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In this chapter, we present a join solution capable of identifying the symptoms of Covid-19 in lung X-ray images. The design is to study the components of an automatic medical imaging system suited for detecting signs of defection by Covid-19 in the lung area of the images. In contrast to the conventional implementation, the proposed method allows analytical convolutional neural networks (CNNs) to be integrated smoothly with other learning methods. It relies on feature extraction from the medical images to represent latent features as a result of convolution's implication. These features are proposed to be discovered by CNN, which allow the potential detection of abnormal image patterns. We found that within our case study, feature reduction is being adopted for the development of a new efficient realization for a join solution of CNN and support vector machines (SVMs). We demonstrate that features derived from CNN, its dimensions reduction, and classification are comprehensively explainable by Bayesian inference to capture the fundamental analysis flow enabling the classification of medical images. © 2023 River Publishers.
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Background: Globally, the coronavirus disease-19 (COVID-19) pandemic has had a devastating psychological impact on people, especially the healthcare workers/students, in many different community settings. Limited research has been reported on the mental health issue of healthcare students in Vietnam. Objective(s): This study investigated and quantified depression, anxiety, and psychological distress levels among healthcare students, with an emphasis on comparing those studying pharmacy to students in other healthcare-related disciplines, in Vietnam during the COVID-19 pandemic. Method(s): A cross-sectional study recruited 2246 respondents between September 7 and October 7, 2021, in which 230 were pharmacy students with a mean age of 20.0 +/- 1.6 years and most of them had a low COVID-19 fear level. The standardized Patient Health Questionnaire-4 (PHQ-4) scale, consisting of two subscales of PHQ-2 and Generalized Anxiety Disorder-2 (GAD-2), was utilized for the screening of depression and anxiety levels. Result(s): Pharmacy students scored significantly higher on the PHQ-4 psychological distress measure than non-pharmacy students (mean 2.23 vs. 1.90, p = 0.039). Compared to non-pharmacy students, pharmacy students had higher rates of anxiety (10.4% vs. 6.5%, p = 0.028). Conclusion(s): The prevalence of anxiety was higher among pharmacy students in comparison to non-pharmacy students. These findings present a need to recognize and conduct early intervention measures for mental health problems in healthcare students, especially pharmacy students, during recovery from the COVID-19 pandemic.Copyright © 2022 Pharmacotherapy Publications, Inc.
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Backgrounds: Understanding public opinion in relation to vaccination is critical, as there are several COVID-19 vaccines approved for use in Vietnam. This study aimed to assess public COVID-19 vaccine preferences and intention in Can Tho, Vietnam. Methods: An analytical cross-sectional study was performed between September 20 and October 20, 2021. in people aged 18 and over living in Can Tho, Vietnam, A questionnaire captured demographic information, vaccination intention, preference for vaccine selection, and barriers and motivations related to COVID-19 vaccination. Predictors for vaccination willingness among unvaccinated people were determined using multivariable logistic regression. Results: Out of the proposed vaccines that have been approved by the Vietnam Ministry of Health, AstraZeneca (31.4%), Pfizer (23.5%), and Moderna (14.7%) were the most preferred by participants. Out of 1,470 respondents, 35.8% have received at least one vaccine dose, and of these, 76.9% intended to continue to receive vaccinations. Among the unvaccinated, 74.8% reported that they would be willing to complete the vaccination. Most participants stated that they would receive a COVID-19 vaccine if provided with adequate information on effectiveness and safety (92.7%). The possibility of side effects after vaccination (75.4%) was the most important barrier to vaccination. Education, health status, and prior flu-vaccination were associated with the intention to receive a COVID-19 vaccination among those who had not previously received one. Conclusions: Many unvaccinated adults were willing to receive a COVID-19 vaccination, with AstraZeneca being the preferred choice. These findings could help in the planning of vaccination campaigns to increase vaccination uptake in Vietnam.
