The impact of the COVID-19 lockdown on retinopathy of prematurity screening and management in the United States: a multicenter study.

PURPOSE: To study the effect of the pandemic-related lockdown (physical distance measures and movement restrictions) on the characteristics and management of retinopathy of prematurity (ROP). METHODS: In this controlled, multicenter cohort study, the medical records of patients born prematurely and screened for ROP in the neonatal intensive care unit during four time periods were reviewed retrospectively: (1) November 1, 2018, to March 15, 2019; (2) March 16, 2019, to August 2, 2019 (lockdown control period); (3) November 1, 2019, to March 15, 2020; and (4) March 16, 2020-August 2, 2020. RESULTS: A total of 1,645 patients met inclusion criteria. Among the 1,633 patients with complete data, mean gestational age (GA) at birth was 28.2, 28.4, 28.0, and 28.3 weeks across time periods 1 to 4, respectively (P = 0.16). The mean birth weight of all patients was 1079.1 ± 378.60 g, with no significant variation across time periods (P = 0.08). There were fewer patients screened during the lockdown period (n = 411) compared with the period immediately before (n = 491) and the same period in the prior year (n = 533). Significantly more patients were screened using indirect ophthalmoscopy, compared to digital imaging (telemedicine), during the lockdown (P < 0.01). There were 11.7%, 7.7%, 9.0%, and 8.8% of patients requiring treatment in each time period, respectively (P = 0.42), with a median postmenstrual age at initial treatment of 37.2, 36.45, 37.1, and 36.3 weeks, respectively (P = 0.32). CONCLUSIONS: We recorded a decrease in the number of infants meeting criteria for ROP screening during the lockdown. The GA at birth and birth weight did not differ. Significantly more infants were screened with indirect ophthalmoscopy, compared to digital imaging, during the lockdown.

Epidemiology of pandemic COVID-19 and its association with some chronic diseases in Sulaimani city, Iraq

The study aims to provide the epidemiological characteristics of the COVID-19 patients who admitted to Shahid Dr Hemin Teaching Hospital in Sulaimani city, Iraq. It is a cross-sectional study, the data were collected by a convenience sampling method in the hospital, which started from 2nd October to 31th of December 2020. The current study included all the patients who admitted to the hospital, which involved 371 patients. The data were collected from patient's medical record and a direct interview method was used for filling in the questionnaire form. The collected data were analysed by the SPSS program to produce descriptive statistics such as frequency, percentage, mean and standard deviation while Chi-square test used to find out the association between variables with considering a p-value 0.05 as a significant interpretation. The results show that the age of hospitalized COVID-19 patients ranges from 19-95 years old with mean of (63.69..12.73). The age of majority of patients 159 (42.9%) was between 65-79 years old followed by 50-64 years old 124 (33.4%). Male to female ratio was 2:1. Most of the patients were retired 119 (32.1%) in comparison to other occupations and illiterate patients 151(40.7%) were dominance over other patient's education levels. In addition, majority of patients had hypertension 278(74.9%), diabetes 132 (35.6%) and cardiovascular disease (CVD) 130 (35.0%) and 230 (62.0%) and 141(38.0%) of them were in severe and moderate stage of disease respectively. Also, there was a significant association between the patient's age group and patients' outcome while for gender, occupation, and education level, stage of the disease, there were non-significant. The presence of CVD, hypertension and diabetes increase the mortality rate among the patients. In conclusion, age of COVID-19 patient has a great impact on increasing mortality rate and the presence of comorbidities among the patients significantly raise the mortality rate of COVID-19.

Bibliometric Software: The Most Commonly Used in Research

Scientific research allows for increasing the knowledge of reality and the phenomena that manifest and evolve in it. Today, research is considered a professional competence, which is mainly developed in university institutions. Day by day, the so-called information society is flooded with research works of all types and qualities. At the same time, there is an increase in the number of annual publications that analyze data and measure intellectual works and their contribution to the scientific heritage of each discipline. A series of indicators are generated based on various parameters such as authors, type of document, language, and keywords, among others. The visualization of these numerous indicators, which vary over time, can be achieved effectively through the use of bibliometric software, which is also renewed in its functionality and features. The following is a study, assisted by systematic and bibliometric review techniques, with the aim of identifying the most widely used bibliometric software and those emerging that serve as a guide and good practice in new bibliometric research to obtain notable and relevant knowledge. The applications "VOSviewer", "CiteSpace" and "Bibliometrix" stand out and tools such as "Scopus API R code", "Covidence", "HistCite", "BICOMB", "EndNote X9.6 Statistical", "Ucinet 6.0", "Tools for Innovation Monitoring", "Profiles Research Networking Software", among others, emerge. © 2022 Copyright for this paper by its authors. Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).

