 0 0015 Our study concludes that PCS is associated with poor quality of life persistent symptoms including fatigue dyspnea anosmia sleep disturbances and worse mental health This suggests that we need more research on PCS patients to understand the risk factors causing it and eventually leading to poor quality of life 1 |
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678 Continuation of telemedicine in otolaryngology post COVID 19 Applications by subspecialty The purpose of this paper is to review the literature and compile key clinically relevant applications of telemedicine for use in otolaryngology relevant to the post COVID 19 era Systematic Literature Review Pubmed and Google Scholar Pubmed and Google Scholar were queried using combined key words such as telemedicine covid and otolaryngology The searches were completed in March August 2020 Additional queries were made with particular subspecialty phrases such as rhinology or otology to maximize yield of relevant titles Relevant articles were selected for abstract review Applicable abstracts were then selected for review of the full text Initial search identified 279 results These were screened for relevance and 100 abstracts were selected for review Abstracts were excluded if they were not in English not related to otolaryngology or if the full text was unavailable for access Of these 37 articles were selected for complete review of the full text The sudden healthcare closures during the COVID 19 pandemic resulted in a sharp increase in the use of telemedicine particularly in subspecialty fields Otolaryngologists are at a unique risk of infection resulting from the examination of the head and neck and aerosol generating procedures due to the predilection of viral particles for the nasal cavities and pharynx The COVID 19 pandemic may have served as a catalyst to implement telemedicine into clinical practice however identifying ways to integrate telemedicine long term is key for a sustainable and viable practice in the post COVID 19 era Although many states are now finding themselves on the down sloping side of their infection rate curve many others remain at the apex Additionally the risk of future waves of this pandemic or the onset of another pandemic should not be overlooked Practice modification guidelines that mitigate infection risk by utilizing telemedicine would be useful in these instances Telemedicine can help to reduce infection spread by limiting unnecessary in person interactions and help conserve personal protective equipment PPE by facilitating remote care with the added benefits of expanding care to broad geographic areas limiting cost time and travel burden on patients and families and enabling consistent follow up 0 |
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187 Pediatric long COVID An overlooked phenomenon Long COVID is a well documented multisystem disease in adults Far less is known about long term sequelae of COVID in children Here we report on the occurrence of long COVID in Dutch children We conducted a national survey asking Dutch pediatricians to share their experiences on long COVID in children We furthermore describe a case series of six children with long COVID to explore the clinical features in greater detail With a response rate of 78 of Dutch pediatric departments we identified 89 children aged 2 18 years suspected of long COVID with various complaints Of these children 36 experienced severe limitations in daily function The most common complaints were fatigue dyspnea and concentration difficulties with 87 55 and 45 respectively Our case series emphasizes the nonspecific and broad clinical manifestations seen in post COVID complaints Our study shows that long COVID is also present in the pediatric population The main symptoms resemble those previously described in adults This novel condition demands a multidisciplinary approach with international awareness and consensus to aid early detection and effective management 1 |
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327 COVID 19 from an acute to chronic disease Potential long term health consequences Coronavirus disease 2019 COVID 19 is caused by the severe acute respiratory syndrome coronavirus 2 SARS CoV 2 Despite pulmonary impairments being the most prevalent extra pulmonary manifestations of COVID 19 are abundant Confirmed COVID 19 cases have now surpassed 57 8 million worldwide as of 22 November 2020 With estimated case fatality rates number of deaths from COVID 19 divided by number of confirmed COVID 19 cases varying between 1 and 7 there will be a large population of recovered COVID 19 patients that may acquire a multitude of long term health consequences While the multi organ manifestations of COVID 19 are now well documented the potential long term implications of these manifestations remain to be uncovered In this review we turn to previous similar coronaviruses i e SARS CoV 1 and Middle East respiratory syndrome coronavirus MERS CoV in combination with known health implications of SARS CoV 2 infection to predict potential long term effects of COVID 19 including pulmonary cardiovascular hematologic renal central nervous system gastrointestinal and psychosocial manifestations in addition to the well known post intensive care syndrome It is necessary to monitor COVID 19 patients after discharge to understand the breadth and severity of long term effects This can be accomplished by repurposing or initiating large cohort studies to not only focus on the long term consequences of SARS CoV 2 infection but also on acquired immune function as well as ethno racial group and household income disparities in COVID 19 cases and hospitalizations The future for COVID 19 survivors remains uncertain and if this virus circulates among us for years to come long term effects may accumulate exponentially 1 |
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483 Narrative review on clinical considerations for patients with diabetes and COVID 19 More questions than answers Diabetes obesity and hypertension are common comorbidities associated with increased severity and mortality rates from Corona Virus Disease COVID 19 In this narrative review using the PubMed database we discuss epidemiological data and pathophysiological links between diabetes and COVID 19 The potential effects of glycaemic control and antidiabetic drugs on the prevalence and outcomes of COVID 19 are also reviewed as well as the role of telemedicine and diabetes self management in the post COVID 19 era Diabetes has been linked to COVID 19 morbidity and mortality although further research is needed to elucidate this association In the meantime physicians should be aware of the potential rise in the prevalence of diabetes due to unhealthy lifestyle changes during the pandemic its severity and complications and focus on achieving optimal diabetes prevention and management Telemedicine and diabetes self management may help towards this direction Dipeptidyl peptidase 4 DPP4 inhibitors glucagon like peptide 1 GLP 1 receptor agonists and sodium glucose transporter 2 SGLT2 inhibitors may affect viral entry and infection and thus COVID 19 outcomes as shown in observational studies Diabetes has been associated with COVID 19 development and progression Certain antidiabetic drugs may influence COVID 19 prevention and management The results of ongoing randomized clinical trials will shed more light on this field 0 |
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663 Performance of a computer aided diagnosis system for SARS CoV 2 pneumonia based on ultrasound images In this study we aimed to leverage deep learning to develop a computer aided diagnosis CAD system toward helping radiologists in the diagnosis of SARS CoV 2 virus syndrome on Lung ultrasonography LUS A CAD system is developed based on a transfer learning of a residual network ResNet to extract features on LUS and help radiologists to distinguish SARS CoV 2 virus syndrome from healthy and non SARS CoV 2 pneumonia A publicly available LUS dataset for SARS CoV 2 virus syndrome consisting of 3909 images has been employed Six radiologists with different experiences participated in the experiment A comprehensive LUS data set was constructed and employed to train and verify the proposed method Several metrics such as accuracy recall precision and F1 score are used to evaluate the performance of the proposed CAD approach The performances of the radiologists with and without the help of CAD are also evaluated quantitively The p values of the t test shows that with the help of the CAD system both junior and senior radiologists significantly improve their diagnosis performance on both balanced and unbalanced datasets Experimental results indicate the proposed CAD approach and the machine features from it can significantly improve the radiologists performance in the SARS CoV 2 virus syndrome diagnosis With the help of the proposed CAD system the junior and senior radiologists achieved F1 score values of 91 33 and 95 79 on balanced dataset and 94 20 and 96 43 on unbalanced dataset The proposed approach is verified on an independent test dataset and reports promising performance The proposed CAD system reports promising performance in facilitating radiologists diagnosis SARS CoV 2 virus syndrome and might assist the development of a fast accessible screening method for pulmonary diseases 0 |
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500 Detection of SARS CoV 2 by using real time PCR nasopharyngeal swabs in suspected patients and related and their clinical medication The corona name derived from their crown like spike proteins attach with cell receptors It belongs to coronaviradae family and nideovirales order envelop virus size range 65 125nm and positive single standard RNA between 26 4 to 31 7 kb and contain 7096 amino acid There are four subtypes that have been detected these are alpha beta gamma and delta The 267 covid 19 blood and nasopharyngeal samples were collected from Multan region RNA extraction from nasopharyngeal samples and run the PCR The blood samples use for clinical tests Lactate dehydrogenase serum ferritin level D Dimer TG cholesterol thyphoidot HDL lymphocyte count and CRP 127 47 21 out of 267 patients were covid 19 PCR positive and showed the amplification of ORF1ab E and N gene while 140 individuals were covid 19 PCR negative and not showed the amplification of ORF1ab E and N gene The patients with negative Covid 19 PCR the other analysis tests such as lactate dehydrogenase HDL ferritin ESR CBP D Dimer Tg cholesterol CRP and CT scan The patients effected covid 19 have higher values of D Dimer ESR Neutrophils LDH CRP and ferritin level than normal ranges However the values of HDL cholesterol and lymphocytes were decreased from the normal range 0 |
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403 Dementia and COVID 19 a Bidirectional Liaison Risk Factors Biomarkers and Optimal Health Care Cognitive impairment following SARS CoV 2 infection is being increasingly recognized as an acute and possibly also long term sequela of the disease Direct viral entry as well as systemic mechanisms such as cytokine storm are thought to contribute to neuroinflammation in these patients Biomarkers of COVID 19 induced cognitive impairment are currently lacking but there is some limited evidence that SARS CoV 2 could preferentially target the frontal lobes as suggested by behavioral and dysexecutive symptoms fronto temporal hypoperfusion on MRI EEG slowing in frontal regions and frontal hypometabolism on 18F FDG PET Possible confounders include cognitive impairment due to hypoxia and mechanical ventilation and post traumatic stress disorder Conversely patients already suffering from dementia as well as their caregivers have been greatly impacted by the disruption of their care caused by COVID 19 Patients with dementia have experienced worsening of cognitive behavioral and psychological symptoms and the rate of COVID 19 related deaths is disproportionately high among cognitively impaired people Multiple factors such as difficulties in remembering and executing safeguarding procedures age comorbidities residing in care homes and poorer access to hospital standard of care play a role in the increased morbidity and mortality Non pharmacological interventions and new technologies have shown a potential for the management of patients with dementia and for the support of their caregivers 0 |
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234 Rheumatological complications of Covid 19 COVID 19 has caused unprecedented hardships in the 21st century with more than 150 million infections Various immunological phenomena have been described during the course of the infection and this infection has also triggered autoimmunity Rheumatological illnesses have been described following resolution of the acute infection hence we sought to conduct a review of the rheumatological complications of COVID 19 We conducted a literature search for articles relating to sequelae of COVID 19 from Jan 2020 to 30th April 2021 We found a number of reports of inflammatory arthritis after SARS CoV 2 infection SLE and renal disease have been described and vasculitis also appears to be a common complication Rhabdomyolysis and myositis has also been reported in a number of patients We also found some evidence of large vessel vasculitis in long COVID patients This review highlights a number of important complications such as inflammatory arthritis lupus like disease myostis and vasculitis following SARS CoV 2 infection 1 |
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436 Revisiting maternal and child undernutrition in low income and middle income countries variable progress towards an unfinished agenda 13 years after the first Lancet Series on maternal and child undernutrition we reviewed the progress achieved on the basis of global estimates and new analyses of 50 low income and middle income countries with national surveys from around 2000 and 2015 The prevalence of childhood stunting has fallen and linear growth faltering in early life has become less pronounced over time markedly in middle income countries but less so in low income countries Stunting and wasting remain public health problems in low income countries where 4 7 of children are simultaneously affected by both a condition associated with a 4 8 times increase in mortality New evidence shows that stunting and wasting might already be present at birth and that the incidence of both conditions peaks in the first 6 months of life Global low birthweight prevalence declined slowly at about 1 0 a year Knowledge has accumulated on the short term and long term consequences of child undernutrition and on its adverse effect on adult human capital Existing data on vitamin A deficiency among children suggest persisting high prevalence in Africa and south Asia Zinc deficiency affects close to half of all children in the few countries with data New evidence on the causes of poor growth points towards subclinical inflammation and environmental enteric dysfunction Among women of reproductive age the prevalence of low body mass index has been reduced by half in middle income countries but trends in short stature prevalence are less evident Both conditions are associated with poor outcomes for mothers and their children whereas data on gestational weight gain are scarce Data on the micronutrient status of women are conspicuously scarce which constitutes an unacceptable data gap Prevalence of anaemia in women remains high and unabated in many countries Social inequalities are evident for many forms of undernutrition in women and children suggesting a key role for poverty and low education and reinforcing the need for multisectoral actions to accelerate progress Despite little progress in some areas maternal and child undernutrition remains a major global health concern particularly as improvements since 2000 might be offset by the COVID 19 pandemic 0 |
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196 Risk Predictors and Symptom Features of Long COVID Within a Broad Primary Care Patient Population Including Both Tested and Untested Patients Symptoms may persist after the initial phases of COVID 19 infection a phenomenon termed long COVID Current knowledge on long COVID has been mostly derived from test confirmed and hospitalized COVID 19 patients Data are required on the burden and predictors of long COVID in a broader patient group which includes both tested and untested COVID 19 patients in primary care This is an observational study using data from Platform C19 a quality improvement program derived research database linking primary care electronic health record data EHR with patient reported questionnaire information Participating general practices invited consenting patients aged 18 85 to complete an online questionnaire since 7th August 2020 COVID 19 self diagnosis clinician diagnosis testing and the presence and duration of symptoms were assessed via the questionnaire Patients were considered present with long COVID if they reported symptoms lasting 4 weeks EHR and questionnaire data up till 22nd January 2021 were extracted for analysis Multivariable regression analyses were conducted comparing demographics clinical characteristics and presence of symptoms between patients with long COVID and patients with shorter symptom duration Long COVID was present in 310 3151 9 8 patients with self diagnosed clinician diagnosed or test confirmed COVID 19 Only 106 310 34 2 long COVID patients had test confirmed COVID 19 Risk predictors of long COVID were age 40 years adjusted Odds Ratio AdjOR 1 49 1 05 2 17 female sex adjOR 1 37 1 02 1 85 frailty adjOR 2 39 1 29 4 27 visit to A E adjOR 4 28 2 31 7 78 and hospital admission for COVID 19 symptoms adjOR 3 22 1 77 5 79 Aches and pain adjOR 1 70 1 21 2 39 appetite loss adjOR 3 15 1 78 5 92 confusion and disorientation adjOR 2 17 1 57 2 99 diarrhea adjOR 1 4 1 03 1 89 and persistent dry cough adjOR 2 77 1 94 3 98 were symptom features statistically more common in long COVID This study reports the factors and symptom features predicting long COVID in a broad primary care population including both test confirmed and the previously missed group of COVID 19 patients 1 |
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135 Long COVID Making The Invisible Visible After recovering from acute COVID 19 infection a physician is stricken with the debilitating symptoms of long COVID 1 |
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508 An analysis of chronic kidney disease as a prognostic factor in pediatric cases of COVID 19 Advanced age is a risk factor for severe infection by acute respiratory syndrome coronavirus 2 SARS CoV 2 Children however often present with milder manifestations of Coronavirus Disease 2019 COVID 19 Associations have been found between COVID 19 and multisystem inflammatory syndrome in children MIS C Patients with the latter condition present more severe involvement Adults with comorbidities such as chronic kidney disease CKD are more severely affected This narrative review aimed to look into whether CKD contributed to more severe involvement in pediatric patients with COVID 19 The studies included in this review did not report severe cases or deaths and indicated that pediatric patients with CKD and previously healthy children recovered quickly from infection However some patients with MIS C required hospitalization in intensive care units and a few died although it was not possible to correlate MIS C and CKD Conversely adults with CKD reportedly had increased risk of severe infection by SARS CoV 2 and higher death rates The discrepancies seen between age groups may be due to immune system and renin angiotensin system differences with more pronounced expression of ACE2 in children Immunosuppressant therapy has not been related with positive or negative effects in individuals with COVID 19 although current recommendations establish decreases in the dosage of some medications To sum up with CKD was not associated with more severe involvement in children diagnosed with COVID 19 Studies enrolling larger populations are still required 0 |
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151 Long COVID Patient Symptoms and its Evaluation and Management While the acute case burdens and deaths from the COVID 19 pandemic in Nepal approaching 700 000 and 10 000 respectively have been costly the characteristics and potentially huge dimensions of the chronic disease sequelae of this infectious disease are only slowly becoming apparent We reviewed Pub Med major medical meeting and medical journal and investigative journalist materials seeking to frame and describe COVID 19 chronic disease The consequences of COVID 19 infections follow major organ damage and induction of immunological and hormonal systems dysfunction The first injuries are consequent to direct viral effects on tissues and vasculitis endothelialitis thrombosis and inflammatory events Pulmonary cardiac brain and kidney tissues incur function limiting damage with dyspnea arrythmias decreased exercise capacity cognitive dysfunction and decreased glomerular filtration rates The second process is characterized by immune dysregulation and autoimmunity and dysfunction of hormonal regulation systems with high fluctuating levels of physical and mental fatigue multiple site pain and ache and non restorative sleep in 10 30 of cases This communication proposes evaluation and management of chronic COVID 19 patients with efficient assessment of commonest symptoms targeted physical examination and organ function testing and interventions based on specific organ functional status and experience with similar chronic immune syndromes such as myalgic encephalomyelitis 1 |
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559 Lung Cancer Surgery with Persistent COVID 19 Infection A 71 year old man with a history of drug induced interstitial pneumonia was diagnosed with COVID 19 infection and simultaneously found to have a pulmonary mass suggesting a coexisting lung cancer Approximately one month after COVID 19 pneumonia resolved the patient electively underwent right upper lobectomy Postoperatively acute exacerbation of interstitial pneumonia occurred and the patient died on the 15th postoperative day 0 |
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435 The paediatric weight management office visit via telemedicine pre to post COVID 19 pandemic Telemedicine is a powerful tool that erases many logistical barriers to care and may increase access Due to the need for social distancing the COVID 19 pandemic has temporarily reduced in person visits for clinical care Providers clinical staff and patients are pressed to acutely learn new skills and adapt clinical care through the use of telemedicine whilst administrators policy makers and regulatory organizations make changes to existing policies to meet this national emergency Our tertiary care interdisciplinary paediatric weight management clinic began the use of telemedicine 5 years ago to bring access to an underserved rural population at their primary care office which has allowed our clinic to pivot seamlessly to in home telemedicine visits during the pandemic Telemedicine rules and regulations are rapidly changing to meet the COVID 19 national emergency but many supports for new telemedicine providers are already in place In this article we provide an overview of telemedicine components policies and regulations We review the operationalization of our clinics telemedicine visit prior to the pandemic We discuss how telemedicine services are impacted by COVID 19 and key resources are provided Finally we reimagine telemedicine services post pandemic to expand effective coordinated health care particularly for patients with chronic needs such as obesity 0 |
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614 Rotavirus gastroenteritis in children hospitalized in northeastern Poland in 2006 2020 Severity seasonal trends and impact of immunization The introduction of the rotavirus vaccine in 2006 significantly reduced childhood incidence of acute gastroenteritis AGE worldwide The rotavirus vaccine was included in Polands national immunization program in 2021 Our study aimed to summarize the epidemiology of AGE in northeastern Poland prior to 2021 and to evaluate the effectiveness of voluntary out of pocket rotavirus childhood vaccination on the incidence of rotavirus AGE A review of patients aged 0 17 years with gastroenteritis hospitalized between 2006 and 2020 in northeastern Poland in the context of rotavirus vaccine coverage in the region Rotavirus was the most common agent of gastroenteritis in hospitalized patients The seasonality of rotavirus gastroenteritis peaked between February and May in each year of study except for 2020 when the COVID 19 pandemic skewed any viable comparison of seasonality Rotavirus vaccine coverage in northeastern Poland did not exceed 25 during the study period and had no impact on hospitalization numbers Rotavirus was the primary causative agent of AGE in children hospitalized in northeastern Poland during the study period Voluntary vaccinations did not affect the number of hospitalizations due to rotavirus AGE Our data suggest that universal immunization is key to achieving a significant reduction of rotavirus associated diarrhea 0 |
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253 Cognitive decline following acute viral infections literature review and projections for post COVID 19 Recently much attention has been drawn to the importance of the impact of infectious disease on human cognition Several theories have been proposed to explain the cognitive decline following an infection as well as to understand better the pathogenesis of human dementia especially Alzheimers disease This article aims to review the state of the art regarding the knowledge about the impact of acute viral infections on human cognition laying a foundation to explore the possible cognitive decline followed coronavirus disease 2019 COVID 19 To reach this goal we conducted a narrative review systematizing six acute viral infections as well as the current knowledge about COVID 19 and its impact on human cognition Recent findings suggest probable short and long term COVID 19 impacts in cognition even in asymptomatic individuals which could be accounted for by direct and indirect pathways to brain dysfunction Understanding this scenario might help clinicians and health leaders to deal better with a wave of neuropsychiatric issues that may arise following COVID 19 pandemic as well as with other acute viral infections to alleviate the cognitive sequelae of these infections around the world 1 |
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274 Characterization and Biomarker Analyses of Post COVID 19 Complications and Neurological Manifestations As the SARS CoV 2 pandemic continues reports have demonstrated neurologic sequelae following COVID 19 recovery Mechanisms to explain long term neurological sequelae are unknown and need to be identified Plasma from 24 individuals recovering from COVID 19 at 1 to 3 months after initial infection were collected for cytokine and antibody levels and neuronal enriched extracellular vesicle nEV protein cargo analyses Plasma cytokine IL 4 was increased in all COVID 19 participants Volunteers with self reported neurological problems nCoV i n i 8 had a positive correlation of IL6 with age or severity of the sequalae at least one co morbidity and increased SARS CoV 2 antibody compared to those COVID 19 individuals without neurological issues CoV i n i 16 Protein markers of neuronal dysfunction including amyloid beta neurofilament light neurogranin total tau and p T181 tau were all significantly increased in the nEVs of all participants recovering from COVID 19 compared to historic controls This study suggests ongoing peripheral and neuroinflammation after COVID 19 infection that may influence neurological sequelae by altering nEV proteins Individuals recovering from COVID 19 may have occult neural damage while those with demonstrative neurological symptoms additionally had more severe infection Longitudinal studies to monitor plasma biomarkers and nEV cargo are warranted to assess persistent neurodegeneration and systemic effects 1 |