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Introduction: Patients presenting for radiation therapy (RT) at a single institution were analysed regarding treatment delays and disparities during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study was conducted at an urban multidisciplinary cancer centre. In April 2020, the institution's radiation oncology department implemented universal COVID-19 screening protocols prior to RT initiation. COVID-19 testing information on cancer patients planned for RT from 04/2020 to 01/2021 was reviewed. Trends of other lifetime COVID-19 testing and overall care delays were also studied. Results: Two hundred and fifty-four consecutive cancer patients received RT. Median age was 63 years (range 24-94) and 57·9% (n = 147) were Black. Most (n = 107, 42·1%) patients were insured through Medicare. 42·9% (n = 109) presented with stage IV disease. One (0·4%) asymptomatic patient tested positive for COVID-19 pre-RT. The cohort received 975 lifetime COVID-19 tests (median 3 per patient, range 1-18) resulting in 29 positive test results across 21 patients. Sixteen patients had RT delays. Identifying as Hispanic/Latino was associated with testing positive for COVID-19 (p = 0·015) and RT delay (p = 0·029). Conclusion: Most patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, increased testing burden, delays in diagnostic workup and testing positive for COVID-19 may intensify disparities affecting this urban patient population. © The Author(s), 2022. Published by Cambridge University Press.
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Air distribution system could critically affect SARS-CoV-2 transmission in indoor space;therefore, this study aims at demonstrating numerical characteristics of SARS-CoV-2 migration with varied air distribution system configurations. Seven cases were investigated regarding three major aspects: how fast suspended particles can be removed from the ventilated space or changed into deposited particles;how much particles are attached to various object surfaces which leads to an infection by touching fomite. All cases were analyzed through computational fluid dynamics (CFD). Both different shapes (round or linear diffusers) and installation locations (ceiling or floor) of inlet and outlet diffusers were investigated. Results showed that different air distribution system would lead to different dispersion profiles of infectious particles and different deposition pattern of particles on interior surfaces. With the same air flow rate, linear-diffuser would perform better for CO2 extraction while requiring less time to remove or collide the same magnitude of suspended droplets compared to round-diffuser. However, how quickly removed or suspended droplets collide is not proportional to how less the number of total particles are remained. Two additional cases with double sized space possessing best ventilation configuration were also examined to explore potential application of the best-ventilated configuration to various spatial expansion cases.
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Background: Globally, the coronavirus disease-19 (COVID-19) pandemic has had a devastating psychological impact on people, especially the healthcare workers/students, in many different community settings. Limited research has been reported on the mental health issue of healthcare students in Vietnam. Objective(s): This study investigated and quantified depression, anxiety, and psychological distress levels among healthcare students, with an emphasis on comparing those studying pharmacy to students in other healthcare-related disciplines, in Vietnam during the COVID-19 pandemic. Method(s): A cross-sectional study recruited 2246 respondents between September 7 and October 7, 2021, in which 230 were pharmacy students with a mean age of 20.0 +/- 1.6 years and most of them had a low COVID-19 fear level. The standardized Patient Health Questionnaire-4 (PHQ-4) scale, consisting of two subscales of PHQ-2 and Generalized Anxiety Disorder-2 (GAD-2), was utilized for the screening of depression and anxiety levels. Result(s): Pharmacy students scored significantly higher on the PHQ-4 psychological distress measure than non-pharmacy students (mean 2.23 vs. 1.90, p = 0.039). Compared to non-pharmacy students, pharmacy students had higher rates of anxiety (10.4% vs. 6.5%, p = 0.028). Conclusion(s): The prevalence of anxiety was higher among pharmacy students in comparison to non-pharmacy students. These findings present a need to recognize and conduct early intervention measures for mental health problems in healthcare students, especially pharmacy students, during recovery from the COVID-19 pandemic. Copyright © 2022 Pharmacotherapy Publications, Inc.
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Time series prediction models have played a vital role in guiding effective policymaking and response during the COVID-19 pandemic by predicting future cases and deaths at the country, state, and county levels. However, for emerging diseases, there is not sufficient historic data to fit traditional supervised prediction models. In addition, such models do not consider human mobility between regions. To mitigate the need for supervised models and to include human mobility data in the prediction, we propose Spatial Probabilistic Contrastive Predictive Coding (SP-CPC) which leverages Contrastive Predictive Coding (CPC), an unsupervised time-series representation learning approach. We augment CPC to incorporate a covariate mobility matrix into the loss function, representing the relative number of individuals traveling between each county on a given day. The proposal distribution learned by the algorithm is then sampled by the Metropolis-Hastings algorithm to give a final prediction of the number of COVID-19 cases. We find that the model applied to COVID-19 data can make accurate short-term predictions, more accurate than ARIMA and simple time-series extrapolation methods, one day into the future. However, for longer-term prediction windows of seven or more days into the future, we find that our predictions are not as competitive and require future research. © 2022 ACM.
