Rights awareness and COVID-19 tourism job losses: perspectives from Malaysia

This qualitative study applies the labour market segmentation theory to examine tourism job losses through the indirect causes of pay cuts, unpaid leave and the take-up of side hustle–accepted by the employees partly from loyalty, camaraderie and empathy. Where the prolonged hardship from these measures leads to resignations, employers gain from the avoidance of termination benefits mandated by a retrenchment exercise. The losses occasioned to the worker include the non-eligibility for state-funded wage subsidy and foregone termination benefits. Through a legal analysis of COVID-19 job losses, the study posits that tourism workers' lack of rights awareness contributed to the voluntary acceptance of these lawful but detrimental strategies. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Association between Food Insecurity and Blood Pressure in A Multiethnic Population

Hypertension (HTN) is the strongest modifiable risk factor for CVD that is disproportionately higher in racial/ethnic groups, e.g., Native Hawaiians. Native Hawaiians have over a 50% prevalence of HTN (i.e., systolic blood pressure (SBP) of =130mmHg or diastolic blood pressure (DBP) of =80mmHg), placing them at higher risk for CVD. Behavioral/biological risk factors (e.g., BMI, diet, physical activity) are often the focus of epidemiological and intervention research;yet, socioeconomic factors, such as food insecurity, also affect blood pressure.The purpose of this study is to examine the association between food insecurity and SBP and DBP in Native Hawaiians communities, controlling for demographics and behavioral/biological risk factors.Participants in this 2020, cross-sectional study (N = 125) were from six, predominantly Native Hawaiian communities across Hawai'i. Demographic variables included age, sex, education, and race/ethnicity. Potential confounding variables were leisure-time physical activity, daily servings of processed meat, daily servings of red meat, daily servings of fruit and vegetables, resilience, BMI, use of HTN medication, and COVID-19 related mental health. To assess food insecurity participants were asked to indicate how often money for food runs out by the end of the month on a 5-point Likert scale, with higher scores indicating greater frequency. SBP and DBP were measured according to a standardized protocol. All confounding variables with a significant bivariate correlation with SBP or DBP were entered into the respective multiple regression model.Participants were predominantly female (73, 58.4%), had some college or were college graduates (73, 58.4%), a mean age of 39.2yrs (SD=9.9) and mean BMI of 31.6 (SD=8.7). Mean SBP and DBP were in the normotensive range, 122.9+/-17.5 and 79.5+/-11.9, respectively. Female sex (beta=-9.9, SE=2.6, p<0.001), daily servings of fruit and vegetables (beta=-2.35, SE=1.04, p=0.026), BMI (beta=0.76, SE=0.16, p<0.001), use of HTN medication (beta=14.01, SE=4.90, p=0.005), and food insecurity (beta=2.09, SE=0.95, p=0.030) were associated with SBP (R2=0.40, SE=14.05, p<0.001). Male sex, fewer daily servings of fruit and vegetables, greater BMI, use of HTN medication, and more food insecurity were significantly associated with higher DBP. Female sex (beta=-5.03, SE=1.90, p=0.009), BMI (beta=0.51, SE=0.12, p<0.001), and food insecurity (beta=1.36, SE=0.69, p=0.05) were associated with DBP (R2=0.31, SE=10.18, p<0.001). Male sex, greater BMI, and more food insecurity were significantly associated with higher DBP.After controlling for potential confounders, food insecurity retains a significant, independent association with both SBP and DBP such that a greater frequency of food insecurity was related to higher SBP and DBP. This provides additional evidence for the idea that food insecurity may directly impact CVD risk.

Ties that bind: Young people, community and social capital in the wake of the pandemic

The connection that young people have to their local neighbourhood and community has been shown to impact on health and wellbeing, particularly for those living in the most deprived areas. We report on a qualitative participatory study using photo elicitation methods undertaken in three deprived neighbourhoods across London exploring concepts of community and social connection, with young people aged 13-24 years, against the backdrop of the COVID-19 pandemic. The construct of social capital, referring to the extent of solidarity and connection between groups, has been shown to impact on pandemic related outcomes, and is used in this study as a lens to enhance understanding of young people's experience of the pandemic. Young people created heterogenous physical social ties across class, ethnicity, and geographical area which were important during the pandemic, although these may be jeopardised by a range of factors including fear of violence, mistrust of those in power, parental control and place-based inequity. The isolation and localism enforced by the pandemic encouraged young people to pay more attention to the value of local connections they built up both with people and place. Place-based research needs to continue a dialogue with young people, acknowledging and drawing on existing networks, community assets and cultural beliefs. The impact of COVID-19 on accentuating existing inequalities means that the need for place-based action, addressing the social determinants of health and involving the experiences and input of the young, is more vital than ever.Copyright © 2022 London School of Hygiene and Tropical Medicine

