ABSTRACT
Background and aims: In humanitarian settings, access to specialists is limited or absent. The MSF telemedicine store and forward network provides a space for online discussion with different specialists. Complemented with specific planned sessions, real-time discussion can occur among all parties involved, facili-tating the resolution of complex cases. Method Since 2018, case discussion sessions for paediatric cases have been estab-lished between MSF and the paediatric hospital at the University Hospitals of Geneva (HUG). Cases are sent in advance via the telemedicine platform to the fellows who collect information, contact relevant specialists and prepare the summary. Results and discussion Close to 40 sessions have been held. Most cases have been resolved pos-itively for the patient despite their complexity and the lack of diagnos-tic/therapeutic means. The focus of the sessions remains to improve the patient condition. None-theless, they allow senior and junior doctors and medical students to be confronted with new or rare medical situations. They learn skills to pro-vide adapted medical advice for resource-limited and humanitarian set-tings. For some of them, it is a source of motivation to work in humanitar-ian contexts. From the project medical team's perspective: they become more efficient presenting and discussing clinical cases, which in turn helps their critical thinking during their clinical activities. A summary of recom-mendations is sent back to the project medical team after each discussion. Due to COVID-19, the sessions take place virtually. This change has al-lowed much wider and easier access to MSF medical staff in HQ, and in particular the project medical teams, but also to specialists from all over the world. Conclusion This model allows for the focused management of complex cases and has multiple benefits for patients, project medical teams, specialists and med-ical trainees. This model could be replicated in other areas of the HUG for other types of patients depending on project needs and requests.
ABSTRACT
Background-aim: Coronavirus disease (COVID-19) caused by SARS-CoV-2 is characterized by high contagiousness requiring isolation measures. Currently, diagnosis is based on the RT-PCR and/or chest computed tomography (CT) scan, but these methodologies are time-consuming and may delay the diagnosis. CBC-Diff analysis is the first step in patient assessment and may contribute to the diagnosis of COVID-19. Morphological changes of the immune cells can be identified by electro-optical analysis on the hematology analyzer DxH 800 (Beckman Coulter, Inc., Brea, CA). We studied whether the analysis of cellular population data (CPD), provided as part of CBC-Diff analysis by the DxH 800 analyzers can help to identify SARS-CoV-2 infection. Methods: The study included 322 consecutive patients from the emergency unit with positive RT-PCR (Allplex 2019 nCoV Assay, Eurobio, Les Ulis, France) and 285 consecutive patients with clinical suspicion for COVID-19, but who had negative RT-PCR and CT-scan not suggestive of SARS-CoV-2 infection. We also included 137 subjects with a normal CBC-Diff, referred to our institution without evidence of infection and when prevalence of SARS-CoV-2 was very low in France. Blood was collected in EDTA-K3 tubes and analyzed within 6 h after collection. Results: The majority of CPD was different between the 3 groups;CPD of patients (with or without COVID-19) were significantly different of CPD of controls. Four, six and nine CPD for NE, LY, and MO, respectively, were significantly different between COVID-19+ and COVID-19- patients. Using ROC analysis, we identified parameters, which were able to discriminate COVID-19+ patients from COVID-19- patients. The best parameter was SD-V-Mo (Standard Deviation of Monocyte Volume), with AUC 0.819, sensitivity of 91.59% and specificity of 63.03% at the cut-off>21.71. MN-V-Mo (Mean Monocyte Volume) demonstrated AUC 0.742 with sensitivity of 76.64%, specificity of 65.85% at cut-off>180. SD-AL2-MO (Standard Deviation of Axial Light Loss for Monocytes) provided AUC 0.722 with sensitivity of 85.67%, specificity of 52.11% at cut-off>17.51. Currently CPD are research use only;their clinical utility has not been established. Conclusions: Consideration of CPD could constitute a first step and potentially aid in the early diagnosis of COVID-19.
ABSTRACT
The spreading of COVID-19 misinformation on social media could have severe consequences on people's behavior. In this paper, we investigated the emotional expression of misinformation related to the COVID-19 crisis on Twitter and whether emotional valence differed depending on the type of misinformation. We collected 17,463,220 English tweets with 76 COVID-19-related hashtags for March 2020. Using Google Fact Check Explorer API we identified 226 unique COVID-19 false stories for March 2020. These were clustered into six types of misinformation (cures, virus, vaccine, politics, conspiracy theories, and other). Applying the 226 classifiers to the Twitter sample we identified 690,004 tweets. Instead of running the sentiment on all tweets we manually coded a random subset of 100 tweets for each classifier to increase the validity, reducing the dataset to 2,097 tweets. We found that only a minor part of the entire dataset was related to misinformation. Also, misinformation in general does not lean towards a certain emotional valence. However, looking at comparisons of emotional valence for different types of misinformation uncovered that misinformation related to “virus” and “conspiracy” had a more negative valence than “cures,” “vaccine,” “politics,” and “other.” Knowing from existing studies that negative misinformation spreads faster, this demonstrates that filtering for misinformation type is fruitful and indicates that a focus on “virus” and “conspiracy” could be one strategy in combating misinformation. As emotional contexts affect misinformation spreading, the knowledge about emotional valence for different types of misinformation will help to better understand the spreading and consequences of misinformation. © The Author(s) 2021.
ABSTRACT
INTRODUCTION: Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period. MATERIAL AND METHOD: Recommendations based on the consensus conference model. RESULTS: In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies. CONCLUSION: During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.