Early infection risk in patients with systemic lupus erythematosus treated with rituximab or belimumab from the British Isles Lupus Assessment Group Biologics Register (BILAG-BR): a prospective longitudinal study

Background: Patients with systemic lupus erythematosus (SLE) are at an increased risk of infection relative to the general population. We aimed to describe the frequency and risk factors for serious infections in patients with moderate-to-severe SLE treated with rituximab, belimumab, and standard of care therapies in a large national observational cohort. Method(s): The British Isles Lupus Assessment Group Biologics Register (BILAG-BR) is a UK-based prospective register of patients with SLE. Patients were recruited by their treating physician as part of their scheduled care from 64 centres across the UK by use of a standardised case report form. Inclusion criteria for the BILAG-BR included age older than 5 years, ability to provide informed consent, a diagnosis of SLE, and starting a new biological therapy within the last 12 months or a new standard of care drug within the last month. The primary outcome for this study was the rate of serious infections within the first 12 months of therapy. Serious infections were defined as those requiring intravenous antibiotic treatment, hospital admission, or resulting in morbidity or death. Infection and mortality data were collected from study centres and further mortality data were collected from the UK Office for National Statistics. The relationship between serious infection and drug type was analysed using a multiple-failure Cox proportional hazards model. Finding(s): Between July 1, 2010, and Feb 23, 2021, 1383 individuals were recruited to the BILAG-BR. 335 patients were excluded from this analysis. The remaining 1048 participants contributed 1002.7 person-years of follow-up and included 746 (71%) participants on rituximab, 119 (11%) participants on belimumab, and 183 (17%) participants on standard of care. The median age of the cohort was 39 years (IQR 30-50), 942 (90%) of 1048 patients were women and 106 (10%) were men. Of the patients with available ethnicity data, 514 (56%) of 911 were White, 169 (19%) were Asian, 161 (18%) were Black, and 67 (7%) were of multiple-mixed or other ethnic backgrounds. 118 serious infections occurred in 76 individuals during the 12-month study period, which included 92 serious infections in 58 individuals on rituximab, eight serious infections in five individuals receiving belimumab, and 18 serious infections in 13 individuals on standard of care. The overall crude incidence rate of serious infection was 117.7 (95% CI 98.3-141.0) per 1000 person-years. Compared with standard of care, the serious infection risk was similar in the rituximab (adjusted hazard ratio [HR] 1.68 [0.60-4.68]) and belimumab groups (1.01 [0.21-4.80]). Across the whole cohort in multivariate analysis, serious infection risk was associated with prednisolone dose (>10 mg;2.38 [95%CI 1.47-3.84]), hypogammaglobulinaemia (<6 g/L;2.16 [1.38-3.37]), and multimorbidity (1.45 [1.17-1.80]). Additional concomitant immunosuppressive use appeared to be associated with a reduced risk (0.60 [0.41-0.90]). We found no significant safety signals regarding atypical infections. Six infection-related deaths occurred at a median of 121 days (IQR 60-151) days from cohort entry. Interpretation(s): In patients with moderate-to-severe SLE, rituximab, belimumab, and standard immunosuppressive therapy have similar serious infection risks. Key risk factors for serious infections included multimorbidity, hypogammaglobulinaemia, and increased glucocorticoid doses. When considering the risk of serious infection, we propose that immunosupppressives, rituximab, and belimumab should be prioritised as mainstay therapies to optimise SLE management and support proactive minimisation of glucocorticoid use. Funding(s): None.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Analyzing the Effect of Insole Materials on Vibration and Noise Reduction between Floors

The COVID-19 pandemic increased people's time at home and caused an 80% increase in noise disputes between floors. The purpose of this study is to propose suitable materials for making indoor shoes (insoles) to minimize noise between floors. Subjects without back pain and leg-related disease (e.g. arthritis, etc.) from three different age groups (childhood, adolescence, and adulthood) were recruited for the study. Five polymer insole materials were considered: Chloroprene Rubber (CR foam), Ethylene Propylene Diene Monomer (EPDM foam), Natural Latex foam, Ethylene Vinyl Acetate (EVA foam), and Polyurethane (PU foam). From these materials, 20 combinations were prepared and randomly tested for noise and vibration. The results revealed a significant difference in noise and vibration levels based on the type of material used and the age of the subject. Nevertheless, all materials under consideration successfully reduced noise and vibration;in particular, type A-C greatly decreased. The CR foam material was especially effective at noise and vibration reduction (p<.01). This study suggests that adding insoles into socks that children wear at home could reduce noise vibration and disputes between floors. © 2023, The Korean Society of Clothing and Textiles. All rights reserved.