Reshoring from China: comparing the economic statecraft of Japan and South Korea

This article examines the Japanese and South Korean governments' reshoring and diversification policies of supply chains especially away from China since the early 2010s, with particular attention to the measures taken under the 2020–21 pandemic. The article also explores how much Japanese and South Korean reshoring from China, a subset of foreign economic policy, counts as economic statecraft as a deliberate government attempt to achieve geopolitical objectives using ‘economic' means. One would expect these governments, which innovated proactive industrial policies and guided the private sector to catch up with developed economies in the 20th century, to have an easy time encouraging businesses to re-shore. While these two governments have employed various policy instruments to shift their economic dependence away from China, there is only limited success in motivating businesses to return to their homeland. This leads to an intriguing departure in our understanding of the capacity of those two Asian nations, which used to be considered prototypical ‘developmental states' where governments have significant influence over business behaviour. This research brings more nuance and complexity to prevailing state-as-unitary-actor assumption of the economic statecraft literature and advocates closer attention to domestic sources of foreign economic policy. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Impact of Covid Vaccination on Hospitalized Covid-19 Patients - a Renal and Extra-Renal Outcome Study

Introduction: Covid-19 vaccinations are effective as preventive measures against the COVID-19 pandemic infection. There are different types of COVID-19 vaccines available worldwide. The impacts of different types COVID-19 vaccination on hospitalized patients remained uncertain at the early stage of the outbreak. This study examines the clinical outcomes of vaccinated and vaccine naive hospitalized COVID-19 patients. Method(s): This is a retrospective study of hospitalized COVID-19 patients admitted into University Malaya Medical Center from January 2021 until June 2021. Data on patients who were>= 18 years old and hospitalized for >= 48 hours for confirmed COVID-19 infection were captured. Clinical parameters and demographic of patients were collected from electronic medical records (EMR). Vaccine status was determined based on EMR entry and retrospective phone interviews. 2 cohorts of patients were classified based on their COVID vaccination status, and outcome analysis was done with appropriate statistical methods. Result(s): A total of 1529 patients were captured with a male-to-female ratio of 759 (49.6%) and 770 (50.3%). The median age was 55 (IQR: 36-66). 182 patients (12%) received COVID-19 vaccination before admission. The types of COVID vaccination received by patients were Pfizer (n=127;8.4%), AstraZeneca (n=27;1.8%), and Sinovac (n=28;1.8%) respectively.107 patients (7.1%) received two doses of vaccine, 72 patients had one dose (4.7%), and three were injected with three doses (0.2%). Biochemical analysis showed that the vaccination naive group has a higher median of lymphocyte counts (17 vs. 2.02;p<0.001), ferritin (363 vs 221;p=0.001), serum creatinine (67 vs 63;p=0.032). Renal outcome data revealed that unvaccinated patients had more incidence of acute kidney injury (AKI) (92.9% vs 7.1%;p=0.002) and increased level proteinuria (88.5% vs 11.5%;p= 0.011). Covid-19 vaccination group had lower incidence rate of pneumonia (8.9% vs 91.1%;p<0.001), lower ventilator use (4.8% vs 95.2%;p=0.01), and lower ICU admission (5.1% vs 94.9%;p<0.001) compared to vaccine-naive group. The mortality rate was lower 5.2% (n=7) in COVID-19 vaccination compared to 94.8% (n=127) vaccine-naive group;p=0.012. [Formula presented] Conclusion(s): In our study, COVID-19 vaccination effectively lowered the incidence of AKI, pneumonia, ICU admission, and mortality translating to better overall outcome. No conflict of interestCopyright © 2023

Aki in Hospitalized Covid-19 Patients- an Epidemiology Study in a Tertiary Center

