National early warning score on admission as risk factor for invasive mechanical ventilation in COVID-19 patients: A STROBE-compliant study.

ABSTRACT: The coronavirus disease (COVID-19) has become a global pandemic. Invasive mechanical ventilation is recommended for the management of patients with COVID-19 who have severe respiratory symptoms. However, various complications can develop after its use. The efficient and appropriate management of patients requires the identification of factors associated with an aggravation of COVID-19 respiratory symptoms to a degree where invasive mechanical ventilation becomes necessary, thereby enabling clinicians to prevent such ventilation. This retrospective study included 138 inpatients with COVID-19 at a tertiary hospital. We evaluated the differences in the demographic and clinical data between 27 patients who required invasive mechanical ventilation and 111 patients who did not. Multivariate logistic regression analysis indicated that the duration of fever, national early warning score (NEWS), and lactate dehydrogenase (LDH) levels on admission were significantly associated with invasive mechanical ventilation in this cohort. The optimal cut-off values were: fever duration ≥1 day (sensitivity 100.0%, specificity 54.95%), NEWS ≥7 (sensitivity 72.73%, specificity 92.52%), and LDH >810 mg/dL (sensitivity 56.0%, specificity 90.29%). These findings can assist in the early identification of patients who will require invasive mechanical ventilation. Further studies in larger patient populations are recommended to validate our findings.

Multiple cranial nerve palsies with small angle exotropia following COVID-19 mRNA vaccination in an adolescent: A case report.

BACKGROUND: Several vaccines against the severe acute respiratory syndrome coronavirus 2 have been approved and widely distributed, raising public concerns regarding the side effects of immunization, as the incidence of ease. Although many adverse events following the coronavirus disease 2019 (COVID-19) vaccine have been reported, neurological complications are relatively uncommon. Herein, we report a rare case of multiple cranial palsies following COVID-19 vaccination in an adolescent patient. CASE SUMMARY: A previously healthy, 14-year-old Asian girl with facial palsy presented to the emergency department with inability to close the right eye or wrinkle right side of the forehead, and pain in the right cheek. She had received second dose of the COVID-19 mRNA vaccine (Pfizer-BioNTech) 18 days before onset of symptoms. She was diagnosed with Bell's palsy and prescribed a steroid (1 mg/kg/day methylprednisolone) based on symptoms and magnetic resonance imaging findings. However, the next day, all sense of taste was lost with inability to swallow solid food; the gag reflex was absent. Horizontal diplopia was also present. Due to worsening of her condition, she was given high-dose steroids (1 g/day methylprednisolone) for 3 days and then discharged with oral steroids. Improvement in the symptoms was noted 4 days post steroid treatment completion. At the most recent follow-up, her general condition was good with no symptoms except diplopia; ocular motility disturbances were noted. Hence, prism glasses were prescribed for diplopia relief. CONCLUSION: Small-angle exotropia was observed in the facial, trigeminal, and glossopharyngeal nerve palsies, in our patient. The etiology of this adverse effect following vaccination was thought to be immunological.

Assessment of information on YouTube on the effect of acupuncture in patients with COVID-19: A cross-sectional study.

Medical-related information rapidly spreads throughout the internet. However, these types of information often contain inaccurate information, which can lead to harmful misconceptions. In this study, we evaluated the reliability, quality, and accuracy of videos uploaded on YouTube that harbor claims on the effects of acupuncture on COVID-19 treatment. This is a cross-sectional study. Videos uploaded on YouTube up to February 17, 2022, were searched, and the keywords used were as follows: "acupuncture," "coronavirus," "COVID 19," "COVID-19," "Corona," "COVID," and "SARSCoV2." The top 50 videos in English were viewed and evaluated. The reliability of the videos was evaluated using the modified DISCERN scale, the content-quality was evaluated using the Global Quality Scale. The accuracy of the information in each video was evaluated as well. Of the 50 videos, only 8% were found to be reliable and 64% were of poor quality. Additionally, 98% of the videos were misleading. The mean modified DISCERN scores was 1.72 and the mean Global Quality Scale score was 2.06. Despite the videos being made by experts, their reliability, content-quality, and accuracy were found to be low. The spread of inaccurate information may result in the use of inappropriate and potentially harmful treatment methods for patients. Videos that contain medical information should be produced based on verified scientific evidence.