Perceptions of accuracy in online news during the COVID-19 pandemic

In this research, we assessed how young adults determine the accuracy of news articles and sources through a seven-day diary study. We performed a qualitative analysis on the participants' responses and found that the participants mainly used nine different strategies to evaluate the accuracy of COVID news. The majority of respondents relied on their inherent trust and the reputation of a given news outlet instead of actively determining if the information was accurate. Young adults also used their perception of the quality of the article, personal logical reasoning, cross referencing the information, availability of data, among others. We discuss the implications of the results and propose practical suggestions © 2023, First Monday.All Rights Reserved.

Best Practice Recommendations for Stroke Vascular Imaging During Iodinated Contrast Shortage.

GE Healthcare© announced on April 19, 2022, that their main factory and distributor of iodinated contrast had experienced a temporary shutdown because of COVID-19 outbreak in Shanghai, China. This, along with other supply chain issues, led to a worldwide shortage of iodinated contrast agents, Omnipaque and Visipaque. Our Comprehensive Stroke Center was confronted with the cascading effect of this iodinated contrast material shortage. We took immediate steps to revise our protocols and processes to continue to provide high-quality care to our stroke patients. A multidisciplinary working group comprised of representatives of our stroke center, including vascular neurology, diagnostic neuroradiology, and neurovascular surgery, urgently met to brainstorm how to mitigate the shortage. We established parameters and local guidelines for the use of CT angiography, CT perfusion, and digital subtraction angiography for stroke patients. In this article, we propose "best practice" recommendations from a single Joint Commission approved Comprehensive Stroke Center that can be used as blueprint by other hospital systems when navigating potential future supply chain issues, to provide consistent high-quality stroke care.

A Study on the Influence of Omni Channel's Shopping Value on Users' Innovative Tendency and Service Attitudes

Purpose: Due to COVID-19, the rapidly changing untact culture from offline to online has spread rapidly, increasing the utilization of omni-channel. However, among the studies on consumers in the online market, there are not many studies that analyze Shopping Values and attitudes toward omnichannel Acceptance. Research design, data, and methodology: This study investigated through empirical analysis how Shopping Values and innovation propensity of consumers using omni channels affect omni channel Acceptance attitudes. The analysis results based on a total of 268 questionnaires using SPSS v.23 and AMOS v.23 statistical programs are as follows. Results: First, it was found that the perceived Value of omnichannel use had a positive effect on the innovation tendency, and the pleasure Value had a greater effect than the actual Value. Second, it was found that the practical and hedonic Value of the omnichannel had a positive effect on the attitude of service Acceptance. Third, it was found that Omni Channel's consumer innovation tendency had a positive effect on service Acceptance attitude. Conclusion: This study proved that Shopping Value perception and individual innovation propensity for omnichannel services have a positive effect on Acceptance attitude, and it is of academic significance in that it expanded understanding of what factors are needed to increase Acceptance attitude of Omni Channel services © Copyright: The Author(s)

Developmental venous anomaly thrombosis in a patient with coronavirus disease 2019-associated hypercoagulability: illustrative case.

BACKGROUND: Spontaneous thrombosis of a developmental venous abnormality (DVA) is a rare complication associated with hypercoagulability. The objective of this case report is to describe an association between DVA thrombosis and mild coronavirus disease 2019 (COVID-19) infection in a vaccinated patient. OBSERVATIONS: A 28-year-old male with hypertension presented with severe headache and left-sided hemiparesis. Five weeks prior to presentation, the patient experienced mild respiratory symptoms and tested positive for COVID-19. Admission brain computed tomography (CT) showed a large right parieto-occipital intracerebral hemorrhage with surrounding edema. CT venography and catheter angiography showed a thrombosed DVA with associated venous infarction as the hemorrhage etiology. He was treated with decompressive hemicraniectomy, external ventricular drain placement, and systemic anticoagulation. The patient was functionally independent (modified Rankin Scale score, 2) at 4-month follow-up. Hypercoagulability work-up was unremarkable. LESSONS: Delayed DVA thrombosis after the COVID-19 infectious period may represent an association between the infection and a protracted systemic viral-induced hypercoagulable state. The severity of COVID-19 symptomatology does not appear to correlate with risk of DVA thrombosis. Young patients with a recent history of COVID-19 infection who present with venous infarction should be evaluated for an underlying thrombosed DVA.

