All-Fabric Triboelectric Nanogenerator (AF-TENG) Smart Face Mask: Remote Long-Rate Breathing Monitoring and Apnea Alarm.

Since the beginning of the COVID-19 pandemic, the use of face masks has become not only mandatory in several countries but also an acceptable approach for combating the pandemic. In the quest for designing an effective and useful face mask, triboelectric nanogenerators (TENGs) have been recently proposed. Novel functionalities are provided with the use of TENGs in face masks due to the induced triboelectrification generated by the exhaled and inhaled breath, allowing their use as an energy sensor. Nonetheless, within the face mask, the presence of nontextile plastics or other common triboelectric (TE) materials can be undesired. Herein, we propose the use of an all-fabric TENG (AF-TENG) with the use of high molecular weight polyethylene (UHMWPE) and cotton fabric as negative and positive triboelectric layers, respectively. With these materials, it is possible to detect the breathing of the patient, which in the case of not detecting a signal over a few minutes can trigger an alarm locally, providing valuable time. Also, in this article, we have sent breathing signals locally and remotely to distances up to 20 km via Wi-Fi and LoRa, the same as warning signals in the case of detecting anomalies. This work reveals the use of TENGs in smart face masks as an important tool to be used in difficult epidemiological periods to the general public, bringing much more comfort and relaxation to patients and elderly in today's society, and based on pristine eco-friendly materials.

Effect of Expanded Hemodialysis with Theranova® in Patients with COVID-19.

INTRODUCTION: Cytokine storm control is the main target for improving severe COVID-19 by using immunosuppressive treatment. Effective renal replacement therapy (RRT) could give us an advantage removing cytokines in patients with RRT requirements superimposed on COVID-19. METHODS: This is a prospective observational study in COVID-19 patients who required hemodialysis (HD). Patients were assigned to online hemodiafiltration (OL-HDF) and expanded HD (HDx) according to Brescia group recommendations. We measured several cytokines, ß2 microglobulin and albumin levels pre/post-dialysis and on 1st-2nd week. We compared levels among both techniques and control group (HD without COVID-19). RESULTS: We included 26 patients: 18 with COVID-19 on RRT (5 of them had acute kidney injury [AKI]) and 8 controls. We confirm higher cytokine levels in COVID-19 patients than controls and even higher in patients with AKI than in those with chronic kidney disease. Most cytokines raised during HD session, except IL-10 and TNFα. IL-10 was eliminated by any dialysis technique, while clearance of TNFα was higher in the HDx group. HDx achieved a deeper normalization of cytokines and ß2 microglobulin reduction. Mortality was higher in the OL-HDF group than the HDx group. DISCUSSION: Not all cytokines behave equally along HD session. The following characteristics should be taken into account, such as intrinsic kinetic profile during a HD session. HDx seems to get better performance, probably due to the combination of different factors; however, we did not reach statistical significance due to the small sample size, dropout, and reduction of AKI incidence during the 2nd pandemic wave. CONCLUSION: HDx appears to provide better clearance for TNFα and ß2 microglobulin during HD session and associates lower mortality. We propose the HDx technique for COVID-19 patients with RRT requirements since it seems to be safe and more effective than OL-HDF. Further studies are still needed, but we hope that our preliminary data may help us in future pandemic waves of SARS-CoV-2 or other viruses still to come.

On variants and vaccines: The effectiveness of Covid-19 monoclonal antibody therapy during two distinct periods in the pandemic.