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257 COVID 19 associated mucormycosis Case report and systematic review Increasing number of patients with COVID 19 associated mucormycosis have been reported especially from India recently We have described a patient with COVID 19 associated mucormycosis and searched and analyzed current medical literature to delineate the characteristics of COVID 19 associated mucormycosis We reported a patient developed mucormycosis during post COVID period We searched literature to describe the incidence clinical features and outcomes of COVID 19 associated mucormycosis Demographic features risk factors clinical features diagnostic methods treatment and outcome were analyzed We describe a 54 year old male hospitalized due to severe COVID 19 pneumonia He was given long term high doses of systemic steroids He developed maxillo fascial mucormycosis and died of sepsis Our literature search found 30 publications describing 100 patients including present case report The majority n 68 were reported from India 76 were male The most commonly seen risk factors were corticosteroid use 90 5 diabetes 79 and hypertension 34 Also excessive use of broad spectrum antibiotics were noted in cases Most frequent involvements were rhino orbital 50 followed by rhino sinusal 17 and rhino orbito cerebral 15 Death was reported as 33 out of 99 patients 33 3 Steroid use diabetes environmental conditions excessive use of antibiotics and hypoxia are main risk factors Despite medical and surgical treatment mortality rate is high A multidisciplinary approach is essential to improve the conditions facilitating the emergence of COVID 19 associated mucormycosis 1 |
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570 Utility of telemedicine in sub Saharan Africa during the COVID 19 pandemic A rapid review Telemedicine is the use of technology to achieve remote care This review looks at the utility of telemedicine during the pandemic period March 2020 to February 2021 Eleven articles met inclusion criteria There was moderate use of telemedicine in sub Sahara Africa during the pandemic however there were also some limitations Benefits of telemedicine include continuing medical service provision connecting relatives with loved ones in quarantine education and awareness of mental health issues and toxicovigilance and infection control Challenges to the implementation of telemedicine on the continent were lack of supporting telemedicine framework and policies digital barriers and patient and healthcare personnel biases To address these challenges this article proposes the development of policy frameworks that fosters telemedicine use by all stakeholders including medical insurance organizations the introduction of telemedicine training of medical workers educational awareness programs for the public and improvement of digital platforms access and affordability 0 |
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537 RdRp inhibitors and COVID 19 Is molnupiravir a good option Rapid changes in the viral genome allow viruses to evade threats posed by the host immune response or antiviral drugs and can lead to viral persistence in the host cells RNA dependent RNA polymerase RdRp is an essential enzyme in RNA viruses which is involved in RNA synthesis through the formation of phosphodiester bonds Therefore in RNA viral infections such as SARS CoV 2 RdRp could be a crucial therapeutic target The present review discusses the promising application of RdRp inhibitors previously approved or currently being tested in human clinical trials in the treatment of RNA virus infections Nucleoside inhibitors NIs bind to the active site of RdRp while nonnucleoside inhibitors NNIs bind to allosteric sites Given the absence of highly effective drugs for the treatment of COVID 19 the discovery of an efficient treatment for this pandemic is an urgent concern for researchers around the world We review the evidence for molnupiravir MK 4482 EIDD 2801 an antiviral drug originally designed for Alphavirus infections as a potential preventive and therapeutic agent for the management of COVID 19 At the beginning of this pandemic molnupiravir was in preclinical development for seasonal influenza When COVID 19 spread dramatically the timeline for development was accelerated to focus on the treatment of this pandemic Real time consultation with regulators took place to expedite this program We summarize the therapeutic potential of RdRp inhibitors and highlight molnupiravir as a new small molecule drug for COVID 19 treatment 0 |
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431 Scope context and quality of telerehabilitation guidelines for physical disabilities a scoping review To identify the available guidance and training to implement telerehabilitation movement assessments for people adults and children with a physical disability including those recovering from COVID 19 Rapid scoping review PubMed CINAHL PsychInfo Cochrane Embase Web of Science PEDro UK Health Forum WHO National Archives and NHS England were searched using the participant concept context framework from 2015 to August 2020 Primary studies that recruited individuals with physical disabilities and guidance documents aimed at providers to implement movement related telerehabilitation were included 23 articles 11 primary research studies 3 systematic reviews and 9 guidance documents were included out of 7857 that were identified from the literature search Two main issues were found 1 telerehabilitation guidance from both research studies and guidance documents was not specific to movement related assessment and 2 most primary research studies provided neither guidance nor training of movement specific assessment to practitioners Of the COVID 19 related guidance two articles reported COVID 19 management that only referred to identifying COVID 19 status without references to specific movement related guidance Telerehabilitation guidance and training have existed pre COVID 19 yet the lack of specific movement related information and provider support is surprising This gap must be addressed to optimise effective implementation of remote assessments for those with physical disabilities Open Science Framework osf io vm6sp 0 |
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364 A standardized definition of placental infection by SARS CoV 2 a consensus statement from the National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development SARS CoV 2 Placental Infection Workshop Pregnant individuals infected with SARS CoV 2 have higher rates of intensive care unit admission oxygen requirement need for mechanical ventilation and death than nonpregnant individuals Increased COVID 19 disease severity may be associated with an increased risk of viremia and placental infection Maternal SARS CoV 2 infection is also associated with pregnancy complications such as preeclampsia and preterm birth which can be either placentally mediated or reflected in the placenta Maternal viremia followed by placental infection may lead to maternal fetal transmission vertical which affects 1 to 3 of exposed newborns However there is no agreed upon or standard definition of placental infection The National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development convened a group of experts to propose a working definition of placental infection to inform ongoing studies of SARS CoV 2 during pregnancy Experts recommended that placental infection be defined using techniques that allow virus detection and localization in placental tissue by one or more of the following methods in situ hybridization with antisense probe detects replication or a sense probe detects viral messenger RNA or immunohistochemistry to detect viral nucleocapsid or spike proteins If the abovementioned methods are not possible reverse transcription polymerase chain reaction detection or quantification of viral RNA in placental homogenates or electron microscopy are alternative approaches A graded classification for the likelihood of placental infection as definitive probable possible and unlikely was proposed Manuscripts reporting placental infection should describe the sampling method location and number of samples collected method of preservation of tissue and detection technique Recommendations were made for the handling of the placenta examination and sampling and the use of validated reagents and sample protocols included as appendices 0 |
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226 Perspective of Immunopathogenesis and Immunotherapies for Kawasaki Disease Kawasaki Disease KD is an acute inflammatory illness that mostly occurs in children below 5 years of age with intractable fever mucocutaneous lesions lymphadenopathy and lesions of the coronary artery CAL KD is sharing clinical symptoms with systemic inflammatory syndrome in children MIS C which is related to COVID 19 Certain genes are identified to be associated with KD but the findings usually differ between countries and races Human Leukocyte Antigen HLA allele types and toll like receptor TLR expression are also correlated to KD The acute hyperinflammation in KD is mediated by an imbalance between augmented T helper 17 Th17 Th1 responses with high levels of interleukin IL 6 IL 10 IL 17A IFN γ and IP 10 in contrast to reduced Th2 Treg responses with lower IL 4 IL 5 FoxP3 and TGF β expression KD has varying phenotypic variations regarding age gender intravenous immunoglobulin IVIG resistance macrophage activation and shock syndrome The signs of macrophage activation syndrome MAS can be interpreted as hyperferritinemia and thrombocytopenia contradictory to thrombocytosis in typical KD the signs of KD with shock syndrome KDSS can be interpreted as overproduction of nitric oxide NO and coagulopathy For over five decades IVIG and aspirin are the standard treatment for KD However some KD patients are refractory to IVIG required additional medications against inflammation Further studies are proposed to delineate the immunopathogenesis of IVIG resistance and KDSS to identify high risk patients with genetic susceptibility and to develop an ideal treatment regimen such as by providing idiotypic immunoglobulins to curb cytokine storms NO overproduction and the epigenetic induction of Treg function 1 |
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682 Pathophysiology of Takotsubo Cardiomyopathy Reopened Debate Takotsubo cardiomyopathy TTC a persistently obscure dysfunctional condition of the left ventricle is uniquely transient but nevertheless dangerous It features variable ventricular patterns and is predominant in women For 30 years pathophysiologic investigations have progressed only slowly and with inadequate focus It was initially proposed that sudden onset spastic obliteration of coronary flow induced myocardial ischemia with residual stunning and thus TTC Later it was generally accepted without proof that in the presence of pain or emotional stress the dominant mechanism for TTC onset was a catecholamine surge that had a direct toxic myocardial effect We think that the manifestations of TTC are more dynamic and complex than can be assumed from catecholamine effects alone In addition after reviewing the recent medical literature and considering our own clinical observations especially on spasm we theorize that atherosclerotic coronary artery disease modulates and physically opposes obstruction during spasm This phenomenon may explain the midventricular variant of TTC and the lower incidence of TTC in men We continue to recommend and perform acetylcholine testing to reproduce TTC and to confirm our theory that coronary spasm is its initial pathophysiologic factor An improved understanding of TTC is especially important because of the conditions markedly increased incidence during the ongoing COVID 19 pandemic 0 |
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347 Clinical utility of targeted SARS CoV 2 serology testing to aid the diagnosis and management of suspected missed late or post COVID 19 infection syndromes Results from a pilot service implemented during the first pandemic wave During the first wave of the global COVID 19 pandemic the clinical utility and indications for SARS CoV 2 serological testing were not clearly defined The urgency to deploy serological assays required rapid evaluation of their performance characteristics We undertook an internal validation of a CE marked lateral flow immunoassay LFIA SureScreen Diagnostics using serum from SARS CoV 2 RNA positive individuals and pre pandemic samples This was followed by the delivery of a same day named patient SARS CoV 2 serology service using LFIA on vetted referrals at central London teaching hospital with clinical interpretation of result provided to the direct care team Assay performance source and nature of referrals feasibility and clinical utility of the service particularly benefit in clinical decision making were recorded Sensitivity and specificity of LFIA were 96 1 and 99 3 respectively 113 tests were performed on 108 participants during three week pilot 44 participants n 48 had detectable antibodies Three main indications were identified for serological testing new acute presentations potentially triggered by recent COVID 19 e g pulmonary embolism n 5 potential missed diagnoses in context of a recent COVID 19 compatible illness n 40 and making infection control or immunosuppression management decisions in persistently SARS CoV 2 RNA PCR positive individuals n 6 We demonstrate acceptable performance characteristics feasibility and clinical utility of using a LFIA that detects anti spike antibodies to deliver SARS CoV 2 serology service in adults and children Greatest benefit was seen where there is reasonable pre test probability and results can be linked with clinical advice or intervention Experience from this pilot can help inform practicalities and benefits of rapidly implementing new tests such as LFIAs into clinical service as the pandemic evolves 0 |
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282 Symptom Persistence Despite Improvement in Cardiopulmonary Health Insights from longitudinal CMR CPET and lung function testing post COVID 19 The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease COVID 19 are unclear We sought to describe their natural history in previously hospitalised patients compare this with controls and assess the relationship between symptoms and cardiopulmonary impairment at 6 months post COVID 19 Fifty eight patients and thirty matched controls single visit recruited between 14 sup th sup March 25 sup th sup May 2020 underwent symptom questionnaires cardiac and lung magnetic resonance imaging CMR cardiopulmonary exercise test CPET and spirometry at 3 months following COVID 19 Of them forty six patients returned for follow up assessments at 6 months At 2 3 months 83 of patients had at least one cardiopulmonary symptom versus 33 of controls Patients and controls had comparable biventricular volumes and function Native cardiac T sub 1 sub marker of fibroinflammation and late gadolinium enhancement LGE marker of focal fibrosis were increased in patients at 2 3 months Sixty percent of patients had lung parenchymal abnormalities on CMR and 55 had reduced peak oxygen consumption pV O sub 2 sub on CPET By 6 months 52 of patients remained symptomatic On CMR indexed right ventricular RV end diastolic volume 4 3 mls m sup 2 sup i P i 0 005 decreased and RV ejection fraction 3 2 i P i 0 0003 increased Native T sub 1 sub and LGE improved and was comparable to controls Lung parenchymal abnormalities and peak V O sub 2 sub although better were abnormal in patients versus controls 31 had reduced pV O sub 2 sub secondary to symptomatic limitation and muscular impairment Cardiopulmonary symptoms in patients did not associate with CMR lung function or CPET measures In patients cardiopulmonary abnormalities improve over time though some measures remain abnormal relative to controls Persistent symptoms at 6 months post COVID 19 did not associate with objective measures of cardiopulmonary health The authors work was supported by the NIHR Oxford Biomedical Research Centre Oxford British Heart Foundation BHF Centre of Research Excellence RE 18 3 34214 United Kingdom Research Innovation and Wellcome Trust This project is part of a tier 3 study C MORE within the collaborative research programme entitled PHOSP COVID Post hospitalization COVID 19 study a national consortium to understand and improve long term health outcomes funded by the Medical Research Council and Department of Health and Social Care National Institute for Health Research Grant MR V027859 1 ISRCTN number 10980107 1 |
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158 Multisystem Inflammatory Syndrome in Children and COVID 19 Infections The arrival of SARS Co V 2 severe acute respiratory syndrome coronavirus 2 has brought not only the COVID 19 coronavirus disease 2019 pandemic but also the development of a cluster of symptoms known as multisystem inflammatory syndrome in children MIS C Information regarding the long term implications of COVID 19 infections in children as well as MIS C is scarce and is emerging on an almost daily basis The purpose of this article is to provide an overview of the recent literature regarding COVID 19 and MIS C a Kawasaki like inflammatory syndrome that developed in children around the same time the COVID 19 pandemic began Because the school nurse monitors children across a variety of developmental domains they are in a unique position to identify changes and notice long term trends related to the health and development of children who contract both COVID 19 and MIS C 1 |
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656 Blended and e learning in pediatric education harnessing lessons learned from the COVID 19 pandemic Face to face education as the traditional basis for medical education was disrupted by the COVID 19 pandemic as learners and educators were moved online with little time for preparation Fortunately as online learning has grown together with medical education shifting to problem based and team centered learning over the last three decades existing resources have been adapted and improved upon to meet the challenges Effective blended learning has resulted in innovative synchronous and asynchronous learning platforms Clearly to do this well requires time effort and adjustment from clinicians educators and learners but it should result in an engaging change in teaching practice Its success will rely on an evaluation of learning outcomes educator and learner satisfaction and long term retention of knowledge It will be important to maintain ongoing assessment of all aspects of the medical education process including how to best teach and assess theory physiology pathology history taking physical examination and clinical management Conclusion The COVID 19 pandemic triggered emergency transitional processes for teaching and assessment in medical education which built upon existing innovations in teaching medicine with the use of technology These strategies will continue to evolve so as to provide the basis for an enduring hybrid teaching model involving blended and e learning in medical education What is Known Most pediatricians provide clinical teaching to medical students and residents but few have had formal training in online educational approaches and techniques Being able to adapt to new and innovative integrated teaching methods is of key importance when becoming a competent teacher What is New This review presents an up to date summary of best practice in blended and e learning and how it may be optimally delivered Knowledge of the principles of e learning and how people learn more generally helps pediatricians shape their clinical teaching and facilitates better interaction with medical students and residents 0 |
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165 COVID 19 long covid and its societal consequences COVID 19 is an acute highly transmissible respiratory infection that is potentially lethal but often mild sometimes asymptomatic especially in the young However it has become clear that in some patients there may be sequelae involving tissues other than the lung resulting in other types of morbidity and sometimes longer term consequences that are often termed long covid In this Lilliput we summarize recent findings about COVID 19 sequelae with a particular focus on long covid We also discuss some of the long scars that COVID 19 and long covid will collectively leave on society that we term Societal Long Covid 1 |
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176 Long COVID long term effects The term Long COVID or Post COVID describes a condition characterized by persistence of symptoms for at least 12 weeks after the onset of COVID 19 It may last several months but the duration is still matter of observation The symptoms and the clinical manifestations are clinically heterogeneous and suggesting involvement of multi organs systems including the cardiovascular system The general recurrent symptoms include fatigue breathlessness myalgia headache loss of memory and impaired concentration Patients report loss of their previous psychophysical performance Cardiovascular involvement manifests with common symptoms such as palpitations and chest pain and less commonly with events such as late arterial and venous thromboembolisms heart failure episodes strokes or transient ischaemic attack myo pericarditis The diagnostic criteria are mainly based on the narrative of the patients Measurable biomarkers or instrumental findings or clinical events are not yet framed in a shared diagnostic framework The open question for clinicians and researchers is whether biomarkers electrocardiogram non invasive imaging and clinical monitoring should be included in a shared diagnostic protocol aimed at defining the diagnostic path and protecting patients at risk of unexpected events 1 |
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566 Are we there yet Unbundling the potential adoption and integration of telemedicine to improve virtual healthcare services in African health systems Since the outbreak of COVID 19 the attention has now shifted towards universal vaccination to gracefully lift strict COVID 19 restrictions previously imposed to contain the spread of the disease Sub Saharan Africa is experiencing an exponential increase of infections and deaths coupled with vaccines shortages personal protective equipment weak health systems and COVID 19 emerging variants Some developed countries integrated telemedicine to reduce the impacts of the shortage of healthcare professionals and potentially reduce the risk of exposure ensuring easy delivery of quality health services while limiting regular physical contact and direct hospitalization However the adoption of telemedicine and telehealth is still nascent in many sub Saharan Africa countries Therefore this study reflects on progress made towards the use of telemedicine virtual health care services challenges encountered and proffers ways to address them We conducted a systematic literature review to synthesise literature on telemedicine in sub Saharan Africa The study revealed that telemedicine provides unprecedented benefits such as improving efficiency effective utilization of healthcare resources forward triaging prevention of medical personnel infection aiding medical students clinical observation and participation and assurance of social support for patients However the absence of policy on virtual care and political will cost of sustenance of virtual health care services inadequate funding technological and infrastructural barriers patient and healthcare personnel bias on virtual care and cultural barriers are identified as limiting factors to the adoption of virtual health care in many African health systems To alleviate some of these barriers we recommend the development of robust policies and frameworks for virtual health care the inclusion of virtual care in the medical school curriculum supporting virtual care research and development increasing health funding removing monopolisation of telecommunication services developing of virtual health solutions that address eccentricities of African health systems 0 |
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532 Inflammasomes and Childhood Autoimmune Diseases A Review of Current Knowledge Inflammasomes are multiprotein complexes capable of sensing pathogen associated molecular patterns PAMPs danger associated molecular patterns DAMPs and cellular perturbations Upon stimulation the inflammasomes activate the production of the pro inflammatory cytokines IL 1β and IL 18 and induce gasdermin D mediated pyroptosis Dysregulated inflammasome signaling could lead to hyperinflammation in response to environmental triggers thus contributing to the pathogenesis of childhood autoimmune autoinflammatory diseases In this review we group childhood rheumatic diseases into the autoinflammation to autoimmunity spectrum and discuss about the involvement of inflammasomes in disease mechanisms Genetic mutations in inflammasome components cause monogenic autoinflammatory diseases while inflammasome related genetic variants have been implicated in polygenic childhood rheumatic diseases We highlight the reported associations of inflammasome signaling related genetic polymorphisms protein levels with pediatric autoimmune disease susceptibility and disease course Furthermore we discuss about the use of IL 1 receptor antagonist as an adjunctive therapy in several childhood autoimmune diseases including macrophage activation syndrome MAS and multisystem inflammatory syndrome in children MIS C related to COVID 19 A comprehensive multi cohort comparison on inflammasome gene expression profile in different pediatric rheumatic diseases is needed to identify patient subsets that might benefit from the adjunctive therapy of IL 1β inhibitors 0 |
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217 Redox imbalance links COVID 19 and myalgic encephalomyelitis chronic fatigue syndrome Although most patients recover from acute COVID 19 some experience postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection PASC One subgroup of PASC is a syndrome called long COVID 19 reminiscent of myalgic encephalomyelitis chronic fatigue syndrome ME CFS ME CFS is a debilitating condition often triggered by viral and bacterial infections leading to years long debilitating symptoms including profound fatigue postexertional malaise unrefreshing sleep cognitive deficits and orthostatic intolerance Some are skeptical that either ME CFS or long COVID 19 involves underlying biological abnormalities However in this review we summarize the evidence that people with acute COVID 19 and with ME CFS have biological abnormalities including redox imbalance systemic inflammation and neuroinflammation an impaired ability to generate adenosine triphosphate and a general hypometabolic state These phenomena have not yet been well studied in people with long COVID 19 and each of them has been reported in other diseases as well particularly neurological diseases We also examine the bidirectional relationship between redox imbalance inflammation energy metabolic deficits and a hypometabolic state We speculate as to what may be causing these abnormalities Thus understanding the molecular underpinnings of both PASC and ME CFS may lead to the development of novel therapeutics 1 |