Remdesivir-Associated Sinus Arrest in COVID-19: A Potential Indication for Close Cardiac Monitoring.

Remdesivir is an antiviral, nucleoside analog used extensively during the coronavirus-disease 2019 (COVID-19) pandemic with proven efficacy against COVID-19-induced acute respiratory distress syndrome (ARDS). Our case report details the clinical course of a 50-year-old, COVID-19-positive patient who developed sinus arrest after being treated with remdesivir. Within 24 hours of discontinuing remdesivir therapy, the patient's sinus arrest resolved to a normal sinus rhythm. The findings from our case report add to a growing body of evidence on the cardiotoxic profile of remdesivir. Remdesivir's ability to cause bradyarrhythmias, and specifically sinus arrest, should be acknowledged when considering the use of this drug in at-risk patients.

Is the SARS-cov2 evolved in human being: a prospective genetic analysis

COVID-19 is the deadly respiratory disease of the century caused by new type unknown origin Coronavirus. The recent effort of the word researchers is toward finding the origin of the virus. The current study investigated the extent of molecular similarity and divergence between SARS-CoV2 and other related Coronavirus. An attempt has been made to investigate the epidemiological study of this new contagious virus using molecular biology techniques. The phylogenetic trees for all human coronaviruses with the novel Coronavirus have been built using a several complete amino acid sequences of the four known structural proteins, S (spike), E (envelope), M (membrane), and N (nucleocapsid). The result of the study revealed that the SARS-CoV2 is related to human SARS-CoV isolated from different countries very cloely, especially those strains recovered from China in recent times, 2020. The evolutionary changes observed in the inserted 23 amino acids in the RNA binding domain (RBD) of the coronvirus spike glycoprotein which cannot be detected in any other human coronavirus. Moreover, the 2019-nCoV is not closely related to other alpha, beta and gamma human Coronavirus, including MERS-CoV. The current study concluded that 2019-nCoV is more likely believed to originated from SARS-CoV. The probability is more vital to be originated from the strain isolated in China in 2020, which is coincident with the spraed of COVID-19 in the same country. The phyloepidemiologic analyses suggested that the coronaviruses are circulating in human hosts evolving gradually by times in response to the different environment stimuli facing the virus inside the host in different geographical areas. Furthermore, the analysis showed the flow of transmission, and evolutionary changes of SARS-CoV2 which may be directed from the transmission of SARS-CoV from human to Bat and Pangolin then jumped to human again in the crowded market Wuhan city in China.

Immunological approaches and different strategies for vaccine development against SARS-CoV-2

Globally, SARS-CoV-2 outbreak is considered as pandemic viral infection by the World Health Organization (WHO). In the immunological response aspect, a very limited understanding has been progressed, mainly innate and adaptive immunity responses toward the virus. SARS-COV-2 causes severe respiratory disease and sometimes ended with the death. The body of the patients has ability to develop the immunity to cure the patient and more importantly both humoral and cellular immunity have studied against SARS-COV-2. There are different immune responses against the viral infection as it has seen in other previous diseases such as SARS-COV and MESR. On the base on immune response detected in recovered patients, scientists have started to develop the vaccines. Moreover, there are different strategies that used by researchers and pharmacological companies to develop vaccines including attenuated or killed viruses, RNA of a spike protein, and vector expressing a particular protein of the virus. The common antibodies have detected to work against SARS-COV-2 in sera of infected or recovered patients are immunoglobin G (IgG) and immunoglobin M (IgM). The sera of patients recovered from COVID-19, after tittering of immunoglobulins (IgG titer) can be used for either treatment of disease or prophylaxis of infection by SARS-COV-2. This study gives an update on the current immunological approaches and vaccination strategies for the emerging SARS-COV-2, and discusses the challenges and hurdles to overcome for developing efficacious vaccines against this dangerous pathogen.

