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Aims: COVID-19 leaves diverse sequalae beyond the acute illness, referred to as 'long COVID'. However, the aetiology, characteristics and risk factors of Long-COVID is still lacking. COVID-19 patients experience various stressful events and suffer emotional distress which causes post-traumatic stress disorders. This study aimed to investigate association between of perceived distress to COVID-19 infection and long COVID. Method(s): Data from 56 patients who visited the psychiatric department of our post-COVID clinic between March and June 2022 were analysed. All patients completed a subjective symptom checklist [32 symptoms in eight categories], selected cognitive function tests [digit span test, trail making test (TMT), and Stroop word colour interference test], and validated neuropsychological scales [Hospital Anxiety and Depression Scale (HAS and HDS), Pittsburgh sleep quality index (PSQI) and Impact of event scale-revised (IES-R)]. We classified patients into two groups, 'High distress group'(N = 37) and 'Low distress group (N = 19) through IES-R score (cut-off = 25). The frequency and severity of long COVID-symptoms between the two groups were compared with Mann-whitney and chi-square test. Result(s): The average age of the patients was 53.34 years, and 70.53 days had passed from the SARS-CoV-2 confirmation using RTPCR. 'High distress group' showed higher HAS (284 vs. 455, p = .01), HDS (197 vs. 387, p = .032), and PSQI (238 vs. 428, p = .05) scores and suffered shortness of breath, palpitation, tingling, subjective memory deficit more frequently. Regarding neurocognitive functioning, there was no difference between two groups. Conclusion(s): Managing perceived distress due to COVID-19 could alleviate the long-covid sequalae especially in neuropsychiatric area.
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[Background] Sleep is closely related to immune function and human health, and adequate sleep is an important foundation for human health. [Objective] This study investigates the sleep status of the first-line medical staff in Wuhan in a fight against the coronavirus disease 2019 (COVID-19) outbreak, provides reference for improving the sleep quality of the first-line medical staff in public health emergencies. [Methods] Through convenience sampling, 112 medical workers (first-line group) who aided the COVID-19 fight in Wuhan and 134 medical staff (non-first-line group) who did not participate in the fight were selected. The Pittsburgh Sleep Quality Index (PSQI) was employed to collect data on the incidence of sleep disorders, time to fall asleep, duration of sleep, sleep efficiency, sleep disorders, use of sleep aid, and daytime functions. In addition, a self-made questionnaire was used to investigate the common concerns and time allocation characteristics of the first-line medical workers in the context of major infectious disease outbreaks. [Results] There were no significant differences between the two groups in demographic variables such as gender, age, job title, educational background, marriage status, number of children, and working years (P > 0.05). In the first-line group, 62 medical workers (55.36%) reported sleep disorders, while in the non-first-line group, 54 medical workers (40.30%) did;the difference was statistically significant (P=0.008). Among the seven components of the PSQI, the median sleep time (component 3) score of the first-line group was 1.5, which was higher than that of the non-first-line group (median 1.0) (P < 0.001);the median sleep efficiency (component 4) score of the first-line group was 1.0, which was higher than that of the non-first-line group (median 0) (P < 0.001). The actual sleep duration of the first-line group [(5.65+/-1.15) h] was lower than that of the non-first-line group [(7.00+/-1.40) h] (P < 0.001). The distributions of common concerns were different between the two group. The top three concerns were being infected (76.79%), exhausted (37.50%), and overloaded (27.68%) in the first-line group, and family members being infected (53.73%), being infected (45.52%), and child care (33.58%) in the non-first-line group. [Conclusion] The first-line medical team members report poor sleep quality, short sleep time, low sleep efficiency, sleep disorders, and many psychological concerns. It is necessary to take appropriate measures to improve their sleep quality.Copyright © 2021, Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.