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Since interleukin-8 (IL-8/CXCL8) and its receptor, CXCR1 and CXCR2, were known in the early 1990s, biological pathways related to these proteins were proven to have high clinical value in cancer and inï¬ammatory/autoimmune conditions treatment. Recently, IL-8 has been identified as biomarker for severe COVID-19 patients and COVID-19 prognosis. Boyles et al. (mAbs 12 (2020), pp. 1831880) have published a high-resolution X-ray crystal structure of the LY3041658 Fab in a complex human CXCL8. They described the ability to bind to IL-8 and the blocking of IL-8/its receptors interaction by the LY3041658 monoclonal antibody. Therefore, the study has been designed to identify potential small molecules inhibiting interleukin-8 by targeting LY3041658/IL-8 complex structure using an in silico approach. A structurebased pharmacophore and molecular docking models of the protein active site cavity were generated to identify possible candidates, followed by virtual screening with the ZINC database. ADME analysis of hit compounds was also conducted. Molecular dynamics simulations were then performed to survey the behaviour and stability of the ligand-protein complexes. Furthermore, the MM/PBSA technique has been utilized to evaluate the free binding energy. The final data confirmed that one newly obtained compound, ZINC21882765, may serve as the best potential inhibitor for IL-8.
Subject(s)
COVID-19 Drug Treatment , Interleukin-8 , Humans , Molecular Docking Simulation , Quantitative Structure-Activity Relationship , Molecular Dynamics Simulation , LigandsABSTRACT
Purpose: We aimed to investigate the mortality from SARS-CoV-2 in kidney transplant recipients in the Bronx, New York since the beginning of the pandemic Methods: Between March 16, 2020 and November 5, 2021, 453 patients were diagnosed with SARS-CoV-2 infection. 316 were diagnosed by RT-PCR while the remaining 137 tested positive for anti-SARS-CoV-2 nucleocapsid IgG and did not have significant symptoms and had not been previously tested by RT-PCR Results: Of the 316 patients diagnosed by RT-PCR, 214 patients were hospitalized while 102 patients were managed at home as outpatient. 194 (61.3%) were male, median age 61 years old (IQR: 48-69), predominantly Hispanic (56.2%) and African American (29.5%). 75% received a deceased-donor renal transplant, 58% received anti-thymocyte induction. Most patients were on triple immunosuppression (95% on calcineurin inhibitors, 87% on anti-metabolite, and 97% on prednisone). Hypertension was the most common comorbidity followed by diabetes mellitus, heart disease and lung disease. A total of 65 patients (20.5%) died. The mortality rate was 37 % (47/128) in patients diagnosed between March 16 and April 30, 2020. From May 1, 2020 to end of December 2020 mortality rate has significantly decreased to 11% (7/61). Since the beginning of 2021 till November 5, 2021 the mortality rate is 7.7% (10/129). Twenty-seven patients were diagnosed with COVID-19 despite being partially of fully vaccinated (25 fully vaccinated, 2 after one dose of vaccine). 13/27 (48%) were managed at home while 14/27 (52%) were hospitalized and 2 (7%) of them died. Twenty-eight patients received treatment with casirivimab and imdevimab post diagnosis of SARS-CoV-2 starting 2021 and none of those patients have died. Conclusion(s): In summary, mortality from SARS-CoV-2 infection in kidney transplant recipients was higher earlier at the pandemic and has significantly decreased over time. This could be explained by initial exposure of the patients with higher viral load due to lack of personal protection and social distancing. However, since the judicious use of monoclonal antibodies and vaccination, in addition to social distancing protocols and use of facemask, the mortality in kidney transplant recipients has decreased over time.