Introduction: Coronavirus disease 2019 (COVID-19) related acute kidney injury (AKI) is a recognized complication of the disease and may result in high morbidity and mortality rate. The reported incidence and outcome vary worldwide. This study aimed to assess the AKI rate in hospitalized COVID-19 patients and identify risk predictors/prognosticator associated with the complication. Method(s): This is a retrospective study of hospitalized COVID-19 patients at the University Malaya Medical Center admitted from January 2021 until June 2021. Data on patients who were>= 18 years old and hospitalized for >= 48 hours for confirmed COVID-19 infection were captured. Clinical parameters and demographic of patients were collected from electronic medical records. The staging of AKI was based on criteria as per KDIGO guidelines. Result(s): A total of 1529 patients were found to have fulfilled the criteria for the study with a male-to-female ratio of 759 (49.6%) to 770 (50.3%). The median age was 55 (IQR: 36-66). 500 patients (32.7%) had diabetes, 621 (40.6%) had hypertension, and 5.6% (n=85) had pre-existing chronic kidney disease (CKD). The incidence rate of AKI was 21.1% (n=323). The proportion of different AKI stages of 1,2 and 3 were 16.3%, 2.1%, and 2.7%, respectively. A total of 15 hospitalized patients (0.98%) needed dialysis. 190 patients (58.8%) of AKI group had complete recovery of renal function. Demographic factors that were associated with an increased risk of developing AKI included: age (p< 0.001), diabetes (p<0.001), hypertension (p<0.001), CKD (p<0.001) and vaccination status (p=0.002). Analysis of biochemical parameters in AKI cohort revealed statistically significant lower lymphocytes & platelet counts, higher ferritin levels, and poorer renal function (creatinine based)) compared with the non-AKI cohort. Outcome analysis in our cohort revealed that AKI was associated with prolonged hospitalization (p<0.001) and higher mortality rates with P< 0.001). [Formula presented] Conclusion(s): AKI is a common complication among hospitalized COVID-19 patients. The increased risk was associated with underlying comorbidities and had an adverse outcome on patient morbidity and mortality. No conflict of interestCopyright © 2023

Convalescent Plasma as Adjunctive Therapy for Hospitalized Patients with COVID-19: The Co-CLARITY Trial

Background and Objective. Convalescent plasma therapy (CPT) may reduce the risk of disease progression among patients with COVID-19. This study was undertaken to evaluate the efficacy and safety of CPT in preventing ICU admission among hospitalized COVID-19 patients. Methods. In this open-label randomized controlled trial, we randomly assigned hospitalized adult patients with COVID-19 in a 1:1 ratio to receive convalescent plasma as an adjunct to standard of care or standard of care alone. The primary endpoint was ICU admission within first 28 days of enrolment. Primary safety endpoints include rapid deterioration of respiratory or clinical status within four hours of convalescent plasma transfusion and cumulative incidence of serious adverse events during the study period including transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), severe allergic reactions, and transfusion-related infections. Results. A total of 22 patients were assigned to receive convalescent plasma as an adjunct to standard of care and 22 to receive standard of care alone. The median time from onset of COVID-19 symptoms to study enrolment was eight days (IQR, 4 to 10). Two patients (9.1%) in the CPT group and one patient (4.5%) in the control group were admitted to the ICU. The primary outcome measure, ICU admission, was not different between the two groups (q-value >0.9). No patient who received convalescent plasma had rapid deterioration of respiratory/clinical status within four hours of transfusion and none developed TRALI, TACO, anaphylaxis, severe allergic reactions, or transfusion-related infections. There was also no significant difference in the secondary outcomes of 28-day mortality (two patients in the CPT group and none in the control group, q-value >0.90), dialysis-free days, vasopressor-free days, and ICU-free days. Conclusions. Among hospitalized COVID-19 patients, no significant differences were observed in the need for ICU admission between patients given CPT as adjunct to standard of care and those who received standard of care alone. Interpretation is limited by early termination of the trial which may have been underpowered to detect a clinically important difference. © 2023 University of the Philippines Manila. All rights reserved.