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93 Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID 19 in a Multistate Health Care Systems Network United States March June 2020 Prolonged symptom duration and disability are common in adults hospitalized with severe coronavirus disease 2019 COVID 19 Characterizing return to baseline health among outpatients with milder COVID 19 illness is important for understanding the full spectrum of COVID 19 associated illness and tailoring public health messaging interventions and policy During April 15 June 25 2020 telephone interviews were conducted with a random sample of adults aged 18 years who had a first positive reverse transcription polymerase chain reaction RT PCR test for SARS CoV 2 the virus that causes COVID 19 at an outpatient visit at one of 14 U S academic health care systems in 13 states Interviews were conducted 14 21 days after the test date Respondents were asked about demographic characteristics baseline chronic medical conditions symptoms present at the time of testing whether those symptoms had resolved by the interview date and whether they had returned to their usual state of health at the time of interview Among 292 respondents 94 274 reported experiencing one or more symptoms at the time of testing 35 of these symptomatic respondents reported not having returned to their usual state of health by the date of the interview median 16 days from testing date including 26 among those aged 18 34 years 32 among those aged 35 49 years and 47 among those aged 50 years Among respondents reporting cough fatigue or shortness of breath at the time of testing 43 35 and 29 respectively continued to experience these symptoms at the time of the interview These findings indicate that COVID 19 can result in prolonged illness even among persons with milder outpatient illness including young adults Effective public health messaging targeting these groups is warranted Preventative measures including social distancing frequent handwashing and the consistent and correct use of face coverings in public should be strongly encouraged to slow the spread of SARS CoV 2 1 |
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540 The neutralizing antibody response post COVID 19 vaccination in patients with myeloma is highly dependent on the type of anti myeloma treatment Recent data suggest a suboptimal antibody response to COVID 19 vaccination in patients with hematological malignancies Neutralizing antibodies NAbs against SARS CoV 2 were evaluated in 276 patients with plasma cell neoplasms after vaccination with either the BNT162b2 or the AZD1222 vaccine on days 1 before the first vaccine shot 22 and 50 Patients with MM n 213 SMM n 38 and MGUS n 25 and 226 healthy controls were enrolled in the study NCT04743388 Vaccination with either two doses of the BNT162b2 or one dose of the AZD1222 vaccine leads to lower production of NAbs in patients with MM compared with controls both on day 22 and on day 50 p 0 001 for all comparisons Furthermore MM patients showed an inferior NAb response compared with MGUS on day 22 p 0 009 and on day 50 p 0 003 Importantly active treatment with either anti CD38 monoclonal antibodies Mabs or belantamab mafodotin and lymphopenia at the time of vaccination were independent prognostic factors for suboptimal antibody response following vaccination In conclusion MM patients have low humoral response following SARS CoV 2 vaccination especially under treatment with anti CD38 or belamaf This underlines the need for timely vaccination possibly during a treatment free period and for continuous vigilance on infection control measures in non responders 0 |
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356 Coronavirus disease and male fertility a systematic review Based on the information from other SARS CoV infections in the patients recovered from COVID 19 particularly cases in the reproductive age gonadal function evaluation and andrological consultation comprising semen analysis are recommended Based on the COVID 19 infected patients seminal fluid analyses SARS CoV 2 may employ the male reproductive system as a transmission pathway It has been also demonstrated that angiotensin converting enzyme 2 ACE2 can be strongly expressed at the protein levels in the testicular cells The high expression of ACE2 in testes suggests that testes in the COVID 19 infected males can have an important role in the viral persistence and this subject needs further investigations Several researchers have examined males recovered from COVID 19 but still large scale experiments are needed to determine the effects of SARS CoV 2 on the male reproductive system as well as viral transmission risk Comprehensive researches are required to figure out the presence of the SARS CoV 2 virus in seminal fluid as well as its sexual transmissibility and impact on sperm characteristics 0 |
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411 SARS COV 2 can you be over it Uncertainty has surrounded the duration of immunity against SARS CoV 2 This concerns both the duration of vaccine immunity and the duration of natural immunity We aim to critically review the information available today and draw practical conclusions This is a narrative review of the recently published information on the topic compared with the knowledge we already have of the behavior of various viral infectious agents It is too early to have any meaningful information on the duration of vaccine immunity against SARS CoV 2 For those who already had the infeciton the rate of reinfection is very low Most reinfections are due to laboratory errors to incomplete cure of the primary infection to the supervening immunodeficiency of the host or to pre existing immunodeficiency made evident by the SARS CoV 2 infection The available studies on the immunology of the infection converge in indicating that it generates a robust and persistent immunity This behavior does not differ from that of respiratory viruses known to date in naturally occurring viral respiratory infections reinfections are exceptional The civil community awaits suggestions from scientists not only to protect susceptible people but to be able to safely resume activities made uncertain by the pandemic From the information we have to date we suggest that in principle patients who have already overcome the infection should not be prioritized to the SARS CoV 2 vaccine Instead they could be provided with an immunological passport that allows them to resume a normal social life 0 |
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8 Challenges in defining Long COVID Striking differences across literature Electronic Health Records and patient reported information Since late 2019 the novel coronavirus SARS CoV 2 has introduced a wide array of health challenges globally In addition to a complex acute presentation that can affect multiple organ systems increasing evidence points to long term sequelae being common and impactful The worldwide scientific community is forging ahead to characterize a wide range of outcomes associated with SARS CoV 2 infection however the underlying assumptions in these studies have varied so widely that the resulting data are difficult to compareFormal definitions are needed in order to design robust and consistent studies of Long COVID that consistently capture variation in long term outcomes Even the condition itself goes by three terms most widely Long COVID but also COVID 19 syndrome PACS or post acute sequelae of SARS CoV 2 infection PASC In the present study we investigate the definitions used in the literature published to date and compare them against data available from electronic health records and patient reported information collected via surveys Long COVID holds the potential to produce a second public health crisis on the heels of the pandemic itself Proactive efforts to identify the characteristics of this heterogeneous condition are imperative for a rigorous scientific effort to investigate and mitigate this threat 1 |
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33 Post acute sequelae of SARS CoV 2 infection PASC a protocol for a multidisciplinary prospective observational evaluation of a cohort of patients surviving hospitalisation in Sao Paulo Brazil COVID 19 may lead to persistent and potentially incapacitating clinical manifestations post acute sequelae of SARS CoV 2 infection PASC Using easy to apply questionnaires and scales often by telephone interviewing several studies evaluated samples of COVID 19 inpatients from 4 weeks to several months after discharge However studies conducting systematic multidisciplinary assessments of PASC manifestations are scarce with thorough in person objective evaluations restricted to modestly sized subsamples presenting greatest disease severity We will conduct a prospective observational study of surviving individuals above 18 years of age from a cohort of over 3000 subjects with laboratory confirmed COVID 19 who were treated as inpatients at the largest academic health centre in Sao Paulo Brazil Hospital das Clínicas Faculdade de Medicina Universidade de São Paulo All eligible subjects will be consecutively invited to undergo a 1 2 day series of multidisciplinary assessments at 2 time points respectively at 6 9 months and 12 15 months after discharge Assessment schedules will include detailed multidomain questionnaires applied by medical research staff self report scales objective evaluations of cardiopulmonary functioning physical functionality and olfactory status standardised neurological psychiatric and cognitive examinations as well as diagnostic laboratory muscle ultrasound and chest imaging exams Remaining material from blood tests will be incorporated by a local biobank for use in future investigations on inflammatory markers genomics transcriptomics peptidomics and metabolomics All components of this programme have been approved by local research ethics committees We aim to provide insights into the frequency and severity of chronic post COVID multiorgan symptoms as well as their interrelationships and associations with acute disease features sociodemographic variables and environmental exposures Findings will be disseminated in peer reviewed journals and at scientific meetings Additionally we aim to provide a data repository to allow future pathophysiological investigations relating clinical PASC features to biomarker data extracted from blood samples RBR 8z7v5wc Pre results 1 |
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515 Risk of infection and transmission of SARS CoV 2 among children and adolescents in households communities and educational settings A systematic review and meta analysis There is uncertainty with respect to SARS CoV 2 transmission in children 0 19 years with controversy on effectiveness of school closures in controlling the pandemic It is of equal importance to evaluate the risk of transmission in children who are often asymptomatic or mildly symptomatic carriers that may incidentally transmit SARS CoV 2 in different settings We conducted this review to assess transmission and risks for SARS CoV 2 in children by age groups or grades in community and educational settings compared to adults Data for the review were retrieved from PubMed EMBASE Cochrane Library WHO COVID 19 Database China National Knowledge Infrastructure CNKI Database WanFang Database Latin American and Caribbean Health Sciences Literature LILACS Google Scholar and preprints from medRixv and bioRixv covering a timeline from December 1 2019 to April 1 2021 Population screening contact tracing and cohort studies reporting prevalence and transmission of SARS CoV 2 in children were included Data were extracted according to PRISMA guidelines Meta analyses were performed using Review Manager 5 3 Ninety studies were included Compared to adults children showed comparable national risk ratio RR 0 87 95 confidence interval CI 0 71 1 060 and subnational RR 0 81 95 CI 0 66 1 01 prevalence in population screening studies and lower odds of infection in community household contact tracing studies odds ratio OR 0 62 95 CI 0 46 0 84 On disaggregation adolescents observed comparable risk OR 1 22 95 CI 0 74 2 04 with adults In educational settings children attending daycare preschools OR 0 53 95 CI 0 38 0 72 were observed to be at lower risk when compared to adults with odds of infection among primary OR 0 85 95 CI 0 55 1 31 and high schoolers OR 1 30 95 CI 0 71 2 38 comparable to adults Overall children and adolescents had lower odds of infection in educational settings compared to community and household clusters Children 10 years showed lower susceptibility to COVID 19 compared to adults whereas adolescents in communities and high schoolers had comparable risk Risks of infection among children in educational settings was lower than in communities Evidence from school based studies demonstrate it is largely safe for children 10 years to be at schools however older children 10 19 years might facilitate transmission Despite this evidence studies focusing on the effectiveness of mitigation measures in educational settings are urgently needed to support both public health and educational policy making for school reopening 0 |
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468 Quality of life after intensive care a systematic review of the literature To evaluate quality of life at least 12 months after discharge from the intensive care unit of adult critically ill patients to evaluate the methodology used to assess long term quality of life and to give an overview of factors influencing quality of life EMBASE PubMed MEDLINE OVID SCI Web of Science the Cochrane Library Google Scholar and personal files Data extraction was performed independently and cross checked by two reviewers using a predefined data extraction form Eligible studies were published between 1999 and 2009 and assessed quality of life 12 months after intensive care unit discharge by means of the Medical Outcomes Study 36 Item Short Form Health Survey the RAND 36 Item Health Survey EuroQol 5D and or the Nottingham Health Profile in adult intensive care unit patients Fifty three articles 10 multicenters were included with the majority of studies performed in Europe 68 The Medical Outcomes Study 36 Item Short Form Health Survey was used in 55 and the EuroQol 5D the Nottingham Health Profile the RAND 36 Item Health Survey or a combination was used in 21 9 8 or 8 respectively A response rate of 80 was attained in 26 studies 49 Critically ill patients had a lower quality of life than an age and gender matched population but quality of life tended to improve over years The worst reductions in quality of life were seen in cases of severe acute respiratory distress syndrome prolonged mechanical ventilation severe trauma and severe sepsis Study quality criteria defined as a baseline quality of life assessment the absence of major exclusion criteria a description of nonresponders and a comparison with a reference population were met in only four studies 8 Results concerning the influence of severity of illness comorbidity preadmission quality of life age gender or acquired complications were conflicting Quality of life differed on diagnostic category but overall critically ill patients had a lower quality of life than an age and gender matched population A minority of studies met the predefined methodologic quality criteria Results concerning the influence of the patients characteristics and illnesses on long term quality of life were conflicting 0 |
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519 Clinical Cardiovascular Adverse Events Reported Post COVID 19 Vaccination Are they a real risk Given the urgent need to control the spread of the novel COVID 19 virus thirteen vaccines have been approved for emergency use before completing all three phases of the clinical trials Thereby a careful monitor of the adverse effects postvaccination is essential We searched through PubMed and other reporting systems like VAERS for the reported cardiovascular adverse events post COVID 19 vaccination Through our review we determined that the incidence of all the reported cardiovascular events is very rare Additionally the vaccine was initially given to the elderly and high risk populations in which cardiovascular events such as myocardial infarction and arrhythmias are already more prevalent while other cardiovascular events such as myocarditis or vaccine induced thrombotic thrombocytopenia were more common in younger populations Moreover a direct causal relationship if any between vaccination and adverse events is yet to be fully elucidated Thus at this time point the benefits of vaccination far outweigh the risk 0 |
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659 Pet Keeping in the Time of COVID 19 The Canine and Feline Companions of Young Children Amid COVID 19 childrens interactions with pet animals in the household were at times strengthened strained or established anew Extensive periods of confinement made the home environment not only the site for most family activities but also the hub for childrens school and many adults work Research on the role of pets during the pandemic has consisted primarily of online surveys with the general finding that sweeping changes to daily living had major consequences for the dynamics between pets and people This article addresses issues related to young children and pet keeping within the context of the recent world health crisis and the resultant lockdowns First it describes how the definition of a pet has changed It then examines childrens attachments to dogs and cats the two species most frequently chosen as pets for young children worldwide Next it highlights the potential risks and rewards of children cohabitating with cats and dogs at a time when many families were sequestered in homes The article concludes with a discussion of the limitations and contributions of research on pet keeping during COVID 19 and suggests appropriate next steps that take into consideration the welfare of young children and their companion animals 0 |
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427 Cardiorespiratory and skeletal muscle damage due to COVID 19 making the urgent case for rehabilitation It has become increasingly evident that COVID 19 contributes to multiorgan pathophysiology The systemic inflammatory response increases both pro inflammatory cytokine and chemokine levels leading to immune dysregulation and increasing the likelihood of incurring cardiac and pulmonary injuries Longer periods of hospitalization 20 days increase susceptibility to ICU acquired muscle weakness and deconditioning which decreases muscle function and functional capacity These conditions affect the quality of life in the post COVID 19 period and require multi disciplinary approaches to rehabilitate the cardiopulmonary and musculoskeletal systems of these patients In this context this narrative review which included articles published in the Embase PEDro and PubMed databases up to December 2020 is focused on discussing the essential role of exercise and rehabilitation health professionals in the COVID 19 recovery process from hospitalization to hospital discharge addressing strategies for professionals to mitigate the cardiac and pulmonary impairments associated with hospitalization to home or ambulatory rehabilitation purposing ways to conduct rehabilitation programs to restore their functional status and quality of life after the infection In the current environment these findings further point to the vital role of rehabilitation health professionals in the coming years and the urgent need to develop strategies to assist COVID 19 survivors 0 |
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46 Persisting symptoms three to eight months after non hospitalized COVID 19 a prospective cohort study Long COVID 19 is a proposed syndrome negatively affecting the health of COVID 19 patients We present data on self rated health three to eight months after laboratory confirmed COVID 19 disease compared to a control group of SARS CoV 2 negative patients We followed a cohort of 8786 non hospitalized patients who were invited after SARS CoV 2 testing between February 1 and April 15 2020 794 positive 7229 negative Participants answered online surveys at baseline and follow up including questions on demographics symptoms risk factors for SARS CoV 2 and self rated health compared to one year ago Determinants for a worsening of self rated health as compared to one year ago among the SARS CoV 2 positive group were analyzed using multivariate logistic regression and also compared to the population norm The follow up questionnaire was completed by 85 of the SARS CoV 2 positive and 75 of the SARS CoV 2 negative participants on average 132 days after the SARS CoV 2 test At follow up 36 of the SARS CoV 2 positive participants rated their health somewhat or much worse than one year ago In contrast 18 of the SARS CoV 2 negative participants reported a similar deterioration of health while the population norm is 12 Sore throat and cough were more frequently reported by the control group at follow up Neither gender nor follow up time was associated with the multivariate odds of worsening of self reported health compared to one year ago Age had an inverted U formed association with a worsening of health while being fit and being a health professional were associated with lower multivariate odds A significant proportion of non hospitalized COVID 19 patients regardless of age have not returned to their usual health three to eight months after infection 1 |
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60 Diagnostic and Pharmacological Potency of Creatine in Post Viral Fatigue Syndrome Post viral fatigue syndrome PVFS is a widespread chronic neurological disease with no definite etiological factor s no actual diagnostic test and no approved pharmacological treatment therapy or cure Among other features PVFS could be accompanied by various irregularities in creatine metabolism perturbing either tissue levels of creatine in the brain the rates of phosphocreatine resynthesis in the skeletal muscle or the concentrations of the enzyme creatine kinase in the blood Furthermore supplemental creatine and related guanidino compounds appear to impact both patient and clinician reported outcomes in syndromes and maladies with chronic fatigue This paper critically overviews the most common disturbances in creatine metabolism in various PVFS populations summarizes human trials on dietary creatine and creatine analogs in the syndrome and discusses new frontiers and open questions for using creatine in a post COVID 19 world 1 |
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192 SARS CoV 2 related microvascular damage and symptoms during and after COVID 19 Consequences of capillary transit time changes tissue hypoxia and inflammation Corona virus disease 2019 COVID 19 causes symptoms from multiple organs after infection by severe acute respiratory syndrome corona virus 2 SARS CoV 2 They range from early low blood oxygen levels hypoxemia without breathlessness silent hypoxia delirium rashes and loss of smell anosmia to persisting chest pain muscle weakness and pain fatigue confusion memory problems and difficulty to concentrate brain fog mood changes and unexpected onset of hypertension or diabetes SARS CoV 2 affects the microcirculation causing endothelial cell swelling and damage endotheliitis microscopic blood clots microthrombosis capillary congestion and damage to pericytes that are integral to capillary integrity and barrier function tissue repair angiogenesis and scar formation Similar to other instances of critical illness COVID 19 is also associated with elevated cytokine levels in the systemic circulation This review examines how capillary damage and inflammation may contribute to these acute and persisting COVID 19 symptoms by interfering with blood and tissue oxygenation and with brain function Undetectable by current diagnostic methods capillary flow disturbances limit oxygen diffusion exchange in lungs and tissue and may therefore cause hypoxemia and tissue hypoxia The review analyzes the combined effects of COVID 19 related capillary damage pre existing microvascular changes and upstream vascular tone on tissue oxygenation in key organs It identifies a vicious cycle as infection and hypoxia related inflammation cause capillary function to deteriorate which in turn accelerates hypoxia related inflammation and tissue damage Finally the review addresses the effects of low oxygen and high cytokine levels in brain tissue on neurotransmitter synthesis and mood Methods to assess capillary functions in human organs and therapeutic means to protect capillary functions and stimulate capillary bed repair may prove important for the individualized management of COVID 19 patients and targeted rehabilitation strategies 1 |
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351 Kidney implications of SARS CoV2 infection in children Research indicates that severe acute respiratory syndrome coronavirus 2 SARS CoV2 infection can impact every organ and the effects can range from asymptomatic to severe disease Since it was first discovered in December 2019 our understanding has grown about its impact on kidney disease In general children have less severe disease than adults and this tendency appears to extend to special pediatric kidney populations e g chronic kidney disease and immunosuppressed patients with solid organ transplants or nephrotic syndrome However in a fraction of infected children SARS CoV2 causes an array of kidney manifestations ranging from acute kidney injury to thrombotic microangiopathy with potential implications for increased risk of morbidity and mortality Additional considerations surround the propensity for clotting extracorporeal circuits in children with SARS CoV2 infection that are receiving kidney replacement therapy This review provides an update on our current understanding of SARS CoV2 for pediatric nephrologists and highlights knowledge gaps to be addressed by future research during this ongoing pandemic particularly the social disparities magnified during this period 0 |
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552 BCG Vaccination Program Mitigates COVID19 Related Mortality A Reality Check Since its origin in the Wuhan province of China in December 2019 Coronavirus Disease 19 COVID 19 has spread to most parts of the world and has infected millions of people However the significant variability in the mortality rate across the world indicates some underlying factors especially the immunity factors that may have a potential role in this variability One such factor that is being discussed and tested is the Bacillus Calmette Guerin BCG vaccine The available evidence suggests that BCG vaccination provides broad protection against respiratory infections as well as other infections Therefore BCG may prove to be a barrier for COVID 19 infection and may offer a ray of hope In this review we contrasted BCG vaccination program with COVID 19 mortality and analyzed trained immunity and cross protection against unrelated pathogens due to BCG vaccination On analyzing the available data we observed that countries without universal BCG vaccination policy are severely affected while countries having universal BCG policies are less affected Based on these data we propose that the SARS CoV 2 related qualified immunity cross protection against unrelated pathogens and COVID 19 impact variations could be partly explained by the different national policies regarding BCG childhood vaccination The combination of reduced morbidity and mortality may make BCG vaccination a potential new tool in the fight against COVID 19 0 |
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280 Long term Complications of COVID 19 SARS CoV 2 has rapidly spread across the globe and infected hundreds of millions of people worldwide As our experience with this virus continues to grow our understanding of the both short and long term complications of infection with SARS CoV 2 continues to grow as well Just as there is heterogeneity in the acute infectious phase there is heterogeneity in the long term complications seen following COVID 19 illness The purpose of this review article is to present the current literature with regards to the epidemiology pathophysiology and proposed management algorithms for the various long term sequalae that have been observed in each organ system following infection with SARS CoV 2 We will also consider future directions with regards to newer variants of the virus and their potential impact on the long term complications observed 1 |