Assessment of information on YouTube on the effect of acupuncture in patients with COVID-19: A cross-sectional study

Medical-related information rapidly spreads throughout the internet. However, these types of information often contain inaccurate information, which can lead to harmful misconceptions. In this study, we evaluated the reliability, quality, and accuracy of videos uploaded on YouTube that harbor claims on the effects of acupuncture on COVID-19 treatment. This is a cross-sectional study. Videos uploaded on YouTube up to February 17, 2022, were searched, and the keywords used were as follows: “acupuncture,” “coronavirus,” “COVID 19,” “COVID-19,” “Corona,” “COVID,” and “SARSCoV2.” The top 50 videos in English were viewed and evaluated. The reliability of the videos was evaluated using the modified DISCERN scale, the content-quality was evaluated using the Global Quality Scale. The accuracy of the information in each video was evaluated as well. Of the 50 videos, only 8% were found to be reliable and 64% were of poor quality. Additionally, 98% of the videos were misleading. The mean modified DISCERN scores was 1.72 and the mean Global Quality Scale score was 2.06. Despite the videos being made by experts, their reliability, content-quality, and accuracy were found to be low. The spread of inaccurate information may result in the use of inappropriate and potentially harmful treatment methods for patients. Videos that contain medical information should be produced based on verified scientific evidence.

YouTube as a source of information regarding the effect of vitamin C on coronavirus disease.

OBJECTIVES: With the expansion of the internet, social media platforms have become a major source of medical information. However, medical information on online multimedia platforms is often inaccurate. In the current study, we evaluated the reliability, quality, and accuracy of the most viewed YouTube videos featuring the effects of vitamin C on COVID-19. METHODS: A search was conducted on YouTube on January 13, 2022, using the keywords ("ascorbic acid" OR "vitamin C" OR "sodium ascorbate" OR "L-ascorbic") AND ("coronavirus" OR "COVID 19" OR "COVID-19" OR "Corona" OR "COVID" OR "SARSCoV2"). We assessed the 50 most-viewed videos using a modified DISCERN scale (mDISCERN) and Global Quality Scale (GQS). Additionally, the accuracy of the information in each video was evaluated. RESULTS: Out of the 50 most-viewed videos featuring the effect of vitamin C on COVID-19, 54% were not reliable. Furthermore, 62% presented poor quality, and 74% were misleading or neither accurate nor misleading. The average mDISCERN and GQS scores of the 50 included videos were 2.2 ± 1.4 (≥ 3: highly reliable) and 2.2 ± 1.1 (2: generally poor), respectively. Although the videos were made by medical doctors, their reliability, quality, and accuracy were not significantly different from those displayed in other sources, including fitness channels, television or internet-based news or programs, consumers, company channels, product advertisements, or prepared by nurses. CONCLUSIONS: The reliability, quality, and accuracy of the 50 most-viewed videos on the effect of vitamin C on COVID-19 were not high. Video creators, especially medical doctors, should make an effort so that the videos present reliable content with high-quality and correct information is disseminated to people.

The pros and cons of entry restrictions: are entry restrictions really effective in preventing the spread of SARS-CoV-2?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide, leading the World Health Organization to declare coronavirus disease 2019 (COVID-19) a pandemic. To curb the unchecked spread of SARS-CoV-2 infection, most countries have enforced travel restrictions. However, it is debatable whether such restrictions are effective in containing infections and preventing pandemics. Rather, they may negatively impact economies and diplomatic relationships. Each government should conduct an extensive and appropriate analysis of its national economy, diplomatic status, and COVID-19 preparedness to decide whether it is best to restrict entering travelers. Even if travelers from other countries are allowed entry, extensive contact tracing is required to prevent the spread of COVID-19. In addition, governments can implement "travel bubbles," which allow the quarantine-free flow of people among countries with relatively low levels of community transmission. An accurate evaluation of the benefits and losses due to entry restrictions during the COVID-19 pandemic would be helpful in determining whether entry restrictions are an effective measure to reduce the spread of infection in future pandemics.

The effectiveness of high-dose intravenous vitamin C for patients with coronavirus disease 2019: A systematic review and meta-analysis.