A Perspective on Emerging Inter-Disciplinary Solutions for the Sustainable Management of Food Waste

Since food waste is a contemporary and complicated issue that is widely debated across many societal areas, the world community has designated the reduction of food waste as a crucial aspect of establishing a sustainable economy. However, waste management has numerous challenges, such as inadequate funding, poor waste treatment infrastructure, technological limitations, limited public awareness of proper sanitary practices, and inadequate legal and regulatory frameworks. A variety of microorganisms participate in the process of anaerobic digestion, which can be used to convert organic waste into biogas (e.g., methane) and nutrient-rich digestate. In this study, we propose a synergy among multiple disciplines such as nanotechnology, omics, artificial intelligence, and bioengineering that leverage anaerobic digestion processes to optimize the use of current scientific and technological knowledge in addressing global food waste challenges. The integration of these fields carries with it a vast amount of potential for improved waste management. In addition, we highlighted the relevance, importance, and applicability of numerous biogas-generating technologies accessible in each discipline, as well as assessing the impact of the COVID-19 epidemic on waste production and management systems. We identify diverse solutions that acknowledge the necessity for integration aimed at drawing expertise from broad interdisciplinary research to address food waste management challenges. © 2022 by the authors.

Would people prefer city-center living in the post-COVID era?: Experience, status, and attitudes to social disasters

The COVID-19 pandemic was a significant social disaster that radically affected the paradigm of current urbanization and city-center living. Responses to the disaster varied depending on related experiences, individual status, and attitudes. Thus, this research extends the previous literature by examining the effects of experiences related to the COVID-19 pandemic, socioeconomic status, and how perceptions and attitudes affect preferences for city-center living in the Seoul Metropolitan Area, South Korea. We use data from PSSRAC (Perception Survey of Seoul metropolitan area Residential Awareness during COVID-19) of 2021. A binary logistic regression method is used to examine significant characteristics that affected the residential preference change due to "Experience,” "Status,” and "Attitude” in the COVID-19 era. The findings showed that respondents' experience, status, and attitude related to the pandemic could have a complex effect on predictions of preference, for central or suburban living tendencies in the post-COVID-19 era. In terms of "Experience,” people who had bad experiences during the pandemic, for example, poor economic conditions were associated with suburban area living trends. For "Status,” socially and economically vulnerable groups preferred suburban residence due to the steep rise in housing prices in the city center after the pandemic. Finally, for "Attitude,” ‘value of housing for investment” was positively associated with a preference for city-center living in the post-COVID-19 era;respondents with a higher priority for maintaining remote work tended not to change their current residence. This study may provide planners, housing developers, and policymakers with meaningful implications for addressing urban changes in the post-COVID-19 era. Additionally, it is expected that this research's ESA analysis and results can be used as a valid reference for other global cities. © The Author(s) 2023.

Multiple opportunistic infection in a male with systemic lupus erythematosus and concomitant human immunodeficiency virus infection

Background/Purpose: Concomitant systemic lupus erythematosus (SLE) and human immunodeficiency virus (HIV) infection cases are rare worldwide. It is established that SLE patients have an increased risk of opportunistic infection due to immune dysregulation, as well as in HIV. Method(s): A case of a 25-year- old Filipino man with systemic lupus erythematosus admitted due to a 1-week intermittent fever associated with headache, loss of appetite, and generalized body weakness was reviewed in a tertiary hospital in the Philippines. Result(s): An initial diagnosis was made from the clinical presentation of Raynaud's phenomenon, an elevated antinuclear antibody (1:320;nuclear, speckled), 2+ proteinuria, thrombocytopenia, and nail fold capillaroscopy findings consistent with mixed connective tissue disease. Patient was started on hydroxychloroquine and prednisone. He was admitted as a case of Streptococcus bacteremia with COVID-19 pneumonia after initial diagnosis, presenting as fever, and thrombocytopenia as low as 23.000/mul. Patient presented with a scaly erythematous annular lesion at his left wrist since December 2021 where a skin punch biopsy showed findings consistent with dermatophytosis. Direct immunofluorescence staining showed deposition of granular IgM (+3), C3 (+1), Fibrinogen (+3), and C1q (+1) in the basement membrane zone consistent with Lupus Erythematosus. Additional findings were oral thrush, dermatophytosis, and Pneumocystis pneumonia. Patient was started on antibiotics, remdesivir, and antifungal medications. Being severely immunocompromised, work up for HIV was initiated. Rapid HIV screening was positive, CD4 count revealed 7 (3.14%), and subsequent confirmatory western blot was positive. Additional treatment included hydroxychloroquine, methylprednisolone pulse therapy, and platelet concentrate transfusion. He was referred for CD4 monitoring, and ARV treatment enrollment, however, the patient expired a month after his discharge. Conclusion(s): This case is thereby reported to document a rare case of systemic lupus erythematosus (SLE) male patient with concomitant HIV, SARS-CoV- 2, and opportunistic infections secondary to AIDS. Diagnosis becomes challenging in patients with autoimmune diseases and multiple infectious diseases as clinical presentations tend to overlap and may show similar manifestations. In this setting, skin biopsy utilizing direct immunofluorescence can help establish an accurate diagnosis especially when clinical features and histopathology are overlapping.