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543 Experience of a COVID 19 outbreak response in a general hospital in Gyeonggi Province Korea Coronavirus disease 2019 COVID 19 outbreaks in general hospitals are particularly risky because they not only overburden the regional healthcare delivery system but also increase the possibility of community transmission This study shares an experience of a COVID 19 outbreak response in a general hospital in Gyeonggi Province Korea Since the first COVID 19 confirmed case was recognized in Hospital A on March 29 2020 the Immediate Response Team of Gyeonggi Province and Korea Disease Control and Prevention Agency devised a plan to conduct an epidemiological investigation and minimize the paralysis of hospital functions Apart from the epidemiological investigation a risk assessment of the hospital and management of contacts including patients and workers were also undertaken In total 72 confirmed cases were identified including 26 hospitalized patients 16 healthcare personnel 7 visitors and 22 cases identified externally The majority of the confirmed cases were exposed in Ward B or were contacts of people exposed in Ward A 58 3 of 72 cases Among healthcare personnel caregivers were found to be the most vulnerable to COVID 19 in this outbreak Preparation for all possible situations in medical facilities is important because it is difficult to find alternative resources The findings of this study provide information on controlling the further transmission of COVID 19 and furnish evidence of the importance of ordinary management skills to be prepared for COVID 19 0 |
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567 Last Aid Courses as measure for public palliative care education for adults and children a narrative review To provide a narrative overview of the current knowledge on Last Aid Courses LAC and experiences from the implementation process in different countries Major challenges for public health palliative care include supporting all people who wish to die at home and educating the public about death dying and palliative care LAC commenced in 2015 in order to educate and empower citizens to participate in end of life care and to improve the public debate about death and dying The International Last Aid project and the International Last Aid working group were established to provide and evaluate public palliative care education PPCE using LAC A literature search in PubMed Medline was performed and a narrative overview of the existing literature on LAC and PPCE is provided In addition experiences from the implementation process are presented An International Last Aid working group was established with representatives from different countries and national organisations This group revises the curriculum and contents of LAC in regular intervals with the latest revision in October 2020 Scientific evaluation of LAC is coordinated by the international Last Aid Research Group Europe LARGE Work on LAC has commenced in 18 countries The overall results show that LAC are feasible and very well accepted in many different countries and cultures Adults children and other groups such as hospital employees and police officers have participated in LAC LAC for citizens is also possible in an online course format that was established and tested during the COVID 19 pandemic Scientific work on the effects of LAC and cultural issues connected to LAC are ongoing in a number of countries LAC are feasible and well accepted by citizens in different countries The courses can contribute to a public debate on death dying and palliative care and may contribute to empowering citizens in providing end of life care 0 |
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457 The risk to child nutrition during and after COVID 19 pandemic what to expect and how to respond The current study aimed to address the key areas of concern for child nutrition both during and after the COVID 19 pandemic and proposes strategic responses to reduce child undernutrition in the short and long term A descriptive literature review was performed The search of the literature was conducted through using electronic databases including PubMed Web of Science Google Scholar and Cochrane library A wide range of published articles focused on child malnutrition were reviewed The study was focused on children especially those under 5 years The current study proposes strategic responses to reduce child undernutrition These responses include strengthening access to community based nutrition services that support the early detection and treatment of undernourished children and emergency food distribution including fortified foods with vitamins and minerals to vulnerable households particularly those with children under 5 years Moreover counseling and promotion programmes should be reinforced to revitalise community nutrition education in areas such as gestation exclusive breast feeding and complementary feeding and hygienic practices involving handwashing proper sanitation and other basic behavioural changes The COVID 19 pandemic has affected many countries especially those in the regions of South Asia and sub Saharan Africa in which there has been an ongoing burden of child undernutrition However malnutrition is preventable and can be eliminated through a multisectoral strategic approach The effective execution of a multisectoral approach towards preventing childhood malnutrition will require not only a financial investment but also the collective efforts from different ministries of the governments UN affiliated agencies and non governmental organisations 0 |
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84 Central Sensitization Phenotypes in Post Acute Sequelae of SARS CoV 2 Infection PASC Defining the Post COVID Syndrome To develop and implement criteria for description of post COVID syndrome based on analysis of patients presenting for evaluation at Mayo Clinic Rochester between November 2019 and August 2020 A total of 465 patients with a history of testing positive for COVID 19 were identified and their medical records reviewed After a thorough review utilizing the DELPHI methods by an expert panel 42 9 cases were identified with persistent central sensitization CS symptoms persisting after the resolution of acute COVID 19 herein referred to as Post COVID syndrome PoCoS In this report we describe the baseline characteristics of these PoCoS patients Among these 42 PoCoS patients the mean age was 46 2 years median age was 46 5 years Pain 90 fatigue 74 dyspnea 43 and orthostatic intolerance 38 were the most common symptoms The characteristics of an initial 14 patients were utilized for the development of clinical criteria via a modified Delphi Method by a panel of experts in central sensitization disorders These criteria were subsequently applied in the identification of 28 additional cases of suspected PoCoS A 2 reviewer system was used to analyze agreement with using the criteria with all 28 cases determined to be either probable or possible cases by the reviewers Inter reviewer agreement using these proposed defining criteria was high with a Cohens alpha of 88 Here we present what we believe to be the first definitional criteria for Post COVID syndrome These may be useful in clinical phenotyping of these patients for targeted treatment and future research 1 |
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26 Return to work disabilities and occupational health in the age of COVID 19 We have read with great interest the two editorials by Burdorf et al The COVID 19 pandemic one year later an occupational perspective 1 and The COVID 19 Coronavirus pandemic consequences for occupational health 2 The authors highlight the importance of the societal consequences of the outbreak and changes in the world of work to manage occupational health The key points identified such as individual socio economic factors psychological effects and occupations with highest risk of contamination modify return to work approaches It is estimated that around 800 million people of working age worldwide were living with disabilities before the SARS CoV 2 pandemic In early January 2021 the cumulative COVID 19 hospitalisation rate reached 207 4 100 000 18 49 year olds and 505 7 100 000 50 64 year olds respectively in the United States 3 In France the hospitalisation rate was 411 5 100 000 across all ages 4 A recent cohort study of working age men who were hospitalised for COVID 19 highlighted the long term health consequences of such a disease 5 The SARS CoV 2 pandemic creates new challenges for occupational health shifting attention away from return to work after health problems to resuming work during an outbreak dealing with lockdown and taking special account of workers with vulnerabilities 6 7 We recommend considering three different aspects of occupational medicine during a pandemic Firstly for most workers at high risk of severe COVID 19 the issues of work disability and resuming work had never occurred before the epidemic Recommendations such as physical and social distancing and wearing a facemask are highly advisable to protect against infection but may not be enough to enable some individuals to resume work Therefore decision making requires individual comprehensive assessments of the underlying medical condition the SARS CoV 2 contamination risk associated with either regular work or teleworking and vaccination opportunities The second situation concerns workers who have suffered from COVID 19 Preliminary studies suggest that long recovery duration is related to high severity 7 but this is still a matter of debate for patients suffering from long COVID 19 5 8 9 a condition for which the long term effects remain unknown Any long running recovery must be considered to be a potential sign of long COVID 19 These long lasting syndromes occur among patients with severe symptoms but have also been reported independently of acute phase severity hospitalisation and receiving medical oxygen 8 9 Researchers worldwide are currently investigating such syndromes Strategies promoting return to work for these workers will need to be implemented and could be similar to programmes developed for other chronic conditions Moreover numerous more serious sequelae following critical illness suggest the need for enhanced support by rehabilitation and occupational health specialists Finally the consequences of the epidemic must be evaluated over time for people who suffered from functional limitations before COVID 19 as their physical and mental condition may be modified by the epidemic and specifically the consequences of lockdown 10 In all of these situations medical social financial and working contexts are key elements In addition to a medical assessment the use of scales such as the Work Ability Index WAI 11 or the Work Productivity and Activity Impairment WPAI 12 can help perform long term follow up and provide information about work capacity and workload It also gives a back to basics perspective urging politicians to move towards a decent work for all policy as advocated by the United Nation s Sustainable Development Goal SDG 8 which the WHO has endorsed 13 References 1 Burdorf A Porru F Rugulies R The COVID 19 pandemic one year later an occupational perspective Scand J Work Environ Health online first https doi org 10 5271 sjweh 3956 2 Burdorf A Porru F Rugulies R The COVID 19 Coronavirus pandemic consequences for occupational health Scand J Work Environ Health 2020 46 3 229 230 https doi org 10 5271 sjweh 3893 3 COVID 19 Hospitalizations Internet Available from https gis cdc gov grasp COVIDNet COVID19_3 html 4 COVID 19 in France vaccine and allergy management in occupational setting Descatha A et al Arch Mal Prof Environ 2021 Accepted for publication 5 Huang C Huang L Wang Y Li X Ren L Gu X et al 6 month consequences of COVID 19 in patients discharged from hospital a cohort study Lancet 2021 397 10270 220 32 https doi org 10 1016 S0140 6736 20 32656 8 6 Shaw WS Main CJ Findley PA Collie A Kristman VL Gross DP Opening the Workplace After COVID 19 What Lessons Can be Learned from Return to Work Research J Occup Rehabil 2020 30 3 299 302 https doi org 10 1007 s10926 020 09908 9 7 Taylor T Das R Mueller K Pransky G Christian J Orford R et al Safely Returning America to Work Part I General Guidance for Employers J Occup Environ Med 2020 62 9 771 9 https doi org 10 1097 JOM 0000000000001984 8 Carfì A Bernabei R Landi F Gemelli Against COVID 19 Post Acute Care Study Group Persistent Symptoms in Patients After Acute COVID 19 JAMA 2020 324 6 603 5 https doi org 10 1001 jama 2020 12603 9 Tenforde MW Kim SS Lindsell CJ Billig Rose E Shapiro NI Files DC et al Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID 19 in a Multistate Health Care Systems Network United States March June 2020 MMWR Morb Mortal Wkly 2020 69 30 993 8 https doi org 10 15585 mmwr mm6930e1 10 Chudasama YV Gillies CL Zaccardi F Coles B Davies MJ Seidu S et al Impact of COVID 19 on routine care for chronic diseases A global survey of views from healthcare professionals Diabetes Metab Syndr 2020 14 5 965 7 https doi org 10 1016 j dsx 2020 06 042 11 Tuomi K Eleven year follow up of aging workers Scand J Work Environ Health 1997 23 1 1 71 12 Reilly MC Zbrozek AS Dukes EM The validity and reproducibility of a work productivity and activity impairment instrument PharmacoEconomics 1993 4 5 353 65 https doi org 10 2165 00019053 199304050 00006 13 Organization WH Health in the 2030 agenda for sustainable development Sixty Ninth World Health Assembly Document A 2016 p69 1 |
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59 Long term changes in pulmonary function among patients surviving to COVID 19 pneumonia The aim of this study was to assess respiratory function at the time of clinical recovery 6 weeks 6 months and 12 months after discharge in patients surviving to COVID 19 pneumonia Our case series consisted of 13 hospitalized patients with COVID 19 pneumonia Baseline pulmonary function tests were 55 7 15 6 for FEV1 68 6 16 0 for FVC and 1 2 0 1 for FEV1 FVC Although pulmonary function showed a small improvement after 6 weeks patients experienced a more significant improvement after 6 and 12 months in FEV1 95 4 13 7 and 107 2 16 5 respectively p 0 001 FVC 91 3 14 5 and 105 9 15 6 respectively p 0 001 and FEV1 FVC values 1 04 0 04 and 1 01 0 05 respectively p 0 001 COVID 19 pneumonia may result in significant alterations in lung function with a mainly restrictive pattern partly persisting at 6 weeks after recovery from acute phase but significantly improving during a 12 month follow up period 1 |
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136 Neurological sequelae of COVID 19 a review The COVID 19 pandemic has produced a myriad of challenges including identifying and treating neurological sequelae COVID 19 can cause olfactory and respiratory dysfunction with average recovery within 1 month and a minority of patients experiencing symptoms at 8 month follow up Headaches are also very common up to 93 amongst patients with persistent COVID 19 symptoms COVID 19 illness may also affect cognition although results are mixed While many studies have focused on acute COVID 19 symptoms more longitudinal studies will need to assess the neurological sequelae of the disease Furthermore care must be taken when attributing sequelae to COVID 19 illness and not an unrelated cause Finally there is concern that COVID 19 may be associated with secondary illnesses such as Guillain Barre and may even contribute to the development of diseases such as Alzheimers 1 |
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619 Potentials of Antitussive Traditional Persian Functional Foods for COVID 19 Therapy sup sup Coronavirus disease 2019 is a worldwide pandemic resulting in a severe acute respiratory syndrome Remdesivir is the only FDA approved drug for hospitalized patients older than age 12 It shows the necessity of finding new therapeutic strategies Functional foods FFs could have co therapeutic and protective effects against COVID 19 infection Traditional Persian medicine TPM one of the safest and most popular schools of medicine for hundreds of years has recommended potential FF candidates to manage such a global pandemic To reveal the potential of TPM in terms of antitussive FFs traditional Persian pharmacopoeia Qarabadin e Salehi was searched using the keywords i Soaal i and i Sorfeh i Also a search of MEDLINE PubMed Central Google Scholar and Science Direct was performed for the relevant literature published from the inception up to March 2021 A combination of search terms including cough antitussive antioxidant anti inflammation antiviral COVID 19 mucoactive mucolytic expectorant and mucoregulatory was also applied The potential mechanism of action in SARS CoV 2 infection was discussed Twelve TPM FFs were found including Laooqs Morabbas a Saviq a soup and a syrup They are combinations of two to seven ingredients Natural compounds of mentioned formulations have the main pharmacological mechanisms including antiviral anti inflammatory antioxidant antihistamine bronchodilator immunomodulatory and mucoactive effects as well as central or peripheral antitussive activities FFs are cost effective easily accessible and safe options for both treatment and prevention of COVID 19 They might have positive psychological effects along with their pharmacological effects and nutritional virtues They could also manage persistent respiratory discomforts after recovery from COVID 19 0 |
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360 Cost Analysis of Medical Students Applying to Orthopaedic Surgery Residency Implications for the 2020 to 2021 Application Cycle During COVID 19 Although studies have evaluated the economic burden to medical students desiring an orthopaedic residency broadly no study has evaluated in detail the application costs away rotation costs interview costs and total costs Given that the Association of American Medical Colleges and the American Orthopaedic Associations Council of Orthopaedic Residency Directors have recommended orthopaedic surgery residency programs for the 2021 residency application cycle cancel away rotations and in person interviews our objective was to evaluate the cost savings to medical students applying during this time and the potential implications Using the 2019 to 2020 Texas STAR Dashboard database we queried responses from applicants applying to orthopaedic surgery residency The dashboard was queried to record the application costs away rotation costs interview costs and total costs for medical school seniors applying to orthopaedic surgery residency Demographic information for applicants was also recorded Mean and median costs were reported with percentile distributions and geographic comparisons A Kruskal Wallis H test was used to determine whether there were statistically significant differences in mean costs by medical school region The 2019 to 2020 Texas STAR Dashboard database had 473 responses from applicants to orthopaedic surgery residency The mean application costs were 1 990 away rotation costs were 3 182 interview costs were 3 129 and total costs were 8 205 The mean total costs for applicants from Midwest schools were significantly less than Western schools 7 410 applicant vs 9 909 applicant p 0 008 There was no significant difference between the mean application fees between regions Away rotation costs for applicants from schools in the Midwest 2 413 applicant were significantly less compared with Northeast 3 279 applicant South 3 343 applicant and West 3 913 applicant all p 0 002 Interview costs for applicants from schools in the Northeast 2 891 applicant were less than applicants from Western US schools 3 831 applicant p 0 038 In the COVID 19 era orthopaedic residency applicants could save on average 6 311 through the use of virtual interviews and lack of away rotations There are geographic implications with applicants from Western US medical schools potentially saving most 0 |
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478 The efficacy challenges and facilitators of telemedicine in post treatment cancer survivorship care an overview of systematic reviews Telemedicine services have been increasingly used to facilitate post treatment cancer survivorship care including improving access monitoring health status health behaviors and symptom management enhancing information exchange and mitigating the costs of care delivery especially since the COVID 19 pandemic To inform guidance for the use of telemedicine in the post COVID era the aim of this overview of systematic reviews SRs was to evaluate the efficacy of and survivor engagement in telemedicine interventions in the post treatment survivorship phase and to consider implementation barriers and facilitators PubMed Cochrane CENTRAL CINAHL Embase and Web of Science databases were searched SRs that examined the use of telemedicine in the post treatment phase of cancer survivorship published between January 2010 and April 2021 were included Efficacy data were synthesized narratively Implementation barriers and facilitators were synthesized using the Consolidated Framework for Implementation Research Twenty nine SRs were included A substantive body of evidence found telemedicine to benefit the management of psychosocial and physical effects particularly for improving fatigue and cognitive function There was a lack of evidence on the use of telemedicine in the prevention and surveillance for recurrences and new cancers as well as management of chronic medical conditions This overview highlights a range of diverse barriers and facilitators at the patient health service and system levels This review highlights the benefits of telemedicine in addressing psychosocial and physical effects but not in other areas of post treatment cancer survivorship care This large review provides practical guidance for use of telemedicine in post treatment survivorship care 0 |
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620 Challenges in Feeding Children Posed by the COVID 19 Pandemic a Systematic Review of Changes in Dietary Intake Combined with a Dietitians Perspective To examine the evidence that the dietary quality of children changed between the period preceding the COVID 19 pandemic and the first year during the pandemic A systematic review of the evidence for dietary changes occurring as a result of the pandemic related restrictions in Part I of this article yielded 38 original research articles These articles had conflicting results some describing improvements in overall quality and some describing deteriorations As a whole the studies were characterized by a low study quality and children were poorly represented Taken together these studies do not provide enough evidence to draw conclusions about whether dietary habits changed or not as a result of the pandemic However in a wider narrative review of the psychosocial changes occurring as a result of the COVID 19 pandemic and the known associations of these factors with a dietary intake in Part II we conclude that there is a reason to expect that the dietary quality of children might have been adversely affected by the COVID 19 pandemic One the one hand the literature fails to provide conclusive evidence on changes in the dietary quality of children resulting from the COVID 19 pandemic On the other hand the broader literature supports the hypothesis that childrens dietary quality will have declined during the pandemic Taken together we urgently need more high quality research on childrens changes in dietary intake occurring over the pandemic This will provide important information on whether any potential long term consequences of such changes if they exist need to be examined and ameliorated 0 |
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430 A cardiovascular magnetic resonance imaging based pilot study to assess coronary microvascular disease in COVID 19 patients Coronavirus disease 2019 COVID 19 is caused by severe acute respiratory syndrome coronavirus 2 SARS CoV 2 and is primarily characterised by a respiratory disease However SARS CoV 2 can directly infect vascular endothelium and subsequently cause vascular inflammation atherosclerotic plaque instability and thereby result in both endothelial dysfunction and myocardial inflammation infarction Interestingly up to 50 of patients suffer from persistent exercise dyspnoea and a post viral fatigue syndrome PVFS after having overcome an acute COVID 19 infection In the present study we assessed the presence of coronary microvascular disease CMD by cardiovascular magnetic resonance CMR in post COVID 19 patients still suffering from exercise dyspnoea and PVFS N 22 patients who recently recovered from COVID 19 N 16 patients with classic hypertrophic cardiomyopathy HCM and N 17 healthy control patients without relevant cardiac disease underwent dedicated vasodilator stress CMR studies on a 1 5 T MR scanner The CMR protocol comprised cine and late gadolinium enhancement LGE imaging as well as velocity encoded VENC phase contrast imaging of the coronary sinus flow CSF at rest and during pharmacological stress maximal vasodilation induced by 400 µg IV regadenoson Using CSF measurements at rest and during stress global myocardial perfusion reserve MPR was calculated There was no difference in left ventricular ejection fraction LV EF between COVID 19 patients and controls 60 57 63 vs 63 60 66 p NS There were only N 4 COVID 19 patients 18 showing a non ischemic pattern of LGE VENC based flow measurements showed that CSF at rest was higher in COVID 19 patients compared to controls 1 78 ml min 1 19 2 23 ml min vs 1 14 ml min 0 91 1 32 ml min p 0 048 In contrast CSF during stress was lower in COVID 19 patients compared to controls 3 33 ml min 2 76 4 20 ml min vs 5 32 ml min 3 66 5 52 ml min p 0 05 A significantly reduced MPR was calculated in COVID 19 patients compared to healthy controls 2 73 2 10 4 15 11 vs 4 82 3 70 6 68 p 0 005 No significant differences regarding MPR were detected between COVID 19 patients and HCM patients In post COVID 19 patients with persistent exertional dyspnoea and PVFS a significantly reduced MPR suggestive of CMD similar to HCM patients was observed in the present study A reduction in MPR can be caused by preceding SARS CoV 2 associated direct as well as secondary triggered mechanisms leading to diffuse CMD and may explain ongoing symptoms of exercise dyspnoea and PVFS in some patients after COVID 19 infection 0 |
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390 Fever in the Returned Pediatric Traveler Global mobility has been steadily increasing in recent years The assessment of the febrile child returning from international travel is a diagnostic challenge The COVID 19 pandemic has profoundly affected international travel and made evaluation and management of the sick returned traveler more challenging Children visiting friends and relatives abroad remain at higher risk of infection compared to tourists This review presents a guidance on the initial assessment of a traveling febrile child including interpretation of medical history physical examination and laboratory findings Important clues to etiology include exposure to different infectious agents incubation periods of pathogens and prophylaxis regimens and vaccines received Early identification of potentially life threatening and highly contagious infections is essential In this article we discuss the epidemiology evaluation and management of specific travel related infections such as malaria typhoid fever dengue fever viral hemorrhagic fever rickettsiosis leptospirosis schistosomiasis gastrointestinal and respiratory infections 0 |
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497 Mental illness and suicide among physicians The COVID 19 pandemic has heightened interest in how physician mental health can be protected and optimised but uncertainty and misinformation remain about some key issues In this Review we discuss the current literature which shows that despite what might be inferred during training physicians are not immune to mental illness with between a quarter and a third reporting increased symptoms of mental ill health Physicians particularly female physicians are at an increased risk of suicide An emerging consensus exists that some aspects of physician training working conditions and organisational support are unacceptable Changes in medical training and health systems and the additional strain of working through a pandemic might have amplified these problems A new evidence informed framework for how individual and organisational interventions can be used in an integrated manner in medical schools in health care settings and by professional colleagues is proposed New initiatives are required at each of these levels with an urgent need for organisational level interventions to better protect the mental health and wellbeing of physicians 0 |
