Impact of the COVID-19 surge on phototherapy in Taiwan: Experience from a university hospital

The coronavirus disease 2019 (COVID-19) pandemic has led to widespread changes in medical practice. This study evaluated the impact COVID-19 on phototherapy in a university hospital before and after the first surge. The study encompassed the time 5 months prior to and after the first surge of the COVID-19 pandemic spanning from May to July, 2021, in Taiwan, that resulted in the temporary closure of phototherapeutic unit. A total of 981 individual patients received phototherapy during the study period. More specifically, vitiligo, psoriasis (Ps) represented the groups with the highest patient numbers. The number of patients (n=413) receiving phototherapy 5 months after the re-opening phototherapeutic unit reached similar level as compared to the number (n~400) before the temporary closure due to surge of COVID-19 infections. For vitiligo and Ps, 39.6% and 41.9% of the patients resumed phototherapy after the pandemic-associated temporary closure of the phototherapeutic unit, respectively. A closer look into the patient profiles revealed no significant difference in age, gender, and number of sessions received per week between the patients who resumed or stopped phototherapy after the temporary closure in different patient groups. Comparison of profiles between patients who resumed phototherapy after the closure and who initiated phototherapy after the closure revealed that patients who initiated phototherapy after the temporary closure received more sessions of phototherapy per week as compared to those who resumed phototherapy. This study reveals a significant impact of the COVID-19 pandemic on patients undergoing phototherapy. Although the number of patients visiting phototherapeutic units may be similar before and after the temporary closure due to the pandemic, only about 40% of patients will resume phototherapy. New strategies and continuous education are needed to improve patient management in times of pandemic.Copyright © 2023

Membranous Nephropathy in the Era of COVID-19 and Vaccines: Is There a Story to Tell?

Background: Membranous nephropathy is a relatively common glomerular pathology that manifests with either nephrotic or sub-nephrotic range proteinuria. Evidence is emerging of COVID-19 and its vaccines having an influence on various glomerular diseases, including IgA nephropathy and minimal change disease, with limited information on membranous nephropathy. Data from our tertiary centre suggested a rise in cases of membranous nephropathy within a month after vaccination. Method(s): Patients who had renal biopsies in 2021 were identified from pathology results and online clinical records. Information on COVID-19 status, COVID vaccinations and biochemical results were compared. Patients were then split into 2 groups;those presenting within 1 month of vaccination or COVID infection and those who hadn't had vaccinations or a COVID infection within 4 weeks of presentation. Result(s): Complete vaccination and COVID infection history was present in 17 of the 24 patients. Of the 17 patients, 6 were in group 1 and 11 in group 2. 16 out of the 17 patients had nephrotic range proteinuria, 6 also had an AKI at presentation. There was no significant difference in presentation between the groups (see table 1). Conclusion(s): Our data has not conclusively shown a difference between the two groups probably because of the low numbers. But further studies are needed to see if there is a link between either COVID infections or COVID vaccinations and glomerular disease.

Effect of the COVID-19 Pandemic on Clinical Phenotype of Glomerular Disease: Single Centre Experience

Background: Presenting features for glomerular disease can be varied, including but not exclusively, acute kidney injury, nephrotic syndrome or haemo-proteinuria. At our regional tertiary centre we conducted a retrospective study to see whether clinical presentations of glomerular diseases had changed during the COVID-19 pandemic. Method(s): In this study, new and repeat native renal biopsies were included from January 2018 to October 2021. Glomerular pathologies of interest included minimal change disease, membranous nephropathy, IgA nephropathy, lupus nephritis and pauciimmune glomerulonephritis. We looked at three periods of time: prior to the start COVID-19 pandemic in 2018/19;during the COVID-19 pandemic in 2020;and after the introduction of COVID-19 vaccines in 2021. Result(s): 263 biopsies were identified over the 4-year period. IgA nephropathy - n = 13. Lupus nephritis - n = 43. The different classes of lupus nephritis are shown in (see figure 1) Minimal change disease - n = 57. All presented with the nephrotic syndrome. Between 6-25% over the study period presented with AKI (mean 19%) Pauci-immune glomerulonephritis - n = 85. Between 81%-91% over the study period presented with AKI, or AKI on CKD (mean 84%) Membranous glomerulopathy - n = 66. 50%, presented with the nephrotic syndrome. 20% presented with AKI in addition to proteinuria. Conclusion(s): Our analysis has not shown a significant change in clinical presentations of glomerular disease. There has not been an increased propensity in presenting with AKI in minimal change disease or membranous nephropathy. We saw the highest proportion of class IV lupus nephritis in 2021.