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Purpose : During the COVID-19 pandemic lockdown, ophthalmology injection clinic volume at the Veteran Affairs (VA) Greater Los Angeles decreased by 50% and it rebounded back to pre-COVID clinic volumes immediately after. The COVID-19 vaccines were introduced for individuals 16 years and older under emergency use authorization by the FDA in December of 2020. The focus of this study is to examine non-ophthalmic characteristics of patients in intravitreal injection clinic during the COVID-19 vaccine era. Methods : Retrospective chart review study of patients who received intravitreal injections during 7-week period in 2021 (COVID-19 vaccine era) was compared to 2019 (baseline pre-pandemic), and 2020 (peak COVID-19). Electronic medical records were used to obtain patients' demographics, ophthalmic conditions, non-ophthalmic conditions, and COVID-19 vaccine records. Results : During the 7-week period in 2021, 88.5 % of patients receiving intravitreal injections were vaccinated (n= 263). Of the vaccinated patients, 83.6% received the Pfizer vaccine, 3.8% Moderna, and 1.1% J&J. Of those receiving either the Pfizer or Moderna vaccine, 1.7% were partially vaccinated while all others were fully vaccinated. Patients with a higher BMI were more likely to follow up after vaccination compared to baseline (p=0.019). Hispanic patients were more likely to follow up after vaccination compared to peak COVID-19 period (p=0.026). Cancer patients were more likely to follow up following vaccine compared to baseline (p=0.0001), but no difference compared to peak COVID-19 period. Transplant patients were more likely to follow up following vaccination compared to peak COVID-19 period (p=0.0001), but no difference compared to baseline (p=0.656). Patients with COPD were less likely to follow up even with vaccine (p=0.0001). Conclusions : The availability of the COVID-19 vaccines impacted intravitreal injection follow up at the VA Los Angeles ophthalmology injection clinic. Most patients receiving intravitreal injection clinic were fully vaccinated. Immunocompromised patients and those with higher BMI were more likely to follow up after the availability of COVID-19 vaccination. Patients with COPD were less likely to follow up even with the availability of vaccines.
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Purpose : In 2019, a novel teleretinal imaging program was implemented at the Veteran Affairs (VA) Greater Los Angeles Healthcare System providing remote OCT evaluation with prompt retinal specialist evaluation. The purpose of this study was to determine how the COVID-19 pandemic affected the tele-OCT screening program in its second year of implementation. Methods : Retrospective chart review study of patients evaluated by a retina specialist through asynchronous tele-OCT evaluation in 2019 and 2020. Electronic medical records were used to obtain patients' demographic and clinical characteristics, tele-OCT consult results, and patient adherence to tele-OCT follow-up plans. Results : There were 108 tele-OCT consults in 2020 compared to 158 tele-OCT consults in 2019, a 32% decrease. There was no significant difference in overall patient adherence to follow-up between the two years. In 2020, patients who had diagnosed anxiety were less likely to be adherent compared to 2019 (37.5% v. 71.4%, p=0.023). In 2020, the retinal diagnosis was less likely to be changed after teleretinal consultation compared to 2019 (12.96% v. 29.1%, p<0.01). Conclusions : The decrease in tele-OCT use reflects the decrease in patients presenting to referring clinics that utilized the consult mechanism during the COVID-19 pandemic. Patient anxiety should be considered when addressing compliance. The teleretinal program is providing an education benefit to referring providers.
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Since the onset of the COVID-19 pandemic, mil-lions of coronavirus sequences have been rapidly deposited in publicly available repositories. The sequences have been used primarily to monitor the evolution and transmission of the virus. In addition, the data can be combined with spatiotemporal information and mapped over space and time to understand transmission dynamics further. For example, the first COVID-19 cases in Australia were genetically related to the dominant strain in Wuhan, China, and spread via international travel. These data are currently available through the Global Initiative on Sharing Avian Influenza Data (GISAID) yet generally remains an untapped resource for data scientists to analyze such multi-dimensional data. Therefore, in this study, we demonstrate a system named Phyloview, a highly interactive visual environment that can be used to examine the spatiotemporal evolution of COVID-19 (from-to) over time using the case study of Louisiana, USA. PhyloView (powered by ArcGIsInsights) facilitates the visualization and exploration of the different dimensions of the phylogenetic data and can be layered with other types of spatiotemporal data for further investigation. Our system has the potential to be shared as a model to be used by health officials that can access relevant data through GISAID, visualize, and analyze it. Such data is essential for a better understanding, predicting, and responding to infectious diseases. © 2022 IEEE.