Tracking Disease Outbreaks from Sparse Data with Bayesian Inference

The COVID-19 pandemic provides new motivation for a classic problem in epidemiology: estimating the empirical rate of transmission during an outbreak (formally, the time-varying reproduction number) from case counts. While standard methods exist, they work best at coarse-grained national or state scales with abundant data, and struggle to accommodate the partial observability and sparse data common at finer scales (e.g., individual schools or towns). For example, case counts may be sparse when only a small fraction of infections are caught by a testing program. Or, whether an infected individual tests positive may depend on the kind of test and the point in time when they are tested. We propose a Bayesian framework which accommodates partial observability in a principled manner. Our model places a Gaussian process prior over the unknown reproduction number at each time step and models observations sampled from the distribution of a specific testing program. For example, our framework can accommodate a variety of kinds of tests (viral RNA, antibody, antigen, etc.) and sampling schemes (e.g., longitudinal or cross-sectional screening). Inference in this framework is complicated by the presence of tens or hundreds of thousands of discrete latent variables. To address this challenge, we propose an efficient stochastic variational inference method which relies on a novel gradient estimator for the variational objective. Experimental results for an example motivated by COVID-19 show that our method produces an accurate and well-calibrated posterior, while standard methods for estimating the reproduction number can fail badly.

Effect of the COVID-19 Pandemic on the Management of Acute Cholecystitis and Assessment of the Crisis Approach: A Multicenter Experience in Egypt.

INTRODUCTION: The covid-19 pandemic has had a drastic impact on all medical services. Acute cholecystitis is a serious condition that accounts for a considerable percentage of general surgical acute admissions. Therefore, the Royal College of Surgeons' Commissioning guidance' recommended urgent admission to secondary care and early cholecystectomy. During the first wave of hospital admissions associated with COVID-19, most guidelines recommended conservative treatment in order to limit the admission rates and free up spaces for COVID-19-infected patients. However, reviews of this approach have not been widely done to assess the results and, in turn, planning our future management approach when future pressures on in-patient admissions are inevitable. METHODS: Our study included all acute cholecystitis patients who needed surgical intervention in one Centre in the UK over three distinct periods (pre-COVID-19, during the first lockdown, and lockdown ease). Comparison between these groups were done regarding intraoperative and postoperative results. RESULTS: The conservative management led to a high rate of readmission. Moreover, delayed cholecystectomy was associated with increased operative difficulties such as extensive adhesions, intraoperative blood loss, and/or complicated gall bladder pathologies such as perforated or gangrenous gall bladder (29.9%, 16.7%, and 24.8%, respectively). The resulting postoperative complications of surgical and nonsurgical resulted in a longer hospital stay (13.5 d). CONCLUSION: The crisis approach for acute cholecystitis management failed to deliver the hoped outcome. Instead, it backfired and did the exact opposite, leading to longer hospital stays and extra burden to the patient and the healthcare system.

Low dose radiotherapy (Ldrt) can be an option for curing covid-19?

In December 2019, the epidemic of Coronavirus Disease 2019 (COVID-19) broke out in Wuhan in China. Symptoms of COVID-19 are non-definite and mild symptoms include: fever, cough. However, elderly and populations with comorbidities such as diabetes, hypertension are more likely to be at risk of severe pulmonary infection and death. Many therapies have been proposed and assed for treating (COVID-19). In April 2020, two papers appeared that suggested clinical trials of low dose radiotherapy (LDRT) for COVID19 pneumonia. Following that, some researchers carried out some studies, and they modify the amount of doses and fractionation. Regarding the aging, some study using a sensitive age that ranged from 18 to 50 years, are more likely to have stochastic effects that cannot analyzed directly as it needs more time to experience these effects. In this review, we analysis the possibility of a low dose radiotherapy that can have in treating COVID-19 pneumonia, by using almost all accessed publications that performed on a low dose radiotherapy (LDRT) for curing bacteria or virus as well as studies that focus on using LDRT for antiinflammatory. We show that LDRT can perform the mitigation and the repair response of the immune system to provide a potential therapy of COVID-19. A single dose of low-dose radiotherapy can be effective in both cost and time and could potentially relieve symptoms of respiratory rapidly. However, such treatment would not be without obstacle and it can be difficult since it is necessary to recognize those few patients who are more benefit from radiation treatment and identifying short and long-term impacts. clinical stage of disease should be known. Additionally, it is not acceptable to report that LDRT would be superior to any type treatment that are currently under taking, until results from clinical trial will be released.

