Monkeypox awareness, knowledge, and attitude among undergraduate preclinical and clinical students at a Malaysian dental school: An emerging outbreak during the COVID-19 era

Objective: To evaluate the awareness, knowledge, and attitude on monkeypox viral infection among preclinical and clinical dental students in Malaysia. Methods: A cross-sectional study was conducted among 229 preclinical and clinical dental students via an online self-reported questionnaire. The questionnaire included 3 items on awareness, 15 items on knowledge, 9 items on attitude and 2 open-ended questions. Data were presented as frequencies and percentages. Chi-square test was used to compare knowledge and awareness scores between preclinical and clinical dental students and content analysis was performed for open-ended responses. Results: Preclinical and clinical dental students were aware of the existence of monkeypox (89.5% and 94.4%, respectively), that the disease emerged in non-endemic countries (81.0% and 87.1%, respectively) and that it was declared a public health emergency of international concern by the World Health Organization (73.3% and 79.0%, respectively). Clinical dental students' overall knowledge level was significantly higher than preclinical dental students (P=0.014). Both preclinical (95.2%) and clinical (96.8%) dental students demonstrated positive attitudes toward monkeypox with no significant difference (P=0.736) noted between them. Three themes emerged from the open-ended questions: (1) reimplementation of nationwide lockdown, (2) impact on the economy and health, and (3) disruption to the educational system. Students also anticipated their face-to-face learning to be reduced should there be a new outbreak. Conclusions: Both preclinical and clinical dental students showed comparable awareness and attitudes, while the latter demonstrated greater satisfactory knowledge toward the re-emergence of monkeypox during the COVID-19 pandemic. Nonetheless, efforts to improve dental students' understanding of this alarming outbreak are required, to safeguard their health and minimise transmission.

Dynamic characteristics of COVID-19 infection in Chinese children

From the start of the coronavirus disease 2019 (COVID-19) pandemic in 2020, COVID-19 infection in the pediatric population has aroused great attention. This article presents dynamic epidemiological characteristics of COVID-19 infection in pediatric patients from January 2020 to March 2022 in China. These data contributed essential insights and shared experience on the management of COVID-19 in children. To date, the unvaccinated population and events with children need more attention. Copyright © 2022 E-Century Publishing Corporation. All rights reserved.

Safe and effective administration of multiple recombinant factors on VA-ECMO via post-oxygenator pigtail during acute massive pulmonary hemorrhage