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469 The downstream effects of COVID 19 a call for supporting family wellbeing in the NICU Parents of NICU infants are a vulnerable population from a psychological perspective and often experience high levels of acute stress depression anxiety and post traumatic stress The added burden of the current SARS CoV 2 disease COVID 19 pandemic is likely to exacerbate these issues with potential implications for the wellbeing of infants and families in the short and long term In this paper we propose utilizing the stress contagion framework and consider how psychosocial stress can spill over into the parent infant relationship domain which can impact child development and family wellbeing longer term As the effects of the pandemic will likely persist well beyond the acute stage we offer advocacy points and general guidelines for healthcare professionals to consider in their quest to mitigate stress and build resilience in NICU families 0 |
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301 Post COVID 19 neurological syndrome Implications for sequelaes treatment Study design Literature review Describe the implications of post COVID syndrome due to neurological sequelae including treatment and the differences that may exist between this group of patients and those who present these events not associated with COVID 19 A non systematic review of the literature was carried out in PubMed and Science Direct databases using the keywords Post acute COVID 19 syndrome Neurological complications Neurologic Manifestations COVID 19 and Rehabilitation as well as synonyms which were combined with the operators AND and OR The COVID 19 viral caustive agent SARS CoV 2 has a high affinity for human angiotensin converting enzyme 2 receptor on type II pneumocytes This receptor is also expressed in neurons and glial cells Based on the foregoing and other not so clear mechanisms it is stated that SARS CoV 2 has tropism for the nervous system being evident through the neurological manifestations observed in patients with mild moderate and severe phenotype of the disease such as anosmia ageusia headache cerebrovascular accidents Guillain Barré syndrome seizures and encephalopathy This can generate severe sequelae and even fatal outcomes in those affected Neurological complications caused by COVID 19 are frequent and represent a risk that compromises the functional capacity and the life of patients The suspicion of these conditions the strict control of metabolic alterations and cardiovascular risk factors the effective and safe treatment of these entities are a current challenge throughout the pandemic The rehabilitation process in these patients is a challenge This is due to the limitations generated by multi organ damage as well as risk of brain death 1 |
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629 Health Literacy and Food Literacy for K 12 Schools in the COVID 19 Pandemic Food literacy a sub area of health literacy is achieving attention in schools academia research health care businesses and governments worldwide Against the current COVID 19 pandemic backdrop the relevance of food literacys interconnected attributes such as nutritional knowledge food skills and food environment is gaining traction Enhancing health and food literacy in the K 12 school environment are important empowerment tools with the potential to reduce health inequalities as vulnerable people are at risk of limited health literacy We aim to clarify the meaning of food literacy and its relationship to health literacy and other factors influencing eating behavior We offer a proposed conceptual model depicting connections between relevant theories and constructs in the field of health and nutrition Concrete actions are offered that contemporary schools can take guided by the utility of the model This visual can help guide schools multidimensional health and food literacy efforts while considering the realities of the current COVID 19 pandemic context and beyond This model will provide an overarching reference for schools to consider key constructs to support practice research policy and intervention efforts to advance their health and food literacy agendas 0 |
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61 Expansion of Cytotoxic CD4 T cells in the lungs in severe COVID 19 The contributions of T cells infiltrating the lungs to SARS CoV 2 clearance and disease progression are poorly understood Although studies of CD8 T cells in bronchoalveolar lavage and blood have suggested that these cells are exhausted in severe COVID 19 CD4 T cells have not been systematically interrogated within the lung parenchyma We establish here that cytotoxic CD4 T cells CD4 CTLs are prominently expanded in the COVID 19 lung infiltrate CD4 CTL numbers in the lung increase with disease severity and progression is accompanied by widespread HLA DR expression on lung epithelial and endothelial cells increased apoptosis of epithelial cells and tissue remodeling Based on quantitative evidence for re activation in the lung milieu CD4 CTLs are as likely to drive viral clearance as CD8 T cells and may also be contributors to lung inflammation and eventually to fibrosis in severe COVID 19 In severe COVID 19 cytotoxic CD4 T cells accumulate in draining lymph nodes and in the lungs during the resolving phase of the disease Re activated cytotoxic CD4 T cells and cytotoxic CD8 T cells are present in roughly equivalent numbers in the lungs at this stage and these cells likely collaborate to eliminate virally infected cells and potentially induce fibrosis A large fraction of epithelial and endothelial cells in the lung express HLA class II in COVID 19 and there is temporal convergence between CD4 CTL accumulation and apoptosis in the lung In severe COVID 19 activated CD4 CTLs accumulate in the lungs late in diseaseThese cells likely participate in SARS CoV 2 clearance collaborating with CD8 T cells many of which exhibit an exhausted phenotypeT cells likely contribute to the late exacerbation of inflammationCD4 CTLs have been linked to fibrosis in many disorders and could also be responsible for the eventual induction of fibrosis in a subset of COVID 19 patients The contributions of T cells infiltrating the lungs to SARS CoV 2 clearance and disease progression are poorly understood Although studies of CD8 T cells in bronchoalveolar lavage and blood have suggested that these cells are exhausted in severe COVID 19 CD4 T cells have not been systematically interrogated within the lung parenchyma We establish here that cytotoxic CD4 T cells CD4 CTLs are prominently expanded in the COVID 19 lung infiltrate CD4 CTL numbers in the lung increase with disease severity and progression is accompanied by widespread HLA DR expression on lung epithelial and endothelial cells increased apoptosis of epithelial cells and tissue remodeling Based on quantitative evidence for re activation in the lung milieu CD4 CTLs are as likely to drive viral clearance as CD8 T cells and may also be contributors to lung inflammation and eventually to fibrosis in severe COVID 19 1 |
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424 Management of allergic diseases in pregnancy Allergic diseases like asthma allergic rhinitis food allergy hymenoptera allergy or atopic dermatitis are highly prevalent in women of childbearing age and may affect up to 30 of this age group This review focuses on the management of allergic diseases during pregnancy Furthermore we discuss the challenges of counseling women with allergic diseases in the reproductive age including considerations relevant to the ongoing SARS CoV 2 pandemic To create the optimal milieu for the unborn child a multitude of immunological changes occur during pregnancy which may favor type 2 responses and aggravate disease phenotypes In co occurrence with suboptimal preconception disease control this elevated Th2 responses may aggravate allergic disease manifestations during pregnancy and pose a risk for mother and child Due to limitations in conducting clinical trials in pregnant women safety data on anti allergic drugs during pregnancy are limited The lack of information and concerns among pregnant patients demands counseling on the benefits of anti allergic drugs and the potential and known risks This includes information on the risk for mother and child of disease aggravation in the absence of treatment By doing so informed decisions and shared decision making can take place 0 |
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170 Prevalence of potential respiratory symptoms in survivors of hospital admission after coronavirus disease 2019 COVID 19 A systematic review and meta analysis Knowledge on the sequelae of Coronavirus Disease 2019 COVID 19 remains limited due to the relatively recent onset of this pathology However the literature on other types of coronavirus infections prior to COVID 19 reports that patients may experience persistent symptoms after discharge To determine the prevalence of respiratory symptoms in survivors of hospital admission after COVID 19 infection A living systematic review of five databases was performed in order to identify studies which reported the persistence of respiratory symptoms in COVID 19 patients after discharge Two independent researchers reviewed and analysed the available literature and then extracted and assessed the quality of those articles Of the 1 154 reports returned by the initial search nine articles were found in which 1 816 patients were included in the data synthesis In the pooled analysis we found a prevalence of 0 52 CI 0 38 0 66 i p i 0 01 i I i sup 2 sup 97 0 37 CI 0 28 0 48 i p i 0 01 i I i sup 2 sup 93 0 16 CI 0 10 0 23 i p i 0 01 i I i sup 2 sup 90 and 0 14 CI 0 06 0 24 i p i 0 01 i I i sup 2 sup 96 for fatigue dyspnoea chest pain and cough respectively Fatigue dyspnoea chest pain and cough were the most prevalent respiratory symptoms found in 52 37 16 and 14 of patients between 3 weeks and 3 months after discharge in survivors of hospital admission by COVID 19 respectively 1 |
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354 School closures were over weighted against the mitigation of COVID 19 transmission A literature review on the impact of school closures in the United States The pandemic caused by severe acute respiratory syndrome coronavirus 2 SARS CoV 2 has spread wildly across the world In March of 2020 almost all kindergarten through 12th grade K 12 schools were closed in the United States in an urgent attempt to curb the pandemic in the absence of effective therapeutics or vaccination Thirteen months since then schools remain partially closed Accumulated evidence suggests that children and adolescents are not the primary facilitators of transmission limiting the restrictive effects of school closures on disease transmission The negative effects of school closures on K 12 students need to be systematically reviewed Following the guideline of Preferred Reporting Items for Systematic Reviews and Meta analyzes a comprehensive literature search from PubMed EMBASE Cochrane Library Scopus and Web of Science regarding school closures and its impact on K 12 students was conducted The primary outcomes included the impact of school closures on the mitigation of the pandemic and the resulting public health concerns of K 12 students Prolonged school closures possessed negative effects on K 12 students physical mental and social well being and reduced the number of health and social workers hindering the reopening of the country School closures were over weighted against the mitigation of coronavirus disease 2019 COVID 19 transmission A safe reopening of all K 12 schools in the United States should be of top priority 0 |
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408 Efficacy and Safety of COVID 19 Convalescent Plasma in Hospitalized Patients A Randomized Clinical Trial There is clinical equipoise for COVID 19 convalescent plasma CCP use in patients hospitalized with COVID 19 To determine the safety and efficacy of CCP compared with placebo in hospitalized patients with COVID 19 receiving noninvasive supplemental oxygen CONTAIN COVID 19 a randomized double blind placebo controlled trial of CCP in hospitalized adults with COVID 19 was conducted at 21 US hospitals from April 17 2020 to March 15 2021 The trial enrolled 941 participants who were hospitalized for 3 or less days or presented 7 or less days after symptom onset and required noninvasive oxygen supplementation A unit of approximately 250 mL of CCP or equivalent volume of placebo normal saline The primary outcome was participant scores on the 11 point World Health Organization WHO Ordinal Scale for Clinical Improvement on day 14 after randomization the secondary outcome was WHO scores determined on day 28 Subgroups were analyzed with respect to age baseline WHO score concomitant medications symptom duration CCP SARS CoV 2 titer baseline SARS CoV 2 serostatus and enrollment quarter Outcomes were analyzed using a bayesian proportional cumulative odds model Efficacy of CCP was defined as a cumulative adjusted odds ratio cOR less than 1 and a clinically meaningful effect as cOR less than 0 8 Of 941 participants randomized 473 to placebo and 468 to CCP 556 were men 59 1 median age was 63 years IQR 52 73 373 39 6 were Hispanic and 132 14 0 were non Hispanic Black The cOR for the primary outcome adjusted for site baseline risk WHO score age sex and symptom duration was 0 94 95 credible interval CrI 0 75 1 18 with posterior probability P cOR 1 72 the cOR for the secondary adjusted outcome was 0 92 95 CrI 0 74 1 16 P cOR 1 76 Exploratory subgroup analyses suggested heterogeneity of treatment effect at day 28 cORs were 0 72 95 CrI 0 46 1 13 P cOR 1 93 for participants enrolled in April June 2020 and 0 65 95 CrI 0 41 to 1 02 P cOR 1 97 for those not receiving remdesivir and not receiving corticosteroids at randomization Median CCP SARS CoV 2 neutralizing titer used in April to June 2020 was 1 175 IQR 76 379 Any adverse events excluding transfusion reactions were reported for 39 8 2 placebo recipients and 44 9 4 CCP recipients P 57 Transfusion reactions occurred in 2 0 4 placebo recipients and 8 1 7 CCP recipients P 06 In this trial CCP did not meet the prespecified primary and secondary outcomes for CCP efficacy However high titer CCP may have benefited participants early in the pandemic when remdesivir and corticosteroids were not in use ClinicalTrials gov Identifier NCT04364737 0 |
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654 Mother to child transmission of severe acute respiratory syndrome coronavirus 2 review of classification systems and systematic reviews To review the various classification systems for mother to child transmission MTCT of SARS CoV 2 and collate existing evidence on systematic reviews of MTCT of SARS CoV 2 To date there are three classification systems for MTCT of SARS CoV 2 including the WHO classification developed by expert consensus based on in utero intrapartum and postnatal exposure of the babies to the virus The systems variously classify babies tested for suspected SARS CoV 2 infection as confirmed probable possible indeterminate and unlikely for MTCT To date 68 systematic reviews have been published between December 2019 and March 2021 on SARS CoV 2 MTCT Most of the reviews included cases series and case reports in their pooling of data and often used SARS CoV 2 infection and test positivity interchangeably Several classification systems are available to assist in determining the timing of SARS CoV 2 infection in new borns Existing reviews of MTCT are of poor quality and report variable rates of SARS CoV 2 positivity A high quality systematic review is needed on the extent of confirmed vertical transmission of SARS CoV 2 risk factors for MTCT of SARS CoV 2 the prevalence and persistence of viral particles or immunological response in reported biological samples Primary studies should categorize MTCT using classifications such as WHO classification system that considers the strength of the timing of classification and persistence of positivity taking into account the sterility of the collected samples 0 |
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598 Environmental impact of increased soap consumption during COVID 19 pandemic Biodegradable soap production and sustainable packaging A year into the coronavirus disease 2019 pandemic the role of washing hands with soap and hand disinfectants is unavoidable as a primary way to control the infection spread in communities and healthcare facilities The extraordinary surge in demand for handwashing products has led to environmental concerns Since soaps are complex mixtures of toxic and persistent active ingredients the prudent option is to promote eco friendly replacements for the current products On the other hand with the increase in soap packaging waste production soap packaging waste management and recycling become essential to reduce environmental impact This systematic review aimed to collect some recent methods for identifying biodegradable and sustainable raw materials to produce and package cleaning agents especially soap 0 |
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670 Is fetal MRI ready for neuroimaging prime time An examination of progress and remaining areas for development A major challenge in designing large scale multi site studies is developing a core scalable protocol that retains the innovation of scientific advances while also lending itself to the variability in experience and resources across sites In the development of a common Healthy Brain and Child Development HBCD protocol one of the chief questions is is fetal MRI ready for prime time While there is agreement about the value of prenatal data obtained non invasively through MRI questions about practicality abound There has been rapid progress over the past years in fetal and placental MRI methodology but there is uncertainty about whether the gains afforded outweigh the challenges in supporting fetal MRI protocols at scale Here we will define challenges inherent in building a common protocol across sites with variable expertise and will propose a tentative framework for evaluation of design decisions We will compare and contrast various design considerations for both normative and high risk populations in the setting of the post COVID era We will conclude with articulation of the benefits of overcoming these challenges and would lend to the primary questions articulated in the HBCD initiative 0 |
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621 Easing of Regulatory Barriers to Telemedicine Abortion in Response to COVID 19 For many people seeking abortion during the continuing COVID 19 pandemic telemedicine abortion is the safest and most acceptable method posing lower risk of exposure to the virus In addition by reducing in person visits with health care providers increased use of telemedicine for abortion can reduce pressure on overburdened health systems Given the benefits of telemedicine during the pandemic government agencies in several countries took measures to temporarily allow telemedicine abortion We conducted key word English language searches to identify examples of government action to remove regulatory barriers to the practice of telemedicine abortion in response to the pandemic We found instances of government agencies in eight countries taking steps to ease regulatory barriers to telemedicine abortion Telemedicine abortion is safe cost effective and may be the preferred method of abortion during acute periods of COVID 19 transmission as well as after the pandemic has abated As one step to expanding access to abortion with medicine where abortion is legal health agencies and other regulatory bodies can take steps to remove barriers specific to telemedicine abortion 0 |
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266 COVID 19 and the clinical course of rheumatic manifestations The manifestations of COVID 19 have been evolving over time Various post COVID 19 syndromes are being recognised Various viruses have been implicated in the pathogenesis of autoimmune diseases and we expect a similar outcome with the severe acute respiratory syndrome associated coronavirus 2 SARS CoV 2 The SARS CoV 2 virus penetrates various tissues and organs and has a predisposition to lead to endotheliitis that may cause vascular manifestations including thrombosis SARS CoV 2 has been shown to activate Toll like receptors and the complement system It perpetuates NETosis and leads to autoantibody formation These predispose to systemic autoimmunity Both reactive arthritis and connective tissue disorders such as lupus and inflammatory myositis have been reported after COVID 19 Other reported autoimmune disorders include haemolytic anaemia immune thrombocytopenia cutaneous vasculitis and Guillain Barré like acute demyelinating disorders The multi system inflammatory syndrome in children and its adult counterpart are another post COVID 19 entity that presents as an admixture of Kawasaki disease and staphylococcal toxic shock syndrome Patients with preexisting rheumatic diseases may flare during the SARS CoV 2 infection They may develop novel autoimmune features also The immune suppressants used during the acute COVID 19 illness may confound the outcomes whereas comorbidities present in patients with rheumatic diseases may mask them There is an urgent need to follow up patients recovering from COVID and monitor autoantibody production in the context of rheumatic manifestations Key Points COVID 19 is associated with both innate and acquired immune reactions and production of various autoantibodies Various immune mediated manifestations such as arthritis myositis haemolytic anaemia thrombocytopenia and acute demyelination may develop after COVID 19 Longitudinal cohort data are warranted to describe predict and test prevent various rheumatic manifestations in post COVID 19 subjects 1 |
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415 The SARS CoV 2 Receptor Axis in Heart and Blood Vessels A Crisp Update on COVID 19 Disease with Cardiovascular Complications The SARS CoV 2 virus causing COVID 19 disease has emerged expeditiously in the world and has been declared pandemic since March 2020 by World Health Organization WHO The destructive effects of SARS CoV 2 infection are increased among the patients with pre existing chronic conditions and in particular this review focuses on patients with underlying cardiovascular complications The expression pattern and potential functions of SARS CoV 2 binding receptors and the attributes of SARS CoV 2 virus tropism in a physio pathological state of heart and blood vessel are precisely described Of note the atheroprotective role of ACE2 receptors is reviewed A detailed description of the possible detrimental role of SARS CoV 2 infection in terms of vascular leakage including endothelial glycocalyx dysfunction and bradykinin 1 receptor stimulation is concisely stated Furthermore the potential molecular mechanisms underlying SARS CoV 2 induced clot formation in association with host defense components including activation of FXIIa complements and platelets endothelial dysfunction immune cell responses with cytokine mediated action are well elaborated Moreover a brief clinical update on patient with COVID 19 disease with underlying cardiovascular complications and those who had new onset of cardiovascular complications post COVID 19 disease was also discussed Taken together this review provides an overview of the mechanistic aspects of SARS CoV 2 induced devastating effects in vital organs such as the heart and vessels 0 |
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317 Effect of COVID 19 on Lungs Focusing on Prospective Malignant Phenotypes Currently the healthcare management systems are shattered throughout the world even in the developed nations due to the COVID 19 viral outbreak A substantial number of patients infected with SARS CoV2 develop acute respiratory distress syndrome ARDS and need advanced healthcare facilities including invasive mechanical ventilation Intracellular infiltration of the SARS CoV2 virus particles into the epithelial cells in lungs are facilitated by the spike glycoprotein S Protein on the outer side of the virus envelope a membrane protein ACE2 angiotensin converting enzyme 2 and two proteases TMPRSS2 and Furin in the host cell This virus has unprecedented effects on the immune system and induces a sudden upregulation of the levels of different pro inflammatory cytokines This can be a cause for the onset of pulmonary fibrosis in the lungs Existence of a high concentration of inflammatory cytokines and viral load can also lead to numerous pathophysiological conditions Although it is well established that cancer patients are among the high risk population due to COVID 19 associated mortality it is still unknown whether survivors of COVID 19 infected subjects are at high risk population for developing cancer and whether any biologic and clinical features exist in post COVID 19 individuals that might be related to carcinogenesis 1 |
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413 Child Maltreatment During COVID 19 Key Conclusions and Future Directions Based on a Systematic Literature Review The COVID 19 pandemic has had a far ranging impact As societies struggled to minimize infection questions arose regarding the consequences for children Initial research reported the urgent need for child protective services worldwide to adapt existing policies and practices to protect children from maltreatment during this time which is the rationale for the current systematic literature review This review examined studies published in peer reviewed journals from March 2020 to October 2020 on child maltreatment CM in the context of COVID 19 Twenty five manuscripts met the inclusion criteria and were predominantly from the United States with three international studies The majority of the studies included CM reports during COVID 19 based on official data The results clearly demonstrated an increased risk for children alongside a worrisome international decrease in CM reports Only two studies addressed interventions during the pandemic The current review highlights that along with the obligation of scholars to advance the protection of children during COVID 19 there is much that is unknown Future studies should examine the impact of the pandemic on children and their surrounding systems as well as child protective services responses which face enormous challenges during a pandemic An additional conclusion is that since children were not identified as a health risk group during the pandemic their protection rights may have been jeopardized Furthermore the variance identified in the policies of different countries pinpoints the urgent need to establish an international protocol for protecting children from maltreatment during COVID 19 a protocol that will hopefully be a basis for policymakers worldwide 0 |
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635 Incidence characteristics and clinical profile of severe acute respiratory syndrome coronavirus 2 SARS CoV 2 infection in patients with pre existing primary immune thrombocytopenia ITP in Spain Infections are one of the well known precipitating factors for relapses in patients with immune thrombocytopenia ITP Severe acute respiratory syndrome coronavirus 2 SARS CoV 2 infection can sometimes lead to or be associated with thrombocytopenia due to an increase in peripheral platelet destruction from inflammatory hyperactivation Currently we do not know if SARS CoV 2 infection modifies the natural evolution of chronic or persistent ITP or if previous immunosuppression of patients with ITP influences the incidence and severity of coronavirus disease 2019 COVID 19 in this group The present study was an observational multicentre national series of 32 adult patients with pre existing ITP and subsequent SARS CoV 2 infection collected by the Spanish ITP Group Grupo Español de Trombocitopenia Inmune GEPTI 0 |
