ABSTRACT
The recent findings reported that the most frequent coronavirus disease 2019 (COVID-19) clinical course in pediatric subjects ranged from mild to moderate form in with nonspecific symptoms such as fever, cough, dyspnea, fatigue, muscle pain, headache, and nasal congestion. On the contrary, a lower frequency of severe COVID-19 forms was reported, including refractory metabolic acidosis, coagulation disorders, tachypnea, severe pneumonia, and septic shock. Recent literature is associated with the COVID-19 pediatric subject to the acute multisystem inflammatory syndrome (MIS-C) with abdominal symptoms and left ventricular systolic dysfunction. The recent findings seem to support that the unvaccinated and comorbid children could present more severe clinical forms. Few data of COVID-19 hospitalization in pediatric intensive care unit (PICU) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in schools were reported during the first wave. The main reasons could be correlated to the early school's closure, while the swabs were destined more frequently to adult symptomatic subjects. The pandemic state generated rise in psychological disorders, anxiety, and depression more frequently during the first year of the disease spread, with a higher prevalence in older adolescents. © 2023 Elsevier Inc. All rights reserved.
ABSTRACT
Objectives: The COVID-19 pandemic has drastically altered the medical landscape. Not in our lifetime have we seen such a rapid and widespread cancellation of scheduled vascular surgical operations. The objective of this study was to evaluate the impact of COVID-19 on the care of patients with carotid disease. Methods: An interim data analysis of the Carotid module of VASCC Project 1: Impact of COVID-19 on Scheduled Vascular Operations was performed. The Vascular Surgery COVID-19 Collaborative (VASCC) was founded in March of 2020. Modules were developed by international vascular surgeon working groups and extensively beta tested before implementation. Each participating site agreed to share a collection of patient data whose vascular surgeries were postponed due to the COVID-19 pandemic. The REDCap database, housed at the University of Colorado, was determined to be exempt from Institutional Review Board review. A total of 57 patients with carotid stenosis whose surgeries were postponed during the COVID-19 pandemic surge in the USA were included in the interim data analysis. Patients whose surgeries were scheduled but not postponed were not included. Results: The mean ± SD age of the 57 patients was 70.5 ± 10.8 years. Seventy per cent were male and 28.1% were female. Seventy-two per cent of patients were white, 17.5% were Hispanic, 1.8% were Asian or Pacific Islander, and 1.8% were black. Seventy-five per cent of patients were asymptomatic, 8.8% had a cerebrovascular accident (CVA), 8.8% had a transient ischaemic attack (TIA), 3.5% had amaurosis fugax, and no patients presented with crescendo TIA (Table 1). The average length of surgical delay was 78.3 ± 36.1 days, with a median of 73 days (interquartile range 45.75 days) (Table 2). Of the 57 patients, 33 (57.9%) had surgeries postponed and successfully completed surgery at time of data entry. Seventy-two per cent of the postponement were due to intuitional policy (Table 3). No patients (0%) decompensated or required an emergency surgery during the delay. Two patients (4.0%) with carotid disease died while waiting for surgery. The cause of death of both patients was unrelated to cerebrovascular disease. Conclusions: None of the asymptomatic patients became symptomatic during the surgery delay. Two patients with carotid disease died while waiting for surgery due to causes not related to cerebrovascular disease. Our interim analysis supports institutional and national guidelines in the USA that patients with asymptomatic carotid stenosis may be safely postponed during a COVID-19 pandemic surge. Further data are needed to evaluate the impact of patients with symptomatic carotid stenosis. [Formula presented] [Formula presented] [Formula presented] [Formula presented] [Formula presented] [Formula presented]
ABSTRACT
The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which is believed to have originated in China towards the end of November 2019, has now spread across the globe, causing a pandemic in 192 countries. The World Health Organization has called it the SARS-CoV-2 pandemic. Rapid dissemination of the virus occurs mainly through the saliva (Flugge's droplets) and aerosol, together with nasal and lachrymal passages. The literature associated with the recent advancement in terms of rapid diagnostics and SARS-CoV-2 vaccines has thoroughly studied the role of ACE2 receptors and Furin, as well as viral agent access into the host cell and its significant persistence at the level of the oral mucosa, which represents the main access to the virus. The purpose of this review was to underline the processes of SARS-CoV-2 infection mechanisms and novel breakthroughs in diagnostics and vaccines. Different technologies, such as the RT-PCR molecular test and the antigenic test, have been developed to identify subjects affected by the SARS-CoV-2 in order to improve the tracking of infection geographical diffusion. Novel rapid and highly sensitive diagnostic tests has been proposed for the detection of SARS-CoV-2 to improve the screening capability of suspected contagions. The strengthening of the vaccination campaign represents the most effective means to combat the SARS-CoV-2 infection and prevent severe manifestations of the virus-different classes of vaccines have been developed for this purpose. Further attention on the novel SARS-CoV-2 variant is necessary in order to verify the protection efficacy and virulence reduction of the infective agent in the recent vaccine campaign.