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– We develop a microsimulation model fed by a particularly rich set of individual data in order to assess the impact of the health crisis on the financial situation of more than 645,000 French companies in 2020. We show that the relative stability in net debt at the macroeconomic level is concealing major disparities on an individual level. Heterogeneity is particularly significant between sectors (before and after public support measures) but is also present within each sector. Our simulations confirm the need for public intervention during the crisis: a mere adjustment in company behaviour is insufficient to absorb the shock. These support measures brought the share of firms with a negative cash flow shock in line with normal years, although “extrem” cash flow shocks occur more frequently than usual. One important lesson learned from this exercise is that sector and size cannot be the only criteria taken into account when drawing up crisis recovery policies. © 2022, Institut National de la Statistique et des Etudes Economiques. All rights reserved.
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Background: Haiphong is a Vietnamese city of 2 million people and a historic hotspot for HIV and drug use. The DRIVE community research program recently demonstrated the end of the HIV epidemic among PWID in the city, with an incidence of 0.085/100PY, and a substantial decrease in HCV incidence in the past 5 years. After the emergence of COVID-19, a one-month strict lockdown was imposed in April 2020 in Vietnam, followed by lighter social distancing restrictions over the year. We investigated whether those measures affected PWID in terms of risk behaviors and access to prevention and care. Methods: Participants were PWID that had been enrolled in a respondent-driven sampling (RDS) survey as part of DRIVE in the last quarter of 2019. They were recalled and interviewed in the last quarter of 2020 by peer educators on their socioeconomic situation, drug use and sexual behaviors, relations to methadone maintenance treatment (MMT) and ART services. They were tested for drugs and methadone in the urine, and for HIV, HCV, and HIV plasma viral load when HIV(+). Changes following the restrictions were assessed by comparing these "after" data to the "before" data collected one year earlier during the RDS survey. In-depth interviews were conducted with 30 participants including 5 female sex workers (FSW). Results: 780 PWID were enrolled. Their mean age was 44 years and 94% were male. 56% were still actively injecting (100% heroin) at the time of the interview;their monthly consumption had decreased from 24 to 17 days on average. The main source of syringes remained pharmacies for 83% before, during and after the lockdown. The proportion of PWID still engaging in sharing decreased from 6.0 to 1.5%. No change in the frequency of condom use was reported. The proportion of PWID on MMT increased from 68.7 to 75.3%. There was no alteration in the HIV cascade of care that was still above 90/90/90. No HIV seroconversion was observed, and HCV incidence remained stable (2.6/100PY, 95%CI: 0.7-6.7). 53% reported a monthly income of less than 130 USD "after" compared to only 9% "before". One FSW reported accepting unsafe sex during the lockdown due to financial pressure. Conclusion: Six months after the beginning of COVID-19-related restrictions, access to harm reduction materials and care services for PWID was maintained and no increase in the number of new HIV or HCV infections was observed. However, this period was a major financial challenge, especially for FSW that were more likely to engage in risky sexual behaviors.
