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Background & aims: Vitamin D supplementation as an immunomodulator has been identified as a potential strat-egy to prevent and treat Coronavirus disease 2019 (COVID-19). We aimed to analyze the effect of 10,000 IU vitamin D3 supplementation on 25(OH)D levels on primary clinical out-comes (conversion length), inflammatory markers (Total Lymphocyte Count (TLC), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR)) and coagulation marker (D-Dimer) in moderate COVID-19 patients at Wahidin Sudirohusodo Hospital, Makassar, Indonesia.Methods: We conducted a single-blind randomized -con-trolled trial on the confirmed moderate COVID-19 patients above 18 years old and low vitamin D status. Each of inter-vention and control groups were supplemented of 10,000 IU and 1000 IU cholecalciferol that taken daily for 2 weeks. Levels of 25(OH)D were analyzed for the primary endpoint (conversion length), then correlated to secondary endpoints (Length of Stay (LOS)), clinical manifestations improvement, and markers TLC, NLR, PLR, and D-Dimer serum, handgrip strength (HGS) as functional capacity measurement, after ad-justed to age, sex, nutritional status based on body mass in- dex (BMI) and Subjective Global Assessment (SGA) tool, co -morbidities, and anti-coagulant administration. Medical nutri-tional therapy was given and presented as energy, protein, carbohydrate, and fat achievement, and vitamin D intake was also calculated.Results: A significant effects was found in 60 samples with pre-intervention vitamin D deficiency (61.7%) and insuffi-ciency (38.3%) status, and 10,000 IU of vitamin D3 supple-mentation could increase 25(OH)D levels within 2 weeks to reach sufficiency status (16.7%). The Vitamin D3 supplemen-tation of 10,000 IU and 1000 IU could significantly increase 25(OH)D levels compared to the control group of 1000 IU (4.61 +/- 5.43 vs.-0.29 +/- 2.72;P <0.0001) and it was correlated to primary clinical outcome, which is length of conversion (6.53 +/- 1.17 vs 10.47 +/- 2.56;P < 0.0001). The increase in HGS (6.61 +/- 3.01 vs. 4.04 +/- 4.44;P = 0.011), LOS (11.63 +/- 2.5 vs. 14.73 +/- 3.45;P = 0.001), and improvement in clinical mani-festations were found to be significant in both groups. We an-alyzed changes the effect of vitamin D supplementation in TLC, NLR, and D-Dimer as marker of coagulopathy associated COVID-19 on both groups that showed were not significant. Positive and significant correlation was only showed on PLR levels after intervention (r=0.368;P=0.045).Conclusion: Supplementation of vitamin D3 10,000 IU in moderate COVID-19 patients had a significant effect on 25(OH)D level, length of conversion, LOS, functional capacity, and PLR levels, but it has negative correlation in TLC, NLR, and D-Dimer levels.This study has been registered in the ClinicalTrial.gov data-base with the identification number NCT05126602.
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Introduction During the current lockdown due to the coronavirus disease 2019 (COVID-19) pandemic, the healthcare system should be modified to reach out to a large number of patients with effective service. Virtual clinics are one possible solution to the challenges healthcare systems face worldwide during the COVID-19 pandemic. Aim To evaluate the experience of the virtual clinic in Dermatology Department at King Khaled University Hospital and to evaluate its advantages and disadvantages, and whether or not this service is practical to apply in the future. Patients and methods To assess the patients' attitude toward virtual clinics, 1220 patients were offered a phone consultation during May 2020. A questionnaire was drafted with 23 questions sent to all the patients via cellular text. Seven of these questions were related to patient demographics. The remaining questions assessed patient satisfaction, occupational efficiency, and quality of care. Statistical analysis was performed using R v 3.6.3. Sociodemographic characteristics were included as independent variables. Ordinal logistic regression was used to assess patient satisfaction. Multivariate logistic regression was used to assess factors associated with satisfaction. Results Only 115 patients responded to the survey. About 34.8% of them found virtual clinics more comfortable compared with face-to-face visits, and 65.2% were satisfied with the care received through these clinics. However, 34.8% of the patients could not know the appropriate treatment, and 37.4% thought they did not receive all the needed information about their health condition. Overall, 71.3% of the patients were satisfied with the provided diagnosis. The most common reason for nonsatisfaction with virtual clinics was the lack of clinical examination (62.39%) and difficulty communicating with the physician (42.94%). Conclusion Virtual dermatology clinics can provide satisfactory dermatology care services to the patients during COVID-19 and can reduce the risk of exposure and transmission of the virus. These services have optimal occupational efficiency, patient-satisfaction rate, and quality of care.