Effect of the COVID-19 Pandemic on Incidence of Glomerular Disease: A Single Centre Report

Background: Glomerular disease carries a significant burden of morbidity and mortality. There is emerging evidence of the impact of the COVID-19 pandemic and COVID-19 vaccination on glomerular disease. The aim of the study was to retrospectively analyse our experience of the incidence of glomerular disease between 2018 and 2021. Method(s): Native renal biopsy results were reviewed to compare the incidence of glomerular disease prior to the COVID-19 pandemic (2018/19);prior to development of COVID-19 vaccination (2020);and after the introduction of COVID-19 vaccines (2021). Biopsy data from January 2018 to October 2021 were collated from pathology records for all glomerular disease patients in our unit. We focused on the incidence of IgA nephropathy, lupus nephritis, minimal change disease, membranous nephropathy and pauci-immune glomerulonephritis. Result(s): 263 native biopsies were performed;45 biopsies in 2018, 75 in 2019, 65 in 2020 and 78 in the first ten months of 2021. The proportional incidence of each disease is shown in figure 1. The incidence of membranous nephropathy was noted to be higher in 2021, coinciding with the introduction of the COVID-19 vaccine programme in the UK, from an average of 23% of cases between 2018-2020, to 31% in the first ten months of 2021. The overall incidence of glomerular disease, excluding vasculitis, seemed to have fallen during 2020. Conclusion(s): The emergence of COVID-19 does not appear to have caused a significant increase in the overall incidence of glomerular disease in our population. We noted an increase in the incidence of membranous nephropathy following the introduction of the COVID-19 vaccination programme in 2021. The relatively lower incidence in 2020 could be related to limited access to primary health care practitioners and consequent reduction in referrals to secondary care at the time.

Perception from Students Regarding Online Synchronous Interactive Teaching in The Clinical Year during COVID-19 Pandemic

Aim: The global pandemic of COVID-192020 has led to the extensive practice of online synchronous learning. Our primary goal is to compare different learning activities to evaluate students' perceptions. Moreover, we also aim to identify factors influencing their perception and satisfaction in these activities. Method(s): We have divided the online activities into bedside teaching, practical skill sessions, tutorials or problem-based learning, and lectures. A questionnaire was distributed to our clinical year students to document their perceptions. Result(s): Three hundred sixty-eight valid responses were received among these four learning activities combined (96 from bedside teaching, 67 from practical skill sessions, 104 from PBL/tutorial, and 101 from lecture). With the relative positive perception regarding online PBL and tutorials and preference for online lectures, there is a high possibility that these classes will remain online. To further improve their experience, students should turn on their videos during lectures. During online PBL and tutorials, good audio and video quality should always be ensured while being encouraged to remain their mic switched on. Online practical skill classes scored high in the DREEM-extracted questionnaire but were not preferred over face-to-face classes. Implementing online classes in this category should remain cautious with the limitations of tools, practice, and feedback. Good audio and video quality may help improve the experience. Conclusion(s): The advantages of learning online may lead to a persistent practice of online teaching after this pandemic. This study provides insight and specific areas that need to improve.