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273 Respiratory function in patients post infection by COVID 19 a systematic review and meta analysis Evidence suggests lungs as the organ most affected by coronavirus disease 2019 COVID 19 The literature on previous coronavirus infections reports that patients may experience persistent impairment in respiratory function after being discharged Our objective was to determine the prevalence of restrictive pattern obstructive pattern and altered diffusion in patients post COVID 19 infection and to describe the different evaluations of respiratory function used with these patients A systematic review was conducted in five databases Studies that used lung function testing to assess post infection COVID 19 patients were included for review Two independent reviewers analysed the studies extracted the data and assessed the quality of evidence Of the 1973 reports returned by the initial search seven articles reporting on 380 patients were included in the data synthesis In the sensitivity analysis we found a prevalence of 0 39 CI 0 24 0 56 p 0 01 I sup 2 sup 86 0 15 CI 0 09 0 22 p 0 03 I sup 2 sup 59 and 0 07 CI 0 04 0 11 p 0 31 I sup 2 sup 16 for altered diffusion capacity of the lungs for carbon monoxide DL sub CO sub restrictive pattern and obstructive pattern respectively Post infection COVID 19 patients showed impaired lung function the most important of the pulmonary function tests affected was the diffusion capacity 1 |
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359 Systematic review of empirical studies comparing the effectiveness of non pharmaceutical interventions against COVID 19 To evaluate which non pharmaceutical interventions NPIs have been more and less effective in controlling the COVID 19 pandemic We performed a systematic review of published and unpublished empirical studies either observational or interventional analysing the comparative effectiveness of NPIs against the COVID 19 pandemic We searched Embase Medline and medRxiv to identify the relevant literature We identified 34 studies During the first wave of the COVID 19 pandemic school closing was the most effective NPI followed by workplace closing business and venue closing and public event bans Public information campaigns and mask wearing requirements were also effective in controlling the pandemic while being less disruptive for the population than other NPIs There was no evidence on the effectiveness of public transport closure testing and contact tracing strategies and quarantining or isolation of individuals Early implementation was associated with a higher effectiveness in reducing COVID 19 cases and deaths while general stringency of the NPIs was not In this systematic review we found that school closing followed by workplace closing business and venue closing and public event bans were the most effective NPIs in controlling the spread of COVID 19 An early response and a combination of specific social distancing measures are effective at reducing COVID 19 cases and deaths Continuous monitoring of NPIs effectiveness is needed in order to adapt decision making 0 |
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506 Bupropion for postpartum smoking relapse A remote protocol for a two arm double blind placebo controlled randomized clinical trial Cigarette smoking among postpartum women remains a significant public health problem despite known health risks to women and their newborns It is estimated that over 50 of women quit smoking during pregnancy but 90 relapse by one year Safe and effective postpartum relapse prevention strategies are urgently needed In an attempt to address this deficit we will investigate the efficacy of bupropion vs placebo as a smoking relapse prevention aid in postpartum women The objective of this paper is to detail an approach to investigate bupropions efficacy for preventing postpartum smoking relapse among women who quit smoking during pregnancy Specifically we designed a two arm double blind placebo controlled randomized trial testing the efficacy of bupropion vs placebo as a relapse prevention tool Mothers of healthy infants who quit smoking while pregnant will be stratified based on current or past history of major depressive disorder or persistent depressive disorder and randomized to receive either active bupropion XL 300 mg day or placebo medication for 12 weeks To respond to safety concerns associated with participant and staff exposure to COVID 19 we revised our original protocol and present procedures which allow our trial to be conducted entirely remotely Primary and secondary outcomes will be assessed at weeks 12 24 36 and 52 post randomization The primary outcome is 7 day point prevalence abstinence at 24 weeks Results of this work have the potential to positively impact women and their children by promoting lifelong cessation eliminating secondhand smoke exposure and modelling of abstinence to children 0 |
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557 Peptides and peptidomimetics as therapeutic agents for Covid 19 The severe acute respiratory syndrome coronavirus 2 SARS CoV 2 Covid 19 pandemic has caused high morbidity and mortality rates worldwide Virus entry into cells can be blocked using several strategies including inhibition of protein protein interactions PPIs between the viral spike glycoprotein and cellular receptors as well as blocking of spike protein conformational changes that are required for cleavage activation and fusogenicity The spike mediated viral attachment and entry into cells via fusion of the viral envelope with cellular membranes involve PPIs mediated by short peptide fragments exhibiting particular secondary structures Thus peptides that can inhibit these PPIs may be used as potential antiviral agents preventing virus entry and spread This review is focused on peptides and peptidomimetics as PPI modulators and protease inhibitors against SARS CoV 2 0 |
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89 Insights from myalgic encephalomyelitis chronic fatigue syndrome may help unravel the pathogenesis of postacute COVID 19 syndrome Severe acute respiratory syndrome coronavirus 2 SARS CoV 2 can cause chronic and acute disease Postacute sequelae of SARS CoV 2 infection PASC include injury to the lungs heart kidneys and brain that may produce a variety of symptoms PASC also includes a post coronavirus disease 2019 COVID 19 syndrome long COVID with features that can follow other acute infectious diseases and myalgic encephalomyelitis chronic fatigue syndrome ME CFS Here we summarize what is known about the pathogenesis of ME CFS and of acute COVID 19 and we speculate that the pathogenesis of post COVID 19 syndrome in some people may be similar to that of ME CFS We propose molecular mechanisms that might explain the fatigue and related symptoms in both illnesses and we suggest a research agenda for both ME CFS and post COVID 19 syndrome 1 |
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514 Angiotensin Converting Enzyme 2 in the Pathogenesis of Renal Abnormalities Observed in COVID 19 Patients Coronavirus disease 2019 COVID 19 was first reported in late December 2019 in Wuhan China The etiological agent of this disease is severe acute respiratory syndrome coronavirus 2 SARS CoV 2 and the high transmissibility of the virus led to its rapid global spread and a major pandemic ongoing at the time of writing this review The clinical manifestations of COVID 19 can vary widely from non evident or minor symptoms to severe acute respiratory syndrome and multi organ damage causing death Acute kidney injury AKI has been recognized as a common complication of COVID 19 and in many cases kidney replacement therapy KRT is required The presence of kidney abnormalities on hospital admission and the development of AKI are related to a more severe presentation of COVID 19 with higher mortality rate The high transmissibility and the broad spectrum of clinical manifestations of COVID 19 are in part due to the high affinity of SARS CoV 2 for its receptor angiotensin Ang converting enzyme 2 ACE2 which is widely expressed in human organs and is especially abundant in the kidneys A debate on the role of ACE2 in the infectivity and pathogenesis of COVID 19 has emerged Does the high expression of ACE2 promotes higher infectivity and more severe clinical manifestations or does the interaction of SARS CoV 2 with ACE2 reduce the bioavailability of the enzyme depleting its biological activity which is closely related to two important physiological systems the renin angiotensin system RAS and the kallikrein kinin system KKS thereby further contributing to pathogenesis In this review we discuss the dual role of ACE2 in the infectivity and pathogenesis of COVID 19 highlighting the effects of COVID 19 induced ACE2 depletion in the renal physiology and how it may lead to kidney injury The ACE2 downstream regulation of KKS that usually receives less attention is discussed Also a detailed discussion on how the triad of symptoms respiratory inflammatory and coagulation symptoms of COVID 19 can indirectly promote renal injury is primary aborded 0 |
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210 Post COVID 19 fatigue and anhedonia A cross sectional study and their correlation to post recovery period Individuals infected by the novel coronavirus SARS CoV 2 have experienced different psychiatric manifestations during the period of infectivity and post COVID 19 infection Fatigue and anhedonia are among the frequently reported manifestations after recovery from this novel viral pandemic leading to early evaluation of those patients and proper management of their complaints which have a drastic burden on different domains of life Also the period after recovery might have an effect on the severity of these two psychiatric presentations This cross sectional observational study aimed to investigate the occurrence of post COVID 19 fatigue and anhedonia and whether the duration after 2 consecutive PCR negative tests has an implication on the severity of the above mentioned psychiatric manifestations Socio demographic characteristics of 200 post COVID 19 patients were collected and also the self assessment anhedonia scale was used to evaluate the degree of anhedonia Fatigue assessment scale used to investigate this domain The study targeted to find a possible correlation between the period after recovery and the other variables including anhedonia and fatigue The study revealed high scores of different subtypes of self assessment anhedonia scale including total intensity total frequency and total changes scores in the studied group also high score of fatigue assessment scale in those patients Positive statistically significant correlation between anhedonia and fatigue in post COVID 19 group also negative statistically significant correlation between duration after recovery and the other 2 variables anhedonia and fatigue in the examined patients Post COVID 19 fatigue and anhedonia were prevalent and commonly reported in the post COVID 19 period also the duration after 2 consecutive negative PCR tests has an implication on the severity rating scale of both anhedonia and fatigue These findings directed our attention to those reported manifestations which affected the socio occupational functioning of the individuals during this whole world pandemic 1 |
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195 Multisystem Inflammatory Syndrome in Children MIS C in an Adolescent that Developed Coronary Aneurysms A Case Report and Review of the Literature A small subset of pediatric patients develop a rare syndrome associated with Coronavirus Disease 2019 COVID 19 infection called multisystem inflammatory syndrome in children MIS C This syndrome shares characteristics with Kawasaki disease A 15 year old girl presented to our Emergency Department ED with fevers and malaise She was diagnosed on her initial visit with an acute viral syndrome and discharged with a COVID polymerase chain reaction test pending which was subsequently negative She returned 3 days later with persistent fever conjunctivitis and a symmetric targetoid rash over her palms She had no adenopathy but her erythrocyte sedimentation rate and C reactive protein were both significantly elevated at 90 mm h and 19 61 mg dL respectively The patient was then transferred to the regional childrens hospital due to a clinical suspicion for MIS C and subsequent COVID 19 immunoglobulin G testing was positive She had been empirically started on intravenous immunoglobulin in addition to 81 mg aspirin daily Initial echocardiograms showed mild dilatation of the left main coronary artery and on repeat echocardiogram a right coronary artery aneurysm was also identified Oral prednisone therapy 5 mg was initiated and the patient was discharged on a continued prednisone taper WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS We present a case of a 15 year old girl who presented to the ED with MIS C who developed coronary aneurysms despite early therapy to increase awareness among emergency physicians of this emerging condition 1 |
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344 Enhanced External Counterpulsation as a Novel Treatment for Post acute COVID 19 Sequelae Severe acute respiratory syndrome coronavirus 2 SARS CoV 2 is the virus responsible for the coronavirus disease 2019 COVID 19 pandemic As patients recover from COVID 19 some continue to report persisting symptoms weeks to months after acute infection These effects have been referred to as post acute sequelae of SARS CoV 2 infection PASC We report the case of a 38 year old woman suffering from PASC symptoms following acute COVID 19 in October 2020 During her acute infection phase she had a home recovery and reported her predominant symptoms as fatigue headaches body pain and shortness of breath After most of her symptoms were resolved she continued to have periodic episodes of fatigue and headaches along with random shortness of breath while at rest and during activities for months beyond the acute phase of the illness She also noted the presence of brain fog as if lacking the same clarity that she had prior to her illness These symptoms persisted for three months before the patient underwent enhanced external counterpulsation EECP therapy in one hour sessions three times per week This therapy was chosen based on the mechanism of action of EECP benefiting patients with ischemic cardiovascular diseases After one week her brain fog had improved with shortness of breath improving after 1 5 weeks The patient reported returning to pre COVID health and fitness after approximately five weeks of EECP treatment To our knowledge this is the first case of using EECP for post COVID shortness of breath fatigue and brain fog 1 |
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388 Review of COVID 19 part 2 Musculoskeletal and neuroimaging manifestations including vascular involvement of the aorta and extremities The coronavirus disease 2019 COVID 19 pandemic caused by the novel severe acute respiratory syndrome coronavirus SARS CoV 2 has affected almost every country in the world resulting in severe morbidity mortality and economic hardship altering the landscape of healthcare forever Its devastating and most frequent thoracic and cardiac manifestations have been well reported since the start of the pandemic Its extra thoracic manifestations are myriad and understanding them is critical in diagnosis and disease management The role of radiology is growing in the second wave and second year of the pandemic as the multiorgan manifestations of COVID 19 continue to unfold Musculoskeletal neurologic and vascular disease processes account for a significant number of COVID 19 complications and understanding their frequency clinical sequelae and imaging manifestations is vital in guiding management and improving overall survival The authors aim to provide a comprehensive overview of the pathophysiology of the virus along with a detailed and systematic imaging review of the extra thoracic manifestation of COVID 19 In Part I abdominal manifestations of COVID 19 in adults and multisystem inflammatory syndrome in children will be reviewed In Part II manifestations of COVID 19 in the musculoskeletal central nervous and vascular systems will be reviewed 0 |
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518 Things must not fall apart the ripple effects of the COVID 19 pandemic on children in sub Saharan Africa Zero to 19 year old children in sub Saharan Africa bear a disproportionate proportion of the global burden of communicable and non communicable diseases Significant public health gains have been made in the fight against these diseases however factors such as underequipped health systems disease outbreaks conflict and political instability continue to challenge prevention and control The novel coronavirus disease COVID 19 pandemic caused by severe acute respiratory syndrome coronavirus 2 SARS CoV 2 introduces new challenges to public health programs in sub Saharan Africa Of particular concern are programs targeting major conditions among children such as undernutrition vaccine preventable pneumonia and diarrhea malaria tuberculosis HIV and sickle cell disease This article focuses on the impact of the COVID 19 pandemic on child health in sub Saharan Africa We review the epidemiology of major pediatric diseases and referencing modeling projections discuss the short and long term impact of the pandemic on major disease control We deliberate on potential complications of SARS CoV 2 co infections co morbidities and identify critical social and ethical issues Furthermore we highlight the paucity of COVID 19 data and clinical trials in this region and the lack of child participants in ongoing studies Lastly approaches and interventions to mitigate the pandemics impact on child health outcomes are discussed IMPACT Children in sub Saharan Africa bear a disproportionate burden of communicable and non communicable diseases globally this remains true even as the COVID 19 pandemic persists Amidst the fast expanding COVID 19 literature there is little comprehensive coverage of the pandemics indirect impact on child health in sub Saharan Africa This article comprehensively outlines the threat that the pandemic poses to major disease prevention and control for children in sub Saharan Africa It discusses the potential impact of SARS CoV 2 co infections co morbidities highlights research gaps and advocates for data and action to mitigate the ripple effects of the pandemic on this population 0 |
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407 Increasing Pediatric Audiology Services via Telehealth Telehealth as a means to deliver health care services has been used by physicians for many years but the use of telehealth in audiology specifically in pediatrics has been minimal Barriers such as licensure reimbursement technology and equipment have been cited as reasons for audiologists not participating in telehealth However the COVID 19 pandemic created the need for telehealth services to be widely used to safely increase access to healthcare and emergent orders helped reduce previous barriers so that audiologists could participate in telehealth service delivery This article details three cases where audiologists delivered telehealth services to children These case studies demonstrate portions of the Division of Audiology Telehealth Program of the Cincinnati Childrens Hospital Medical Center and how they increased access to hearing healthcare in response to the COVID 19 pandemic 0 |
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600 Performance Verification of Five Commercial RT qPCR Diagnostic Kits for SARS CoV 2 Severe acute respiratory syndrome coronavirus 2 SARS CoV 2 which has caused a global pandemic beginning in 2020 can be detected by reverse transcription polymerase chain reaction RT PCR However owing to the urgent need for a large number of detection kits the time spent researching and developing these kits has been shortened during the pandemic and the kits that are being used commercially have not undergone full and independent evaluation To ensure the accuracy of SARS CoV 2 test results performance verification of commercial Real Time quantitative PCR RT qPCR kits is required The performance of five commercial RT qPCR diagnostic kits for SARS CoV 2 used in China was evaluated using a coronavirus disease 2019 COVID 19 RNA liquid performance verification reference product manufactured by Guangzhou Bondson BDS Biotechnology Co Ltd Guangzhou China that uses droplet digital RT PCR technology combined with fluorescence quantitative PCR The five kits of Novel Coronavirus 2019 nCoV nucleic acid detection kit RT qPCR method evaluated were Da An Da An Gene Co Ltd of Sun Yat sen University Liferiver Shanghai ZJ Bio Tech Co Ltd Kinghawk Beijing Kinghawk Pharmaceutical Co Ltd eDiagnosis Wuhan Easy Diagnosis Biomedicine Co Ltd and Maccura Maccura Biotechnology Co Ltd Performance verification criteria included the coincidence rate limit of detection LoD cross reactivity precision and anti interference Finally through the BDS performance verification reference product kit clinical samples are used to verify its clinical diagnostic efficacy The coincidence rate was 100 for all kits except for Kinghawk which was 95 The LoD for Da An eDiagnosis and Maccura was 250copies mL and it was 1000 copies ml for Liferiver Kinghawk was not able to detect its advertised LoD of 500 copies ml The cross reactivity test results were all negative Moreover all kits had a coefficient of variation less than 5 however Liferiver showed the best precision Da An Liferiver and eDiagnosis showed higher sensitivity to the nucleocapsid N gene than they did to the open reading frame ORF 1ab genes Anti interference results for all five kits were positive The results of clinical diagnostic efficacy were that the specificity of the four kits was 1 000 0 877 1 000 the sensitivity of Da An was 1 000 0 850 1 000 Liferiver was 0 964 0 798 0 998 Maccura was 0 893 0 706 0 972 and eDiagnosis was 0 857 0 664 0 953 Except for Kinghawk all commercial RT qPCR diagnostic kits for SARS CoV 2 passed the BDS performance verification Da An and Liferiver have excellent clinical diagnostic specificity and sensitivity This study can provide guidance for the selection or optimization of RT qPCR diagnostic test kits for SARS CoV 2 0 |
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208 Characterizing Long COVID Deep Phenotype of a Complex Condition Numerous publications describe the clinical manifestations of post acute sequelae of SARS CoV 2 PASC or long COVID but they are difficult to integrate because of heterogeneous methods and the lack of a standard for denoting the many phenotypic manifestations Patient led studies are of particular importance for understanding the natural history of COVID 19 but integration is hampered because they often use different terms to describe the same symptom or condition This significant disparity in patient versus clinical characterization motivated the proposed ontological approach to specifying manifestations which will improve capture and integration of future long COVID studies The Human Phenotype Ontology HPO is a widely used standard for exchange and analysis of phenotypic abnormalities in human disease but has not yet been applied to the analysis of COVID 19 We identified 303 articles published before April 29 2021 curated 59 relevant manuscripts that described clinical manifestations in 81 cohorts three weeks or more following acute COVID 19 and mapped 287 unique clinical findings to HPO terms We present layperson synonyms and definitions that can be used to link patient self report questionnaires to standard medical terminology Long COVID clinical manifestations are not assessed consistently across studies and most manifestations have been reported with a wide range of synonyms by different authors Across at least 10 cohorts authors reported 31 unique clinical features corresponding to HPO terms the most commonly reported feature was Fatigue median 45 1 and the least commonly reported was Nausea median 3 9 but the reported percentages varied widely between studies Translating long COVID manifestations into computable HPO terms will improve analysis data capture and classification of long COVID patients If researchers clinicians and patients share a common language then studies can be compared pooled more effectively Furthermore mapping lay terminology to HPO will help patients assist clinicians and researchers in creating phenotypic characterizations that are computationally accessible thereby improving the stratification diagnosis and treatment of long COVID U24TR002306 UL1TR001439 P30AG024832 GBMF4552 R01HG010067 UL1TR002535 K23HL128909 UL1TR002389 K99GM145411 1 |
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184 Immune determinants of COVID 19 disease presentation and severity COVID 19 caused by SARS CoV 2 infection is mild to moderate in the majority of previously healthy individuals but can cause life threatening disease or persistent debilitating symptoms in some cases The most important determinant of disease severity is age with individuals over 65 years having the greatest risk of requiring intensive care and men are more susceptible than women In contrast to other respiratory viral infections young children seem to be less severely affected It is now clear that mild to severe acute infection is not the only outcome of COVID 19 and long lasting symptoms are also possible In contrast to severe acute COVID 19 such long COVID is seemingly more likely in women than in men Also postinfectious hyperinflammatory disease has been described as an additional outcome after SARS CoV 2 infection Here I discuss our current understanding of the immunological determinants of COVID 19 disease presentation and severity and relate this to known immune system differences between young and old people and between men and women and other factors associated with different disease presentations and severity 1 |
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248 Lifestyle Adjustments in Long COVID Management Potential Benefits of Plant Based Diets The SARS CoV 2 pandemic has caused mortality and morbidity at an unprecedented global scale Many patients infected with SARS CoV 2 continue to experience symptoms after the acute phase of infection and report fatigue sleep difficulties anxiety and depression as well as arthralgia and muscle weakness Summarized under the umbrella term long COVID these symptoms may last weeks to months and impose a substantial burden on affected individuals Dietary approaches to tackle these complications have received comparably little attention Although plant based diets in particular were shown to exert benefits on underlying conditions linked to poor COVID 19 outcomes their role with regard to COVID 19 sequelae is yet largely unknown Thus this review sought to investigate whether a plant based diet could reduce the burden of long COVID The number of clinical trials investigating the role of plant based nutrition in COVID 19 prevention and management is currently limited Yet there is evidence from pre pandemic observational and clinical studies that a plant based diet may be of general benefit with regard to several clinical conditions that can also be found in individuals with COVID 19 These include anxiety depression sleep disorders and musculoskeletal pain Adoption of a plant based diet leads to a reduced intake in pro inflammatory mediators and could be one accessible strategy to tackle long COVID associated prolonged systemic inflammation Plant based diets may be of general benefit with regard to some of the most commonly found COVID 19 sequelae Additional trials investigating which plant based eating patterns confer the greatest benefit in the battle against long COVID are urgently warranted 1 |