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Introduction: Dietary therapy for eosinophilic esophagitis (EoE) is an effective first-line treatment aimed at identifying triggers by systematically removing then reintroducing food groups. Success on diet therapy can be augmented by working with a dietitian, but this is not a universal clinical resource. Virtual or telehealth approaches to nutrition care may offer opportunities to implement diet therapy for EoE. We conducted a retrospective study at a tertiary center with six GI dietitians to compare real-world standard in-person versus virtual EoE nutrition practices in terms of access, follow-up< and disease control. Method(s): We identified adults with EoE referred to GI nutrition through query of the electronic medical record by ICD-10 diagnoses and confirmed by chart review. As all nutrition visits prior to the COVID pandemic were performed in-person, standard care was defined as care established in January-December 2019 and virtual care in January-December 2021. Associations were analyzed using Chi-squared and Student's t test (Table). Result(s): A total of 204 patients were included;99 referred for standard in-person and 105 virtual nutrition care. The cohorts did not differ significantly by gender, age at the time of referral, race, and distance lived to our center. Of these, 55.6% (55) standard and 48.6% (51) virtual visits were completed with a dietitian (p=0.341) and 4-food elimination diet was the most commonly planned diet. The majority initiated the diet (80.0% standard, 78.4% virtual, p=0.842) and among them, half successfully attained histologic remission with the elimination phase (63.6% standard, 47.5% virtual, p=0.324). Ultimate treatments plans included remaining on dietary therapy (25.5% standard, 23.5% virtual, p=0.728), no treatment or lost to follow-up (34.6% standard, 25.5% virtual), and medication (25.5% standard, 41.2% virtual). Conclusion(s): There is a growing demand for nutrition care in EoE and in our tertiary practice, we found no differences in the success and response rate on elimination diet or follow-up between patients receiving standard or virtual nutrition care. Virtual approaches to implementing EoE dietary therapy may serve to complement in-person care and offer opportunities for those lacking local dietitian access. However, up to one-third of patients are lost to follow-up or remain untreated, also highlighting a need to identify, understand, and overcome barriers to treatment uptake and disease control .
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Background: Vaccine uptake has been notably lower in minoritized populations in the United States. The impact of previous infection with SARSCoV- 2, disease severity, and persistent symptoms on the uptake of COVID-19 vaccines and boosters in predominantly Black and Latinx communities has not been examined. We aimed to describe correlates of vaccine uptake in a minoritized cohort hospitalized for COVID-19 during the first pandemic wave in New York City, and investigate whether those with more severe initial COVID-19 and persistent symptoms would be less likely to get vaccinated. Method(s): This retrospective cohort study included the electronic medical records of the first 894 consecutive adult patients who survived hospitalization for COVID-19 at a large quaternary care medical center in Northern Manhattan between 1 March and 8 April 2020. We ed data regarding demographics, comorbidities, oxygen requirements during hospitalization, persistence of symptoms at 3- and 6-months after admission, COVID-19 vaccinations through November 2022, and influenza vaccination during the 2018-2019 through 2021-2022 seasons. Unadjusted and adjusted logistic regression analyses were conducted to describe the predictors of COVID-19 vaccination, delayed vaccination (first dose after 6 May 2021), and receipt of a booster vaccine. Statistical analyses were performed using R V.4.2.1. Result(s): The cohort of 894 patients was predominantly Latinx (54%) and Non- Hispanic Black (15%). 41% received at least one influenza vaccine pre-COVID, and 67% had at least one comorbidity. 22% (199/894) remained COVID-19 unvaccinated. Of the individuals who received at least one dose of COVID-19 vaccine, 57% (397/695) received at least one booster. Exactly 31% (212/695) delayed vaccination. 25% (27/106) of unvaccinated individuals reported persistent generalized symptoms compared to 18% (78/436) of vaccinated individuals. Multiple logistic regression showed that Hispanic/Latinx ethnicity, age 35-64, and concurrent influenza vaccination were associated with increased COVID-19 vaccine uptake. No association was found between vaccine uptake and disease severity or persistence of symptoms. Conclusion(s): Achieving a deeper understanding of the factors driving vaccine hesitancy is critical to increasing and sustaining acceptance of COVID-19 vaccination especially in communities with historically low uptake of annual vaccines.
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COVID-19 not only led to a significant loss of human lives but also brought indelible economic loss. To transfer the natural disaster risk, a variety of financial instruments written on the environmental phenomena have been developed and issued by financial institutions. The gamma distribution family is characterized by sparsity, heavy tail, and high skewness;thus, it has been widely used to model the data of environmental phenomena. To exploit the versatility of the gamma distribution, Vitiello and Poon propose the pricing model for financial instruments under the general equilibrium risk neutral valuation relationship (RNVR) framework. Though the VP model is capable of pricing financial instruments, their underlying is limited to a single asset. However, the vast majority of firms face various risks and prefer more efficient and cheaper ways to hedge these risks and maintain financial stability. To price multiple-asset financial instruments, this study extends the single-asset VP model to a multi-asset VP model (MVP) under the RNVR framework. Based on the MVP model, this study demonstrates two applications to price basket options and spread options. To manage the pricing of financial instruments that do not have closed-form pricing formulas, this study develops the Monte Carlo simulation method within the MVP model framework. For risk management, this study provides hedge ratios for market practitioners to manage their risk exposures. © 2023 Taylor & Francis Group, LLC.
