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The COVID-19 pandemic has resulted in amended regulations and guidelines governing the practice of dentistry and dental hygiene to ensure the protection of both patients and clinicians from transmission of the SARS-CoV-2 virus. These guidelines include changes in personal protective equipment and, under some guidelines, the institution of a fallow period after any aerosol-generating procedure (AGP). This study aimed to investigate the effect of both ventilation and 4-handed dentistry in clinical practice with patients undergoing supportive periodontal therapy (SPT) by air polishing, ultrasonic and hand instrumentation in a closed operatory. We studied 34 patients during SPT using either 2-or 4-handed dentistry in an operatory with either 0 or 20 additional air changes/h (ACH). Under clinical conditions, 20 additional ACH are adequate to eliminate aerosols produced during an SPT and before the cessation of the AGP. The presence of an assistant had no significant effect on the time needed for aerosol particles to return to baseline values following the AGP. This study supports the efficacy of 20 additional ACH during the process of AGP, but does not support the need for an extended fallow period or 4-handed dentistry to provide additional high-volume evacuation throughout the procedure.
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COVID-19 is one of the many infectious diseases which rely on human interactions for its spread and infectivity. In an environment where human mobility is constantly subjected to change, measuring the impact of this on infectivity would be a major challenge. Among many indicators of transmission, mobility has emerged as an important factor contributing to the surge in COVID-19 cases and deaths. Here, we study the coupling between the COVID -19 impact and mobility trends caused by government NPIs (Non-Pharmaceutical Interventions) such as lockdown and social distancing. The study includes mobility reports from Google (about varied dimensions of local mobility), daily number of COVID-19 cases and deaths and information on NPIs in 9 Italian regions for over 2 years from 2020. The intent is to find possible associations between the COVID-19 impact and human mobility. The methodology is inspired by a study of Wang et al. in 2020. Our findings suggest that the trend in local mobility can help in forecasting the dynamics of COVID-19. These findings can support the policymakers in formulating the best data-driven approaches for tackling confinement issues and in structuring future scenarios in case of new outbreaks. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Introduction: Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). kidney damage linked to COVID-19 could take on specific characteristics by genetic, environmental and socio-cultural factors. This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in COVID-19 patients at Centre Medical de Kinshasa (CMK). Method(s): In a prospective cohort study carried out at the Kinshasa Medical Center (KMC), consecutive patients admitted to the ICU were screened for the presence of AKI from March 1st, 2020 to January 1st, 2022 period covered the first 4 waves of the Covid-19 pandemic. We included all adult inpatients (>=18 years old) with a positive COVID-19 PCR result. Patients on chronic dialysis (hemodialysis or peritoneal dialysis) and those with less than two creatinine measurements were excluded. Aki was defined according KDIGO guidelines. Univariate and multivariate analysis were performed by Cox regression to identify risk factors for AKI and association between AKI and in-hospital mortality. The significance level of p value was set at 0.05. Result(s): A total of 217 patients were included in the study of which most were males (77.0%) and blacks (80.2%). AKI was diagnosed in 63 out of 217 (29%) COVID-19 patients after a median time of 2 days (0-7). Stages 1, 2, or 3 AKI accounted for 39.7%, 11.1% and 49.2%, respectively. Hemodialysis was performed in 7.8% of the subjects and 69.8% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were first COVID-19 wave (HR: 3.1 [1.2-8.4] p=0.022), obesity (HR: 1.2 [1.02-6.7] p=0.046), higher SOFA score (HR: 6.1 [2.1-17.3] p=0.001) and CRP at day 7 (HR: 1.9 [1.1-10.0] p=0.023). Patients with AKI had a mortality rate of 57.1%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (HR:2.96 [1.93-4.65] p=0.013) compared to non-AKI patients. Conclusion(s): AKI was present in three out of ten COVID-19 patients. The most significant risk factors for AKI were first wave, obesity, higher SOFA score and CRP. Despite dialysis, AKI has been associated with almost threefold increase in overall mortality and seven out of ten survivors did not recover kidney function after AKI. No conflict of interestCopyright © 2023