The Way to Better Learning Online: Using Online Discussions in College Classes During COVID-19

In recent years, a large body of evidence demonstrates that active learning through engaging college students in a discussion leads to increased learning outcomes. However, more empirical studies are needed to understand its effectiveness in online classes. In Experiment 1, students majoring in veterinary medicine were randomly assigned to three conditions: Lecture and Review, Lecture and Discussion, and Self-study and Discussion. Post-test results showed that the two discussion groups achieved significantly higher scores than the review group. Moreover, among the two discussion groups, the self-study group performed better than the lecture group. To reconsider the reliability and generalizability of our study we conducted Experiment 2 in which, we compared the performance of the two discussion conditions again for students majoring in social science. Our findings indicate that not only online discussions but active learning activities such as self-studying before the discussion is also crucial for students' learning. © ISLS.

Pedicled Infrahyoid Flap Reconstruction for Head and Neck Cancers - an Early Experience in Hong Kong

Aim: Head and neck cancer surgeries often result in defects requiring reconstruction. When compared to free flaps, local flaps are associated with shorter operation time, which is preferred in patients with comorbidities and during COVID pandemic with local attrition of anesthetists. Submental flap has a theoretical risk of compromising oncological outcome in level I neck dissection. Alternatively, infrahyoid flap harvest is confined to the central compartment, which is a rare region for lymph node spread. To our knowledge, infrahyoid flap reconstruction has not been reported in Hong Kong. This study aims to evaluate the surgical outcome in patients underwent infrahyoid flap reconstruction at our unit. Method(s): 6 patients (median age 67) who had received infrahyoid flap reconstruction from May2018 to May2022 were retrieved. The primary lesion sites included tongue (4 patients), concomitant retromolar and buccal mucosa (1 patient) and submandibular region (1 patient). The blood supply, dimension of flap skin paddle, flap survival and complications were evaluated. Result(s): The dimension of flap skin paddle was 25 cm2 (range 20- 28). Blood supply was all via superior thyroid vessels. 100% flap survival was achieved in 5 out of 6 patients. Only one patient developed superficial skin necrosis which was treated conservatively. One patient had mild dehiscence of donor site. One patient suffered from disease recurrence and succumbed one year after operation. The other patients are alive up to today. Conclusion(s): In our experience, pedicled infrahyoid flap is a safe and reliable procedure for reconstruction of medium-sized defects after head and neck cancer surgeries.

Prevalence, Recurrences, and COVID-19 Impact on Pediatric Epistaxis

Introduction: Pediatric epistaxis is highly prevalent, yet patient characteristics, frequency of office cauterizations, and outcomes have been minimally described. This study examined the epidemiology and prevalence of epistaxis and potential impact by COVID-19. Method(s): A retrospective summary was performed on all patients (0-18 years) seen/treated for epistaxis by pediatric otolaryngologists within a single health care system across northeast and southeast United States between January 1, 2013, and October 31, 2021. Demographics, geographics, medical history, and office and operating room cauterization were reviewed. Data were analyzed using chi2 and logistic regression. Result(s): Of 9770 unique patients, with 26,699 epistaxis encounters, 62% were male. Median age at first encounter was 8.5 years;50% of patients were White. Encounters were most frequent during the fall (September-November) and least frequent during winter (December-February) with no significant differences. The incidence of epistaxis has significantly increased since the onset of the COVID-19 pandemic (P<.001). Overall, 27% received a procedural intervention, 54% required more than a single visit. Logistic regression revealed age, ethnicity, and geographical region as independent predictors of receiving a procedure on the first encounter, with a model receiver-operating characteristic (ROC) curve with area=0.75 (95% CI, 0.73-0.76). Similarly, procedural intervention, history of allergies, and nasal steroid use were independent predictors of recurrent visits, with a model ROC curve with area=0.79 (95% CI, 0.78-0.80). Conclusion(s): The incidence of pediatric epistaxis is not significantly correlated with seasonality. However, there has been a significant increase in epistaxis encounters during the COVID-19 pandemic. Recurrent visits for pediatric epistaxis were significantly predicted by procedural intervention, allergies, and nasal steroid use.

