Disruptions in Global Supply Chains due to COVID 19

The recent witnessed pandemic COVID-19 caused severe distress in the Global Supply Chains (GSCs). Worldwide lockdowns, job losses, etc. helped in the creation of this problem. We describe the characteristics that distinguish epidemic outbreaks as a distinct supply chain disruption risk category. It is clearly highlighted that there is lack of visibility of disruptions in GLOBAL SUPPLY Chains and delayed industry response to COVID-19. The COVID-19 outbreak has certainly forced firms to re-evaluate their business strategies. The lead time, the speed of epidemic propagation and the upstream and downstream interruption durations in the supply chain are all significant aspects. This research can be used by decision teams to predict the short-term and long-term impacts of supply chain occurrences and to define pandemic supply chain strategies and tactics. This paper discusses the impact of COVID-19, the effect of lockdown and problems in existing technologies. Possible solutions regarding reducing the effect of pandemic and plans to prepare for the future are also depicted. © 2022 The authors and IOS Press. All rights reserved.

Assessment of Knowledge and Attitude of Interns in the Prevention and Control of COVID-19

Background:Coronavirus disease 2019 (COVID-19) is defined as an illness caused by a novel coronavirus, now called Severe Acute Respiratory Syndrome Coronavirus 2. The present study was conducted to assess knowledge and attitude of interns in the prevention and control of COVID-19. Materials & Methods:50 interns of both genders were included. A questionnaire assessed knowledge comprising of each item contained 3 options, namely, “true”, “false” and “don’t know”;1 point was given for a correct answer, and 0 points were awarded for an incorrect answer or a “don’t know” response. The total score of this section ranged from 0 to 13, and higher scores were correlated with more knowledge. The attitude section included items, and a Likert scale was used to assess the level of agreement with the statements;response options ranged from 1 (strongly disagree) to 5 (strongly agree). Results: Out of 50 subjects, males were 22 and females were 28. What causes COVID-19 replied correct by 94%, incubation period of COVID-19 by 95%, overall mortality of COVID-19 by 84%, what are laboratory test available by 98%, family gatherings may spread infection by 89%, washing hands frequently, wearing masks and other measures can effectively prevent infection by 99%, most have good prognosis by 82% and suspected and confirmed patients should be isolated and treated in designated hospitals by 94%. Attitude was strongly agree, agree, not sure, disagree and strongly disagree in response to I pay close attention to the development of the epidemic situation in 94%, 5%, 1% respectively, I think I am playing an important role in controlling the epidemic in 92%, 3%, 3%, 1% and 1% respectively. It is believed that the outbreak will soon be contained in 90%, 2%, 5%, 2% and 1% and I am willing to cooperate with the relevant departments to take prevention and control measures in 82%, 8%, 6%, 3% and 1% respectively. Conclusion: Interns had sufficient knowledge and attitude in the prevention and control of COVID-19.

Gastrointestinal Manifestations Of Covid-19 In Icu And Non-Icu Patients: A Multi-Center Cohort Study

Background: Coronavirus disease 2019 (COVID-19) has infected over 62 million people worldwide as of November 28, 2020. Emerging studies have revealed a high prevalence of gastrointestinal (GI) symptoms among patients with COVID-19, and coronavirus particles have been found in their stool. However, there are minimal data regarding the impact of COVID-19 severity on the GI system. In this study, we evaluated GI and hepatobiliary manifestations in a large number of hospitalized patients across the United States (US) with COVID-19 based on admission to the intensive care unit (ICU), a surrogate for COVID-19 severity. Methods: Seven US academic centers ed data from patients who had a positive COVID-19 test and were hospitalized. Demographics, presenting symptoms, clinical, and laboratory data were ed, as were hospitalization outcomes. Patients were stratified According to admission to the ICU (yes/no) during their hospital course. GI and hepatobiliary manifestations and outcomes were compared using the Chi-square test, and parametric laboratory values were compared using Student’s t test. Results: Of a total of 1,896 COVID-19 positive patients, 730 patients (38.5%) were admitted to the ICU (Table 1). ICU admissions were more likely to be male (64.2% vs. 52.1%;p<0.01). The most common presenting symptom was dyspnea in ICU patients (57.8%) versus cough in non-ICU patients (47.9%).The prevalence of patients reporting GI symptoms was similar between ICU and non-ICU patients (20.4% vs 21.1%;p=0.14). Compared with non-ICU patients, ICU patients had a higher prevalence of abnormal serum aspartate aminotransferase (AST) values (16.0% vs. 6.7%;p<0.01) and total bilirubin > 3 mg/dL (3.1% vs. 0.8%;p<0.01) (Table 2). There was not a significant difference in prevalence of abnormal alanine aminotransferase (ALT) values between the two groups (9.6% vs. 7.1%;p=0.13). The peak values of AST, ALT, and total bilirubin among all patients in the cohort were 3384 U/L, 1274 U/L, and 54 mg/dL, respectively. Conclusions: In a large US-based cohort of hospitalized patients with COVID-19, GI symptoms did not differ between ICU and non-ICU patients despite their high prevalence. ICU patients were more likely to have serum liver test abnormalities. In this context, further investigation is needed to clarify whether hepatobiliary dysfunction stems from direct injury from COVID-19 or an indirect effect of ICU-related multi-organ dysfunc-tion. Such insight would help guide future management to reduce the risk of and mitigate hepatic injury in these patients (Table Presented) (Table Presented)