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X-linked inhibitor of apoptosis (XIAP) deficiency is a primary immunodeficiency associated with recurrent hemophagocytic lymphohistiocytosis (HLH) episodes. The clinical phenotypes of XIAP deficiency vary, ranging from splenomegaly to life-threatening inflammation. We report a case of XIAP deficiency with unusual late-onset HLH presentation likely triggered by a drug allergy. A previously healthy adolescent boy presented to the hospital with fever and rash seven days after starting antibiotics for a neck abscess. Laboratory evaluation demonstrated cytopenias, elevated liver enzymes, and increased inflammatory markers. Initially, antibiotics were discontinued due to concern for drug rash. He continued to deteriorate clinically and became hypotensive. Additional testing revealed decreased NK cell function, as well as elevated ferritin, triglycerides, and soluble IL-2 receptor. SLAM-Associated Protein (SAP) and XIAP evaluation by flow cytometry demonstrated decreased XIAP expression. Subsequently, genetic testing revealed a known pathogenic mutation in BIRC4 (c.421_422del), confirming the diagnosis of XIAP deficiency.Copyright © 2023
ABSTRACT
The revise is given as follows: The rapid emergence of the super-spreader COVID-19 with severe economic calamities with devastating social impact worldwide created the demand for effective research on the spread dynamics of the disease to combat and create surveillance systems on a global scale. In this study, a novel hybrid Deterministic Autoregressive Fractional Integral Moving Average (ARFIMA) model is presented to forecast the bimodal COVID-19 transmission dynamics. The heterogeneity of multimodal behavior of the COVID-19 pandemic in Pakistan is modeled by a hybrid paradigm, in which a deterministic pattern is combined with the ARFIMA model to absorb the inherent chaotic pattern of the pandemic spread. The fractional fluctuation of the real epidemic system is effectively taken as a paradigm by stochastic type improved the deterministic model and ARFIMA process. Special transformations are also introduced to enhance the convergent rate of the bimodal paradigm in deterministic modeling. The outcome of the improved deterministic model is combined with the ARFIMA model is evaluated on the spread pattern of pandemic data in Pakistan for the next 30 days. The performance-indices of the hybrid-model based on Relative-Errors and RMSE statistics confirmed the effectiveness of the proposed paradigm for long-term epidemic modeling compared to other classical and machine learning algorithms. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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Background: Trichotillomania and skin picking are two forms of body focused repetitive behaviors [BFRBs] classified among Obsessive Compulsive Disorders. Socio-governmental changes which had accompanied COVID-19 overwhelmed patients with BFRBs whom already experienced anxiety and social isolation. Our study was designed to determine if there is an association between COVID-19 pandemic and worsening of symptoms of BFRB disorders ( in particular, trichotillomania and skin picking patients). Methods: Cross-sectional online survey-based study conducted from June to August 2021. The survey collected data about participants sociodemographic, knowledge, concerns, and psychological impacts by using Massachusetts General Hospital Hair Pulling Scale ( MGHHPS) and/or modified skin picking scale-revised (SPS-R). Results: A total of 171 participants joined the study including 34 (19.9%) male and 137 (80.1%) females. There was a significant difference of the total modified SPS-R (max 32), the mean score has increased by 7.62 during COVID-19 (t=6.42, p<0.001). Also, 7 parameters (subscales) are statistically significant. There was a significant difference of Frequency of urges, the mean score has increased during COVID-19 by 1.33 (t=3.16, p<0.05=0.025). Conclusion: Throughout COVID-19 pandemic in Saudi Arabia, results revealed clearly the significant negative psychological impact of it on the population, specifically on those with BFRBs. The study gives a clue that both diseases are under-diagnosed, hence, the authors suggest conducting community screening programs for early and proper management. We suggest providing more attention and further protective psychological strategies during such stressful situations that go parallel with the physical health care plans.