WIDENING RURAL-URBAN DIVIDE IN TELEHEALTH USE DURING THE COVID-19 PANDEMIC: A NATIONAL OBSERVATIONAL STUDY OF PRIMARY CARE DELIVERY IN THE VETERANS HEALTH ADMINISTRATION

BACKGROUND: Telehealth can effectively connect patients to clinicians across distance and time, but its accessibility remains limited for rural populations. The Veterans Health Administration (VA), serving 9+ million patients across 50 states, has long championed telehealth use through national initiatives that distribute tablets to patients for video visits and that provide contingency clinician staffing via telehealth for underserved clinics. VA efforts had focused largely on rural populations where disparities in health care access and telehealth use existed but have since expanded more broadly with the onset of the COVID-19 pandemic. This study examines rural-urban differences in telehealth use for primary care services across all VA healthcare systems nationally before and after pandemic onset. METHODS: In an ongoing VA quality improvement (non-research) effort, we conducted a retrospective study on Veterans who received primary care (PC, n= 6,340,167 patients;63,541,577 visits) and mental health integration (PC-MHI, n= 977,243 patients;3,621,653 visits) services from 138 VA healthcare systems, nationwide. For each site, we aggregated monthly counts of telehealth (and specifically, video) visits for PC and PC-MHI separately during 12-months before (March 16, 2019-March 15, 2020) and 21-months after pandemic onset (March 16, 2020-December 16, 2021). We examined whether rurality of VA healthcare system predicted telehealth (and video) use for all primary care related (PC and PC-MHI) encounters over time, adjusting for VA size (number of patients), age/disability (Charlson Comorbidity Index), and racial-ethnic composition (%Black, %Hispanic) in regression analyses. RESULTS: In fully adjusted models, rural VAs initially had higher rates of PC telehealth use than urban VAs (35% vs 29%), which reversed after pandemic onset (56% vs 60%), leading to a 35% reduction in odds of telehealth use over time (CI=0.55-0.76;p<0.001). In comparison, the rural-urban gap grew even larger for PC-MHI services (OR=0.49;CI=0.36-0.68;p<0.001), as rural lagged urban telehealth expansion (before 29% vs 25%;after 77% vs 84%). While video use was low overall, the rural-urban divide was stark for PC (OR=0.28;CI=0.19-0.40;p<0.001) and PC-MHI services (OR=0.34;CI=0.21-0.56;p<0.001). Rural VAs initially had higher rates of PC (2% vs 1%) and PC-MHI video use (8% vs 5%) than urban VAs, which reversed after pandemic onset (PC 4% vs 6%;PC-MHI 21% vs 33%). CONCLUSIONS: Despite initial telehealth gains in rural VAs, the pandemic exacerbated the rural-urban telehealth divide across sites. Compared to urban VAs, telehealth expansion lagged for rural ones, especially in mental health integration services. Video visits still constituted a minority of primary care services delivered. To prevent widening rural-urban divides, telehealth implementation efforts should address persistent disparities in structural capacity (e.g., internet bandwidth) and tailor technology to encourage adoption among rural users.

Inactivated and mRNA COVID-19 Vaccines Affect F-18-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Oncology Patients

Introduction: We aimed to analyse the effect of coronavirus disease 2019 (COVID-19) vaccination on F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging findings in cancer patients. Methods: A total of 165 oncology patients who underwent FDG PET/CT between 1 May 2021 and 30 September 2021 after their first or second COVID-19 vaccination with were included in this retrospective study. The occurrence and pattern of FDG uptake at the injection site (usually deltoid), ipsilateral axillary and other regional lymph nodes, were measured. Results: Overall, the incidence of FDG-avid ipsilateral regional nodal uptake was 26.7% (44/165), with a median maximal standardised uptake value of 3.2 (range, 1.7-13.8). Vaccine-associated hypermetabolic lymphadenopathy (VAHL) was found in 11.4% (5/44) of the subjects beyond 6 weeks after vaccination. VAHL was more common in patients receiving BioNTech-Fosun mRNA vaccine (compared with patients receiving the Sinovac CoronaVac inactivated vaccine), and in women (p < 0.05). Conclusion: VAHL is common and can be observed beyond 6 weeks after vaccination. It was seen more frequently in women and in patients receiving the mRNA-based vaccine. Proper vaccination history documentation, locating the vaccination site contralateral to the primary cancer, and appropriate scheduling of FDG PET/CT are advisable for correct image interpretation.