Introduction: Massive bleeding on extracorporeal membrane oxygenation (ECMO) is associated with multiple coagulation defects, including depletion of coagulation factors and development of acquired von Willebrand syndrome (AVWS). The use of recombinant factors, in particular recombinant activated factor VII (rFVIIa, Novoseven), to treat severe refractory hemorrhage in ECMO has been described. However, the use of multiple recombinant factors has been avoided in large part due to concern for circuit complications and thrombosis. Here, we describe the safe and effective administration of rFVIIa and recombinant von Willebrand factor complex (vWF/ FVIII, Humate-P) via post-oxygenator pigtail catheter on VA-ECMO for the treatment of massive pulmonary hemorrhage. Case Description: A 21-month-old (13.4 kg) girl with a recent history of COVID-19 infection presented to an outside hospital with parainfluenza bronchiolitis resulting in acute refractory hypoxemic respiratory failure (oxygenation index 58), refractory septic shock, and myocardial dysfunction. She was cannulated to VA-ECMO and subsequently diagnosed with necrotizing pneumonia from Pseudomonas and herpes simplex infections. Her course was complicated by a large left-sided pneumatocele and bronchopleural fistula requiring multiple chest tubes. She also had right mainstem bronchus obstruction from necrotic airway debris and complete right lung atelectasis. She was noted to have prolonged episodes of mucosal and cutaneous bleeding (oropharynx, chest tube insertion sites, peripheral IV insertion sites) associated with absent high molecular weight von Willebrand multimers consistent with AVWS. Tranexamic acid infusion was initiated and bivalirudin anticoagulation was discontinued. VA-ECMO flows were escalated to 140-160 ml/kg/min to maintain circuit integrity and meet high patient metabolic demand in the absence of anticoagulation. On ECMO day 26, she underwent bronchoscopy to clear necrotic debris from her airway to assist with lung recruitment. The procedure was notable for mucosal bleeding requiring topical epinephrine and rFVIIa. Post-procedure, she developed acute hemorrhage from her right mainstem bronchus, resulting in significant hemothorax (estimated 950 ml) with mediastinal shift, increased venous pressures, desaturation and decreased ECMO blood flow rate, necessitating massive transfusion of 2,050 ml (150 ml/kg) of packed red blood cells, platelets, plasma and cryoprecipitate. An airway blocker was placed in the mid-trachea to control bleeding. In addition to transfusion of appropriate blood products and continuation of tranexamic acid infusion, she was given both rFVIIa (100mcg/kg) and vWF-FVIII (70 units vWF/kg loading dose on the day of hemorrhage, followed by 40 units vWF/kg every 12 hours for 3 additional doses). Both products were administered over 10 minutes through a post-oxygenator pigtail to allow the product to circulate throughout the patient prior to entering the ECMO circuit. The circuit was closely monitored during administration and no changes to circuit integrity were noted in the subsequent hours while hemostasis was achieved. The ECMO circuit remained without thrombosis for 9 days after the bleeding event. Discussion: Balancing anticoagulation and hemostasis is a central challenge in maintaining ECMO support, especially given the prevalence of acquired coagulopathies such as AVWS. For our patient, AVWS contributed to mucosal bleeding necessitating cessation of anticoagulation and utilization of a high ECMO blood flow strategy to minimize circuit clot burden. This was further complicated by absent native lung function and minimal myocardial function, resulting in complete dependence on ECMO. An acute massive pulmonary hemorrhage was treated with multiple recombinant factors (rFVIIa and vWF/FVIII), that are often avoided on ECMO. To minimize clotting risk to the circuit and to maximize transit of these factors to our patient, we added a post-oxygenator pigtail for administration. While this approach was the result of extreme circumstances, th use of a post-oxygenator pigtail for administration of recombinant factors may represent a viable strategy for refractory hemorrhage while on ECMO.

Fuzzy multi-criteria decision-making approach for online food delivery (OFD) companies evaluation and selection: A case study in Vietnam

The COVID-19 pandemic has boosted the growth of the online food delivery (OFD) market in every corner of the world. In Vietnam, the food delivery service is rising rapidly and opening a large gateway of opportunities for numerous OFD platforms, also making it a competing business market in this country. Thus, to keep up with the ever-changing market dynamics, there are numerous measures and dimensions for the OFD entrepreneurs to take into consideration towards sustainable development. This paper’s objective is to evaluate major OFD companies in Vietnam based on a comprehensive set of criteria, which are social and environmental criteria (healthy and safety, information security, and environmental impact), economic criteria (delivery cost, operational capability, and risk management), service quality (order fulfillment, delivery speed, convenience of payment, online/offline service level, and customer feedback), and technology (web design, realtime tracking systems, and marketing techniques). To achieve this objective, this work proposes a multi-criteria decision-making (MCDM)-based framework combining the fuzzy analytic hierarchy process (FAHP) and the weighted aggregated sum product assessment (WASPAS). The FAHP is used to generate criteria weights in which fuzzy set theory is applied to translate the linguistic evaluation statements of experts. Then, WASPAS is used to rank the OFD companies against the selected criteria. The evaluation criteria that have obtained maximum weight priority in the FAHP analysis are “convenience of payment”, “delivery speed”, “online service level”, “order fulfillment”, and “delivery cost”. From the final ranking of WASPAS, Foody is today the best performing OFD player in Vietnam regarding the selected criteria, followed by GrabFood and Now. The proposed methodology can be an accurate and robust evaluation model for the industry, while the managerial implications of this study provide significant materials for decision-makers in the OFD market in improving their businesses towards sustainable development. © 2021 by the authors.