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Background: The management of patients with immuno-rheumatological diseases has profoundly changed during the COVID 19 pandemic and telemedicine has played an important role in the disease follow-up. In addition to monitoring disease activity and any adverse events, especially infectious events, assessing the psychological situation of the patient can be fundamental in particular considering that COVID-19 has also a serious impact on mental health and it has been demonstrated a signifcantly higher incidence of anxiety disorders and depressive symptoms especially in younger people Objectives: The aim of this study is to evaluate the incidence of depressive disorders, anxiety and fbromyalgia in our patients with rheumatoid arthritis and psoriatic arthritis during the lockdown period due to the COVID 19 pandemic and validate the use of telemedicine in the clinical management of these patients. Methods: Patients affected by rheumatoid and psoriatic arthritis treated with biological disease-modifying drugs were contacted to evaluate the state of health and the presence of any adverse events and a nurse administered the clinimetric questionnaires assessment to evaluate the disease activity, the impact of rheumatic disease on the health status and the presence of anxiety, depression and fbromy-algia. In particular the following scales have been used: The Rheumatoid Arthritis Impact of Disease (RAID), the Psoriatic arthritis impact of disease (PsAID), Beck Depression Inventory BDI-II, State-Trait Anxiety Inventory (STAI) and The Fibromy-algia Rapid Screening Tool questionnaire (FIRST), The VAS scale for the assessment of pain. Patients who reported disease fare-up or adverse events underwent an outpatient visit and during visit Disease Activity Score (DAS 28) and Disease Activity Index for Psoriatic Arthritis (DAPSA) were used. Results: 171 patients with rheumatoid arthritis (RA) and 129 patients with psoriatic arthritis were enrolled. The incidence of fbromyalgia was increased in the two groups during the lockdown compared to the previous evaluations and in particular in patients with psoriatic arthritis (AR p =0.013, AP p= 0.001).Our analysis did not report signifcant differences between the two groups for the presence of fbromyal-gia and anxiety-related disorders during lockdown, but a prevalence of depressive disorders in patients with rheumatoid arthritis was observed.During lockdown in RA patients, (n=50), no correlation was found between DAS28 and RAID score (r=0.112, p=0.438) and in PsA patients (n=34), no correlation was found between DAPSA and PSAID score (r=0.131, p=0.459) while median value of RAID was higher in STAI I and II positive and median value of PSAID was higher in STAI I and II positive. Patients positive at BDI had higher RAID score (median 6.28 vs 1.14) and PSAID (median 4.95 vs 2.85) score (Mann Whitney p<0.001 and p=0.003) Conclusion: In conclusion, mental and physical stress during COVID-19 pandemic can greatly worsen FM symptoms and intensify the patients' suffering without a clinical fare of the infammatory disease for patients affected by rheumatoid arthritis. Telemedicine has allowed us to identify patients who needed a face-to-face approach for therapeutic reevaluation even if not related to a fare of the disease.
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The COVID-19 pandemic has shown the lack of tools for widely monitoring air quality in indoor public spaces, enabling data-driven decisions in everyday life, as they can play a significant role in abating the propagation of the SARS-CoV-2virus. Even actions as simple as opening doors and windows to ventilate rooms are widely known to be highly effective, and they may be further beneficial if triggered depending on a proper evaluation of indoor air quality levels. However, several online systems currently available on the Web mainly provide theoretical indoor air quality estimations without adequately exploiting IoT-supplied data streams. To tackle such issues, this paper describes a smart service for alerting when the air quality conditions become critical for SARS-COV-2 propagation. It is based on a cyber-physical-social platform, enabled by IoT devices that monitor air quality components, elaborates over the collected samples to infer the risk of SARS-COV-2 propagation. The result of the process alerts enabled users. © 2021 IEEE.