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Background: Reliable methods to identify anaplastic lymphoma kinase (ALK) fusions are critical to matching patients to ALK tyrosine kinase inhibitors (TKIs) therapy, on or off trial. Various methods including FISH have been used, but immunohistochemistry (IHC) and next-generation sequencing (NGS) are most commonly employed. Evaluating the concordance of IHC and NGS is key, particularly in non-lung cancers where data is sparse. Method(s): NGS+ (MSK-IMPACT DNA hybrid capture NGS and/or RNA anchored multiplex PCR) and/or IHC+ (clone: D5F3) patients with cancers of any histology were identified as ALK+. ALK IHC was scored as negative (0), equivocal (e: 1+, 2+) or positive (3). Concordance of ALK detection (number of NGS+ and IHC+/total number of patients with NGS and IHC) was calculated. For patients with metastatic disease treated with any ALK TKI in the first-line (1L) setting, progression-free survival (PFS) was reported. Result(s): 347 ALK+ solid tumor patients were identified. As expected, the majority (96%, n=336) had lung cancer, however, 11 patients with 11 unique non-lung cancer histologies were found (3 gastrointestinal, 2 gynecologic, 1 breast, 1 thyroid, 1 primary brain tumor, 1 DLBCL, 1 PEComa, and 1 CUP). 57% had EML4-ALK fusions;36 non-EML4 ALK rearrangements were identified, including four novel fusions (PEKHA7-ALK, ZFPM2-ALK, TRIM24-ALK, ALK-MYO3B). ALK was evaluated by IHC alone in 83 patients (23.9%). The concordance rate between NGS and IHC was 85%. Among discordant cases, 11% (n=28) were IHC+/NGS-, 24% (n=63) were IHCe/NGS-, 3% (n=8) were IHCe/NGS+, and 0.4% (n=1) was IHC-/NGS+. The most frequent ALK TKIs were alectinib (n= 87, 58%) and crizotinib (n= 56, 38%). PFS on 1L ALK TKIs for patients with IHC+/NGS+ (n=134), IHC-/NGS+(n=1), IHC+/NGS- (n=8), IHCe/NGS+ (n=4), IHCe/NGS- (n=1) was 26 months, 26 months, 39 months, 41 months, 9 months respectively. Conclusion(s): In a population including multiple tumor types, NGS and IHC were highly concordant in ALK fusion detection. ALK TKI benefit may be observed in cases with discordant testing, in which only one assay detects a putative ALK fusion. Legal entity responsible for the study: The authors. Funding(s): NIH Cancer Center grant: P30CA008748. Disclosure: M.G. Kris: Financial Interests, Personal, Research Grant: Boehringer Ingelheim, National Lung Cancer Partnership, Pfizer, PUMA, Stand up to Cancer;Financial Interests, Personal, Advisory Role: Ariad, AstraZeneca, Bind Bioscience, Boehringer Ingelheim, Chug Pharma, Clovis, Covidien, Daiichi Sankyo, Esanex, Genentech;Financial Interests, Personal, Invited Speaker: Boehringer Ingelheim, Novartis, Millenium, Pfizer, Roche. A. Drilon: Financial Interests, Personal, Advisory Board: Ignyta/Genentech/Roche, Loxo/Bayer/Lilly, Takeda/Ariad/Millennium, TP Therapeutics, AstraZeneca, Pfizer, Blueprint Medicines, Helsinn, BeiGene, BerGenBio, Hengrui Therapeutics, Exelixis, Tyra Biosciences, Verastem Oncology, MORE Health, AbbVie, 14ner/Elevation Oncology, Remedica Ltd, ArcherDX, Monopteros, Novartis, EMD Serono, Melendi, Liberum, Repare RX, Amgen, Janssen, EcoR1, Monte Rosa;Financial Interests, Personal, Other, CME: Medscape, Onclive, PeerVoice, Physicians Education Resources, Targeted Oncology, Research to Practice, PeerView Institute, Paradigm Medical Communications, WebMD, MJH Life Sciences, Med Learning, Imedex, Answers in CME, Medscape, Clinical Care Options, AiCME;Financial Interests, Personal, Other, CME, Consulting: Axis;Financial Interests, Personal, Other, Consulting: Nuvalent, Merus, EPG Health, mBrace, Harborside Nexus, Ology, TouchIME, Entos, Treeline Bio, Prelude, Applied Pharmaceutical Science, Inc;Financial Interests, Personal, Invited Speaker: Chugai Pharmaceutical, Remedica Ltd, RV More;Financial Interests, Personal, Stocks/Shares: Treeline Biosciences;Financial Interests, Personal, Royalties: Wolters Kluwer;Financial Interests, Personal, Other, stocks: mBrace;Financial Interests, Institutional, Funding, Research funding: Pfizer, Exelixis, GlaxoSmithKline, Teva, Taiho, PharmaMar;Finan ial Interests, Personal, Funding, Research: Foundation Medicine;Non-Financial Interests, Personal, Member: ASCO, AACR, IASLC;Other, Personal, Other, Food/Beverage: Merck, PUMA, Merus;Other, Personal, Other, Other: Boehringer Ingelheim. All other authors have declared no conflicts of interest.Copyright © 2023 European Society for Medical Oncology