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BACKGROUND: The COVID-19 pandemic has significantly disrupted the delivery of healthcare, including oral healthcare services. The restrictions imposed for mitigating spread of the virus forced dental practitioners to adopt significant changes in their workflow pattern. The aim of this study was to investigate the impact of the pandemic on the practice of oral and maxillofacial pathology in two countries in regard to educational activities, and clinical and diagnostic pathology services. MATERIAL AND METHODS: An online questionnaire was distributed to oral and maxillofacial pathologists in the United States and Canada. The survey was designed by combining dichotomous, multiple choice, and Likert response scale questions. Statistical analysis of the collected data was performed with SPSS software. RESULTS: Most pathologists, at the time of survey completion, were teaching synchronously, primarily with case-based learning and live lectures. During lockdown, 52.4% and 50.0% of those with trainees expected their residents to show up for clinic- and laboratory-related procedures respectively. The pathologists were most concerned for their residents' inadequate clinical exposure, future placement, and face-to-face teaching time. About 89.0% pathologists were able to provide emergent care, with 82.4% and 23.5% having performed telehealth consultations and oral biopsy procedures, respectively. During the lockdown, the pathology laboratories for 90.9% of participants received biopsy specimens that predominantly comprised of potentially malignant or malignant lesions. However, a reduction in the number of biopsy submissions was reported. CONCLUSIONS: Given the challenges of the pandemic, oral and maxillofacial pathologists in the United States and Canada successfully continued their pursuits in education, clinical care, and diagnostic pathology services.
Subject(s)
COVID-19 , Dentists , Pathology, Oral , COVID-19/epidemiology , Communicable Disease Control , Dentists/psychology , Humans , Pandemics/prevention & control , Professional Role , United StatesABSTRACT
Study Objective: Age and medical co-morbidities are well-known risk factors for need for hospitalization in COVID-19. It is unclear whether, and which, baseline echocardiographic abnormalities may refine triage in the emergency department beyond clinical risk factors, and hence help identify patients at higher risk for need for hospitalization. We aimed to investigate echocardiographic variables associated with risk of hospitalization in COVID-19 patients. Methods: Electronic health records (EHR) were screened retrospectively to identify adults with a positive COVID-19 test throughout St. Luke’s University Health Network from March 1, 2020-October 31, 2020, and had a transthoracic echocardiogram (TTE) within 15-180 days prior. Baseline medical co-morbidities and echocardiographic variables were compared between patients stratified by hospitalization. Continuous variables were compared using Student’s t-test or Mann-Whitney U-test;categorical variables using the χ 2-test or Fisher’s Exact test. Univariate logistic regression was used to select significant predictors for multivariate analysis. Backward stepwise logistic regression was performed to identify predictors of need for hospitalization, a surrogate for mild versus moderate-severe disease. Results: 193 patients met inclusion criteria (83 hospitalized). Mean TTE to COVID19 positivity time was 86±52 days. Hospitalized patients were older and more likely to suffer co-morbidities (Table 1). Age, medical co-morbidities and several echocardiographic variables predicted need for hospitalization. Multivariate analysis revealed age, coronary disease, COPD, and left atrial (LA) enlargement (≥4 cm) independently predicting hospitalization with excellent discrimination (AUC 0.809, figure 1). Estimates plots are depicted in Figure 2. Conclusion: We present, to our knowledge the first cohort indicating that LA enlargement, in a largely unselected population, is an independent marker of need for hospitalization (a surrogate for worse than mild disease) among COVID-19 patients, and could perhaps be considered in addition to clinical risk assessment in the ED, when available. Being “upstream” from the left ventricle (LV), LA enlargement is an indicator of sustained LV pressure and/or volume overload resulting from diverse etiologies, including hypertension, valvular heart disease, and ischemic heart disease. Hence, LA size has long been known to be an independent predictor of cardiovascular events, stroke, and all-cause mortality among patients with underlying cardiovascular disease as well as the general population. Importantly, LA diameter emerged as a more powerful predictor than LV hypertrophy of COVID-19 severity, as indicated by need for hospitalization. [Formula presented] [Formula presented] [Formula presented]