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62 Preparing for the long haul Autonomic complications of COVID 19 As global numbers of COVID 19 grow chronic neurological symptoms including those of autonomic dysfunction are being reported with increasing frequency Mounting evidence suggests that many patients experience chronic and sometimes debilitating symptoms long after their acute infectious period leading to the new diagnostic category of post acute COVID syndrome Many symptoms of post acute COVID syndrome appear autonomic in nature suggesting that autonomic impairment may play a central role in the underlying pathophysiology In this review we discuss the autonomic symptoms and manifestations of post acute COVID syndrome potential mechanisms involved and future directions for a better understanding of this novel condition 1 |
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597 The development and use of an anatomy based retraining program MusAARP to assess and treat focal hand dystonia in musicians A pilot study Movement dysfunctions are commonly reported in musicians and in extreme cases may result in a persisting loss of motor control This condition whereby motor control of the hand during previously highly trained movements on the instrument is lost is termed focal hand dystonia It is widely considered to be a consequence of prolonged repetitive daily practice often in combination with exposure to a range of other risk factors Current literature recommends retraining as a promising treatment intervention although only scant scientific evidence exists on which components should be included in a retraining program and how these may be best administered A progressive muscle activation and movement exercise program was devised by one of the authors applying a series of anatomy based off instrument movement tasks This series of fine motor control exercises was used to both assess and retrain focal hand dystonia in a population of musicians The standardized approach aimed to provide a systematic method of retraining musically relevant muscular synergies that could later be applied to the instrument while still allowing individual modifications Retraining sessions were mostly run online as a consequence of the coronavirus pandemic although some early sessions were also able to be undertaken face to face Both qualitative and quantitative measures were used in this case series to evaluate program efficacy due to the typical heterogeneity of the focal hand dystonia participants This included blinded external neurological evaluation of video footage using the Tubiana grading system written subjective feedback exercise progressions and performance outcomes Pilot testing of 4 patients indicated the utility of the program over approximately a 12 month time period All subjects improved 2 of whom have returned to pre dystonia performance levels These patients reported the importance of patience and persistence with daily exercise sessions in their recovery Using off instrument playing relevant exercises to enhance fine motor control and muscle activation can be effective in retraining focal hand dystonia regardless of additional treatments or level of performance They should be regularly practiced and progressed in order for effects to be best progressed to instrumental applications Further research may elucidate whether there are optimal outcomes with single or particular combinations of treatment approaches 0 |
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603 Relationship of chest computed tomography score with disease severity and laboratory values in children with COVID 19 Although chest computed tomography CT score has been well evaluated in adult coronavirus disease COVID 19 its use in paediatric cases is insufficiently studied Our aim is to evaluate the relationship of chest CT score with disease severity and laboratory parameters Seventy six paediatric patients with confirmed COVID 19 and chest CT evaluation on admission have been included in this study Chest CT score was calculated for each of the five lobes considering the extent of anatomical involvement as follows 0 0 1 5 2 5 25 3 26 50 4 51 75 and 5 75 The resulting total CT score was the sum of each individual lobar score the range was between 0 and 25 Total chest CT score was found to be positively correlated with alanine aminotransferase and d dimer and negatively correlated with lymphocyte count In receiver operating characteristic analysis total chest CT score had area under the curve 0 99 95 confidence interval 0 98 1 00 at cut off 2 with 95 sensitivity and 96 specificity for the severe disease Furthermore in depth analysis of lobar CT scores showed a correlation between left upper lobe with lymphocyte count left lower lobe with d dimer right middle and lower lobes with alanine aminotransferase and right upper lobe with leukocyte count There is a significant relationship between chest CT score and COVID 19 severity and laboratory findings in children This suggests that chest CT scores can be used to assess the severity of the disease and can play an important role in paediatric clinical practice 0 |
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32 Post COVID syndrome A single center questionnaire study on 1007 participants recovered from COVID 19 Post recovery manifestations have become another concern in patients who have recovered from coronavirus disease 2019 COVID 19 Numerous reports have shown that COVID 19 has a variety of long term effects on almost all systems including respiratory cardiovascular gastrointestinal neurological psychiatric and dermatological systems We aimed to investigate the prevalence and characteristics of the post COVID syndrome among COVID 19 survivors and to determine the factors associated with persistent symptoms This prospective study enrolled in patients with COVID 19 followed in hospital or outpatient clinics in Ankara City Hospital We performed a special questionnaire to inquire about the presence of persistent symptoms beyond 12 weeks from the first diagnosis Demographic data comorbid diseases characteristics of acute COVID 19 presence of persistent symptoms by systems and knowledge about outpatient clinic visits after recovery were assessed Of a total of 1007 participants 39 0 had at least one comorbidity and 47 5 had persistent symptoms Fatigue easy fatigability myalgia and loss of weight were the most frequent persistent symptoms overall 29 3 followed by respiratory symptoms 25 4 A total of 235 participants had visited outpatient clinics due to several reasons during the post COVID 19 period and 17 of them were hospitalized Severe acute COVID 19 hospitalization and presence of comorbidity were independent factors for the development of persistent symptoms Fully understanding the spectrum of the post COVID syndrome is essential for appropriate management of all its long term effects Our study once again underlined the fact that the prevalence of post COVID syndrome is higher than expected and concerns many systems and a multidisciplinary follow up should be provided to COVID 19 survivors in the post recovery period 1 |
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666 Age dependence of the natural history of infection with severe acute respiratory syndrome coronavirus 2 SARS CoV 2 An analysis of Diamond Princess data Following an outbreak of coronavirus disease 2019 COVID 19 on the cruise ship Diamond Princess passengers and crew were followed up to determine prognosis We examined the epidemiological determinants of COVID 19 natural history using these follow up data We analysed infection status diagnosis clinical symptoms and prognosis for all passengers and crew members on the Diamond Princess We estimated the risk of infection associated with exposure within cabin rooms as well as the risks of various clinical manifestations of disease along with their epidemiological determinants The adjusted odds ratio aOR of infection for individuals tested by PCR on or after 12 February 2020 compared with before this date was 0 53 95 confidence interval CI 0 39 0 72 reflecting decreased transmission during onboard quarantine Among infected individuals older age was associated with elevated odds of symptomatic illness aOR 1 01 95 CI 1 00 1 02 severe disease aOR 1 08 95 CI 1 05 1 12 and death aOR 1 12 95 CI 1 05 1 21 Severe COVID 19 disease death and symptomatic illness were more frequent among older individuals on Diamond Princess Older elderly cases age 80 years had the highest risks of severe disease and death Inter room transmission was successfully prevented by the onboard quarantine 0 |
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160 Cerebrospinal Fluid Analysis Post COVID 19 Is Not Suggestive of Persistent Central Nervous System Infection This study was undertaken to assess whether SARS CoV 2 causes a persistent central nervous system infection SARS CoV 2 specific antibody index and SARS CoV 2 RNA were studied in cerebrospinal fluid following COVID 19 Cerebrospinal fluid was assessed between days 1 and 30 n 12 between days 31 and 90 n 8 or later than 90 days post COVID 19 n 20 after COVID 19 diagnosis SARS CoV 2 RNA was absent in all patients and in none of the 20 patients with post COVID 19 syndrome were intrathecally produced anti SARS CoV 2 antibodies detected The absence of evidence of SARS CoV 2 in cerebrospinal fluid argues against a persistent central nervous system infection as a cause of neurological or neuropsychiatric post COVID 19 syndrome ANN NEUROL 2021 1 |
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465 Management of epistaxis a guide for junior doctors Epistaxis is commonly seen as an acute presentation to the emergency department The level of severity can range from a minor ooze to a life threatening bleed The initial management is often the responsibility of junior doctors working in otolaryngology or the emergency department so they must be familiar with the initial steps in treating this often distressing condition The COVID 19 pandemic has complicated matters further as much of the management takes place in the upper airway This article outlines the key considerations in the management of epistaxis especially during the COVID 19 pandemic 0 |
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618 Prolonged viral shedding in feces of pediatric patients with coronavirus disease 2019 To determine the dynamic changes of severe acute respiratory syndrome coronavirus 2 SARS CoV 2 RNA in respiratory and fecal specimens in children with coronavirus disease 2019 COVID 19 From January 17 2020 to February 23 2020 three paediatric cases of COVID 19 were reported in Qingdao Shandong Province China Epidemiological clinical laboratory and radiological characteristics and treatment data were collected Patients were followed up to March 10 2020 and dynamic profiles of nucleic acid testing results in throat swabs and fecal specimens were closely monitored Clearance of SARS CoV 2 in respiratory tract occurred within two weeks after abatement of fever whereas viral RNA remained detectable in stools of pediatric patients for longer than 4 weeks Two children had fecal SARS CoV 2 undetectable 20 days after throat swabs showing negative while that of another child lagged behind for 8 days SARS CoV 2 may exist in childrens gastrointestinal tract for a longer time than respiratory system Persistent shedding of SARS CoV 2 in stools of infected children raises the possibility that the virus might be transmitted through contaminated fomites Massive efforts should be made at all levels to prevent spreading of the infection among children after reopening of kindergartens and schools 0 |
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182 COVID 19 in persons aged 70 in an early affected German district Risk factors mortality and post COVID care needs A retrospective observational study of hospitalized and non hospitalized patients Cohorts of hospitalized COVID 19 patients have been studied in several countries since the beginning of the pandemic So far there is no complete survey of older patients in a German district that includes both outpatients and inpatients In this retrospective observational cohort study we aimed to investigate risk factors mortality and functional outcomes of all patients with COVID 19 aged 70 and older living in the district of Tübingen in the southwest of Germany We retrospectively analysed all 256 patients who tested positive for SARS CoV 2 in one of the earliest affected German districts during the first wave of the disease from February to April 2020 To ensure inclusion of all infected patients we analysed reported data from the public health department as well as the results of a comprehensive screening intervention in all nursing homes of the district n 1169 Furthermore we examined clinical data of all hospitalized patients with COVID 19 n 109 The all cause mortality was 18 Screening in nursing homes showed a point prevalence of 4 6 39 of residents showed no COVID specific symptoms according to the official definition at that time The most important predictors of mortality were the need for inpatient treatment odds ratio OR 3 95 95 confidence interval CI 2 00 7 86 p 0 001 and care needs before infection non hospitalized patients OR 3 79 95 CI 1 01 14 27 p 0 037 hospitalized patients OR 2 89 95 CI 1 21 6 92 p 0 015 Newly emerged care needs were a relevant complication of COVID 19 27 of previously self sufficient patients who survived the disease were not able to return to their home environment after discharge from the hospital Our findings demonstrate the importance of a differentiated view of risk groups and long term effects within the older population These findings should be included in the political and social debate during the ongoing pandemic to evaluate the true effect of COVID 19 on healthcare systems and individual functional status 1 |
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492 From Beginning to End A Single Radiology Residency Programs Experience with Web Based Resident Recruitment during COVID 19 and a Review of the Literature COVID 19 disrupted the practice of in person visits for the 2020 2021 recruitment cycle This past year Graduate Medical Education GME programs converted to online interviews and virtual visits for all applicants Given the unpredictable nature of this pandemic it remains unclear when or if conventional travel for residency interviews will resume Therefore it is important to reflect on this past season and look ahead to our next recruitment and interview cycle Here we review prior publications studying faculty and applicant experiences with web based interviewing strategies and we describe our own residency programs recruitment strategy for a virtual interview season including survey results of reactions by both interviewers and candidates following our first season in this new era of virtual meetings and interviews Web based recruitment and interviews are feasible and can be done well with careful planning and preparation of those involved Concerns persist primarily among applicants that virtual visits to a training program are inadequate for providing sufficient information prior to ranking Regardless of future travel restrictions GME programs will likely benefit all stakeholders by offering web based recruitment and interviews while also providing opportunities for optional in person visits 0 |
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216 Mild and Asymptomatic COVID 19 Convalescents Present Long Term Endotype of Immunosuppression Associated With Neutrophil Subsets Possessing Regulatory Functions The SARS CoV 2 infection coronavirus disease 2019 COVID 19 is associated with severe lymphopenia and impaired immune response including expansion of myeloid cells with regulatory functions e g so called low density neutrophils containing granulocytic myeloid derived suppressor cells LDNs PMN MDSCs These cells have been described in both infections and cancer and are known for their immunosuppressive activity In the case of COVID 19 long term complications have been frequently observed long COVID In this context we aimed to investigate the immune response of COVID 19 convalescents after a mild or asymptomatic course of disease We enrolled 13 convalescents who underwent a mild or asymptomatic infection with SARS CoV 2 confirmed by a positive result of the PCR test and 13 healthy donors without SARS CoV 2 infection in the past Whole blood was used for T cell subpopulation and LDNs PMN MDSCs analysis LDNs PMN MDSCs and normal density neutrophils NDNs were sorted out by FACS and used for T cell proliferation assay with autologous T cells activated with anti CD3 mAb Serum samples were used for the detection of anti SARS CoV 2 neutralizing IgG and GM CSF concentration Our results showed that in convalescents even 3 months after infection an elevated level of LDNs PMN MDSCs is still maintained in the blood which correlates negatively with the level of CD8 sup sup and double negative T cells Moreover LDNs PMN MDSCs and NDNs showed a tendency for affecting the production of anti SARS CoV 2 S1 neutralizing antibodies Surprisingly our data showed that in addition to LDNs PMN MDSCs NDNs from convalescents also inhibit proliferation of autologous T cells Additionally in the convalescent sera we detected significantly higher concentrations of GM CSF indicating the role of emergency granulopoiesis We conclude that in mild or asymptomatic COVID 19 convalescents the neutrophil dysfunction including propagation of PD L1 positive LDNs PMN MDSCs and NDNs is responsible for long term endotype of immunosuppression 1 |
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126 Chronic SARS CoV 2 a Cause of Post acute COVID 19 Sequelae Long COVID Severe acute respiratory syndrome coronavirus 2 SARS CoV 2 is the cause coronavirus disease 2019 COVID 19 Most individuals recover from SARS CoV 2 infection however many continue to experience a cluster of persistent symptoms for months following resolution of acute disease a syndrome that has been named Long COVID While the biological cause or causes of Long COVID have not yet been confirmed the main proposals have centred around either virus induced autoimmunity or virus induced tissue dysfunction However an alternative suggestion that a latent chronic infection could be responsible for the symptoms of Long COVID has received minimal attention despite recent findings that SARS CoV 2 genetic material and infections are detected in some individuals months following resolution of respiratory disease Here we discuss literature supporting the possibility that Long COVID occurs as a result of chronic SARS CoV 2 infections 1 |
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174 Covid 19 Induced Dysautonomia A Menace of Sympathetic Storm Among the plethora of debilitating neurological disorders of COVID 19 syndrome in survivors the scope of SARS CoV 2 induced dysautonomia DNS is yet to be understood though the implications are enormous Herein we present an inclusive mini review of SARS CoV 2 induced DNS and its associated complications Although the direct link between Covid 19 and DSN is still speculative the hypothetical links are thought to be either a direct neuronal injury of the autonomic pathway or a para post infectious immune induced mechanism SARS CoV 2 infection induced stress may activate the sympathetic nervous system SNS leading to neuro hormonal stimulation and activation of pro inflammatory cytokines with further development of sympathetic storm Sympathetic over activation in Covid 19 is correlated with increase in capillary pulmonary leakage alveolar damage and development of acute respiratory distress syndrome Furthermore SARS CoV 2 can spread through pulmonary mechanoreceptors and chemoreceptors to medullary respiratory center in a retrograde manner resulting in sudden respiratory failure Taken together DSN in Covid 19 is developed due to sympathetic storm and inhibition of Parasympathetic nervous system mediated anti inflammatory effect with development of cytokine storm Therefore sympathetic and cytokine storms together with activation of Renin Angiotensin System are the chief final pathway involved in the development of DSN in Covid 19 1 |
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665 Selenium Deficiency Due to Diet Pregnancy Severe Illness or COVID 19 A Preventable Trigger for Autoimmune Disease The trace element selenium Se is an essential part of the human diet moreover increased health risks have been observed with Se deficiency A sufficiently high Se status is a prerequisite for adequate immune response and preventable endemic diseases are known from areas with Se deficiency Biomarkers of Se status decline strongly in pregnancy severe illness or COVID 19 reaching critically low concentrations Notably these conditions are associated with an increased risk for autoimmune disease AID Positive effects on the immune system are observed with Se supplementation in pregnancy autoimmune thyroid disease and recovery from severe illness However some studies reported null results the database is small and randomized trials are sparse The current need for research on the link between AID and Se deficiency is particularly obvious for rheumatoid arthritis and type 1 diabetes mellitus Despite these gaps in knowledge it seems timely to realize that severe Se deficiency may trigger AID in susceptible subjects Improved dietary choices or supplemental Se are efficient ways to avoid severe Se deficiency thereby decreasing AID risk and improving disease course A personalized approach is needed in clinics and during therapy while population wide measures should be considered for areas with habitual low Se intake Finland has been adding Se to its food chain for more than 35 years a wise and commendable decision according to todays knowledge It is unfortunate that the health risks of Se deficiency are often neglected while possible side effects of Se supplementation are exaggerated leading to disregard for this safe and promising preventive and adjuvant treatment options This is especially true in the follow up situations of pregnancy severe illness or COVID 19 where massive Se deficiencies have developed and are associated with AID risk long lasting health impairments and slow recovery 0 |
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90 Outcomes Among Patients Referred to Outpatient Rehabilitation Clinics After COVID 19 diagnosis United States January 2020 March 2021 As of June 30 2021 33 5 million persons in the United States had received a diagnosis of COVID 19 1 Although most patients infected with SARS CoV 2 the virus that causes COVID 19 recover within a few weeks some experience post COVID 19 conditions These range from new or returning to ongoing health problems that can continue beyond 4 weeks Persons who were asymptomatic at the time of infection can also experience post COVID 19 conditions Data on post COVID 19 conditions are emerging and information on rehabilitation needs among persons recovering from COVID 19 is limited Using data acquired during January 2020 March 2021 from Select Medical outpatient rehabilitation clinics CDC compared patient reported measures of health physical endurance and health care use between patients who had recovered from COVID 19 post COVID 19 patients and patients needing rehabilitation because of a current or previous diagnosis of a neoplasm cancer who had not experienced COVID 19 control patients All patients had been referred to outpatient rehabilitation Compared with control patients post COVID 19 patients had higher age and sex adjusted odds of reporting worse physical health adjusted odds ratio aOR 1 8 pain aOR 2 3 and difficulty with physical activities aOR 1 6 Post COVID 19 patients also had worse physical endurance measured by the 6 minute walk test sup sup 6MWT p 0 001 compared with control patients Among patients referred to outpatient rehabilitation those recovering from COVID 19 had poorer physical health and functional status than those who had cancer or were recovering from cancer but not COVID 19 Patients recovering from COVID 19 might need additional clinical support including tailored physical and mental health rehabilitation services 1 |
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235 Collaborative Cohort of Cohorts for COVID 19 Research C4R Study Study Design The Collaborative Cohort of Cohorts for COVID 19 Research C4R is a national prospective study of adults at risk for coronavirus disease 2019 COVID 19 comprising 14 established United States US prospective cohort studies For decades C4R cohorts have collected extensive data on clinical and subclinical diseases and their risk factors including behavior cognition biomarkers and social determinants of health C4R will link this pre COVID phenotyping to information on SARS CoV 2 infection and acute and post acute COVID related illness C4R is largely population based has an age range of 18 108 years and broadly reflects the racial ethnic socioeconomic and geographic diversity of the US C4R is ascertaining severe acute respiratory syndrome coronavirus 2 SARS CoV 2 infection and COVID 19 illness using standardized questionnaires ascertainment of COVID related hospitalizations and deaths and a SARS CoV 2 serosurvey via dried blood spots Master protocols leverage existing robust retention rates for telephone and in person examinations and high quality events surveillance Extensive pre pandemic data minimize referral survival and recall bias Data are being harmonized with research quality phenotyping unmatched by clinical and survey based studies these will be pooled and shared widely to expedite collaboration and scientific findings This unique resource will allow evaluation of risk and resilience factors for COVID 19 severity and outcomes including post acute sequelae and assessment of the social and behavioral impact of the pandemic on long term trajectories of health and aging 1 |
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206 Dysphagia Care Across the Continuum A Multidisciplinary Dysphagia Research Society Taskforce Report of Service Delivery During the COVID 19 Global Pandemic At the time of writing this paper there are over 11 million reported cases of COVID 19 worldwide Health professionals involved in dysphagia care are impacted by the COVID 19 pandemic in their day to day practices Otolaryngologists gastroenterologists rehabilitation specialists and speech language pathologists are subject to virus exposure due to their proximity to the aerodigestive tract and reliance on aerosol generating procedures in swallow assessments and interventions Across the globe professional societies and specialty associations are issuing recommendations about which procedures to use when to use them and how to reduce the risk of COVID 19 transmission during their use Balancing safety for self patients and the public while maintaining adequate evidence based dysphagia practices has become a significant challenge This paper provides current evidence on COVID 19 transmission during commonly used dysphagia practices and provides recommendations for protection while conducting these procedures The paper summarizes current understanding of dysphagia in patients with COVID 19 and draws on evidence for dysphagia interventions that can be provided without in person consults and close proximity procedures including dysphagia screening and telehealth 1 |