Changes in vertical jump performance and body composition before and after COVID-19 lockdown

This study aimed to determine the effects of a 16-week COVID-19 lockdown on body composition and vertical jump performance. Thirteen martial artists participated in this study. Participants were tested at: 1) pre-lockdown (pre), 2) post-lockdown (post), 3) two-weeks-post-lockdown (post+2), and 4) four-weeks-post-lockdown (post+4). Repeated-measures-ANOVAs were conducted with post-hoc analyses. Differences were observed in vertical jump height (VJH) (10.33%), peak velocity (PV) (3.10%), reactive-strength-index-modified (RSImod) (13.8%), and peak-propulsive-power (PPP) (6.00%) from pre-to-post. There as an increase from post-to-post+2 in VJ (13.06%), PV (4.12%), RSImod (14.0%), and PPP (4.66%). There was an increase from post to post+2 in VJH (10.8%), PV (3.1%), RSImod (14.0%), and PPP (3.0%). Fat mass (FM) and BF% increased from pre to post (13% and 11%, respectively) and decreased from post to post+4 (8% and 11%, respectively);fat-free mass (FFM) decreased from pre-to-post (11%) and decreased from post-to-post+4 (8%). There were moderate associations (rmc = 0.42-0.47) between FFM and VJH, FMM and PPP, FFM and PV, BF% and PV, and FM and PV. While the lockdown resulted in a significant decrease in vertical jump performance and increases in BF and FM, participant's performance returned to pre-lockdown levels after only 2-4 weeks of post-lockdown training by decreasing BF, FM, and increasing FFM. © Faculty of Education. University of Alicante.

The Effects of Positive Technology Readiness in Smart Airports on Integrated Technology Acceptance Theories and Information-Sharing Intentions

Smart airports have been emerged due to the fourth industrial revolution and the development of the aviation industry. The advent of smart airports makes it possible for the airports to accommodate more and more flight travelers than ever. The researcher conducted a study to investigate users' information sharing intentions according to the technology readiness and integrated technology acceptance theories due to the expansion of unmanned services resulting from the COVID-19 pandemic. Targeting airplane travelers through smart airports over the last three years, the researcher collected 370 survey responses. Among them, 354 answers were valid with the exclusion of 16 responses to improve the validity of the research analysis. The researcher used statistics programs such as SPSS (version 22) and AMOS (version 22) to measure frequency, validity, reliability analysis, and route analysis. Sub-variables of positive technology readiness, such as optimism and innovativeness, significantly affect performance expectation and attempt expectation, social status, and facilitating conditions, which are sub-variables of UTAUT. In contrast, optimism does not affect facilitating conditions. Besides, the research findings imply that UTAUT does affect information-sharing intentions. The researcher clarified the effects of positive technology readiness and expanded technology acceptance intentions and their relationships to information sharing intentions based on research results. © 2022 IEEE.

Development and Implementation of DIGEST: The Digital Interactive Gastroenterology Education Suite for Trainees