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Introduction: The European Resuscitation Council recommends cardiopulmonary resuscitation (CPR) training at age 12 or earlier to improve CPR utilization. [1] The COVID-19 pandemic has caused limitations on resources and in-person instruction (IPI). Remote video instruction (RVI) may increase participation in CPR education in areas with otherwise limited capacity. Purpose(s): The study compares the efficacy of RVI versus IPI on elementary school students' theoretical knowledge, confidence, and attitudes about CPR. Method(s): Data for in-person and remote instruction was collected in fifth grade classrooms (age 10-11 years) from 2019 to 2021. In the experimental RVI group, a total of 62 students (50.0% female) viewed a thirty-minute video-based lesson, practiced on household objects, and were invited to create their own instructional video. A total of 385 students (53.3% female) in the control IPI group participated in a one-hour traditional lesson with video and hands-on instruction. After their respective lesson, students completed a questionnaire assessing demographics, knowledge, and attitudes about CPR within 24 hours. Result(s): Demographics are listed for the participating students in Table 1. There was a significantly higher rate of previous training for the in-person group. A logistic regression showed that this did not correlate with performance on knowledge items. In-person instruction did not demonstrate superiority to remote video instruction in any of the knowledge items tested, as listed in Table 2. In fact, the students in the RVI group achieved significantly better outcomes in knowledge of compression rate (85.5% vs 55.7%, p<0.001). The RVI group also showed a trend towards superiority in knowledge of the first step of CPR (79.0% vs 68.6%, p=0.0964) Compared to students in the control group, students receiving RVI achieved confidence at similar levels (p=0.546). There was an increase in confidence from a median of 3 to 4 in both the RVI and IPI groups. Students from both groups similarly agreed at high levels that CPR should be required, and that training should start at 5th grade. Of note, the students receiving RVI demonstrated a willingness to disseminate their knowledge, with 37.1% willing to share with 6 or more people. Altogether, these students created 62 videos to share with members of their community. Discussion(s): The results show that remote instruction is a viable method that can achieve similar if not better results versus in-person instruction. A growing body of evidence supports that children as young as 11 years can acquire CPR knowledge and skills. [2] Students in both arms strongly supported training starting in 5th grade. Previous research has shown that younger learners have a higher likelihood of sharing CPR training with others. [3] In our study, a significant portion of students created and planned to share videos with community members, suggesting a powerful multiplier effect.
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Since the beginning of world-wide COVID-19 pandemic, facial masks have been recommended to limit the spread of the disease. However, these masks hide certain facial attributes. Hence, it has become difficult for existing face recognition systems to perform identity verification on masked faces. In this context, it is necessary to develop masked Face Recognition (MFR) for contactless biometric recognition systems. Thus, in this paper, we propose Complementary Attention Learning and Multi-Focal Spatial Attention that precisely removes masked region by training complementary spatial attention to focus on two distinct regions: masked regions and backgrounds. In our method, standard spatial attention and networks focus on unmasked regions, and extract mask-invariant features while minimizing the loss of the conventional Face Recognition (FR) performance. For conventional FR, we evaluate the performance on the IJB-C, Age-DB, CALFW, and CPLFW datasets. We evaluate the MFR performance on the ICCV2021-MFR/Insightface track, and demonstrate the improved performance on the both MFR and FR datasets. Additionally, we empirically verify that spatial attention of proposed method is more precisely activated in unmasked regions. © 2023 IEEE.
