Post-operative bleeding complications in a periodontitis patient testing positive for COVID-19: A case report

Background: Recent scientific evidence states that a subset of COVID-19 patients have a risk of increased bleeding tendency. This case report presents a 38-year-old woman with periodontitis, generalized stage III, grade C with an abnormal post-operative blood clot formation, who tested positive for COVID-19 5 days after a standard periodontal surgery. nature.com/articles/s41598-020-80010-z. Description of the procedure: After initial periodontal treatment and re-evaluation, we proceeded to the surgical phase including: 1. regenerative procedure with EMD 15 2. regenerative procedure with EMD 44 3. open flap debridement 13-23 4. shortened flap 34-37. Outcomes: Periodontal surgical procedures (1) and (2) proceeded without any complications and were considered standard. On day 1 after the third periodontal surgery (3), the patient was called for post-operative control. The patient had no complaints.On day 2 post-operative, the patient reported by email excess of bleeding in the oral cavity from the operated area, simultaneously with fever and loss of taste. A photo taken by the patient confirmed the abnormal blood clot. On day 3, in compliance with COVID-19 protocols, the patient was seen urgently in our clinic while her COVID-19 symptoms had started to decline. During the appointment, the bleeding tendency was less acute than the day before. Further suturing for precaution was decided. The same day the patient received a COVID-19 PCR test. On day 4 post-operative, the report of the PCR test was confirmatory for COVID-19 and the patient reported no further complaints of intraoral bleeding. Conclusions: After considering the normal response of the initial treatment and the well documented good post-operative healing pattern of the periodontal tissues for this patient, we concluded that the abnormal bleeding tendency was associated with an active phase of COVID-19. Clinicians should be aware that during the first days after a periodontal surgery patients could have bleeding complications due to an active phase of COVID-19. labblog.uofmhealth.org/lab-report/ subset-of-covid-19-patients-have-increased-bleeding-risk.

A prospective multicenter study assessing humoral immunogenicity and safety of the mRNA SARS-CoV-2 vaccines in Greek patients with systemic autoimmune and autoinflammatory rheumatic diseases.

OBJECTIVES: To investigate humoral responses and safety of mRNA SARS-CoV-2 vaccines in systemic autoimmune and autoinflammatory rheumatic disease (SAARD) patients subjected or not to treatment modifications during vaccination. METHODS: A nationwide, multicenter study, including 605 SAARD patients and 116 controls, prospectively evaluated serum anti-SARS-CoV-2 S1-protein IgG antibody titers, side-effects, and disease activity, one month after complete vaccination, in terms of distinct treatment modification strategies (none, partial and extended modifications). Independent risk factors associated with hampered humoral responses were identified by data-driven multivariable logistic regression analysis. RESULTS: Patients with extended treatment modifications responded to vaccines similarly to controls as well as SAARD patients without immunosuppressive therapy (97.56% vs 100%, p = 0.2468 and 97.56% vs 97.46%, p > 0.9999, respectively). In contrast, patients with partial or without therapeutic modifications responded in 87.50% and 84.50%, respectively. Furthermore, SAARD patients with extended treatment modifications developed higher anti-SARS-CoV-2 antibody levels compared to those without or with partial modifications (median:7.90 vs 7.06 vs 7.1, p = 0.0003 and p = 0.0195, respectively). Mycophenolate mofetil (MMF), rituximab (RTX) and methotrexate (MTX) negatively affected anti-SARS-CoV-2 humoral responses. In 10.5% of vaccinated patients, mild clinical deterioration was noted; however, no differences in the incidence of deterioration were observed among the distinct treatment modification SAARD subgroups. Side-effects were generally comparable between SAARD patients and controls. CONCLUSIONS: In SAARD patients, mRNA SARS-CoV-2 vaccines are effective and safe, both in terms of side-effects and disease flares. Treatment with MMF, RTX and/or MTX compromises anti-SARS-CoV-2 antibody responses, which are restored upon extended treatment modifications without affecting disease activity.

How Secure is Home: Assessing Human Susceptibility to IoT Threats

The use of Internet of Things (IoT) devices within the home has become more popular in recent years and with the COVID-19 pandemic more employees are working from home. Risk management has become decentralised, which is problematic for organisations since potential risks towards the company can not be controlled in a standardised and formal way. On the other side, users are suffering from smart home attacks due to the nature of IoT such as its heterogeneity and non-standardised architecture. However, the behaviour and attitudes of the user can dictate the increase or decrease of risk and possible losses due to the end user's responsibility within the IoT life cycle. In this paper, we suggest that a user's behaviour and attitude towards IoT devices within the smart home is imperative when designing a risk model for the home. We then consider the human element in the risk assessment process in IoT. We present a Smart Home Behaviour and Attitude Risk Model (SH-BARM) to discuss the importance of human behaviour and attitudes within the home and propose a solution to that will aid smart home inhabitants and organisations. © 2020 ACM.