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Background. In January-March 2020, the Centers for Disease Control and Prevention (CDC) issued multiple warnings regarding COVID-19 travel-associated risks. We sought to describe US travelers seeking pretravel consultation regarding international travel at US Global TravEpiNet (GTEN) sites before and after the initial COVID-19 travel warnings. Methods. We prospectively collected data at 22 GTEN sites pre-COVID-19 (January-December 2019) and 18 GTEN sites during the COVID-19 pandemic (April 2020-March 2021). We excluded travelers evaluated during January-March 2020, when CDC travel guidance was evolving rapidly. Travelers used standardized questionnaires to self-report data regarding demographics and travel-related characteristics. Providers confirmed these data and documented their recommendations during pretravel consultation, which could be performed virtually. We conducted descriptive analyses of differences in demographics, travel-related characteristics, vaccinations, and medications (SAS v9.4;Cary, NC). Results. Compared with 16,903 pre-COVID-19 consultations, only 1,564 consultations occurred during the COVID-19 pandemic, a 90% reduction (Table). During COVID-19, a greater proportion of travelers were children aged 1-5 years, visiting friends and relatives (VFR), with itineraries ≥ 30 days, and going to Africa;a smaller proportion of travelers were aged > 55 years, or traveling to Southeast Asia or the Western Pacific. During COVID-19, fewer vaccine-eligible travelers received vaccines at the pretravel consultation except for yellow fever, and a greater proportion were referred to another provider for vaccination (Figure). Table. Demographics and travel-related characteristics of international travelers seeking pretravel consultation at Global TravEpiNet sites before and during the COVID-19 pandemic Table continued. Demographics and travel-related characteristics of international travelers seeking pretravel consultation at Global TravEpiNet sites before and during the COVID-19 pandemic Figure. Vaccinations and reasons for nonvaccination among vaccine-eligible international travelers at pretravel consultations at Global TravEpiNet (GTEN) sites before and during the COVID-19 pandemic. Among vaccine-eligible travelers, we summarized those who were vaccinated at the visit (blue) and not vaccinated (orange). We then categorized reasons for nonvaccination into: provider decision (solid), referral to another provider (dots), traveler refusal (striped), or other (hatched). COVID-19 vaccination was not available at GTEN sites during the analysis period;although COVID-19 vaccinations outside of GTEN sites might have affected vaccination recommendations, they were unlikely to have had a large effect given their limited availability in January-March 2021. Conclusion. Compared with pre-COVID-19, US travelers seeking pretravel consultations at GTEN sites during the pandemic might be at higher risk for travel-related infections given VFR status, traveling for ≥ 30 days, and going to Africa. Fewer vaccine-eligible travelers were vaccinated at pretravel consultations, which could reflect more virtual pretravel consultations. Counseling and vaccination for international travelers continue to be priorities during the COVID-19 pandemic.
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Introduction: Patients presenting for radiation therapy (RT) at a single institution were analysed regarding treatment delays and disparities during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study was conducted at an urban multidisciplinary cancer centre. In April 2020, the institution's radiation oncology department implemented universal COVID-19 screening protocols prior to RT initiation. COVID-19 testing information on cancer patients planned for RT from 04/2020 to 01/2021 was reviewed. Trends of other lifetime COVID-19 testing and overall care delays were also studied. Results: Two hundred and fifty-four consecutive cancer patients received RT. Median age was 63 years (range 24-94) and 57·9% (n = 147) were Black. Most (n = 107, 42·1%) patients were insured through Medicare. 42·9% (n = 109) presented with stage IV disease. One (0·4%) asymptomatic patient tested positive for COVID-19 pre-RT. The cohort received 975 lifetime COVID-19 tests (median 3 per patient, range 1-18) resulting in 29 positive test results across 21 patients. Sixteen patients had RT delays. Identifying as Hispanic/Latino was associated with testing positive for COVID-19 (p = 0·015) and RT delay (p = 0·029). Conclusion: Most patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, increased testing burden, delays in diagnostic workup and testing positive for COVID-19 may intensify disparities affecting this urban patient population. © The Author(s), 2022. Published by Cambridge University Press.
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Introduction: Dyspnea seems to be rarely reported in pneumonitis caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), sometimes giving rise to the term "silent hypoxemia". Dyspnea, the perception of sensory information related to breathing, is associated with a negative emotional experience. It would result from the activation of structures of the limbic/paralimbic system, including the insula. The latter would be the interoceptive alarm center, linking the perception of visceral sensations (including dyspnea) to the conscious experience of emotions. The neuroinvasive potential of SARS-CoV-2 via the olfactory bulbs raises suspicion of limbic/paralimbic damage but also of the brain stem during respiratory damage from Coronavirus Disease 2019 (COVID-19). We formulate the hypothesis that an attenuation of the affective component of dyspnea during hypoxia, resulting from impairment of interoception, is the consequence of impairment of these neurological structures.