Purpose/Objectives: Clinical clerkship curricula should exist to provide rotating learners on subspecialty rotations with consistent exposure to specific topics geared towards the discipline of interest, such as Pediatric Gastroenterology (GI). In the spring of 2020, the COVID-19 pandemic forced the medical community to pivot to both virtual patient care and medical education. Many teachers were forced to transition their curricula away from traditional, in-person didactics to asynchronous, on-line learning. We developed the Digital Interactive Gastroenterology Education Suite for Trainees (DIGEST) a novel pediatric gastroenterology curriculum on GOOGLE classroom for rotating learners. Our aims were to assess the curriculum and to study learning outcomes amongst trainees. Design/Methods: A general needs assessment in 2019 identified a lack of standardized educational experience amongst the rotating learners on Pediatric GI service. We developed DIGEST to provide a standardized educational experience for all learners. Our resource acquisition method included interrogation of the Pediatrics in Review (PIR) subject collections, review of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) CPG repository, and a search for topics of interest on MedEd Portal. We organized these resources using a simple, subject-based (i.e. Constipation) format for the classroom: Required readings, Supplemental (optional) readings, Videos & Podcasts and simulations (Figure 1). Next, a “Rotation Passport” was created to guide learners' expectations during the rotation, to facilitate a balance between educational activities and patient care, and to eliminate differences in educational exposures, or clinical opportunities which could be affected by seasonal variations in disease processes or presentations. DIGEST addressed procedural skills using low-fidelity human patient simulation (LFHPS) scenarios from MedEd Portal including: nasogastric tube placement, gastrostomy replacement, and abdominal radiograph interpretation. The COVID-19 pandemic compelled us to transition this program from our departments' secure share drive to the GOOGLE classroom. Learners assessed DIGEST and the LFHPS using the physician assistant clinical rotation evaluation (PACRE) instrument and the Student Satisfaction and Self-Confidence in Learning scale (SSSCL), respectively. We targeted a composite score > 4 (Likert scale 1- 5;1-Strongly Disagree, 5-Strongly Agree) for all questions. Finally, the curriculum quality of DIGEST was evaluated by a Health Professions Education expert using the Course Review Report Rubric. Results: 7 possible learners participated and responded to the questionaires (100% response rate). Learners reported a superior learning experience and increased confidence with DIGEST (Table 1). The HPE expert reported that the course design of DIGEST met or exceeded expectations in all categories. Conclusion/Discussion: DIGEST is a novel pediatric gastroenterology curriculum for rotating learners could be easily deployed, or replicated, for civilian Pediatric GI divisions to use with their learners or expanded on a larger platform to enhance learning for a wider audience. (Table Presented).

Impact of COVID-19 pandemic on hemodialysis access thrombosis.

BACKGROUND: Delay in care of suspected stenosis or thrombosis can increase the chance of losing a functioning hemodialysis access. Access to care and resources were restricted during the COVID-19 pandemic. To evaluate the impact of the pandemic on arteriovenous fistula (AVF) and arteriovenous graft (AVG) procedures we have assessed the number and success of thrombectomies done before and during the COVID-19 pandemic. METHODS: We examined all AVF and AVG angiograms with and without interventions, including thrombectomies, performed at a single center during April 2017-March 2021 (pre-COVID-19 era) and April 2020-March 2021 (COVID-19 era). RESULTS: The proportion of procedures that were thrombectomies was higher during the COVID-19 era compared to the pre-COVID-19 era (13.3% vs 8.7%, p = 0.009). The proportion of thrombectomy procedures was higher during COVID-19 for AVF (8.2% vs 3.0%, p < 0.001) but there was no difference for AVG (26.5% vs 27%, p = 0.99). There was a trend toward a higher likelihood of unsuccessful thrombectomy during COVID-19 (33.3% vs 20.4%, p = 0.08). CONCLUSIONS: More dialysis access thromboses and unsuccessful thrombectomies were noted during the COVID-19 pandemic. This difference could be due to a delay in patients getting procedures to maintain their dialysis accesses.

Outcomes Associated with Asthma Exacerbations with Respiratory Failure Treated with Extracorporeal Membrane Oxygenation