BACKGROUND: While Covid-19 monoclonal antibody therapies (Mab) have been available in the outpatient setting for over a year and a half, little is known about the impact of emerging variants and vaccinations on the effectiveness of Mab therapies. We sought to determine the effectiveness of Covid-19 Mab therapies during the first two waves of the pandemic in Los Angeles County and assess the impact of vaccines, variants, and other confounding factors. METHODS AND FINDINGS: We retrospectively examined records for 2209 patients of with confirmed positive molecular SARS-CoV2 test either referred for outpatient Mab therapy or receiving Mab treatment in the emergency department (ED) between December 2020 and 2021. Our primary outcome was the combined 30-day incidence of ED visit, hospitalization, or death following the date of referral. Additionally, SARS-CoV2 isolates of hospitalized patients receiving Mabs were sequenced. The primary outcome was significantly reduced with combination therapy compared to bamlanivimab or no treatment (aHR 0·60; 95% CI ·37, ·99), with greater benefit in unvaccinated, moderate-to-high-risk patients (aHR ·39; 95% CI ·20, ·77). Significant associations with the primary outcome included history of lung disease (HR 7·13; 95% CI 5·12, 9·95), immunocompromised state (HR 6·59; 95% CI 2·91-14·94), and high social vulnerability (HR 2·29, 95% CI 1·56-3·36). Two predominant variants were noted during the period of observation: the Epsilon variant and the Delta variant. CONCLUSIONS: Only select monoclonal antibody therapies significantly reduced ED visits, hospitalizations, and death due to COVID-19 during. Vaccination diminished effectiveness of Mabs. Variant data and vaccination status should be considered when assessing the benefit of novel COVID-19 treatments.

Impact of the COVID-19 Pandemic on the Diagnosis and Prognosis of Melanoma.

BACKGROUND: Early detection of melanoma is one of the main diagnostic goals of dermatologists worldwide, due to the increasing incidence of the disease in our environment. However, the irruption of the SARS-CoV-2 pandemic has posed a challenge to global healthcare, forcing systems to focus their resources on the fight against COVID-19. METHODS: Retrospective cohort study. The exposed cohort were patients diagnosed with melanoma in the year after the general confinement in Spain (15 March 2020) and the unexposed cohort were patients with melanoma diagnosed in the previous year. RESULTS: 130 patients were included. No differences were observed between demographic characteristics in both cohorts. The mean Breslow of melanoma before the onset of the pandemic was 1.08, increasing to 2.65 in the year after the onset of the pandemic (p < 0.001). On the other hand, the percentage of melanomas in situ decreased from 38.96% to 16.98% in the year after the declaration of the state of alarm in Spain. CONCLUSIONS: The SARS-CoV-2 outbreak has led to a reduction in the early diagnosis of melanoma, with an increase in invasive melanomas with poor prognosis histological factors. This could lead to an increase in melanoma-related mortality in the coming years in our environment.

Applicability of probabilistic graphical models for early detection of SARS-CoV-2 reactive antibodies after SARS-CoV-2 vaccination in hematological patients.

Prior studies of antibody response after full SARS-CoV-2 vaccination in hematological patients have confirmed lower antibody levels compared to the general population. Serological response in hematological patients varies widely according to the disease type and its status, and the treatment given and its timing with respect to vaccination. Through probabilistic machine learning graphical models, we estimated the conditional probabilities of having detectable anti-SARS-CoV-2 antibodies at 3-6 weeks after SARS-CoV-2 vaccination in a large cohort of patients with several hematological diseases (n= 1166). Most patients received mRNA-based vaccines (97%), mainly Moderna® mRNA-1273 (74%) followed by Pfizer-BioNTech® BNT162b2 (23%). The overall antibody detection rate at 3 to 6 weeks after full vaccination for the entire cohort was 79%. Variables such as type of disease, timing of anti-CD20 monoclonal antibody therapy, age, corticosteroids therapy, vaccine type, disease status, or prior infection with SARS-CoV-2 are among the most relevant conditions influencing SARS-CoV-2-IgG-reactive antibody detection. A lower probability of having detectable antibodies was observed in patients with B-cell non-Hodgkin's lymphoma treated with anti-CD20 monoclonal antibodies within 6 months before vaccination (29.32%), whereas the highest probability was observed in younger patients with chronic myeloproliferative neoplasms (99.53%). The Moderna® mRNA-1273 compound provided higher probabilities of antibody detection in all scenarios. This study depicts conditional probabilities of having detectable antibodies in the whole cohort and in specific scenarios such as B cell NHL, CLL, MM, and cMPN that may impact humoral responses. These results could be useful to focus on additional preventive and/or monitoring interventions in these highly immunosuppressed hematological patients.