COVID19 and Its Impact on the North and East of Scotland Orthopaedic Trainees

Aim: We conducted a trainee survey at the first peak of the pandemic to investigate the impact of COVID-19 on the North of Scotland (NoS) and East of Scotland (EoS) orthopaedic trainees. Method: An online survey was distributed to all NoS and EoS orthopaedic trainees. All data collection was anonymous. Results: Across both Scottish deaneries, 28 trainees had responded: 39% from EoS and 61% from NoS. Trainees at all stages of training responded to the survey, with the most responses received from specialist trainees in third year of training (ST3) (25%). In response to the pandemic, 18% of trainees had been redeployed and they were from NoS. Since the reconfiguration of service, 18% of trainees had done >20 operations in a month and they were senior trainees. If COVID-19 outbreak is likely going to reduce operating opportunities for a long period, only 36% of trainees would be open to the idea of making standard surgical specialty training longer whereas 57% of trainees would be open to longer working hours to achieve certification in Trauma and Orthopaedic surgery within 96 months. Conclusion: The outbreak of COVID-19 has impacted both deaneries orthopaedic training and urgent restoration of surgical training is essential for individual trainees. Changes in working practices necessitated by COVID-19 have known to impact theatre efficiency. Actions should be taken to improve the theatre efficiency while prioritizing training opportunities.

The Effect of COVID-19 on Orthopaedic Trauma Theatre Efficiency and Surgical Training in the North and East of Scotland Major Trauma Centres - a Year On

Aim: To determine the orthopaedic trauma theatre efficiency in two large major trauma centres (MTCs) in Scotland before and after the outbreak of Coronavirus disease (COVID-19) pandemic. Method: All trauma patients presented to the North and East of Scotland's MTCs prior to the outbreak of COVID-19 (7th May to 7th June 2019), during the first peak of COVID-19 (7th May to 7th June 2020), after Aerosol Generating Procedures updates (7th November to 7th December 2020) and the 'new normal' (7th May to 7th June 2021) were retrospectively reviewed. Training opportunities and theatre time were compared. The Kruskall-Wallis test was used. Results: There were no significant differences in the length of hospital stay (p=0.117, 0.065) and time from injuries and surgery within groups in both MTCs (p=0.508, 0.384). The pandemic has negatively affected the anaesthetic and surgical preparation time, time between end of procedure and send for next case, and turnover time, with more profound effect on the North of Scotland's MTC. The trainee's involvement as main surgeon had decreased with the outbreak of the pandemic, with the junior trainees being affected most severely in North of Scotland. The time taken for patient to arrive to theatre after sending and total downtime were twice as long in the North of Scotland. Conclusion: The COVID-19 pandemic has negatively impacted the orthopaedic trauma theatre efficiency and training opportunities. Actions should be taken to improve the turnover time to maximise theatre efficiency while prioritizing training opportunities.

A study protocol for a double-blind randomised placebo-controlled trial evaluating the efficacy of carrageenan nasal and throat spray for COVID-19 prophylaxis—ICE-COVID