Clinical characteristics of covid-19 in patients: A meta-analysis

An outbreak of coronavirus disease 2019 (COVID-19) was detected in Wuhan, China in December 2019, the causative agent is severe acute respiratory coronavirus 2 (SARS-Co-2). The virus spread quickly to other areas and countries and the disease has become pandemic. This meta-analysis study was carried out to evaluate the clinical characteristics and to assess the prevalence of comorbidities in COVID-19 confirmed patients from January 1, 2020 to December 1, 2020. Totally, 5580 cases were involved in this study, (55.2%) of them were males, the predominant clinical symptoms of COVID-19 patients were fever, cough, and fatigue (61.9, 50.1%, and 34.1% respectively). The most frequent comorbidities were hypertension, diabetes, as well as cardiovascular and cerebrovascular diseases (13.1%, 7.4 %, and 5.9% respectively). The majority of the patients in this study were male, the most prevalent signs and symptoms were fever, cough, and fatigue. The highly repeated comorbidities in the cases were hypertension, diabetes, also cardiovascular and cerebrovascular diseases.

Policies for a second wave

In the spring of 2020, the initial surge of COVID-19 infections and deaths was flattened using a combination of economic shutdowns and noneconomic non-pharmaceutical interventions (NPIs). The possibility of a second wave of infections and deaths raises the question of what interventions can be used to significantly reduce deaths while supporting, not preventing, economic recovery. We use a five-age epidemiological model combined with sixty-six-sector economic accounting to examine policies to avert and to respond to a second wave. We find that a second round of economic shutdowns alone are neither sufficient nor necessary to avert or quell a second wave. In contrast, noneconomic NPIs, such as wearing masks and personal distancing, increasing testing and quarantine, reintroducing restrictions on social and recreational gatherings, and enhancing protections for the elderly together can mitigate a second wave while leaving room for an economic recovery. © 2020, Brookings Institution Press. All rights reserved.

ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTIONS DURING THE COVID-19 PANDEMIC WITH IMPLEMENTATION OF UNIVERSAL MASKING.

PURPOSE: To evaluate the rates of postintravitreal injection-related endophthalmitis during the COVID-19 pandemic with institution of both physician and patient face masking. METHODS: All eyes receiving intravitreal injections of any kind from a single large tertiary retina practice in Houston, TX before (August 2017-March 22, 2020) and after (March 23, 2020-September 2020) COVID-19 pandemic universal masking protocols. The total number of injections and cases of acute injection-related endophthalmitis were determined from billing records and subsequent retrospective chart review. The primary outcome was the rate of endophthalmitis after intravitreal injection. Secondary outcomes included visual acuity, time until initial presentation, patient age, and differences in the overall number of injections performed monthly pre-COVID-19 and post-COVID-19. RESULTS: A total of 134, 097 intravitreal injections were performed during the study period (111,679 pre-COVID-19 and 22,418 post-COVID-19 masking protocols). A total of 41 cases of acute endophthalmitis occurred in the pre-COVID group (0.04%, one in 2,500) and 7 cases in the post-COVID group (0.03%, one in 3,333) P = 0.85. CONCLUSION: In this single center, retrospective study, the implementation of universal patient and physician masking as practiced during the COVID-19 pandemic did not significantly affect the rate of postintravitreal injection endophthalmitis.