Surgical training during the COVID-19 pandemic – a single institution’s trainee survey

Background: Few studies have assessed the impact of COVID-19 on surgical training in low- and middle-income countries. The aim of this study was to survey the effect of the COVID-19 pandemic on postgraduate surgical training, research and registrar wellbeing in South Africa. Methods: A cross-sectional study was conducted as an online survey from 5 October 2020 to 1 December 2020. The study population was registrars from all surgical disciplines at the Faculty of Medicine and Health Sciences of Stellenbosch University. The survey consisted of 26 multiple-choice and five open-ended qualitative questions on the impact of COVID-19 on physical and mental wellbeing, skills acquisition and postgraduate research. Results: Of 98 surgical registrars, 35 (36%) responded. Twenty-three (65.7%) reported missed planned surgical rotations, 30 (85.7%) decreased surgical training time, and 22 (62.9%) reported a perceived decrease in training quality. Simulated skills training was only available to eight (22.9%) participants. Twenty-four (68.6%) experienced burnout and/or depression symptoms during the pandemic. Twenty-seven (77.1%) reported that postgraduate research was unaffected by the pandemic. Conclusion: During the COVID-19 pandemic, surgical trainees at this institution reported a decrease in the quality of surgical training and skills acquisition and a negative impact on their mental wellbeing.

Estimating the surgical backlog from the COVID-19 lockdown in South Africa: A retrospective analysis of six government hospitals.

BACKGROUND: The COVID-19 pandemic reached South Africa (SA) in March 2020. A national lockdown began on 27 March 2020, and health facilities reduced non-essential activity, including many surgical services. PRIMARY OBJECTIVE: to estimate the COVID-19 surgical backlog in Western Cape Province, SA, by comparing 2019 and 2020 general surgery operative volume and proportion at six district and regional hospitals. SECONDARY OBJECTIVE: to compare the operative volume of appendicectomy, laparoscopic cholecystectomy, cancer and trauma between the 2 years. METHODS: This was a retrospective study of general surgery operations from six SA government hospitals in the Western Cape. Data were obtained from electronic operative databases or operative theatre logbooks from 1 April to 31 July 2019 and 1 April to 31 July 2020. RESULTS: Total general surgery operations decreased by 44% between 2019 (n=3 247) and 2020 (n=1 810) (p<0.001). Elective operations decreased by 74% (n=1 379 v. n=362; p<0.001), and one common elective procedure, laparoscopic cholecystectomy, decreased by 68% (p<0.001). Emergency operations decreased by 22% (n=1 868 v. n=1 448; p<0.001) and trauma operations by 42% (n=325 v. n=190; p<0.001). However, non-trauma emergency operations such as appendicectomy and cancer did not decrease. The surgical backlog for elective operations after 4 months from these six hospitals is 1 017 cases, which will take between 4 and 14 months to address if each hospital can do one additional operation per weekday. CONCLUSIONS: The COVID-19 pandemic has created large backlogs of elective operations that will need to be addressed urgently. Clear and structured guidelines need to be developed in order to streamline the reintroduction of full surgical healthcare services as SA slowly recovers from this unprecedented pandemic.

Establishing a South African national framework for COVID-19 surgical prioritisation.

BACKGROUND: Since the start of the COVID-19 pandemic, surgical operations have been drastically reduced in South Africa (SA). Guidelines on surgical prioritisation during COVID-19 have been published, but are specific to high-income countries. There is a pressing need for context-specific guidelines and a validated tool for prioritising surgical cases during the COVID-19 pandemic. In March 2020, the South African National Surgical Obstetric Anaesthesia Plan Task Team was asked by the National Department of Health to establish a national framework for COVID-19 surgical prioritisation. OBJECTIVES: To develop a national framework for COVID-19 surgical prioritisation, including a set of recommendations and a risk calculatorfor operative care. METHODS: The surgical prioritisation framework was developed in three stages: (i) a literature review of international, national and local recommendations on COVID-19 and surgical care was conducted; (ii) a set of recommendations was drawn up based on the available literature and through consensus of the COVID-19 Task Team; and (iii) a COVID-19 surgical risk calculator was developed and evaluated. RESULTS: A total of 30 documents were identified from which recommendations around prioritisation of surgical care were used to draw up six recommendations for preoperative COVID-19 screening and testing as well as the use of appropriate personal protective equipment. Ninety-nine perioperative practitioners from eight SA provinces evaluated the COVID-19 surgical risk calculator, which had high acceptability and a high level of concordance (81%) with current clinical practice. CONCLUSIONS: This national framework on COVID-19 surgical prioritisation can help hospital teams make ethical, equitable and personalised decisions whether to proceed with or delay surgical operations during this unprecedented epidemic.