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Introduction: Acute kidney injury, microangiopathic hemolytic anemia and thrombocytopenia with multiple organ thrombotic microangiopathy (TMA) are typical characteristic presentation of Atypical hemolytic uremic syndrome(aHUS). Infection, pregnancy, operation, and some medication can be a trigger factor to induce the complement system over activation and induce atypical hemolytic uremic syndrome unstable to a life-threatening condition. Both SARS-CoV-2(Severe Acute Respiratory Syndrome Coronavirus 2) infection and COVID 19 vaccination are reported to be the trigger factors for aHUS. There are no clinical trial enrolled aHUS cases to COVID 19 vaccine or anti SARS-CoV2 agent. Therefore, aHUS became a tough medical issue in this pandemic status. In this study, we evaluate the efficacy and disease activity of aHUS after COVID 19 vaccination. Meanwhile, we analysis the severity of COVID 19 infection in our 21 aHUS cases. Method(s): There are 21 aHUS cases enrolled this study from April 2022 to September 2022. Each cases with regular blood sampling which include hemolysis markers (Hemoglobin, Platelet count, LDH, CH50, haptoglobin, Blood smear), renal function and urine analysis every months. While them had COVID 19 vaccination or COVID 19 infection, the above blood sampling and urine analysis should be followed up two weeks later. Once the aHUS cases became severe condition and need hospitalization, our medical team must visit these cases closely and monitor if any new critical issue happen. We confirmed the serum SARS-CoV-2 Spike IgG and Interferon-gamma (IFNgamma) release assay testing for the vaccination efficacy analysis. Result(s): 21 aHUS cases all had COVID 19 vaccination, 2 cases received 1 dose vaccine, 6 cases received 2 doses vaccine and 13 cases received 3 doses vaccine. Only one case with aHUS unstable after Moderna vaccine injection which is self-limited gradually and didn't need extra dose of anti-complement therapy. Interestingly, this case with stable aHUS disease activity while he switches to Pfizer-BioNTech vaccine as his 2nd dose. The SARS CoV-2 Spike IgG level and IFNgamma level are corelated to the dosage of COVID 19 vaccination, the higher doses with the higher level. The SARS-CoV2 spike IgG and IFNgamma level without lower response to the group with regular anti-C5 treatment. For those complete three dose vaccination cases, mix type of COVID-19 vaccination (AZ/mRNA) with better efficacy trend to fix type of mRNA. During this study period, there are 4 cases with COVID 19 infection. One case (already had 2 doses COVID 19 vaccination) needed hospitalization and improved after remdesivir and dexamethasone treatment who with mild aHUS disease activity progression. Two cases (complete three doses COVID 19 vaccination) with stable aHUS disease activity after Molnupiravir treatment. One case (complete three doses COVID 19 vaccination) refused Molnupiravir treatment and had mild aHUS disease activity progression. Conclusion(s): According to our study, we recommend the aHUS patient to have COVID 19 vaccination and multiple doses are more protective for them. aHUS disease activity should be close monitor especially after COVID 19 vaccination, during COVID 19 infection and after COVID 19 infection. Remdesivir and Molmupiravir are relative safe to use for aHUS cases. No conflict of interestCopyright © 2023
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Since the unprecedented outbreak of the COVID-19, numerous meteorological-normalization techniques have been developed in lockdown-imposed regions to decouple the impacts of meteorology and emissions on the atmospheric environment. However, the application of normalization techniques in regions without lockdown is limited. In this study, we propose a novel research framework to investigate the observed and meteorological-normalized concentrations of nitrogen dioxide (NO2) and ozone (O3) across 62 cities in Taiwan. Four meteorological-normalization techniques, namely, the generalized additive model (GAM), generalized linear model (GLM), gradient boosting machine (GBM), and random forest (RF), were developed, optimized, and compared using meteorological and temporal variables. The models were optimized using a systematic trial-and-error approach for data distribution type in GAM and GLM and a grid-search approach for tree numbers in GBM and RF. Based on the findings, for GLM, the optimal data distribution for both NO2 and O3 modeling was Gaussian, whereas for GAM, the optimal data distribution for NO2 and O3 simulation was quasi- Gaussian and Poisson, respectively. In contrast, for RF and GBM, the optimized number of trees varied significantly by site, ranging from 10 to 6310. The simulation performance of RF and GBM was better than that of GAM and GLM across Taiwan and the best-performing optimized model was selected to identify changes in NO2 and O3 concentrations during COVID-19. Throughout 2020, even in the absence of a lockdown, the daily mean meteorological-normalized NO2 and O3 levels across Taiwan decreased by 14.9% and 5.8%, respectively, providing novel insights for sustainable air quality management.Copyright © 2023