Rationale: Asthma affects 20 million adults in the United States resulting in up to 500,000 hospitalizations each year. Patients admitted to the intensive care unit (ICU) for asthma exacerbations requiring invasive ventilation have a mortality of ∼7%. Extracorporeal membrane oxygenation (ECMO) is a salvage technique used in patients with respiratory failure to increase delivery of oxygen, remove CO2 and allow time for recovery. Case series and uncontrolled registry studies have examined benefits of ECMO for asthma exacerbations with respiratory failure, but no studies have examined outcomes associated with use of ECMO for asthma exacerbations compared to standard care. Objective: To assess outcomes associated with use of ECMO during asthma exacerbations requiring invasive ventilation compared to standard care. Methods: Patients were extracted from the Premier Database from 2010-2020 if they had a primary diagnosis of asthma, or a primary diagnosis of respiratory failure with a secondary diagnosis of asthma, and were treated with invasive ventilation. Patients were excluded for age < 18y, no ICU admission, chronic lung disease other than asthma, COVID-19, or if they were not treated with corticosteroids. Hospital mortality was the primary study outcome. Key secondary outcomes included ICU length of stay (LOS), hospital LOS, length of invasive ventilation and hospital costs. Differences in outcomes were assessed using propensity score matching at a 1:2 ratio of ECMO versus no ECMO, and by covariate adjustment of the entire study group. Results: A total of 20,494 patients with asthma exacerbations requiring invasive ventilation were included in the study, of which 130 were treated with ECMO and 20,364 were not. After propensity matching, ECMO (N=103) versus no ECMO (N=206) was associated with reduced mortality (11.4% vs. 23.3%, p = 0.017) and increased hospital costs, but no difference in ICU LOS, hospital LOS or length of mechanical ventilation (Table). The covariate-adjusted model replicated these findings (Table). When individual patients were assigned a probability of being treated with ECMO equal to the hospital rate where they were admitted, each 10% increase in the hospital rate of ECMO was associated with no change in the odds of mortality (OR, 1.12: 95% CI, 0.82-1.52), p=0.48). ECMO was also associated with increased renal replacement therapy (P = 0.02), shock (P=0.02) and 30-day all-cause readmission (P = 0.01). Conclusion: ECMO was associated with reduced mortality at the cost of increased morbidity in asthmatics requiring invasive ventilation, indicating that ECMO has the potential to save thousands of lives.

Effects of wearing personal protective equipment during COVID-19 pandemic on composition and diversity of skin bacteria and fungi of medical workers.

BACKGROUND: During the COVID-19 pandemic, wearing PPE can induce skin damage such as erythema, pruritus, erosion, and ulceration among others. Although the skin microbiome is considered important for skin health, the change of the skin microbiome after wearing PPE remains unknown. OBJECTIVE: The present study aimed to characterize the diversity and structure of bacterial and fungal flora on skin surfaces of healthcare workers wearing personal protective equipment (PPE) during the COVID-19 pandemic using metagenomic next-generation sequencing (mNGS). METHODS: A total of 10 Chinese volunteers were recruited and the microbiome of their face, hand, and back were analysed before and after wearing PPE. Moreover, VISIA was used to analyse skin features. RESULTS: Results of alpha bacterial diversity showed that there was statistically significant decrease in alpha diversity indice in the skin samples from face, hand, and three sites after wearing PPE as compared with the indice in the skin samples before wearing PPE. Further, the results of evaluated alpha fungal diversity show that there was a statistically significant decrease in alpha diversity indices in the skin samples from hand after wearing PPE as compared with the indices in the skin samples before wearing PPE (P < 0.05). Results of the current study found that the main bacteria on the face, hand, and back skin samples before wearing the PPE were Propionibacterium spp. (34.04%), Corynebacterium spp. (13.12%), and Staphylococcus spp. (38.07%). The main bacteria found on the skin samples after wearing the PPE were Staphylococcus spp. (31.23%), Xanthomonas spp. (26.21%), and Cutibacterium spp. (42.59%). The fungal community composition was similar in three skin sites before and after wearing PPE. CONCLUSION: It was evident that wearing PPE may affect the skin microbiota, especially bacteria. Therefore, it was evident that the symbiotic microbiota may reflect the skin health of medical workers during the COVID-19 pandemic.

Clinical characteristics and prognostic factors of myocarditis associated with the mRNA COVID-19 vaccine.

To analyze the clinical presentation and outcomes of myocarditis after administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccine. Nine case series and 15 case reports (74 patients) of myocarditis after administration of the BNT162b2 or mRNA-1273 vaccine were reviewed from PubMed, Scopus, Embase, and Web of Science. We analyzed clinical manifestations, diagnostic findings, and outcomes. In addition, we performed a pooled analysis and investigated risk factors leading to admission to the intensive care unit and recovery with conservative care. Most patients were male (94.6%), and the median age (range) was 17.6 (14-70) years. Patients who received the BNT162b2 (n = 58, 78.4%) vaccine presented fewer systemic symptoms and left ventricular dysfunction than mRNA-1273 recipients. Although patients under 20 years experienced more fever and myalgia, they had better ejection fraction and less prominent myocardial inflammation in magnetic resonance imaging than older patients. The clinical course of all patients was favorable without mortality, and one-third of patients resolved with conservative care alone. Risk factor analyses revealed that patients with gastrointestinal symptoms required intensive care (odds ratio: 20.3, 95% confidence interval 1.90-217, p = 0.013). The risk of fatality in myocarditis subjected to mRNA vaccination seems to be low. However, patients with gastrointestinal symptoms received more intensive care, and a significant proportion of patients recovered with conservative management.