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Background: Transverse myelitis (TM) is most often triggered by an autoimmune reaction due to infections and perhaps vaccines. During the current coronavirus disease 2019 (COVID-19) pandemic, some case reports have shown a temporal association between TM and COVID-19 vaccine. We aimed to report a case of TM with a temporal association with ChAdOx1 nCoV-19 (AZD1222, Oxford/AstraZeneca) vaccine in a Brazilian public hospital. Case Presentation: A 27-year-old woman experienced fever, low back pain and urinary retention 3 weeks after the first dose of the ChAdOx1 nCoV-19 vaccine. Two days later, she experienced decreased strength of the lower limbs associated with paresthesia of the distal extremities. At the hospital, there was progression of weakness associated with anesthesia in T4-L1. Magnetic resonance imaging findings were suggestive of demyelination and acute inflammation. Cerebrospinal fluid analysis showed monomorphonuclear pleocytosis, increased protein and decreased glucose. Gram stain, oligoclonal bands, anti-aquaporin-4 antibody, and screening for infectious agents and connective tissue disease were all negative. During treatment, the patient received 5-day pulse therapy with methylprednisolone, acyclovir and 7-day plasmapheresis. Despite all treatments, she persisted with lower limb plegia, areflexia and anesthesia at the level of T4. She was discharged with a monthly cyclophosphamide plan and outpatient follow up. Conclusions: In the absence of other causes, the diagnosis of TM was made with evidence of a possible temporal association with ChAdOx1 nCoV-19 vaccine. It is important to emphasize that it is a temporal association only and the benefits of vaccination continue to outweigh the risk of TM. © 2021 Japanese Society for Neuroimmunology
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Background: SARS-CoV-2 can determine pneumonia and multiorgan damage due to systemic inflammation. Description of the case: A 51-year-old man was admitted to our CoViD-19 ward for diabetic acidosis and positive SARS-CoV-2 test. The patient had type 1 diabetes mellitus and he was taking insulin. Three days before this admission, he had presented nausea. The first day, after that acidosis was managed with intravenous infusion of insulin and bicarbonate, the patient referred dyspnea while he was breathing ambient air and a chest CT scan was performed with evidence of interstitial pneumonia and multiple bilateral consolidation areas. Supplemental oxygen and antibiotic plus antiviral therapy (remdesivir) were started. During the hospitalization, the patient faced progressive anemia and blood transfusions were administered. For deterioration of respiratory function, noninvasive ventilation was applied. Laboratory exams showed leukocytosis, renal insufficiency, PCR and D-dimer increased. Also cardiac troponin showed a sharp rise;therefore ECG, echocardiography and coronarography were performed with diagnosis of critical stenosis of left anterior descending artery. Cardiac stent was placed, obtaining troponin reduction and cardiac kinesis recovery. In the following days, patient showed progressive improvement of lung inflammation, allowing us shifting to low flow Venturi mask oxygenation. Conclusions: This case shows how complex can be a CoViD-19 patient with metabolic alterations and severe damage to vital organs (as lung, heart and kidney) that request a multidisciplinary approach.
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Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.
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A clinical account written by front-line providers, COVID-19 by Cases is the first comprehensive review text on COVID-19. As such, the inventive format features a case-based and systems-based review of observations, clinical knowledge, basic science, ethics, and personal experiences during the COVID-19 pandemic. With each systems-based chapter encompassing a case report, literature review, and discussion, COVID-19 by Cases is intended for a broad audience, including clinical providers, clinical educators, and students. It also serves as a standalone account to preserve this unique time in human history. COVID-19 by Cases is a multi-institutional effort with input from hospitalists, outpatient physicians, specialists, residents, nurses, pharmacists, clinical educators, and students. © 2021 by Nova Science Publishers, Inc.
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BACKGROUND: Healthcare workers (HCWs) are commonly infected by SARS-CoV-2 and represent one of the most vulnerable groups. Adequate prevention strategies are necessary to guarantee HCWs' safety, as well as to prevent dissemination of the infection among patients. AIMS: To describe a case series of SARS-CoV-2-positive HCWs in a large public healthcare organization in Milan (Italy) during the most devastating weeks of the epidemic and analyse the sources, symptoms and duration of SARS-CoV-2 infection. METHODS: This study included 172 SARS-CoV-2-positive HCWs who were infected between the 25th of February and the 7th of April 2020. A nasopharyngeal swab (NPS) and RT-PCR were used to indicate. RESULTS: Initially, the most common sources of infection were other positive HCWs (49%). Medical doctors and nursing assistants were most frequently infected, with infection rates of 53/1000 and 50/1000, respectively. COVID-19 departments were less affected than internal medicine, surgery, intensive care, or emergency room. The most commonly reported symptom was mild cough, while loss of smell (anosmia) and loss of taste (ageusia) were reported as moderate and severe by 30-40% of HCWs. The time necessary for 50% of workers to recover from the infection was 23 days, while it took 41 days for 95% of HCWs to become virus-free. CONCLUSIONS: HCWs are commonly infected due to close contacts with other positive HCWs, and non-COVID departments were most affected. Most HCWs were asymptomatic or subclinical but contact tracing and testing of asymptomatic HCWs help identify and isolate infected workers.