COVID-19 health waste management in Taiwan

2020 has brought a severe impact on the world. The COVID-19 epidemic has infected more than 30 million people worldwide, and more than a million people have died. International economic activities have also suffered unprecedented harm. Thereforiniiie, relevant personnel’s response to the COVID-19 epidemic is achieved at all stages to prevent COVID-19 injury entirely. Medical institutions, centralized quarantine sites, home quarantine personnel, and all the people involved can adequately handle the waste generated by the COVID-19 epidemic. Therefore, this chapter has formulated management measures and operating principles which mainly constitute the following four sections includes (1) Introduction to health waste management;(2) Waste classification and cleaning methods in COVID-19 medical institutions;(3) Centralized quarantine station and home isolation waste cleaning method;(4) COVID-19 infection control and risk assessment measures in Taiwanese hospitals (5) Feasible application of the smart system in health waste management. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021.

Immunogenicity and safety of a SARS-CoV-2 inactivated vaccine in healthy adults: randomized, double-blind, and placebo-controlled phase 1 and phase 2 clinical trials

BACKGROUND: The significant morbidity and mortality resulted from the infection of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) call for urgent development of effective and safe vaccines. We report the immunogenicity and safety of an inactivated SARS-CoV-2 vaccine, KCONVAC, in healthy adults. METHODS: Phase 1 and phase 2 randomized, double-blind, and placebo-controlled trials of KCONVAC were conducted in healthy Chinese adults aged 18-59 years. The participants in the phase 1 trial were randomized to receive two doses, one each on Days 0 and 14, of either KCONVAC (5 mug/dose or 10 mug/dose) or placebo. The participants in the phase 2 trial were randomized to receive either KCONVAC (at 5 or 10 mug/dose) or placebo on Days 0 and 14 (0/14 regimen) or Days 0 and 28 (0/28 regimen). In the phase 1 trial, the primary safety endpoint was the proportion of participants experiencing adverse reactions/events within 28 days following the administration of each dose. In the phase 2 trial, the primary immunogenicity endpoints were neutralization antibody seroconversion and titer and anti-receptor-binding domain immunoglobulin G seroconversion at 28 days after the second dose. RESULTS: In the phase 1 trial, 60 participants were enrolled and received at least one dose of 5-mug vaccine (n = 24), 10-mug vaccine (n = 24), or placebo (n = 12). In the phase 2 trial, 500 participants were enrolled and received at least one dose of 5-mug vaccine (n = 100 for 0/14 or 0/28 regimens), 10-mug vaccine (n = 100 for each regimen), or placebo (n = 50 for each regimen). In the phase 1 trial, 13 (54%), 11 (46%), and 7 (58%) participants reported at least one adverse event (AE) after receiving 5-mug vaccine, 10-mug vaccine, or placebo, respectively. In the phase 2 trial, 16 (16%), 19 (19%), and 9 (18%) 0/14-regimen participants reported at least one AE after receiving 5-mug vaccine, 10-mug vaccine, or placebo, respectively. Similar AE incidences were observed in the three 0/28-regimen treatment groups. No AEs with an intensity of grade 3+ were reported, expect for one vaccine-unrelated serious AE (foot fracture) reported in the phase 1 trial. KCONVAC induced significant antibody responses;0/28 regimen showed a higher immune responses than that did 0/14 regimen after receiving two vaccine doses. CONCLUSIONS: Both doses of KCONVAC are well tolerated and able to induce robust immune responses in healthy adults. These results support testing 5-mug vaccine in the 0/28 regimen in an upcoming phase 3 efficacy trial. TRIAL REGISTRATION: http://www.chictr.org.cn/index.aspx (No. ChiCTR2000038804, http://www.chictr.org.cn/showproj.aspx?proj=62350;No. ChiCTR2000039462, http://www.chictr.org.cn/showproj.aspx?proj=63353).