Changes in body composition and phase angle during pre-season in professional soccer players / Cambios en la composición corporal y ángulo de fase durante la pretemporada en jugadores de fútbol profesional

RESUMEN: El análisis y el control de la composición corporal son claves en el fútbol por su implicación en el rendimiento. El objetivo de este estudio fue identificar, en jugadores de futbol profesional, el ángulo de fase (PhA) de miembros inferiores con los posibles patrones de mejora del componente magro en los mismos medido por DEXA. Al mismo tiempo, se estudió mediante BIA la evolución de parámetros hídricos de los jugadores, sometidos a un entrenamiento intenso y a un control nutricional de su alimentación y suplementación. Se evaluaron a 18 jugadores (26,28 ± 5,1 años; 85,09 ± 9,16 kg; 185,5 ± 4,32 cm) de un equipo de la primera división de fútbol italiana. Se llevó a cabo el estudio durante cuatro semanas, entre el 11 de julio (pre-test) y el 11 de agosto de 2021 (post-test). La intervención se llevó a cabo en su totalidad en pretemporada, con un confinamiento en modalidad de aislamiento o burbuja total por prevención al contagio del COVID-19, dónde se monitorizaba en un alto porcentaje la vida del jugador, incluyendo factores como la alimentación, el entrenamiento y el descanso. La suplementación estuvo basada en antioxidantes, multivitamínicos, minerales y ácidos grasos poliinsaturados y dos productos en polvo (uno a base de creatina, glutamina y leucina, y otro, a base de aminoácidos esenciales). Los jugadores presentaron una mejora del PhA y del componente magro en los miembros inferiores, con una moderada correlación (r = 0,6). Con respecto al agua intracelular y extracelular, señalar que, a pesar de la alta intensidad del ejercicio durante cuatro semanas, éstas se han mantenido constantes sin presentar variaciones significativas durante el periodo de estudio, lo que indica que no se ha producido un proceso de deshidratación del jugador.

SUMMARY: The analysis and control of body composition is essential in soccer due to its implication in performance. The aim of this study was to identify, in professional soccer players, the phase angle (PhA) of the lower limbs with possible patterns of improvement of the lean component measured by DEXA. At the same time, the evolution of hydric parameters of the players, subjected to intense training and nutritional control of their diet and supplementation, was studied by means of BIA. Eighteen players (26.28 ± 5.1 years; 85.09 ± 9.16 kg; 185.5 ± 4.32 cm) from an Italian first division football team were evaluated. The study was conducted for four weeks, between 11th July (pre- test) and 11th August of 2021 (post-test). The intervention was carried out entirely in pre-season, with confinement in isolation or total bubble mode for prevention of COVID-19 infection, where a high percentage of the player's life was monitored, including factors such as diet, training and rest. Supplementation was based on antioxidants, multivitamins, minerals and polyunsaturated fatty acids and two powdered products (one based on creatine, glutamine and leucine, and the other one, on essential amino acids). The players showed an improvement in PhA and in the lean component in the lower limbs, with a moderate correlation (r = 0.6). With regard to intracellular and extracellular water, it should be noted that, despite the high intensity of exercise during four weeks, these have remained constant without significant variations during the study period, indicating that there has not been a process of dehydration of the player.