Comparison of viral loads in individuals with or without symptoms at time of COVID-19 testing among 32,480 residents and staff of nursing homes and assisted living facilities in massachusetts

Background. Transmission of COVID-19 from people without symptoms confounds public health containment strategies. Comprehensive cross-sectional screening enables assessment of viral load independent of symptoms, informing transmission risks. We quantified SARS-CoV-2 burden by RT-qPCR from comprehensive screening of nursing homes and assisted living facilities in Massachusetts to inform our ability to detect SARS-CoV-2 in individuals with or without symptoms. Methods. From 4/9/20 to 6/9/20, we tested nasopharyngeal (NP) swabs from 32,480 unique individuals comprising staff and residents of the majority of nursing homes and assisted living facilities in Massachusetts. Symptomatology at the time of sampling and demographic information were provided by each facility. NP swabs were collected, RNA extracted, and SARS-CoV-2 testing performed by RT-qPCR. We compared cycle thresholds (Ct) with a standard curve to quantify viral loads. Results. The nursing home and assisted living facilities resident cohort (N = 16,966) was 65% female with mean age 82. The staff cohort (N = 15,514) was 76% female with mean age 45. In all, 2654 residents (15.5%) and 624 staff (4.1%) tested positive for SARS-CoV-2, including 12.7% of residents and 3.7% of staff without symptoms, compared to 53.1% of residents and 18.2% of staff with symptoms. The Ct distributions for viral probes were very similar between populations with and without symptoms (Fig 1), with a statistically but not meaningfully different mean (ΔCt 0.71 cycles, p = 0.006) and a similar range (12-38 cycles). This similarity persisted across all sub-categories examined (age, race, ethnicity, sex, resident/staff). Conclusion. In a large cohort of individuals screened for SARS-CoV-2 by RT-qPCR, we found strikingly similar viral load distributions in patients with or without symptoms at the time of testing. The size of the study population, including both staff and residents spanning a wide range of ages, provides a comprehensive cross-sectional point prevalence measurement of viral burden. Because the distributions of viral loads are very similar regardless of symptoms, existing testing modalities validated for detection of SARS-CoV-2 RNA in symptomatic patients should perform similarly well in individuals without symptoms at the time of testing. (Figure Presented).

Inflammatory Breast Cancer in Men: A rare clinical case report and a literature review.

INTRODUCTION AND IMPORTANCE: The initial misdiagnosis and delayed treatment for inflammatory breast cancer in men is brought about by its rarity and lack of readily available guidelines on pathways. CASE PRESENTATION: A 78-year-old male presented to the breast clinic with an abscess and was later diagnosed with inflammatory breast cancer. He presented with an abscess and was initially treated with antibiotics. Imaging showed a large left breast mass consistent with inflammatory carcinoma with axillary lymph node involvement. Patient was started on Tamoxifen as a bridge for surgery with no response. He eventually had a mastectomy and axillary clearance with the histology confirming the diagnosis and tumour emboli in the lymphatic vessels. Chemotherapy, radiation and dual hormone therapy were included in the adjuvant treatment plan. Two episodes of neutropenic sepsis led to completing only five out of six planned chemotherapy cycles. CLINICAL DISCUSSION: A review of literature and the reported cases was done by the team to contribute to the little information published about the disease and its management. The presented to the breast clinic during the height of the SARS- CoV-2 pandemic. The global impact of SARS-CoV-19 made surgical teams find ways to lessen elective lists to give way for patients affected during the pandemic. CONCLUSION: Very few cases of inflammatory breast cancer have been reported in men. The diagnosis can be missed leading to delay in management. Management can be challenging and complex.

Late onset of Guillain-Barré syndrome following SARS-CoV-2 infection: part of 'long COVID-19 syndrome'?

We describe a case of delayed onset, acute demyelinating neuropathy secondary to novel SARS-CoV-2 infection. A previously healthy 46-year-old man presented with bilateral leg pain and loss of sensation in his feet 53 days after having COVID-19 pneumonitis. He developed painful sensory symptoms followed by a rapidly progressive lower motor neuron weakness involving all limbs, face and respiratory muscles, needing ventilatory support. In keeping with a diagnosis of Guillain-Barré syndrome, cerebrospinal fluid examination showed albuminocytologic dissociation and nerve conduction studies supported the diagnosis of an acute inflammatory demyelinating polyradiculoneuropathy. The delayed neurological dysfunction seen in our patient following SARS-CoV-2 infection may indicate a novel mechanism of disease that is part of the emerging 'long COVID-19 syndrome'.