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COVID-19, a highly infectious disease, has affected the globe tremendously since its outbreak during late 2019 in Wuhan, China. In order to respond to the pandemic, governments around the world introduced a variety of public health measures including contact-tracing, a method to identify individuals who may have come into contact with a confirmed COVID-19 patient, which usually leads to quarantine of certain individuals. Like many other governments, the South Korean health authorities adopted public health measures using latest data technologies. Key data technology-based quarantine measures include:(1) Electronic Entry Log;(2) Self-check App;and (3) COVID-19 Wristband, and heavily relied on individual's personal information for contact-tracing and self-isolation. In fact, during the early stages of the pandemic, South Korea's strategy proved to be highly effective in containing the spread of coronavirus while other countries suffered significantly from the surge of COVID-19 patients. However, while the South Korean COVID-19 policy was hailed as a success, it must be noted that the government achieved this by collecting and processing a wide range of personal information. In collecting and processing personal information, the data minimum principle - one of the widely recognized common data principles between different data protection laws - should be applied. Public health measures have no exceptions, and it is even more crucial when government activities are involved. In this study, we provide an analysis of how the governments around the world reacted to the COVID-19 pandemic and evaluate whether the South Korean government's digital quarantine measures ensured the protection of its citizen's right to privacy. Copyright © 2022 KSII.
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INTRODUCTION: Remdesivir was the first antiviral to show clinical benefit in patients with COVID-19. Trials have demonstrated faster recovery in hospitalized patients treated with remdesivir vs placebo. Guidelines recommend treatment with remdesivir based on hospitalization status, oxygen requirements, and time from symptom onset. However, other factors may be evaluated to determine disease severity and risk for progression to critical illness. The 4C mortality score is a validated tool that may be used to categorize patients by mortality risk at the time of hospital admission for COVID-19. The objective of this study was to determine if the 4C mortality score may be used to predict which patients will benefit from remdesivir at the time of hospital admission. METHOD(S): This was a single-center retrospective cohort study comparing time to recovery among hospitalized patients with moderate-to-severe COVID-19 who were treated with remdesivir compared to those treated with standard of care (SOC). The primary outcome was time to recovery, defined as discharge from the hospital or no longer requiring supplemental oxygen, stratified by the 4C mortality score risk group. Secondary outcomes included in-hospital mortality, hospital length of stay, and time to recovery in patients who were started on remdesivir within 7 days vs after 7 days from symptom onset. A survival analysis was used to analyze time to recovery outcomes. RESULT(S): Data was collected and analyzed for a total of 300 patients, of which 200 received remdesivir and 100 received SOC. Patients in the remdesivir group had a longer time to recovery compared to patients in the standard of care group (6 days vs 4 days). This finding was driven by patients who were categorized to the intermediate risk and high risk mortality groups. Additionally, patients who received remdesivir had a longer length of hospital stay compared to those who received standard of care (12 days vs 9 days). Remdesivir was not associated with an increased rate of adverse events. CONCLUSION(S): This study found that patients who were treated with remdesivir had a longer time to recovery and a longer length of stay compared to those who received SOC. These findings add to the body of evidence questioning the benefit of remdesivir therapy among patients hospitalized with COVID-19.
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Background. SARS-CoV-2 vaccination reduces the risk and severity of coronavirus disease 2019 (COVID-19), but immunogenicity may be reduced in patients undergoing hematopoietic stem cell transplantation (HSCT). The variables that impact the humoral response, such as age, gender, disease and transplant type, prior treatments, and vaccine type, have not been comprehensively described. Methods. A retrospective review was conducted at a single-centre of HSCT recipients who received COVID-19 vaccinations between 2020 and 2021. Participants were included if >18 years and had received at least a single dose of Pfizer, Moderna or Johnson & Johnson (J&J) vaccine. Anti-Spike (S) IgG titers were quantitatively measured at provider discretion during routine care using the Roche Elecsys Anti-SARS-CoV-2 spike immunoassay and categorized as Responders (< 0.8U/mL) and Non-responder (>0.8). Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for Responders vs Non-responders. Controlled risk factors included;Age, disease, treatments, and history of graft-versus-host disease (GVHD). Results. Of 117 HSCT patients assessed, 59 (50.4%) were female, 106 (90.6%) were white, and the median age was 62.5 years (interquartile range [IQR, 49.9-67.8). Vaccinations were administered at a median of 179 days post-transplant (IQR 319 - 105) and antibody responses were measured at a median of 135.5 days post-vaccination (IQR 190-50). 106(90.6%) were responders with a mean titre of 1141.5U/mL (SD=1095.3). 35% had Low (< 100U/mL) titres. Being Female (OR 0.02, 95%CI 0.003 - 0.6) was associated with a slightly higher odds of being a responder. Conclusion. Hematopoietic stem cell transplant recipients demonstrated a high prevalence of anti-S IgG antibody positivity following COVID vaccination. However, neither patient characteristics nor treatment regimens were seen to be strongly associated with anti-S protein positivity among HSCT recipients. More studies are needed to further characterize patient and treatment characteristics that correlate with seroprotection among these patients.