CrowdMap: Spatiotemporal Visualization of Anonymous Occupancy Data for Pandemic Response

CrowdMap is an anonymous occupancy monitoring system developed in response to the COVID-19 pandemic. CrowdMap collects, cleans, and visualizes occupancy data derived from connection logs generated by large arrays of Wi-Fi access points. Thus, CrowdMap is a passive digital tracking tool that can be used to reopen buildings safely, as it helps actively manage occupancy limits and identify utilization trends at scale. Occupancy monitoring is possible at various levels of resolution over large spatial (e.g., from individual rooms to entire buildings) and temporal (e.g., from hours to months) extents. The CrowdMap web-based front-end implements powerful spatiotemporal querying and visualization tools to quickly and effectively explore occupancy patterns throughout large campuses. We will demonstrate CrowdMap and its spatiotemporal GUI that was deployed for an entire university campus with data continuously being collected since summer 2020. © 2021 Owner/Author.

PATIENT WITH RECENT COVID-19 INFECTION PRESENTING WITH ACUTE UPPER AIRWAY OBSTRUCTION

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Acute airway obstruction is a life-threatening event requiring emergent identification and management. Limited reports of acute airway compromise in patients with recent novel coronavirus infection (COVID-19) suggest this may be a rare and late complication in COVID-19 patients. CASE PRESENTATION: A 19-year-old Guatemalan male with no known past medical history, unclear vaccination status, no smoking or alcohol history presented to the emergency department with complaints of worsening sore throat, muffled voice, difficulty swallowing, bloody vomitus, and subjective fever for two hours prior to arrival. He was diagnosed with mild COVID-19 3 weeks prior. History was limited by severe respiratory distress. On physical exam, the patient was afebrile. He had muffled voice, stridor, and a normal uvula. Labs were significant for leukocytosis, and respiratory panel positive for SARS-CoV-2. X-ray of chest and neck were unremarkable. Patient was given dexamethasone and antibiotics. Given concern for airway compromise and possible epiglottitis, the patient was urgently intubated. First attempt with video laryngoscopy was unsuccessful due to extensive edema and erythema of the hypopharyngeal tissues, then re-attempted successfully with a smaller endotracheal tube. The epiglottis could not be visualized. CT neck showed diffuse inflammation with enlargement of the adenoids and tonsils;epiglottis was obscured given presence of the endotracheal tube;no abscess seen. Differential included bacterial or viral epiglottitis, idiopathic angioedema reaction, and post-COVID reaction. The patient was admitted to the ICU for management of presumed epiglottitis and continued on dexamethasone for 40 hours and empiric antibiotics. He had rapid resolution of airway edema, was successfully extubated on day 4 of admission, and discharged home on day 6 with a 10-day course of cephalexin. DISCUSSION: Most mild, symptomatic cases of COVID-19 typically resolve within 2-3 weeks. This late presentation raises concern for epiglottitis as a rare but serious complication of COVID-19. The time course additionally suggests possible post-viral superinfection of the epiglottis and upper airway from other causes. Confirmation via direct visualization or imaging was not possible in this patient but he was treated presumptively for epiglottitis given his concerning physical exam findings. In cases of acute respiratory distress, airway management should supersede diagnostic evaluation due to the risk of rapid respiratory compromise. CONCLUSIONS: There are many known etiologies of acute airway obstruction, including epiglottitis, but it is important to consider COVID-19 as another possible etiology. While direct visualization is the gold standard for confirmation, diagnosis should not precede emergent intubation in cases of severe respiratory distress. REFERENCE #1: Çaytemel B, Kılıç H, Çomoğlu Ş. Approach to otolaryngology emergency in COVID-19 pandemic. Tr-ENT. 2020;30(50):24-36. DISCLOSURES: No relevant relationships by Gerardo Carino, source=Web Response No relevant relationships by Sugi Min, source=Web Response No relevant relationships by Claudia Sorin, source=Web Response

Alarming downtrend in mechanical thrombectomy rates in African American patients during the COVID-19 pandemic-Insights from STAR.

