The different clinical characteristics of COVID-19 patients between pediatric and adults

Background: In December 2019, a novel coronavirus (a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) emerged in Wuhan, China. Objectives: The current research aimed to evaluate the clinical features of COVID-19 infection in pediatric patients and compare them with those of adult patients in Sanandaj, Iran. Methods: Retrospectively, 56 hospitalized cases, including 32 adult and 24 pediatric patients with COVID-19 from March 7th, 2020, to June 5th, 2020, were enrolled in this study. The clinical and laboratory findings of the pediatric patients with COVID-19 infection were analyzed and compared with those of the adult patients. Results: The average number of fever days in adults was higher than that of pediatric patients (P = 0.04). Cough was more severe in adults than in pediatric patients (P = 0.03). Diarrhea was not statistically different between the two groups. Dizziness was far more common in adults than pediatric patients (P = 0.01). The percentage of blood oxygen saturation decreased in both groups, but there was no statistically significant difference between the two groups. C-reactive protein (CRP) was positive in many patients in both groups;however, there was no difference between the pediatric and adult patients. Lymphopenia was significantly higher in adults than in pediatric patients (P = 0.02). As in pediatric patients, an increase in liver enzymes was seen in adults. However, there was no statistically significant difference between the two groups. Conclusions: The present study showed that pediatric patients with COVID-19 infection have milder clinical symptoms than adults. However, according to the laboratory findings, pediatric patients need to be followed up as well as adult patients.

The influencing factors of compliance with health protocols related to Covid-19: a scoping review

Objective(s): The outbreak of Covid-19 is a global health emergency. Compliance with health protocols is the main key to preventing the transmission of this disease. The purpose of the present study was to review the related research to investigate the factors affecting compliance with health protocols related to Covid-19. Methods: This scoping review examined studies published in Persian and English language biomedical journals with related keywords including health protocols, masking, quarantine, distancing, hand washing, and risk perception in search engines such as Google Scholar, PubMed, Web of Science, and SID. Results: In all 22 relevant articles were entered into the review. The results led to the identification of more than 30 effective factors in compliance with health protocols. Factors such as gender, understanding the risk of disease, government measures, the role of friends and family, the media, and people's information sources played the biggest role in people's compliance with the protocols, respectively. Also, protective measures such as staying at home when feeling unwell, covering coughs and sneezes, and not using public transportation during the COVID-19 pandemic had reported having the highest compliance rate and the lowest was behaviors such as washing hands after sneezing and coughing as well as disinfecting the mobile phone. Conclusion: To increase compliance with protocols, it is necessary to consider individual and environmental factors affecting compliance with protocols, which can be categorized as facilitators, barriers, and encouragers of target health behaviors as these factors are context and time-dependent. Timely identification of accurate factors in any country is a key step in formulating and designing interventions to manage pandemics such as Covid- 19. © Iranian Institute for Health Sciences Research. All rights reserved.

May 03, 2022;98 (18 Supplement) MONDAY, APRIL 4 Dysautonomia in Long Haul Covid-19 Infection Impairs Activities of Daily Living and Mental Health: The Patient Perspective

Objective: We report the burden of long haul COVID-19 associated dysautonomia and emphasize impact on activities of daily living and mental health, with the goal of developing interventions. Background: Dysautonomia is an established neurological effect of COVID-19 and has been reported in long-haul COVID-19 patients. It is imperative to understand the impact of this condition from the patient perspective to appreciate individual illness experience, clinical course, and disease burden to develop neurological, psychiatric, and social interventions. Design/Methods: 18 long-haul patients in a COVID-19 Remote Patient Monitoring Program (Precision Recovery: Mount Sinai Health System) were interviewed regarding their experience with COVID-19. Patients were asked about their experiences navigating diagnoses, the health care system, and their recovery process, with emphasis on long-haul symptom course and impact. References to dysautonomia within their long haul COVID-19 experience (symptoms persisting greater than four weeks post initial infection) were analyzed for statistical and qualitative significance. Results: The following symptoms of long-haul COVID-19 dysautonomia were reported: fluctuating fevers 12/18 (67%);heart palpitations/tachycardia: 12/18 (67%);digestion problems 8/18 (44%);dizziness 6/18 (33%);and fluctuations in blood pressure 4/18 (22%). 7/18 (39%) of patients reported 3 or more dysautonmic symptoms. Patients reported three categories of impact on daily activities: (1) routine physical exertion intolerance;(2) impaired ability to care for self (nutrition, hygiene);and (3) impacted social interaction due to physical impedance and/or isolation in experience. The main mental health effects associated with long-haul dysautonomia included: (1) depression and suicide ideation, (2) intense anxiety, and (3) self doubt. Conclusions: Dysautonomia in long haul COVID-19 patients has a devastating impact on daily living and mental health. It is imperative to recognize these effects and understand them from the patient perspective in order to develop compassionate, validating, and efficacious neurological, psychological, and social interventions for this population.

Post Covid-19 Neurological Impairment Effects on Activities of Daily Living: Patient Perspectives from a Remote Patient Monitoring Program

Objective: Here, we emphasize the debilitating effects on daily life of post covid cognitive impairment, from the patient perspective. In this, we will gain deeper insight into the post-acute illness phase of COVID-19 to formulate more compassionate, supportive, and efficacious treatment protocols. Background: Post Covid-19 acute infection neurological impairment has been shown to be a long term effect of the disease. 18 months after the onset of the COVID-19 pandemic, with over 230 million cases worldwide, it has never been more critical to understand such long term effects. Design/Methods: 46 Patients in a COVID-19 Remote Patient Monitoring Program (Precision Recovery: Mount Sinai Health System) were interviewed regarding their experience with COVID-19. Patients were asked about their experiences navigating COVID-19 diagnoses, the health care system, and their recovery process. