COVID-19 and Mucormycosis of Orofacial Region: A Scoping Review.

During the second wave of coronavirus disease, or COVID-19, infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in the year 2021 around the globe, there is a surge in the number of cases of mucormycosis or "Black Fungus" that is directly/indirectly associated with COVID-19. In this review article, mucormycosis of the orofacial region has gained importance from the maximum published literature (45 articles) from various databases like PubMed, Google Scholar, Scopus, Web of Science, and Embase. Rhino-orbital cerebral mucormycosis (ROCM) is a fatal condition associated with COVID-19 among categories of mucormycosis such as pulmonary, oral, gastrointestinal, cutaneous, and disseminated. ROCM targets the maxillary sinus, also involving teeth of the maxilla, orbits, and ethmoidal sinus. These are of particular interest to dentists and oral pathologists for proper diagnosis and identification. Co-morbid conditions, especially diabetes mellitus type II, have to be monitored carefully in COVID-19 patients as they have a higher risk of developing mucormycosis. In this review article, various presentations of COVID-19-linked mucormycosis are mentioned having particular emphasis on pathogenesis, signs and symptoms, clinical presentation, various diagnostic modalities including histopathology, radiology like CT and MRI, serology, tissue culture, various laboratory investigations, treatment protocols, management with prognosis, and so on. Any suspected case of mucormycosis needs quick detection and treatment since it progresses quickly due to the destructive course of infection. Long-term follow-up along with proper care is a must to detect any kind of recurrence.

Initiative to improve quality of paediatric ward-round documentation by application of 'SOAP' format.

BACKGROUND: Audits on record keeping practices at our multidisciplinary hospital revealed unstructured ward-round notes which were dissimilar from each other on aspects of patient information. Written as per the discretion of the rounding physician, the practice compromised team communication and medicolegal safety and risked patient harm. Paediatricians decided to address this concern for their department and proposed to improve the quality of documentation by structuring their notes using subjective, objective, assessment and planning (SOAP) format. On observing only 13% compliance with SOAP use despite education and training to use it, a series of interventions were explored to increase its application. METHODS: Brainstorming sessions with the paediatricians provided practical solutions. These were tested one by one using plan-do-study-act cycles to understand their impact. Team feedback was pursued towards the end of each cycle to understand the opinion of each team member. INTERVENTIONS: Interventions included verbal reminders, individual feedback and SOAP acronym display. Each of these were tested singularly and serially. Acronym display proved successful until the arrival of COVID-19, which disrupted its implementation and redirected paediatricians' work priorities. This led to exploration of a new solution, and paediatricians recommended use of visual reminders at the handover site. Quantitative information was analysed to reject or retain the ideas. RESULTS: Verbal reminders and individual feedback made no difference to SOAP usage. Acronym display improved compliance from 13% to 90% but it fell to 45% during COVID-19. Its replacement with visual reminders during pandemic times reinstated the compliance to a median of 84%. CONCLUSIONS: Selection of a change idea that respected front liner's constraints and suited local work environment proved valuable. Both acronym display and visual reminders served as visual reinforcements towards embracing a note format and proved effective. Perceived benefits from methodically written notes encouraged paediatricians to re-establish simpler measures to retain SOAP application, otherwise disrupted during the COVID-19 pandemic.

On the Detection of COVID-Driven Changes in Atmospheric Carbon Dioxide.

We assess the detectability of COVID-like emissions reductions in global atmospheric CO2 concentrations using a suite of large ensembles conducted with an Earth system model. We find a unique fingerprint of COVID in the simulated growth rate of CO2 sampled at the locations of surface measurement sites. Negative anomalies in growth rates persist from January 2020 through December 2021, reaching a maximum in February 2021. However, this fingerprint is not formally detectable unless we force the model with unrealistically large emissions reductions (2 or 4 times the observed reductions). Internal variability and carbon-concentration feedbacks obscure the detectability of short-term emission reductions in atmospheric CO2. COVID-driven changes in the simulated, column-averaged dry air mole fractions of CO2 are eclipsed by large internal variability. Carbon-concentration feedbacks begin to operate almost immediately after the emissions reduction; these feedbacks reduce the emissions-driven signal in the atmosphere carbon reservoir and further confound signal detection.

Societal shifts due to COVID-19 reveal large-scale complexities and feedbacks between atmospheric chemistry and climate change.

The COVID-19 global pandemic and associated government lockdowns dramatically altered human activity, providing a window into how changes in individual behavior, enacted en masse, impact atmospheric composition. The resulting reductions in anthropogenic activity represent an unprecedented event that yields a glimpse into a future where emissions to the atmosphere are reduced. Furthermore, the abrupt reduction in emissions during the lockdown periods led to clearly observable changes in atmospheric composition, which provide direct insight into feedbacks between the Earth system and human activity. While air pollutants and greenhouse gases share many common anthropogenic sources, there is a sharp difference in the response of their atmospheric concentrations to COVID-19 emissions changes, due in large part to their different lifetimes. Here, we discuss several key takeaways from modeling and observational studies. First, despite dramatic declines in mobility and associated vehicular emissions, the atmospheric growth rates of greenhouse gases were not slowed, in part due to decreased ocean uptake of CO2 and a likely increase in CH4 lifetime from reduced NO x emissions. Second, the response of O3 to decreased NO x emissions showed significant spatial and temporal variability, due to differing chemical regimes around the world. Finally, the overall response of atmospheric composition to emissions changes is heavily modulated by factors including carbon-cycle feedbacks to CH4 and CO2, background pollutant levels, the timing and location of emissions changes, and climate feedbacks on air quality, such as wildfires and the ozone climate penalty.

Regional impacts of COVID-19 on carbon dioxide detected worldwide from space.

Activity reductions in early 2020 due to the coronavirus disease 2019 pandemic led to unprecedented decreases in carbon dioxide (CO2) emissions. Despite their record size, the resulting atmospheric signals are smaller than and obscured by climate variability in atmospheric transport and biospheric fluxes, notably that related to the 2019­2020 Indian Ocean Dipole. Monitoring CO2 anomalies and distinguishing human and climatic causes thus remain a new frontier in Earth system science. We show that the impact of short-term regional changes in fossil fuel emissions on CO2 concentrations was observable from space. Starting in February and continuing through May, column CO2 over many of the world's largest emitting regions was 0.14 to 0.62 parts per million less than expected in a pandemic-free scenario, consistent with reductions of 3 to 13% in annual global emissions. Current spaceborne technologies are therefore approaching levels of accuracy and precision needed to support climate mitigation strategies with future missions expected to meet those needs.