Assessment of the impact of confinement by SARS-CoV-2 on the body composition of elite soccer players / Valoración del impacto del confinamiento por SARS-CoV-2 sobre la composición corporal de una población de futbolistas de élite

RESUMEN: El confinamiento por pandemia por SARS-CoV-2 ha agravado la condición física y nutricional de los deportistas de élite, modificando la rutina de los entrenamientos. La bioimpedancia (BIA) estudia la composición corporal y es utilizada para valorar la evolución de las intervenciones médicas, deportivas y nutricionales. El objetivo del estudio fue observar si una intervención nutricional y una prescripción de actividad física específicas pudieron atenuar los cambios hídricos, de composición corporal, y ángulo de fase (PhA) tras el confinamiento por la pandemia SARS-CoV-2 en una población de futbolistas de élite. En un grupo de 22 futbolistas profesionales (Serie A, Calcio, Italia) se evaluó la BIA antes (febrero 2020) y después (mayo 2020) del confinamiento por la pandemia SARS-CoV-2. Durante el periodo de confinamiento se aplicó una intervención nutricional y prescripción de actividad física específicas. Las medidas de los participantes se realizaron de forma protocolizada, usando material antropométrico y un impedanciómetro multifrecuencia, octopolar y segmental de la marca Tanita modelo MC-780MA. Se aplicó la prueba t de Student para muestras relacionadas. No se observaron diferencias significativas antes y después del periodo de intervención, en el grado de hidratación y composición corporal (masa muscular y masa grasa). Por el contrario, se evidenció un cambio significativo en el PhA. Estos datos nos permiten poder tener una referencia de que intervenciones nutricionales y de actividad física pueden minimizar o disminuir el impacto de un confinamiento en la composición corporal. No obstante, este tipo intervención no fue capaz de atenuar los efectos del confinamiento sobre el PhA, considerado un indicador de la salud celular. Así mismo, aportamos una gráfica vectorial de referencia, mediante SpecificBIVA, de esta población.

SUMMARY: The confinement due to a SARS-CoV-2 pandemic has aggravated the physical and nutritional condition of elite athletes, modifying their training routine. Bioimpedance (BIA) studies body composition and is used to assess the evolution of medical, sports and nutritional interventions. The objective of the study was to observe if a specific nutritional intervention and prescription of physical activity could attenuate the changes in water, body composition, and phase angle (PhA) after confinement due to the SARS-CoV-2 pandemic in a population of professional soccer players. In a group of (22 professional soccer players (Serie A, Calcio, Italy) the BIA was evaluated before (February 2020) and after (May 2020) the confinement due to the SARS-CoV-2 pandemic. During the confinement period, a specific nutritional intervention and prescription of physical activity was applied. The measurements of the participants were carried out in a standardized way, using anthropometric material and a multifrequency, octopolar and segmental impedance measurer of the "Tanita" brand model MC-780MA. Student's T test was applied for related samples. No significant differences were observed before and after the intervention period, in the degree of hydration and body composition (muscle mass and fat mass). On the contrary, a significant change in PhA was evidenced. These data allow us to hav a reference for nutritional and physical activity interventions that can minimize or reduce the impact of confinement on body composition. However, this type of intervention was not able to attenuate the effects of confinement on PhA, considered an indicator of cellular health. Likewise, we provide a reference vector graph, using Specific BIVA, of this population.

Polymorphisms in ACE, ACE2, AGTR1 genes and severity of COVID-19 disease.