OBJECTIVES: Vitamin C has anti-inflammatory effects. This review aimed to investigate the therapeutic effect of high-dose intravenous vitamin C (HDIVC) in patients with coronavirus disease 2019 (COVID-19). METHODS: The following key phrases were searched for article inclusion: "Vitamin C OR ascorbic acid" AND "COVID-19 OR coronavirus disease 2019 OR severe acute respiratory syndrome coronavirus 2 OR SARS-CoV-2″. Articles that utilized HDIVC for the management of patients with COVID-19 were included, whereas review articles and case reports were excluded from this review. Moreover, we performed a meta-analysis to evaluate whether HDIVC can reduce the length of hospital stay and in-hospital mortality rate of patients with severe COVID-19. RESULTS: In total, eight articles were included in this review, and five studies were included in the meta-analysis. The length of hospital stay was not significantly different between the HDIVC and control groups. Also, although our meta-analysis showed a tendency for HDIVC to reduce the in-hospital mortality rate in patients with severe COVID-19, the in-hospital mortality rate was not significantly different between patients treated with HDIVC and those who did not receive HDIVC. CONCLUSIONS: Evidence supporting the therapeutic use of HDICV in COVID-19 patients is lacking. Further studies are required for drawing a clear conclusion on this topic.

Incidence of Post-Traumatic Stress Disorder After Coronavirus Disease.

Background: The coronavirus disease (COVID-19) emerged from China and rapidly spread to many other countries. In this study, we investigated the prevalence of post-traumatic stress disorder (PTSD) among patients with COVID-19 who were treated and discharged from a university hospital in Daegu, Korea. Methods: In total, 64 patients who were diagnosed with COVID-19 and then hospitalized, treated and discharged from the university hospital between February and April 2020 participated in our study. We conducted telephone interviews with the participants and evaluated the presence of PTSD using the Post-Traumatic Stress Disorder Checklist-5 (PCL-5) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; score range: 0-80). If a score of ≥33 was obtained, then a diagnosis of PTSD was made. We analyzed the association between PTSD and demographic and clinical characteristics using the Mann-Whitney U and chi-square tests. Results: In total, 13 patients had a PCL-5 score of ≥33, which indicated that 20.3% (n = 64) of the patients had PTSD. No significant differences were observed in demographic characteristics, including, sex, age, hospitalization time and duration after discharge, between patients with PTSD and those without PTSD. Conclusions: The prevalence rate of PTSD was 20.3% in patients with COVID-19 who had been hospitalized, treated and discharged. Accordingly, clinicians should be aware of the high possibility of PTSD among COVID-19 patients. Mental health interventions supporting the mental health of patients should be provided to affected patients.

Psychological impact of COVID-19 on hospital workers in nursing care hospitals.

AIM: This study aimed to explore coronavirus disease-related psychological stress in hospital workers in nursing care hospitals during the coronavirus disease epidemic. DESIGN: Cross-sectional observational study. METHODS: A questionnaire survey was administered to hospital workers at three nursing care hospitals. RESULTS: Fifty-four workers at three nursing care hospitals (9, 29 and 16 works) responded to our survey. Twenty-four workers (50%) scored ≥5 on the Generalized Anxiety Disorder Scale, indicating the presence of anxiety. For the Patient Health Questionnaire-9, six employees (11.1%) scored ≥10 scores, indicating the presence of depression. Workers who lived with other people with chronic underlying diseases showed significantly higher incidence of the presence of anxiety and depression. In binary logistic regression analysis, when living with persons with chronic underlying diseases, the risk of the presence of depression increased. Also, there was a higher incidence of depression in occupational therapists compared with physical therapists and nurses.

Chest Computed Tomography Findings in Asymptomatic Patients with COVID-19.

BACKGROUND: Little is known about the damage to the respiratory system in asymptomatic patients with coronavirus disease (COVID-19). OBJECTIVE: Herein, we evaluate the findings of chest computed tomography (CT) and radiography in patients with COVID-19 who were asymptomatic. METHODS: We retrospectively investigated patients with a confirmed diagnosis of COVID-19 but who did not show any symptoms. Among the 139 patients with COVID-19 who were hospitalized in Yeungnam University Hopistal in Daegu, South Korea, 10 (7.2%) were asymptomatic. Their chest CT and radiographic findings were analyzed. RESULTS: In the results, all patients (100%) had ground-glass opacity (GGO) on chest CT. Further, the GGO lesions were predominantly distributed peripherally and posteriorly in all patients. In 9 (90%) patients, the GGO lesions were combined with reticular opacity. Air bronchogram due to bronchiolectasis surrounded by GGO was observed in 8 patients (80%). Additionally, the lung lesions were dominant on the right side in all patients. CONCLUSIONS: In conclusion, considering our results that the lung is affected in asymptomatic patients, it will be necessary to extend the indications of COVID-19 testing for effective management of COVID-19 during the pandemic.

Fasting Plasma Glucose Level Independently Predicts the Mortality of Patients with Coronavirus Disease 2019 Infection: A Multicenter, Retrospective Cohort Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a global pandemic, which prompts a consensus for the necessity to seek risk factors for this critical disease. Risk factors affecting mortality of the disease remain elusive. Diabetes and hyperglycemia are known to negatively affect a host's antiviral immunity. We evaluated the relationship between a history of diabetes, fasting plasma glucose (FPG) levels and mortality among severely ill patients with COVID-19. METHODS: This was a retrospective cohort study that assessed 106 adult inpatients (aged ≥18 years) from two tertiary hospitals in Daegu, South Korea. The participants were transferred to tertiary hospitals because their medical condition required immediate intensive care. The demographic and laboratory data were compared between COVID-19 patients who survived and those who did not. RESULTS: Compared with the survivor group, age, and the proportions of diabetes, chronic lung disease and FPG were significantly higher in the deceased group. In the Cox proportional hazards regression model for survival analysis, FPG level and age were identified as significant predictors of mortality (P<0.05). The threshold values for predicting high mortality were age >68 years and FPG of 168 mg/dL, respectively. Among those without diabetes, high FPG remained a significant predictor of mortality (P<0.04). CONCLUSION: High FPG levels significantly predicted mortality in COVID-19, regardless of a known history of diabetes. These results suggest intensive monitoring should be provided to COVID-19 patients who have a high FPG level.

Lessons from South Korea Regarding the Early Stage of the COVID-19 Outbreak.

South Korea has experienced difficulty in controlling the spread of the novel coronavirus disease (COVID-19) during the early stages of the outbreak. South Korea remains passionately determined to protect Koreans against COVID-19 and through trial and error hopes to improve the strategies used to limit the outbreak. Here, we review how COVID-19 spread and what prevention strategies were implemented during the early stages of the outbreak in South Korea. We investigated online newspapers published in South Korea from 21 January 2020 to 20 March 2020, and reviewed academic medical articles related to COVID-19. Additionally, we acquired data on COVID-19 cases through the official website for COVID-19 in South Korea. To date, numerous measures have been applied by the government and the medical community during the early stages of the COVID-19 outbreak including the reporting of methods for diagnostic testing, patient classification, the introduction of drive-through screening centers, COVID-19 preventive measures, implementation of government policies for the shortage of face masks, and entry restrictions. Here, we present data from the early stages of the COVID-19 outbreak and measures to prevent its spread in South Korea. We believe that sharing the experience of South Korea during the COVID-19 outbreak can help other countries to implement strategies to prevent its rapid transmission.

Strategies for the Prevention of the Intra-Hospital Transmission of COVID-19: A Retrospective Cohort Study.

Coronavirus disease (COVID-19) has spread rapidly worldwide. We aimed to review the strategies used by our university hospital in Daegu (South Korea) to prevent the transmission of COVID-19 within our institution. We also investigated the actual situation at our hospital against the recommended guidelines. We conducted a survey among patients and staff in our hospital. Additionally, patients' electronic medical records were reviewed along with closed-circuit television (CCTV) recordings. Various strategies and guidelines developed by our hospital have been implemented. A total of 303 hospital staff and patients had exposure to 29 confirmed COVID-19 patients. Of them, three tested positive for COVID-19 without further transmission. The intra-hospital infection of the disease occurred when the recommended strategies and guidelines such as wearing a mask and isolating for 2 weeks were not followed. In conclusion, the implementation of robust guidelines for preventing the intra-hospital transmission of COVID-19 is essential.

Neurological diseases as mortality predictive factors for patients with COVID-19: a retrospective cohort study.