GASTROINTESTINAL MANIFESTATIONS OF COVID-19 ACROSS THE UNITED STATES: A MULTI-CENTER COHORT STUDY

Background: Coronavirus disease 2019 (COVID-19) has infected over 14 million people in the United States (US) as of December 1, 2020. Recent data have shown that COVID-19 strains appear to demonstrate geographic variation, such as Asian strains predominating in the Western US and European strains predominating in the Eastern US. However, the clinical significance of this variation remains unclear. In this large, multi-center cohort study, we evaluated gastrointestinal (GI) manifestations of COVID-19 regionally and throughout the US. Methods: Patients hospitalized with a positive COVID-19 test were identified at seven US academic centers. As a surrogate for differing COVID-19 strains, patients were stratified into regions (West, Midwest, or Northeast) depending on hospital location. Demographics, presenting symptoms, laboratory data, and hospitalization outcomes were ed. Statistical comparisons were performed with Chi-square and ANOVA tests, as appropriate. Results: A total of 1896 patients were identified (Table 1). Most patients were male (56.8%), and the most prevalent race was Caucasian (40.5%). The mean age was 58.1 years (±19.1), and the mean body mass index (BMI) was 29.9 (±8.4). A third (29.2%) of patients had a known COVID-19 exposure. The mean presenting temperature was 37.3 °C, and dyspnea was the most common presenting symptom (48.2%). GI symptoms were present in 20.3% of the overall cohort (Table 2);diarrhea was most common (12.4%), followed by nausea and/or vomiting (10.3%) and abdominal pain (6.0%). Geographically, GI symptoms were significantly less common in the Western cohort (17.8%) than the Northeastern (25.6%) and Midwestern (26.7%) cohorts. GI complications (GI hemorrhage and pancreatitis) were also significantly less common in the Western cohort (1.5%, 0.2%) than the Northeastern (6.9%, 1.5%) and Midwestern (3.3%, 1.7%) cohorts. The Midwestern cohort had a higher prevalence of moderately elevated serum aspartate aminotransferase (AST;23.5% vs 8.5% in Western and 10.5% in Northeastern cohorts;p<0.01). Compared to the Northeastern and Midwestern cohorts, the Western cohort had a higher prevalence of mildly elevated serum alanine aminotransferase (ALT;20.9% and 20.9% vs 28.5%;p=0.01) and total bilirubin (6.7% and 7.0% vs 11.4%;p=0.03). The presence of GI symptoms was not associated with increased mortality (p=0.15). Conclusions: Although GI manifestations were common among patients hospitalized with COVID-19, there is significant variability in prevalence across the US. GI symptoms and complications were less common in the West than the Northeast or Midwest. Our study highlights notable geographic variations in GI manifestations of COVID-19, prompting the need for further investigation into the mechanisms of these differences. Such insight could identify strategies that mitigate GI complications of COVID-19 infection.(Table presented) Demographic and Clinical Data of Patients with COVID-19 by Geographic Region. (Table presented) Gastrointestinal Manifestations of COVID-19 in Patients by Geographic Region.

SEVERE COVID-19 ASSOCIATED WITH INCREASED RISK OF GI BLEEDING DURING HOSPITALIZATION

INTRO COVID-19 may present with a wide array of extra-pulmonary symptoms. These include coagulopathy, thrombosis, bowel hypomotility and ischemia, to name a few. As a result of the hypercoagulable state of the syndrome, there has been increased usage of anticoagulation in this patient population. We aimed to investigate the incidence of gastrointestinal (GI) bleeding in the setting of severe COVID-19. METHODS This was a retrospective chart review of PCR-confirmed cases of COVID-19 infections in adults admitted at two academic medical centers in the Boston metropolitan area from March 2020 to September 2020. Those under the age of 18 years or with a history of clinically-resolved COVID-19 infection with persistently positive PCR test admitted for other diagnoses were excluded. Pertinent elements from the medical history, admission laboratory data and outcome measures were ed in a standardized fashion. Cases were stratified by severity, with death or requirement of ICU level of care (pressors, intubation, non-invasive ventilation) used to define severe disease. Data was collected on an array of additional clinical outcomes. Multivariate analysis was used to assess for correlation between severity of disease and GI bleeding. RESULTS A total of 475 patients were included in our multivariate analysis. The mean age was 61 years, and 42.1% were females. At presentation, 74.7% of patients had a clinical picture of pneumonia. We classified 256 cases as severe, and found that they were significantly more likely to experience GI bleeding (upper and lower) during their admission (12.8% vs 1.5% p<0.001), often requiring transfusions with packed red-blood products (35.7% vs 4% p<0.001). CONCLUSIONS Our analysis revealed that severe COVID-19 is associated with increased risk of in-hospital GI bleeding and requirement for blood transfusions. An increased risk of GI bleeding within this cohort is likely multifactorial in etiology with the increased usage of anticoagulation, risk of ischemic injury to the GI tract in the setting of shock and possibly liver dysfunction causing deficiencies in the clotting cascade. It should be noted that severe cases were more likely to receive steroids in our cohort (10.2% vs 1.8% p<0.001). Most of these patients were managed conservatively without endoscopic intervention. Further studies need to be done to evaluate initial therapeutic managements to optimize patient care and minimize risk to supporting endoscopic staff in the severe COVID-19 population as this appears to be a growing obstacle and has impact on morbidity and mortality.

New normality among orthodontists amid pandemic COVID-19

The most recently found illness COVID-19 is a viral disease that started in Wuhan, China, in December 2019. The dental procedures consist of the use of aerosols when treating patients. Orthodontists, hence, must be aware of the available evidence and guidelines to create a safe environment for themselves, their patients, and the entire orthodontic team. The following literature includes various protocols, ways out to deal with the pandemic situation, as well as describes the new normality to be accepted post pandemic in clinics as well as college departments.