BACKGROUND: Infection by the SARS-Cov-2 virus produces in humans a disease of highly variable and unpredictable severity. The presence of frequent genetic single nucleotide polymorphisms (SNPs) in the population might lead to a greater susceptibility to infection or an exaggerated inflammatory response. SARS-CoV-2 requires the presence of the ACE2 protein to enter in the cell and ACE2 is a regulator of the renin-angiotensin system. Accordingly, we studied the associations between 8 SNPs from AGTR1, ACE2 and ACE genes and the severity of the disease produced by the SARS-Cov-2 virus. METHODS: 318 (aged 59.6±17.3 years, males 62.6%) COVID-19 patients were grouped based on the severity of symptoms: Outpatients (n = 104, 32.7%), hospitalized on the wards (n = 73, 23.0%), Intensive Care Unit (ICU) (n = 84, 26.4%) and deceased (n = 57, 17.9%). Comorbidity data (diabetes, hypertension, obesity, lung disease and cancer) were collected for adjustment. Genotype distribution of 8 selected SNPs among the severity groups was analyzed. RESULTS: Four SNPs in ACE2 were associated with the severity of disease. While rs2074192 andrs1978124showed a protector effectassuming an overdominant model of inheritance (G/A vs. GG-AA, OR = 0.32, 95%CI = 0.12-0.82; p = 0.016 and A/G vs. AA-GG, OR = 0.37, 95%CI: 0.14-0.96; p = 0.038, respectively); the SNPs rs2106809 and rs2285666were associated with an increased risk of being hospitalized and a severity course of the disease with recessive models of inheritance (C/C vs. T/C-T/T, OR = 11.41, 95% CI: 1.12-115.91; p = 0.012) and (A/A vs. GG-G/A, OR = 12.61, 95% CI: 1.26-125.87; p = 0.0081). As expected, an older age (OR = 1.47), male gender (OR = 1.98) and comorbidities (OR = 2.52) increased the risk of being admitted to ICU or death vs more benign outpatient course. Multivariable analysis demonstrated the role of the certain genotypes (ACE2) with the severity of COVID-19 (OR: 0.31, OR 0.37 for rs2074192 and rs1978124, and OR = 2.67, OR = 2.70 for rs2106809 and rs2285666, respectively). Hardy-Weinberg equilibrium in hospitalized group for I/D SNP in ACE was not showed (p<0.05), which might be due to the association with the disease. No association between COVID-19 disease and the different AGTR1 SNPs was evidenced on multivariable, nevertheless the A/A genotype for rs5183 showed an higher hospitalization risk in patients with comorbidities. CONCLUSIONS: Different genetic variants in ACE2 were associated with a severe clinical course and death groups of patients with COVID-19. ACE2 common SNPs in the population might modulate severity of COVID-19 infection independently of other known markers like gender, age and comorbidities.

Surgical acute abdomen and COVID-19 vaccination.

In response to the publication "Acute appendicitis, foreign bodies and COVID-19 vaccination: correspondence", we reviewed the association between acute surgical abdomen and COVID-19 vaccination.

Food-Away-from-Home Expenditure in Mexico during the COVID-19 Pandemic: A Micro-Econometric Analysis

Disruptive events such as the coronavirus disease 2019 (COVID-19) pandemic have the potential to reshape even the most basic human systems and behaviors, including those related to food production, acquisition, and consumption. This paper provides an in-depth analysis of how the pandemic has changed the ratio of food-away-from-home (FAFH) expenditure to income in Mexico, as well as participation in this market. In 2020, household participation in FAFH expenditures declined in all income deciles and regions, but the impact on household shares is far from uniform. Using a detailed national database of household income and expenditures (N = 87,274), an Engel curve of the Working-Lesser functional form for FAFH including 19 independent variables was estimated using the Heckman method appropriate for censored response data. The results provide statistically significant estimates for income, which both increases the probability of participation in this expenditure and has a negative relationship with its budget share. The number of older adults and the exposure to food insecurity during the pandemic similarly limit participation and increase the budget share. In addition, remittances encourage participation and decrease the budget share. The corrected conditional income elasticity for FAFH is 0.4609;the sign and magnitude indicate that FAFH behaved as a necessary good in Mexico for the proportion of households that maintained spending during the lockdown conditions (about one-third of the sample). An increase or decrease in income will lead to a corresponding change in FAFH expenditure, but the change will be less than proportional.

Uncommon causes of acute appendicitis: foreign bodies in the cecal appendix.

A 50-year-old woman with a history of hysterectomy for endometrial cancer in 2015 visited because of abdominal pain for 1 week and fever simultaneous with her third dose of the COVID-19 vaccine. Physical examination revealed a mobile mass in the right iliac fossa, and laboratory testing showed C-reactive protein at 3 mg/dL, with no further changes. Ultrasound results were consistent with an appendiceal inflammatory mass, and a CT scan revealed an appendicolith as likely cause. The patient was subjected to laparoscopy, which found inside the mass a metallic piece (dental prosthesis) that perforated the appendiceal lumen at the mid portion of the appendix. Appendectomy was completed and the patient was discharged on the third day post-procedure.