INTRODUCTION: In the current study, we evaluated factors that increase the coronavirus disease (COVID-19) patient death rate by analyzing the data from two cohort hospitals. In addition, we studied whether underlying neurological diseases are risk factors for death. METHODS: In this retrospective cohort study, we included 103 adult inpatients (aged ≥ 18 years). We evaluated differences in demographic data between surviving and non-surviving COVID-19 patients. RESULTS: In a multivariate logistic analysis, age and the presence of chronic lung disease and Alzheimer's dementia (AD) were the only significant parameters for predicting COVID-19 non-survival (p < 0.05). However, hypertension, coronary vascular disease, dyslipidemia, chronic kidney disease, diabetes, and history of taking angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme (ACE) inhibitors, as well as nonsteroidal anti-inflammatory drugs (NSAIDs), were not significantly associated with the death of COVID-19 patients. The optimal cutoff value obtained from the maximum Youden index was 70 (sensitivity, 80.77%; specificity, 61.04%), and the odds ratio of non-survival increased 1.055 fold for every year of age. CONCLUSIONS: Clinicians should closely monitor and manage the symptoms of COVID-19 patients who are over the age of 70 years or have chronic lung disease or AD.

Risk factors for disease progression in COVID-19 patients.

BACKGROUND: Coronavirus disease (COVID-19) is rapidly spreading worldwide. Although 10-20% of patients with COVID-19 have severe symptoms, little is known about the risk factors related to the aggravation of COVID-19 symptoms from asymptomatic or mild to severe disease states. METHODS: This retrospective study included 211 patients who were asymptomatic or with mild presentations of COVID-19. We evaluated the differences in demographic and clinical data between the cured (discharged to home) and transferred (aggravated to severe-stage COVID-19) groups. RESULTS: A multivariate logistic analysis showed that body temperature, chills, initial chest X-ray findings, and the presence of diabetes were significantly associated with predicting the progression to severe stage of COVID-19 (p < 0.05). The odds ratio of transfer in patients with COVID-19 increased by 12.7-fold for abnormal findings such as haziness or consolidation in initial chest X-ray, 6.32-fold for initial symptom of chills, and 64.1-fold for diabetes. CONCLUSIONS: Even if patients are asymptomatic or have mild symptoms, clinicians should closely observe patients with COVID-19 presenting with chills, body temperature > 37.5 °C, findings of pneumonia in chest X-ray, or diabetes.

Analysis of SARS-CoV-2 Screening Clinic (Including Drive-Through System) Data at a Single University Hospital in South Korea from 27 January 2020 to 31 March 2020 during the COVID-19 Outbreak.

In this study, we evaluated the efficiency of a drive-through (DT) screening system for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by comparing it with a conventional screening system. We reviewed and analyzed the SARS-CoV-2 screening data obtained at our university hospital. We compared the number of tests for SARS-CoV-2 (using real-time polymerase chain reaction) performed using two different specimen collection systems-DT and conventional-during the coronavirus disease 2019 (COVID-19) outbreak in Daegu. Based on the results, the DT screening system collected 5.8 times more specimens for testing than the conventional screening system. From January 27 to 31 March 2020, 6211 individuals were screened for SARS-CoV-2 infection using either the DT or conventional system. In total, 217 individuals tested positive for SARS-CoV-2 (positive rate: 3.50%). Of the 6211 individuals, 3368 were symptomatic or had a history of contact with COVID-19 patients, and 142 of them tested positive for SARS-CoV-2 (positive rate: 4.22%). Further, 2843 individuals were asymptomatic and had no history of contact with COVID-19 patients, and 75 of them tested positive for SARS-CoV-2 (positive rate: 2.64%). In conclusion, the DT system allowed clinicians to collect specimens for SARS-CoV-2 screening more efficiently than the conventional system. Furthermore, as there might be several COVID-19 patients who remain asymptomatic, expanding the screening test to asymptomatic individuals would be necessary.

The Mental Health Burden of the COVID-19 Pandemic on Physical Therapists.

We evaluated the mental health burden of coronavirus disease (COVID-19) on physical therapists, including their stress and anxiety levels, who were at risk of developing psychological distress and other mental health symptoms. A questionnaire survey was conducted with physical therapists of three university hospitals in South Korea on 10 April 2020. The questionnaires evaluated the presence of anxiety and depression in the respondents. Among the 65 physical therapists who completed our survey, 21 (32.3%) and 12 (18.5%) physical therapists reported having symptoms of anxiety and depression, respectively. If a physical therapist was living with a ≤6-year-old infant or child, the possibility of the presence of anxiety was significantly higher. The risk of depression among those who were in their 30 s and 50 s was significantly higher than among those in their 20 s. Thus, physical therapists living with a ≤6-year-old infant or child and those in their 30 s and 50 s need special attention.