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Background. Children infected with SARS-CoV-2 often have mild or no symptoms, making symptom screening an ineffective tool for determining isolation precautions. As an infection control measure, universal pre-procedural and admission SARS-CoV-2 testing for pediatric patients was implemented in April and August 2020, respectively. Limited data exist on the utility screening programs in the pediatric population. Methods. We performed a retrospective cohort study of pediatric patients (birth to 18 years) admitted to a tertiary care academic medical center from April 2020 to May 2021 that had one or more SARS-CoV-2 point-of-care or polymerase chain reaction tests performed. We describe demographic data, positivity rates and repeat testing trends observed in our cohort. Results. A total of 2,579 SARS-CoV-2 tests were performed among 1,027 pediatric inpatients. Of these, 51 tests (2%) from 45 patients (4.3%) resulted positive. Community infection rates ranged from 4.5-60 cases/100,000 persons/day during the study period. Hispanic patients comprised 16% of the total children tested, but were disproportionately overrepresented (40%) among those testing positive (Figure1). Of 654 children with repeated tests, 7 (0.1%) converted to positive from a prior negative result. Median days between repeat tests was 12 (IQR 6-45), not necessarily performed during the same hospital stay. Five of these 7 patients had tests repeated < 3 days from a negative result, of which only 2 had no history of recent infection by testing performed at an outside facility. Pre-procedural tests accounted for 35% of repeat testing, of which 0.9% were positive. Repeated tests were most frequently ordered for patients in hematology/ oncology (35%) and solid organ transplant/surgical (33%) wards, each with < 3% positive conversion rate. Notably, no hematopoietic stem cell transplant patients tested positive for SARS-CoV-2 during the study period. Conclusion. The positivity rate of universal pre-procedural and admission SARSCoV-2 testing in pediatric patients was low in our inpatient cohort. Tests repeated < 3 days from a negative result were especially low yield, suggesting limited utility of this practice. Diagnostic testing stewardship in certain populations may be useful, especially as community infection rates decline.
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Assessing and improving the safety of social settings is pivotal for the reopening of facilities and institutions during the pandemic. Recent discoveries now suggest that the predominant medium of SARS-CoV-2 transmission is exposure to infectious respiratory aerosols. Airborne viral spread is particularly effective in indoor environments-which have been strongly implicated in high transmission rates and super-spreading events. This study focuses on computational fluid dynamics models developed to study the specific ventilation features of an indoor space and their effects on indoor particle spread. A case study is conducted on a typical classroom at the Cooper Union. Masked occupants are modeled in the room as aerosol sources to compare the performance of different ventilation settings on the exhaust rates of airborne particles. Simulation results reveal that increasing ventilation rates accelerate particle evacuation. Visualization and segregated data comparisons indicate regions of particle accumulation induced by the design and geometry of the classroom in relation to its occupants. Visualization is also used to observe a uniform distribution of airborne particles after only 10 minutes of simulated time-confirming the need for safety measures beyond the six feet distancing guideline. © 2021 by ASME.
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The symptoms of COVID-19 varies from mild to severe. The risk of severe infection occurs about 10% of cases, while the risk of death occurs about 0-14.6% of cases. One of the suspected pathophysiology in cases of severe infection and death of COVID-19 is due to cytokine storms. Exosome plays a vital role in the pathogenesis of several diseases, including severe disease such as sepsis due to cytokine storm. Exosome has been proven as a nanomaterial carrier that can tackle cytokine storm in the treatment of severe COVID-19 infection. Several studies have been conducted for this purpose, and its clinical application continually increases. This review will explore the role of exosomes in cytokine storms that occur in patients with COVID-19 and seek the opportunity to use exosomes in their management. © 2020, Sanglah General Hospital. All rights reserved.