Assessment of hand hygiene strategies on skin barrier function during COVID-19 pandemic: A randomized clinical trial.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has increased the frequency of handwashing. There is scarce evidence regarding the impact of different hand hygiene procedures on skin barrier function in clinical practice. OBJECTIVE: To compare the impact on skin barrier function of different hand hygiene measures in healthcare workers in daily practice. METHODS: A randomized controlled clinical trial was conducted. Participants were randomized to sanitize their hands with water and soap, alcohol-based hand sanitizers (ABHSs), or disinfectant wipes during their 8-hour working shift. Epidermal barrier functional parameters, such as transepidermal water loss (TEWL), and the microbial load were assessed before and immediately after the working day. Tolerance and acceptability of each product were recorded after work. RESULTS: Sixty-two participants were included and 20, 21, and 21 were randomized to use water and soap, ABHS, and disinfectant wipes, respectively. After the 8-hour shift, TEWL increase was higher with disinfectant wipes than with soaps or ABHS (+5.45 vs +3.87 vs -1.46 g h-1  m-2 , respectively; P = .023). Bacteria and fungi colony-forming unit (CFU) count reductions were lower for the water and soap group than for ABHS and disinfectant wipes. Disinfectant wipes were considered more difficult to use (P = .013) compared with water and soap and ABHS. CONCLUSION: Daily hand hygiene with ABHS showed the lowest rates of skin barrier disruption and the highest reduction of CFU.

Indoor Air Quality including Respiratory Viruses.

The detection of SARS-CoV-2 in indoor environments is a cause of increasing concern. In this study, three sampling methodologies have been used in order to collect SARS-CoV-2 and 17 other respiratory viruses in indoor air, combined with a new analytical process to analyze respiratory viruses. Different areas of an ophthalmological hospital were investigated for the presence of these airborne viruses. Moreover, indoor air quality (IAQ) parameters (carbon dioxide, CO2; carbon monoxide, CO; nitrogen dioxide, NO2; volatile organic compounds, VOCs; formaldehyde, HCHO; and particulate matter, PM) have been examined to study the relationship between IAQ and airborne viruses. All indoor air and surface samples assessed were found to be negative for SARS-CoV-2. Nevertheless, another airborne respiratory virus (HRV/ENV) was detected, illustrating that the methodology set out here is a suitable one. Regarding the results for the IAQ, chemical parameters studied in the hall and waiting room of the hospital presented acceptable values. However, in the doctor's consultation room VOCs and HCHO show some instantaneous levels higher than the recommended guide values. The methodological approach described in this paper, integrating conventional IAQ and the assessment of bioaerosols, can be used in research and control programs aimed at promoting a healthy indoor environment.

Economía social y resistencia feminista: el tianguis autogestivo y disidente de Oaxaca, México

El objetivo fue analizar las expresiones económicas, políticas y culturales de las mujeres que integran el Tianguis autogestivo, feminista y disidente de la ciudad de Oaxaca, México. La investigación es cualitativa y se sustenta en las técnicas de los estudios etnográficos. El tianguis se forma por la pérdida de empleos que trajo consigo la pandemia del COVID-19 y recupera la forma original de la organización del mercado al concentrar físicamente a productores y compradores, donde el dinero como medio de intercambio se va sustituyendo paulatinamente por el trueque. El sistema hegemónico, capitalista y patriarcal extiende su dominio de manera sutil e imperceptible en la sociedad, se construye de abajo hacia arriba, pero también muestra el carácter intolerante y represivo del poder institucional, sólo así es posible explicar que las autoridades del municipio de Oaxaca desalojaran y recuperaran de manera violenta el espacio público ocupado por las tianguistas. Las mujeres han tenido que colocarse en resistencia y adoptar una posición política ante la falta de acuerdos con las autoridades municipales para poder continuar con el intercambio y venta de sus mercancías.