Pathogen spectrum changes of respiratory tract infections in children in Chaoshan area under the influence of COVID-19

From January 24, 2020 to May 18, 2020, Chaoshan took measures to limit the spread of COVID-19, such as restricting public gatherings, wearing masks, and suspending classes. We explored the effects of these measures on the pathogen spectrum of pediatric respiratory tract infections in Chaoshan. Pharyngeal swab samples were collected from 4075 children hospitalized for respiratory tract infection before (May-December 2019) and after (January-August 2020) the COVID-19 outbreak. We used liquid chip technology to analyze 14 respiratory pathogens. The data were used to explore between-group differences, age-related differences, and seasonal variations in respiratory pathogens. The number of cases in the outbreak group (1222) was 42.8% of that in the pre-outbreak group (2853). Virus-detection rates were similar in the outbreak (48.3%, 590/1222) and pre-outbreak groups (51.5%, 1468/2853;Χ2= 3.446, P = 0.065), while the bacteria-detection rate was significantly lower in the outbreak group (26.2%, 320/1222) than in the pre-outbreak group (44.1%, 1258/2853;Χ2= 115.621, P < 0.05). With increasing age, the proportions of respiratory syncytial virus (RSV) and cytomegalovirus (CMV) infections decreased, while those of Mycoplasma pneumoniae (MP), and adenovirus (ADV) infections increased. Streptococcus pneumoniae (SP), CMV, and rhinovirus infections peaked in autumn and winter, while RSV infections peaked in summer and winter. We found that the proportion of virus-only detection decreased with age, while the proportion of bacteria-only detection increased with age (Table 2). Anti-COVID-19 measures significantly reduced the number of pediatric hospitalizations for respiratory tract infections, significantly altered the pathogen spectrum of such infections, and decreased the overall detection rates of 14 common respiratory pathogens. The proportion of bacterial, but not viral, infections decreased.

Assessment of deep brain stimulation candidacy during the COVID-19 pandemic: Lessons learned and future directions for neuropsychologists.

ObjectiveNeuropsychological assessment is integral to the pre-surgical deep brain stimulation (DBS) workup for patients with movement disorders. The COVID-19 pandemic quickly affected care access and shifted healthcare delivery, and neuropsychology has adapted successfully to provide tele-neuropsychological (teleNP) DBS evaluations during this time, thus permanently changing the landscape of neuropsychological practice. Method: In this paper, we discuss the lessons learned from the pandemic and we offer care management guidelines for teleNP and in-person evaluations of pre-DBS populations, with exploration of the feasibility of the different approaches for uninterrupted care access. Results: We summarize the strengths and weaknesses of these care models and we provide future directions for the state of clinical neuropsychological practice for DBS programs, with implications for broader patient populations. Conclusions: A better understanding of these dynamics will inform and educate the DBS team and community regarding the complexities of performing DBS neuropsychological evaluations during COVID-19 and beyond.

The global pandemic has permanently changed the state of practice for pre-DBS neuropsychological evaluations.

The evaluation and management of patients with movement disorders has evolved considerably due to the COVID-19 pandemic, including the assessment of candidates for deep brain stimulation (DBS) therapy. Members of the Neuropsychology Focus Group from the Parkinson Study Group Functional Neurosurgical Working Group met virtually to discuss current practices and solutions, build consensus, and to inform the DBS team and community regarding the complexities of performing DBS neuropsychological evaluations during COVID-19. It is our viewpoint that the practice of neuropsychology has adapted successfully to provide tele-neuropsychological pre-DBS evaluations during the global pandemic, thus permanently changing the landscape of neuropsychological services.