BACKGROUND: The coronavirus disease (COVID-19) pandemic has affected stroke care globally. In this study, we aim to evaluate the impact of the current pandemic on racial disparities among stroke patients receiving mechanical thrombectomy (MT). METHODS: We used the prospectively collected data in the Stroke Thrombectomy and Aneurysm Registry from 12 thrombectomy-capable stroke centers in the US and Europe. We included acute stroke patients who underwent MT between January 2017 and May 2020. We compared baseline features, vascular risk factors, location of occlusion, procedural metrics, complications, and discharge outcomes between patients presenting before (before February 2020) and those who presented during the pandemic (February to May 2020). RESULTS: We identified 2083 stroke patients: of those 235 (11.3%) underwent MT during the COVID-19 pandemic. Compared with pre-pandemic, stroke patients who received MT during the pandemic had longer procedure duration (44 vs 38 min, P=0.006), longer length of hospitalization (6 vs 4 days, P<0.001), and higher in-hospital mortality (18.7% vs 11%, P<0.001). Importantly, there was a lower number of African American patients undergoing MT during the COVID-19 pandemic (609 (32.9%) vs 56 (23.8%); P=0.004). CONCLUSION: The COVID-19 pandemic has affected the care process for stroke patients receiving MT globally. There is a significant decline in the number of African American patients receiving MT, which mandates further investigation.

A snapshot of food supply chain in Wuhan under the COVID-19 pandemic

Purpose: The objective is to have a better understanding of the impacts of the COVID-19 pandemic on food supply chain in Wuhan. Design/methodology/approach: Through a simplified flow, the authors qualitatively analyze the impacts of the COVID-19 pandemic on food supply chain. Data was gathered through a telephone survey of food suppliers in Wuhan. Findings: The prevention measures of the COVID-19 pandemic had negative impacts on food supply chain in Wuhan. About 83.1% of food suppliers experienced a decrease in revenues. This is influenced by factors including food category on sale, purchase channel of food, food supplier's household registration and the number of the COVID-19 patients in the located community. Research limitations/implications: Due to the limitation of available data, there is a lack of quantitative analysis on the impact on food supply chain. The sample size of food suppliers is limited. Practical implications: This study identifies the challenges in the food supply chain resulting from the control measures implemented during the COVID-19 pandemic in Wuhan and provides a reference for the design of control measures in other regions. Originality/value: This study supplements the literature regarding the impact of public health emergencies such as the COVID-19 pandemic on food supply chain, especially food suppliers' revenues. © 2020, Emerald Publishing Limited.

International experience of mechanical thrombectomy during the COVID-19 pandemic: insights from STAR and ENRG.

BACKGROUND: In response to the COVID-19 pandemic, many centers altered stroke triage protocols for the protection of their providers. However, the effect of workflow changes on stroke patients receiving mechanical thrombectomy (MT) has not been systematically studied. METHODS: A prospective international study was launched at the initiation of the COVID-19 pandemic. All included centers participated in the Stroke Thrombectomy and Aneurysm Registry (STAR) and Endovascular Neurosurgery Research Group (ENRG). Data was collected during the peak months of the COVID-19 surge at each site. Collected data included patient and disease characteristics. A generalized linear model with logit link function was used to estimate the effect of general anesthesia (GA) on in-hospital mortality and discharge outcome controlling for confounders. RESULTS: 458 patients and 28 centers were included from North America, South America, and Europe. Five centers were in high-COVID burden counties (HCC) in which 9/104 (8.7%) of patients were positive for COVID-19 compared with 4/354 (1.1%) in low-COVID burden counties (LCC) (P<0.001). 241 patients underwent pre-procedure GA. Compared with patients treated awake, GA patients had longer door to reperfusion time (138 vs 100 min, P=<0.001). On multivariate analysis, GA was associated with higher probability of in-hospital mortality (RR 1.871, P=0.029) and lower probability of functional independence at discharge (RR 0.53, P=0.015). CONCLUSION: We observed a low rate of COVID-19 infection among stroke patients undergoing MT in LCC. Overall, more than half of the patients underwent intubation prior to MT, leading to prolonged door to reperfusion time, higher in-hospital mortality, and lower likelihood of functional independence at discharge.