Phase 3 Safety and Efficacy of AZD1222 (ChAdOx1 nCoV-19) Covid-19 Vaccine.

BACKGROUND: The safety and efficacy of the AZD1222 (ChAdOx1 nCoV-19) vaccine in a large, diverse population at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the United States, Chile, and Peru has not been known. METHODS: In this ongoing, double-blind, randomized, placebo-controlled, phase 3 clinical trial, we investigated the safety, vaccine efficacy, and immunogenicity of two doses of AZD1222 as compared with placebo in preventing the onset of symptomatic and severe coronavirus disease 2019 (Covid-19) 15 days or more after the second dose in adults, including older adults, in the United States, Chile, and Peru. RESULTS: A total of 32,451 participants underwent randomization, in a 2:1 ratio, to receive AZD1222 (21,635 participants) or placebo (10,816 participants). AZD1222 was safe, with low incidences of serious and medically attended adverse events and adverse events of special interest; the incidences were similar to those observed in the placebo group. Solicited local and systemic reactions were generally mild or moderate in both groups. Overall estimated vaccine efficacy was 74.0% (95% confidence interval [CI], 65.3 to 80.5; P<0.001) and estimated vaccine efficacy was 83.5% (95% CI, 54.2 to 94.1) in participants 65 years of age or older. High vaccine efficacy was consistent across a range of demographic subgroups. In the fully vaccinated analysis subgroup, no severe or critical symptomatic Covid-19 cases were observed among the 17,662 participants in the AZD1222 group; 8 cases were noted among the 8550 participants in the placebo group (<0.1%). The estimated vaccine efficacy for preventing SARS-CoV-2 infection (nucleocapsid antibody seroconversion) was 64.3% (95% CI, 56.1 to 71.0; P<0.001). SARS-CoV-2 spike protein binding and neutralizing antibodies increased after the first dose and increased further when measured 28 days after the second dose. CONCLUSIONS: AZD1222 was safe and efficacious in preventing symptomatic and severe Covid-19 across diverse populations that included older adults. (Funded by AstraZeneca and others; ClinicalTrials.gov number, NCT04516746.).

Cerebral Venous Sinus Thrombosis in COVID-19 Patients: A Multicenter Study and Review of Literature.

BACKGROUND: COVID-19 infection has been known to predispose patients to both arterial and venous thromboembolic events such as deep venous thrombosis, pulmonary embolism, myocardial infarction, and stroke. A few reports from the literature suggest that Cerebral Venous Sinus Thrombosis (CVSTs) may be a direct complication of COVID-19. OBJECTIVE: To review the clinical and radiological presentation of COVID-19 positive patients diagnosed with CVST. METHODS: This was a multicenter, cross-sectional, retrospective study of patients diagnosed with CVST and COVID-19 reviewed from March 1, 2020 to November 8, 2020. We evaluated their clinical presentations, risk factors, clinical management, and outcome. We reviewed all published cases of CVST in patients with COVID-19 infection from January 1, 2020 to November 13, 2020. RESULTS: There were 8 patients diagnosed with CVST and COVID-19 during the study period at 7 out of 31 participating centers. Patients in our case series were mostly female (7/8, 87.5%). Most patients presented with non-specific symptoms such as headache (50%), fever (50%), and gastrointestinal symptoms (75%). Several patients presented with focal neurologic deficits (2/8, 25%) or decreased consciousness (2/8, 25%). D-dimer and inflammatory biomarkers were significantly elevated relative to reference ranges in patients with available laboratory data. The superior sagittal and transverse sinuses were the most common sites for acute CVST formation (6/8, 75%). Median time to onset of focal neurologic deficit from initial COVID-19 diagnosis was 3 days (interquartile range 0.75-3 days). Median time from onset of COVID-19 symptoms to CVST radiologic diagnosis was 11 days (interquartile range 6-16.75 days). Mortality was low in this cohort (1/8 or 12.5%). CONCLUSIONS: Clinicians should consider the risk of acute CVST in patients positive for COVID-19, especially if neurological symptoms develop.