A narrative review on yoga: a potential intervention for augmenting immunomodulation and mental health in COVID-19.

BACKGROUND: The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has a significant mortality rate of 3-5%. The principal causes of multiorgan failure and death are cytokine release syndrome and immune dysfunction. Stress, anxiety, and depression has been aggravated by the pandemic and its resultant restrictions in day-to-day life which may contribute to immune dysregulation. Thus, immunity strengthening and the prevention of cytokine release syndrome are important for preventing and minimizing mortality in COVID-19 patients. However, despite a few specific remedies that now exist for the SARS-CoV-2virus, the principal modes of prevention include vaccination, masking, and holistic healing methods, such as yoga. Currently, extensive research is being conducted to better understand the neuroendocrinoimmunological mechanisms by which yoga alleviates stress and inflammation. This review article explores the anti-inflammatory and immune-modulating potentials of yoga, along with its role in reducing risk for immune dysfunction and impaired mental health. METHODS: We conducted this narrative review from published literature in MEDLINE, EMBASE, COCHRANE databases. Screening was performed for titles and abstracts by two independent review authors; potentially eligible citations were retrieved for full-text review. References of included articles and articles of major non-indexed peer reviewed journals were searched for relevance by two independent review authors. A third review author checked the excluded records. All disagreements were resolved through discussion amongst review authors or through adjudication by a fourth review author. Abstracts, editorials, conference proceedings and clinical trial registrations were excluded. OBSERVATIONS: Yoga is a nonpharmacological, cost-effective, and safe intervention associated with several health benefits. Originating in ancient India, this vast discipline consists of postures (asanas), breathing techniques (pranayama), meditation (dhyana/dharana), and relaxation. Studies have demonstrated yoga's ability to bolster innate immunity and to inhibit cytokine release syndrome. As an intervention, yoga has been shown to improve mental health, as it alleviates anxiety, depression, and stress and enhances mindfulness, self-control, and self-regulation. Yoga has been correlated with numerous cardioprotective effects, which also may play a role in COVID-19 by preventing lung and cardiac injury. CONCLUSION AND RELEVANCE: This review paves the path for further research on yoga as a potential intervention for enhancing innate immunity and mental health and thus its role in prevention and adjunctive treatment in COVID-19.

Has variable access to health care during the COVID‐19 pandemic impacted the severity of paediatric diabetic ketoacidosis?

Previous studies have indicated that paediatric patients with type 1 diabetes mellitus are presenting with more severe diabetic ketoacidosis (DKA) during the COVID‐19 pandemic. This study was performed to determine the effect that access to health care had on DKA severity and outcomes in children and young people (CYP) with new‐onset diabetes mellitus.This is a retrospective cohort analysis comparing pre‐pandemic and pandemic patients admitted to a 30‐bed paediatric intensive care unit (PICU) in the United States with DKA. A database query identified patients and clinical data were extracted and analysed. Additionally, phone interviews focusing on challenges with health care access during the COVID‐19 pandemic were performed with the parents of CYP admitted during the pandemic.A total of 50 pre‐pandemic and 43 pandemic patients met inclusion criteria and were included in the analysis. Pandemic patients had more severe acidosis (pH 7.10 versus 7.17), a longer duration of insulin infusion (19 versus 15 hours) and increased PICU length of stay (1 versus 0.75 days, all p < 0.05) than pre‐pandemic patients. Patients whose families felt the pandemic affected their child's ability to see a physician had a longer PICU length of stay (1.5 versus 0.9 days, p = 0.004) and a trend towards a lower pH (7.01 versus 7.13, p = 0.106). Patients with a social vulnerability index ≥0.75 were less likely to see a physician before coming to the hospital (p = 0.017).In conclusion, CYP with new‐onset type 1 diabetes who were admitted with DKA during the COVID‐19 pandemic had more severe acidosis and a longer PICU stay. Variable access to health care during the COVID‐19 pandemic may be contributing to this. Copyright © 2022 John Wiley & Sons.

ARE PEDIATRIC NEW-ONSET DIABETES PATIENTS PRESENTING WITH MORE SEVERE DKA DURING THE COVID PANDEMIC?

Phone interviews focusing on the effect of the pandemic were also performed with the families of children admitted from March 2020-21. 51 patients were admitted the year prior to the pandemic and 43 patients during the pandemic with new onset type 1 diabetes and DKA. In conclusion, new onset type one diabetic patients admitted for DKA during the COVID pandemic had more severe acidosis which took longer to resolve, required a longer duration of insulin infusion and a had longer PICU LOS. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

US Rural Surgeons Leading During COVID-19: Where Are They Now?

Rural surgeons from disparate areas of the United States report on the effects of the COVID-19 pandemic in their communities as the virus has spread across the country. The pandemic has brought significant changes to the professional, economic, and social lives of the individual surgeons and their communities.

US Rural Surgeon Responses to the COVID-19 Pandemic: Leadership in a Time of Crisis.

Nine surgeons from rural and remote communities in the United States share early experiences preparing for the COVID-19 pandemic. Relating experiences remarkably different from health care providers in urban areas in America most affected by the first stages of the outbreak, they tell the challenges of organizing resources in facilities already struggling with poverty-stricken communities far from established health care resources and supplies. From Alaska to Appalachia and the Navajo Nation to the rural midwest, they show the leadership and professionalism that exemplify rural surgery.