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640 Effect of Continuous Electrocardiogram Monitoring on Detection of Undiagnosed Atrial Fibrillation After Hospitalization for Cardiac Surgery A Randomized Clinical Trial Postoperative atrial fibrillation POAF occurring after cardiac surgery is associated with adverse outcomes Whether POAF persists beyond discharge is not well defined To determine whether continuous cardiac rhythm monitoring enhances detection of POAF among cardiac surgical patients during the first 30 days after hospital discharge compared with usual care This study is an investigator initiated open label multicenter randomized clinical trial conducted at 10 Canadian centers Enrollment spanned from March 2017 to March 2020 with follow up through September 11 2020 As a result of the COVID 19 pandemic enrollment stopped on July 17 2020 at which point 85 of the proposed sample size was enrolled Cardiac surgical patients with CHA2DS2 VASc congestive heart failure hypertension age 75 years diabetes prior stroke or transient ischemic attack vascular disease age 65 74 years female sex score greater than or equal to 4 or greater than or equal to 2 with risk factors for POAF no history of preoperative AF and POAF lasting less than 24 hours during hospitalization were enrolled The intervention group underwent continuous cardiac rhythm monitoring with wearable patch based monitors for 30 days after randomization Monitoring was not mandated in the usual care group within 30 days after randomization The primary outcome was cumulative AF and or atrial flutter lasting 6 minutes or longer detected by continuous cardiac rhythm monitoring or by a 12 lead electrocardiogram within 30 days of randomization Prespecified secondary outcomes included cumulative AF lasting 6 hours or longer and 24 hours or longer within 30 days of randomization death myocardial infarction ischemic stroke non central nervous system thromboembolism major bleeding and oral anticoagulation prescription Of the 336 patients randomized 163 patients in the intervention group and 173 patients in the usual care group mean SD age 67 4 8 1 years 73 women 21 7 median interquartile range CHA2DS2 VASc score 4 0 3 0 4 0 points 307 91 4 completed the trial In the intent to treat analysis the primary end point occurred in 32 patients 19 6 in the intervention group vs 3 patients 1 7 in the usual care group absolute difference 17 9 95 CI 11 5 24 3 P 001 AF lasting 6 hours or longer was detected in 14 patients 8 6 in the intervention group vs 0 patients in the usual care group absolute difference 8 6 95 CI 4 3 12 9 P 001 In post cardiac surgical patients at high risk of stroke no preoperative AF history and AF lasting less than 24 hours during hospitalization continuous monitoring revealed a significant increase in the rate of POAF after discharge that would otherwise not be detected by usual care Studies are needed to examine whether these patients will benefit from oral anticoagulation therapy ClinicalTrials gov Identifier NCT02793895 0 |
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611 Comparison of Antiviral Agents for Seasonal Influenza Outcomes in Healthy Adults and Children A Systematic Review and Network Meta analysis Antiviral treatment of influenza is recommended for patients with influenza like illness during periods of community cocirculation of influenza viruses and SARS CoV 2 however questions remain about which treatment is associated with the best outcomes and fewest adverse events To compare the efficacy and safety of neuraminidase inhibitors and the endonuclease inhibitor for the treatment of seasonal influenza among healthy adults and children Medline Embase and the Cochrane Register of Clinical Trials were searched from inception to January 2020 the last search was updated in October 2020 Included studies were randomized clinical trials conducted among patients of all ages with influenza treated with neuraminidase inhibitors ie oseltamivir peramivir zanamivir or laninamivir or an endonuclease inhibitor ie baloxavir compared with other active agents or placebo Two investigators identified studies and independently abstracted data Frequentist network meta analyses were performed relative ranking of agents was conducted using P score probabilities Quality of evidence was assessed using the Grading of Recommendations Assessment Development and Evaluations criteria Data were analyzed in October 2020 The time to alleviation of influenza symptoms TTAS complications of influenza and adverse events total adverse events nausea and vomiting A total of 26 trials were identified that investigated antiviral drugs at high or low doses these trials included 11 897 participants among whom 6294 52 9 were men and the mean SD age was 32 5 16 9 years Of all treatments comparing with placebo in efficacy outcomes high quality evidence indicated that zanamivir was associated with the shortest TTAS hazard ratio 0 67 95 CI 0 58 0 77 while baloxavir was associated with the lowest risk of influenza related complications risk ratio RR 0 51 95 CI 0 32 0 80 based on moderate quality evidence In safety outcomes baloxavir was associated with the lowest risk of total adverse events RR 0 84 95 CI 0 74 0 96 compared with placebo based on moderate quality evidence There was no strong evidence of associations with risk of nausea or vomiting among all comparisons except for 75 mg oseltamivir which was associated with greater occurrence of nausea RR 1 82 95 CI 1 38 2 41 and vomiting RR 1 88 95 CI 1 47 2 41 In this systematic review and network meta analysis all 4 antiviral agents assessed were associated with shortening TTAS zanamivir was associated with the shortest TTAS and baloxavir was associated with reduced rate of influenza related complications 0 |
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69 Underserved Does Not Mean Undeserved Unfurling the HCV Care in the Safety Net 1 |
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149 Allergic rhinitis and COVID 19 friends or foes Allergic rhinitis AR is a common disease affecting up to 40 of the general population worldwide In the Coronavirus 2019 COVID 19 pandemic era many observational studies analysing the effect of asthma and chronic obstructive pulmonary disease on the risk of developing COVID 19 were conducted while data on AR are limited In this paper we review the risk of developing SARS Cov 2 infection carried by AR patients the outcomes of those with COVID 19 disease and the COVID 19 influence on the allergic and nasal symptoms and the psychological status of AR patients in both adult and paediatric populations AR patients seem to be protected from COVID 19 infection Even if data about the influence of AR on the severity of COVID 19 disease are still not conclusive it seems that being an AR patient does not increase the risk of poor COVID 19 prognoses The clinical manifestation of AR can be distinguished by COVID 19 symptoms Treating AR adequately is also strongly recommended especially during pandemic 1 |
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668 Fluid Dynamics of Respiratory Infectious Diseases The host to host transmission of respiratory infectious diseases is fundamentally enabled by the interaction of pathogens with a variety of fluids gas or liquid that shape pathogen encapsulation and emission transport and persistence in the environment and new host invasion and infection Deciphering the mechanisms and fluid properties that govern and promote these steps of pathogen transmission will enable better risk assessment and infection control strategies and may reveal previously underappreciated ways in which the pathogens might actually adapt to or manipulate the physical and chemical characteristics of these carrier fluids to benefit their own transmission In this article I review our current understanding of the mechanisms shaping the fluid dynamics of respiratory infectious diseases 0 |
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288 COVID 19 neuropathological point of view pathobiology and dilemmas after the first year of the pandemic struggle This article constitutes a summary of the knowledge on the involvement of the nervous system in COVID 19 concerning its general pathobiology clinical presentation and neuropathological features as well as the future directions of investigation Variable definitions selection bias mainly retrospective analyses of hospitalized patients and different methodologies are implemented in the research of this new disease Central nervous system CNS pathology presents most frequently features of non specific neuroinflammation with microglial activation and lymphoid infiltrations ischemic hypoxic encephalopathy acute cerebrovascular disease and microthrombi Some brain specimens remain unaffected or show only non specific changes of the critical status Interpretations of the neuropathological findings are not always balanced in a clinical context and discrepant in consequence Designing of longitudinal neuropathological studies more frequent autopsies and building of COVID 19 brain banks together with neuroimaging analyses is essential Genetic predispositions or immunological factors corresponding to the disease profile as well as cerebrospinal fluid CSF or serum biomarkers of COVID 19 the impact of different virus variants and influence of the therapy need to be identified The mechanisms causing neuroCOVID and cognitive impairment whether they are infectious toxic vascular or metabolic create other aspects under research There are also many existential questions about post COVID and delayed sequelae of the infection The fight with pandemic is a challenge for the global society with neuropathologists and neuroscientists as important allies in struggle for understanding and conquering COVID 19 1 |
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313 Retinal capillary involvement in early post COVID 19 patients a healthy controlled study Systemic vascular involvement in COVID 19 has been identified in several patients not only endothelial derangement and increased permeability are reported to be early hallmarks of organ damage in patients with COVID 19 but are also the most important cause of worsening of clinical conditions in severe cases of SARS CoV 2 infection There are several reasons to hypothesize that the eye and the retina in particular could be a target of organ damage in SARS CoV 2 infection This cohort observational study analyzes OCT angiography and structural OCT of 70 post COVID 19 patients evaluated at 1 month hospital discharge and 22 healthy control subjects Primary outcomes were macular vessel density VD and vessel perfusion VP structural OCT features were evaluated as secondary outcomes In addition patients and healthy volunteers were evaluated for best corrected visual acuity slit lamp photograph and fundus photo image VD and VP in 3 3 and 6 6 mm scans for SCP and DCP showed no significant differences between the groups Similarly CMT and GCL did not reveal significant differences between post COVID 19 and healthy patients Nine patients 12 9 featured retinal cotton wool spots and 10 patients had vitreous fibrillary degeneration The prevalence of epiretinal membrane and macular hole was similar in the two groups One case of extra papillary focal retinal hemorrhage was reported in the post COVID 19 group Macula and perimacular vessel density and perfusion resulted unaltered in mild post COVID 19 patients at 1 month hospital discharge suggesting no or minimal retinal vascular involvement by SARS CoV 2 1 |
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51 Long COVID in the Faroe Islands a longitudinal study among non hospitalized patients Little is known about long term recovery from COVID 19 disease especially in non hospitalized individuals In this longitudinal study we present symptoms registered during the acute phase as well as long COVID i e long lasting COVID 19 symptoms in patients from the Faroe Islands All consecutive patients with confirmed RT PCR testing from April to June 2020 were invited to participate in this study for the assessment of long COVID Demographic and clinical characteristics and self reported acute and persistent symptoms were assessed using a standardized detailed questionnaire administered at enrollment and at repeated phone interviews in the period 22 th April to Aug 16 th Of the 180 participants 96 3 of the 187 eligible COVID 19 patients 53 1 reported persistence of at least one symptom after a mean of 125 days after symptoms onset 33 3 reported one or two symptoms and 19 4 three or more symptoms At the last follow up 46 7 were asymptomatic compared with 4 4 during the acute phase The most prevalent persistent symptoms were fatigue loss of smell and taste and arthralgias Our results show that it might take months for symptoms to resolve even among non hospitalized persons with mild illness course in the acute phase Continued monitoring for long COVID is needed 1 |
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244 Long term immunologic effects of SARS CoV 2 infection leveraging translational research methodology to address emerging questions The current era of COVID 19 is characterized by emerging variants of concern waning vaccine and natural infection induced immunity debate over the timing and necessity of vaccine boosting and the emergence of post acute sequelae of SARS CoV 2 infection As a result there is an ongoing need for research to promote understanding of the immunology of both natural infection and prevention especially as SARS CoV 2 immunology is a rapidly changing field with new questions arising as the pandemic continues to grow in complexity The next phase of COVID 19 immunology research will need focus on clearer characterization of the immune processes defining acute illness development of a better understanding of the immunologic processes driving protracted symptoms and prolonged recovery ie post acute sequelae of SARS CoV 2 infection and a growing focus on the impact of therapeutic and prophylactic interventions on the long term consequences of SARS CoV 2 infection In this review we address what is known about the long term immune consequences of SARS CoV 2 infection and propose how experience studying the translational immunology of other infections might inform the approach to some of the key questions that remain 1 |
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574 The clinical practice of Pediatric Dentistry post COVID 19 The current evidences The Severe Acute Respiratory Syndrome SARS caused by SARS CoV 2 virus has quickly spread all over the world directly affecting the dentistry practice This study aimed to perform a literature review about the current evidences on biosafety practices and clinical recommendations regarding the return to the elective dental care in the practice of Pediatric dentistry An electronic search was performed in PubMed Scopus Web of Science and Grey literature databases using the terms Pediatric dentistry and COVID 19 Initially 38 studies were retrieved After title and abstract were read it was identified that 22 studies referred specifically to childrens dental practice A total of 19 studies were included in this study The COVID 19 pandemic will imply significant changes in the reorientation of dental practices from biosafety issues to technical procedures Greater rigor in the use of Personal Protective Equipment PPE may cause strangeness for children Consequently an improvement in the management of patients behavior before and during the treatment and new approaches to perform the procedures will be demanded Non aerosol techniques and minimally invasive procedures will be preferable whenever possible Professionals will need to be constantly updated based on what the scientific literature recommends The moment is suitable for the use of preventive practice and minimally invasive techniques 0 |
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156 Interventional Stroke Care in the Era of COVID 19 The current coronavirus disease COVID 19 pandemic caused by severe acute respiratory syndrome coronavirus 2 has led to immense strain on healthcare systems and workers Patients with severe symptoms of COVID 19 may also present with acute neurological emergencies such as ischemic stroke Ischemic stroke in these patients may result from COVID 19 related complications or decompensation of previously asymptomatic cerebrovascular disorders or concurrent ischemic stroke from common stroke risk factors in a patient with COVID 19 Acute ischemic stroke patients with large vessel occlusions require emergent triage intensive care and mechanical thrombectomy Management of patients with large vessel occlusions LVO requires special considerations in the current pandemic Physicians must now account for prognosis of severe COVID 19 resource utilization and risk of infection to healthcare workers when determining eligibility for mechanical thrombectomy MT Here we describe important prognostic factors including age laboratory and imaging findings to consider for MT selection and provide suggestions for taking care of patients with LVO and possible or confirmed COVID 19 It is recommended to perform MT in patients within the established guidelines and consider a conservative approach in cases where there is clinical equipoise to minimize futile reperfusion Lastly we describe an illustrative case of a patient with ischemic stroke and COVID 19 1 |
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536 Safety and immunogenicity of the ChAdOx1 nCoV 19 AZD1222 vaccine against SARS CoV 2 in HIV infection a single arm substudy of a phase 2 3 clinical trial Data on vaccine immunogenicity against SARS CoV 2 are needed for the 40 million people globally living with HIV who might have less functional immunity and more associated comorbidities than the general population We aimed to explore safety and immunogenicity of the ChAdOx1 nCoV 19 AZD1222 vaccine in people with HIV In this single arm open label vaccination substudy within the protocol of the larger phase 2 3 trial COV002 adults aged 18 55 years with HIV were enrolled at two HIV clinics in London UK Eligible participants were required to be on antiretroviral therapy ART with undetectable plasma HIV viral loads 50 copies per mL and CD4 counts of more than 350 cells per μL A prime boost regimen of ChAdOx1 nCoV 19 with two doses was given 4 6 weeks apart The primary outcomes for this substudy were safety and reactogenicity of the vaccine as determined by serious adverse events and solicited local and systemic reactions Humoral responses were measured by anti spike IgG ELISA and antibody mediated live virus neutralisation Cell mediated immune responses were measured by ex vivo IFN γ enzyme linked immunospot assay ELISpot and T cell proliferation All outcomes were compared with an HIV uninfected group from the main COV002 study within the same age group and dosing strategy and are reported until day 56 after prime vaccination Outcomes were analysed in all participants who received both doses and with available samples The COV002 study is registered with ClinicalTrials gov NCT04400838 and is ongoing Between Nov 5 and Nov 24 2020 54 participants with HIV all male median age 42 5 years IQR 37 2 49 8 were enrolled and received two doses of ChAdOx1 nCoV 19 Median CD4 count at enrolment was 694 0 cells per μL IQR 573 5 859 5 No serious adverse events occurred Local and systemic reactions occurring during the first 7 days after prime vaccination included pain at the injection site 26 49 of 53 participants with available data fatigue 25 47 headache 25 47 malaise 18 34 chills 12 23 muscle ache 19 36 joint pain five 9 and nausea four 8 the frequencies of which were similar to the HIV negative participants Anti spike IgG responses by ELISA peaked at day 42 median 1440 ELISA units EUs IQR 704 2728 n 50 and were sustained until day 56 median 941 EUs 531 1445 n 49 We found no correlation between the magnitude of the anti spike IgG response at day 56 and CD4 cell count p 0 93 or age p 0 48 ELISpot and T cell proliferative responses peaked at day 14 and 28 after prime dose and were sustained to day 56 Compared with participants without HIV we found no difference in magnitude or persistence of SARS CoV 2 spike specific humoral or cellular responses p 0 05 for all analyses In this study of people with HIV ChAdOx1 nCoV 19 was safe and immunogenic supporting vaccination for those well controlled on ART UK Research and Innovation National Institutes for Health Research NIHR Coalition for Epidemic Preparedness Innovations NIHR Oxford Biomedical Research Centre Thames Valley and South Midlands NIHR Clinical Research Network and AstraZeneca 0 |
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630 The Wish to Die in later life prevalence longitudinal course and mortality Data from TILDA Wish to Die WTD involves thoughts of or wishes for ones own death or that one would be better off dead To examine the prevalence longitudinal course and mortality risk of WTD in community dwelling older people Observational study with 6 year follow up The Irish Longitudinal Study on Ageing a nationally representative cohort of older adults In total 8 174 community dwelling adults aged 50 years To define WTD participants were asked In the last month have you felt that you would rather be dead Depressive symptoms were measured using the CES D Mortality data were compiled by linking administrative death records to individual level survey data from the study At Wave 1 3 5 of participants 279 8 174 reported WTD Both persistent loneliness OR 5 73 95 CI 3 41 9 64 and depressive symptoms OR 6 12 95 CI 4 33 8 67 were independently associated with WTD Of participants who first reported WTD at Wave 1 or 2 72 did not report WTD when reassessed after 2 years and the prevalence of depressive symptoms 44 and loneliness 19 was more likely to decline in this group at follow up Fifteen per cent of participants expressing WTD at Wave 1 died during a 6 year follow up WTD amongst community dwelling older people is frequently transient and is strongly linked with the course of depressive symptoms and loneliness An enhanced focus on improving access to mental health care and addressing social isolation in older people should therefore be a public health priority particularly in the current context of the Covid 19 pandemic 0 |
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310 Long COVID or post COVID 19 syndrome putative pathophysiology risk factors and treatments Long COVID or post COVID 19 syndrome first gained widespread recognition among social support groups and later in scientific and medical communities This illness is poorly understood as it affects COVID 19 survivors at all levels of disease severity even younger adults children and those not hospitalized While the precise definition of long COVID may be lacking the most common symptoms reported in many studies are fatigue and dyspnoea that last for months after acute COVID 19 Other persistent symptoms may include cognitive and mental impairments chest and joint pains palpitations myalgia smell and taste dysfunctions cough headache and gastrointestinal and cardiac issues Presently there is limited literature discussing the possible pathophysiology risk factors and treatments in long COVID which the current review aims to address In brief long COVID may be driven by long term tissue damage e g lung brain and heart and pathological inflammation e g from viral persistence immune dysregulation and autoimmunity The associated risk factors may include female sex more than five early symptoms early dyspnoea prior psychiatric disorders and specific biomarkers e g D dimer CRP and lymphocyte count although more research is required to substantiate such risk factors While preliminary evidence suggests that personalized rehabilitation training may help certain long COVID cases therapeutic drugs repurposed from other similar conditions such as myalgic encephalomyelitis or chronic fatigue syndrome postural orthostatic tachycardia syndrome and mast cell activation syndrome also hold potential In sum this review hopes to provide the current understanding of what is known about long COVID 1 |
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606 Cutaneous manifestations of COVID 19 in children and adults A virus that does not discriminate Coronavirus disease 2019 COVID 19 is caused by the severe acute respiratory syndrome coronavirus 2 SARS CoV 2 a beta coronavirus with a characteristic S glycoprotein spike on the cell surface Initial reports did not include cutaneous manifestations as a feature of COVID 19 however there is a growing repertoire of reports demonstrating an array of dermatologic manifestations on the skin in children and adults Dermatologic afflictions have been summarized into different categories several times with the most recent analysis identifying six clinical patterns urticaria maculopapular morbilliform eruption papulovesicular exanthem chilblain like acral pattern livedo reticularis livedo racemosa pattern and purpuric vasculitic pattern In children the dermatologic features appear to occur before or concomitantly with other COVID 19 manifestations Dermatologists play a key role in diagnosing patients with COVID 19 who may present for the first time unwittingly exhibiting early signs of COVID 19 We have reviewed the current evidence on the dermatologic impact of COVID 19 in both the adult and pediatric populations 0 |
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448 The impact of coronavirus SARS CoV 2 COVID 19 in water potential risks This review summarizes research data on SARS CoV 2 in water environments A literature survey was conducted using the electronic databases Science Direct Scopus and Springer This complete research included and discussed relevant studies that involve the 1 introduction 2 definition and features of coronavirus 2 1 structure and classification 3 effects on public health 4 transmission 5 detection methods 6 impact of COVID 19 on the water sector drinking water cycle water surface water wastewater 6 5 wastewater treatment and 7 future trends The results show contamination of clean water sources and community drinking water is vulnerable Additionally there is evidence that sputum feces and urine contain SARS CoV 2 which can maintain its viability in sewage and the urban rural water cycle to move towards seawater or freshwater thus the risk associated with contracting COVID 19 from contact with untreated water or inadequately treated wastewater is high Moreover viral loads have been detected in surface water although the risk is lower for countries that efficiently treat their wastewater Further investigation is immediately required to determine the persistence and mobility of SARS CoV 2 in polluted water and sewage as well as the possible potential of disease transmission via drinking water Conventional wastewater treatment systems have been shown to be effective in removing the virus which plays an important role in pandemic control Monitoring of this virus in water is extremely important as it can provide information on the prevalence and distribution of the COVID 19 pandemic in different communities as well as possible infection dynamics to prevent future outbreaks 0 |
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204 Historical Insight into Infections and Disorders Associated with Neurological and Psychiatric Sequelae Similar to Long COVID Long term sequelae of coronavirus disease 2019 COVID 19 due to infection with severe acute respiratory syndrome coronavirus 2 SARS CoV 2 are now recognized However there is still a lack of consensus regarding the terminology for this emerging chronic clinical syndrome which includes long COVID chronic COVID syndrome post COVID 19 syndrome post acute COVID 19 and long hauler COVID 19 In this review I will use the term long COVID A review of the medical history and epidemiology of past pandemics and epidemics in modern literature review identifies common long term post infectious disorders with the common finding of altered cognition In the brain the cerebral hypoxia induced by SARS CoV 2 infection may be caused by mitochondrial dysfunction resulting in brain fog Historically the common symptom of altered cognition has been reported during earlier pandemics which include the influenza pandemics of 1889 and 1892 Russian flu the Spanish flu pandemic 1918 1919 encephalitis lethargica diphtheria and myalgic encephalomyelitis chronic fatigue syndrome or post viral fatigue syndrome There are similarities between chronic fatigue syndrome and the brain fog described in long COVID During past viral epidemics and pandemics a commonality of neural targets may have increased viral survival by conformational matching The neurological and psychiatric sequelae of SARS CoV 2 infection or long COVID may have emerged from neural effects that have emerged from an invertebrate and vertebrate virosphere This review aims to present a historical overview of infections and disorders associated with neurological and psychiatric sequelae that have shown similarities with long COVID 1 |
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