POST-MORTEM EXAMINATION OF THE EFFECTS OF SEVERE ACUTE RESPIRATORY SYNDROME (SARS) ASSOCIATED CORONAVIRUS (SARS-COV) ON TESTIS

Objective: The coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 quickly grew into a global pandemic. The virus has been known to impact the respiratory system;however, the extent of impact on testicular tissue remains unknown. It has been found that COVID-19 binds to angiotensin converting enzyme (ACE) 2 receptors, and since ACE2 expression is high in the testes we believe COVID-19 may be prevalent in testes tissue. Design: In the present study, we analyzed the pathological changes within the testes of three patients who died of COVID-19 pneumonia and sepsis. Materials and Methods: In the present study, autopsy collection was done according to the University of Miami protocol. Testes tissue we collected from COVID-19 positive men (n=3) as well as COVID-19 negative men (n=3) to be used as controls. Tissue was formalin fixed and paraffin embedded. Samples were sectioned to 5-micron sections and stained with hematoxylin and eosin (H&E) as well as subjected to various fluorescently labeled antibodies to specifically differentiate cells or fluorescently labeled COVID RNA hybridization strands within the testes tissue. Fluorescent-labeled tissue slides were imaged on a quantitative pathology scope with various zoom levels allowing for comprehensive qualitative and quantitative imaging. Results: Among pathological examination of H&E stained slides from COVID-19 positive men, one case demonstrated increased inflammation and leukocyte infiltration, as well as occasional seminiferous tubules comprised of only Sertoli cells. The other 2 showed no abnormal change. These 2 cases had no leukocyte or macrophage infiltration, no inflammation, no abnormal basement membrane thickening, or changes to spermatogenesis. There was little to no difference between the two COVID-19 positive cases and COVID-19 negative controls. Sectioned slides from both COVID-19 positive as well as COVID-19 negative men are currently undergoing fluorescent labeled antibody staining for COVID RNA with results pending. Conclusions: This study suggests that, despite the increase in ACE2 receptor presence in testes tissue and the SARS-CoV-2 virus’ propensity to bind to said receptor, the male reproductive tract may not be targets of COVID-19 infection in all men. Whether COVID-19 RNA is detected in testes tissue remains to be evaluated.

Changes in surgical practice in 85 South African hospitals during COVID-19 hard lockdown.

BACKGROUND: In preparation for the COVID-19 pandemic, South Africa (SA) began a national lockdown on 27 March 2020, and many hospitals implemented measures to prepare for a potential COVID-19 surge. OBJECTIVES: To report changes in SA hospital surgical practices in response to COVID-19 preparedness. METHODS: In this cross-sectional study, surgeons working in SA hospitals were recruited through surgical professional associations via an online survey. The main outcome measures were changes in hospital practice around surgical decision-making, operating theatres, surgical services and surgical trainees, and the potential long-term effect of these changes. RESULTS: A total of 133 surgeons from 85 hospitals representing public and private hospitals nationwide responded. In 59 hospitals (69.4%), surgeons were involved in the decision to de-escalate surgical care. Access was cancelled or reduced for non-cancer elective (n=84; 99.0%), cancer (n=24; 28.1%) and emergency operations (n=46; 54.1%), and 26 hospitals (30.6%) repurposed at least one operating room as a ventilated critical care bed. Routine postoperative visits were cancelled in 33 hospitals (36.5%) and conducted by telephone or video in 15 (16.6%), 74 hospitals (87.1%) cancelled or reduced new outpatient visits, 64 (75.3%) reallocated some surgical inpatient beds to COVID-19 cases, and 29 (34.1%) deployed some surgical staff (including trainees) to other hospital services such as COVID-19 testing, medical/COVID-19 wards, the emergency department and the intensive care unit. CONCLUSIONS: Hospital surgical de-escalation in response to COVID-19 has greatly reduced access to surgical care in SA, which could result in a backlog of surgical needs and an excess of morbidity and mortality.