Introduction At present, vaccines form the only mode of prophylaxis against COVID-19. The time needed to achieve mass global vaccination and the emergence of new variants warrants continued research into other COVID-19 prevention strategies. The severity of COVID-19 infection is thought to be associated with the initial viral load, and for infection to occur, viruses including SARS-CoV-2 must first penetrate the respiratory mucus and attach to the host cell surface receptors. Carrageenan, a sulphated polysaccharide extracted from red edible seaweed, has shown efficacy against a wide range of viruses in clinical trials through the prevention of viral entry into respiratory host cells. Carrageenan has also demonstrated in vitro activity against SARS-CoV-2. Methods and analysis A single-centre, randomised, double-blinded, placebo-controlled phase III trial was designed. Participants randomised in a 1:1 allocation to either the treatment arm, verum Coldamaris plus (1.2 mg iota-carrageenan (Carragelose®), 0.4 mg kappa-carrageenan, 0.5% sodium chloride and purified water), or placebo arm, Coldamaris sine (0.5% sodium chloride) spray applied daily to their nose and throat for 8 weeks, while completing a daily symptom tracker questionnaire for a total of 10 weeks. Primary outcome Acquisition of COVID-19 infection as confirmed by a positive PCR swab taken at symptom onset or seroconversion during the study. Secondary outcomes include symptom type, severity and duration, subsequent familial/household COVID-19 infection and infection with non-COVID-19 upper respiratory tract infections. A within-trial economic evaluation will be undertaken, with effects expressed as quality-adjusted life years. Discussion This is a single-centre, phase III, double-blind, randomised placebo-controlled clinical trial to assess whether carrageenan nasal and throat spray reduces the risk of development and severity of COVID-19. If proven effective, the self-administered prophylactic spray would have wider utility for key workers and the general population. Trial registration NCT04590365;ClinicalTrials.gov NCT04590365. Registered on 19 October 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06685-z.

MICROFLUIDIC DIAGNOSTIC AND POINT OF CARE DETECTION SYSTEM FOR SARS-COV-2 FROM SALIVA

We present a nucleic acid-based point-of-care diagnostic for the detection of the SARS-CoV-2 from saliva using an additively manufactured microfluidic cartridge. The assay uses reverse transcriptase loop-mediated isothermal amplification (RT-LAMP) to detect the presence of SARS-CoV-2 RNA on-cartridge in a point-of-care optical detection system based on a smartphone. We show positive results within the 10-30 minutes range and integrated biological controls on the cartridge. We demonstrate the microfluidic diagnostic with human patient samples, with results that are consistent with the off-cartridge validation. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

What's Abuzz? Encephalopathy in a Transplant Recipient

Introduction: Encephalopathy in a transplant recipient is a challenging clinical presentation that requires a broad differential (both infectious and noninfectious) and consideration of exposures. West Nile Virus (WNV) encephalitis is a rare etiology of encephalopathy in a transplant recipient with controversial management. Case: A man in his seventies presented due to encephalopathy in September 2021. Medical history was significant for deceased donor kidney transplant in September 2020 and myasthenia gravis. Immunosuppression consisted of tacrolimus, mycophenolic acid, and prednisone 10 mg daily. He was on fluconazole for coccidioidomycosis prophylaxis. Symptoms consisted of worsening weakness over five days and headaches for two days. On admission, he was febrile to 38.1° C and had altered mental status. He was started on empiric meningitis treatment with ampicillin, vancomycin, cefepime, and acyclovir, and was given doxycycline for atypical coverage. He developed worsening encephalopathy and was intubated for airway protection. CSF profile revealed 255/mm3 WBC (77% neutrophils, 20% lymphocytes, 3% monocytes), 45/mm3 RBC, 61 glucose mg/dL (serum 126 mg/dL), and 96.1 mg/dL protein. Exposure history was significant for visiting family in central Arizona several weeks prior to presentation where he was exposed to mosquitos and two cats. He ate at a fast-food restaurant two days prior to presentation. He received three doses of COVID-19 vaccine. He was born and raised in Arizona and has remote travel to Mexico. Extensive studies (considering the risk factors above) identified the etiology of his encephalopathy as WNV encephalitis with positive serum PCR, elevated serum and CSF IgM with normal IgG. Unfortunately, the patient expired despite aggressive therapy. Discussion: This case represents three interesting challenges that we feel will be of interest to the conference attendees. The first is encephalopathy in a transplant recipient within one year of transplant requires a broad differential including donor-derived infections, opportunistic organisms that can cause meningoencephalitis, as well as knowledge of local and seasonal pathogens on the rise. With the monsoon season in 2021, Arizona rose to become one of the top ten states in the country with WNV cases. The second is management of a critically ill patient with meningitis and myasthenia gravis, since multiple agents for empiric therapy have been associated with worsening of or precipitating myasthenic crisis. Finally, supportive care is the mainstay of the management of WNV encephalitis and IVIG and adjustments in immunosuppression is controversial.