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We identified molecular mechanisms by which Isatidis Radix might prevent or mitigate influenza and corona virus disease 2019 (COVID-19) based on chemical composition and network pharmacology. High performance liquid chromatography coupled to tandem quadrupole time-of-flight mass spectrometry (HPLC-QTOF-MS) was used to analyze the components of Isatidis Radix. Seventy compounds were identified, of which 33 prototype compounds entered the blood. Network pharmacological analysis of 41 potential active components demonstrated that Isatidis Radix can regulate protein kinase B1 (AKT1), serum albumin (ALB), glyceraldehyde-3phosphate dehydrogenase (GAPDH), vascular endothelial growth factor A (VEGFA), tyrosine-protein kinase SRC (SRC), epidermal growth factor receptor (EGFR), intercellular adhesion molecule-1 (ICAM1) and other key genes, which have preventive effects on influenza and COVID-19 through hypoxia inducible factor-1 (HIF-1), vascular endothelial growth factor (VEGF), tumor necrosis factor (TNF), influenza A, Toll-like receptor (TLR), phosphatidylinositol-3-kinase-protein kinase B (PI3K-AKT), COVID-19 and other signaling pathways. This study identifies mechanisms by which Isatidis Radix might act against influenza and COVID-19 that are related to the inflammatory response, immunomodulation and viral defense, and provides a basis for subsequent clinical research. All animal experiments were approved by the Ethics Committee of Shenyang Pharmaceutical University (SYPU-IACUCS2020-12.23-201). Copyright © 2022, Chinese Pharmaceutical Association. All rights reserved.
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Purpose: Diverting loop-ostomies are sometimes formed in patients undergoing resection for rectal cancer with primary anastomosis. Timing to reversal is commonly reported between 3-6 months of original surgery, with longstanding issues of delays secondary to low-surgical prioritisation. Our retrospective study over a 5-year period aims to understand the effect on timing to reversal of the COVID-19 pandemic. Method(s): All patients undergoing resection for rectal cancer were identified from the Hospital Episode Statistics data between 01.01.2018 and 01.07.2021. Data was then cross-referenced with patients undergoing reversal surgery. Demographics, time to surgery, length of stay and post-operative morbidity data were collected. Result(s): There were 262 anterior resections performed. 192 patients had resection with primary anastomosis (PA): 85 had formation of loop ileostomy, 23 formation of loop colostomy. Results before March 2020: 65 resections with PA and ileostomy. 34 (52.3%) reversed with median time to reversal of 266 days, (range 98-1015). 16 resections with PA and colostomy. 7 reversed (44%), median time to reversal 476 days (range 104-768). Results after March 2020: 20 resections with PA and loop-ileostomy. 3 have been reversed (15%), with median time to reversal of 211 days, (range 103-449). 7 resections with PA and colostomy, none reversed. Showing reduction in overall stoma-reversal in the post pandemic period (p = 0.000297). Conclusion(s): We will experience ongoing conflicts with prioritisation of caseloads as the ongoing effects of COVID continue. This is the time for novel solutions to a building crisis, such as ring-fenced lists or same-day surgery with ambulatory follow-up.
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Since the last century, animal viruses have posed great threats to the health of humans and the farming industry. Therefore, virus control is of great urgency, and regular, timely, and accurate detection is essential to it. Here, we designed a rapid on-site visual data-sharing detection method for the Newcastle disease virus with smartphone recognition-based immune microparticles. The detection method we developed includes three major modules: preparation of virus detection vectors, sample detection, and smartphone image analysis with data upload. First, the hydrogel microparticles containing active carboxyl were manufactured, which coated nucleocapsid protein of NDV. Then, HRP enzyme-labeled anti-NP nanobody was used to compete with the NDV antibody in the serum for color reaction. Then the rough detection results were visible to the human eyes according to the different shades of color of the hydrogel microparticles. Next, the smartphone application was used to analyze the image to determine the accurate detection results according to the gray value of the hydrogel microparticles. Meanwhile, the result was automatically uploaded to the homemade cloud system. The total detection time was less than 50 min, even without trained personnel, which is shorter than conventional detection methods. According to experimental results, this detection method has high sensitivity and accuracy. And especially, it uploads the detection information via a cloud platform to realize data sharing, which plays an early warning function. We anticipate that this rapid on-site visual data-sharing detection method can promote the development of virus selfchecking at home.
ABSTRACT
SESSION TITLE: COVID-19 Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: COVID-19 patients requiring admission to an ICU have a higher risk of invasive pulmonary aspergillosis (IPA) with a reported incidence of 19.6%-33.3%. CASE PRESENTATION: A 63-year-old male presented with progressively worsening dyspnea for one week. He has a past medical history of atrial fibrillation, hypertension, and obesity. He was tested positive for COVID about two weeks prior. He did receive a single dose of Moderna vaccine. Initial chest x-ray(CXR) showed diffuse ground-glass opacities. He was initiated on Remdesivir and decadron, and later received a dose of tocilizumab. He was intubated on hospital day 3 for worsened hypoxemia. Repeat CXR suggested some improvement but a new left lower lobe airspace haziness. He also had new-onset leukocytosis with elevated procalcitonin level. He was started on cefepime for concern of superimposed hospital-acquired pneumonia. A second dose of tocilizumab was administered. No clinical improvement was seen, and additional workups were obtained. Serial CXRs revealed increasing diffuse airspace opacities concerning for ARDS. Tracheal aspirate culture grew coagulase-negative staphylococcus and Aspergillosis Fumigatus. Cefepime was changed to vancomycin, and voriconazole and caspofungin were added. Unfortunately, the patient's respiratory status worsened with increasing ventilation requirement. He also developed septic shock and acute renal failure requiring CVVH. He became even more hypotensive after CVVH initiation, and multiple vasopressors were required to maintain his hemodynamics. Unfortunately, he continued to deteriorate and he also developed profound respiratory acidosis. He died shortly afterwards after family decided to withdraw care. DISCUSSION: In this case, in addition to superimposed bacterial pneumonia, pulmonary aspergillosis likely also contributed to his clinical deterioration. The mechanism by which fungal infections develop in COVID-19 infection is not well-understood. Severe COVID-related immune dysregulation, ARDS, and high-dose steroids use are potential culprits for the increased risk of IPA. Tocilizumab, an IL-6 receptor monoclonal antibody used in patients with severe COVID-19 infection, may also predispose the patient to IPA according to post-marketing data. The mortality rate from current case reports is as high as 64.7%. Diagnosis and treatment in such a scenario remain a challenge. Sputum culture, serum Beta-galactomannan, Beta-D glucan, and aspergillosis PCR have low sensitivity. Tissue biopsy and CT scan in critically ill patients are often not feasible. Voriconazole is usually considered the first-line treatment in IPA. CYP3A4-mediated drug interactions between azoles and antiviral agents require further investigation. CONCLUSIONS: Clinicians should be aware that severe COVID-19 patients are at higher risk of IPA. The prognosis is poor. Early detection and treatment in clinically deteriorated patients are warranted. Reference #1: Borman, A.M., Palmer, M.D., Fraser, M., Patterson, Z., Mann, C., Oliver, D., Linton, C.J., Gough, M., Brown, P., Dzietczyk, A. and Hedley, M., 2020. COVID-19-associated invasive aspergillosis: data from the UK National Mycology Reference Laboratory. Journal of clinical microbiology, 59(1), pp.e02136-20. Reference #2: Lai CC, Yu WL. COVID-19 associated with pulmonary aspergillosis: A literature review. J Microbiol Immunol Infect. 2021;54(1):46-53. doi:10.1016/j.jmii.2020.09.004 Reference #3: Thompson Iii GR, Cornely OA, Pappas PG, et al. Invasive Aspergillosis as an Under-recognized Superinfection in COVID-19. Open Forum Infect Dis. 2020;7(7):ofaa242. Published 2020 Jun 19. doi:10.1093/ofid/ofaa242 DISCLOSURES: No relevant relationships by Jason Chang No relevant relationships by Jason Chang No relevant relationships by kaiqing Lin No relevant relationships by Guangchen Zou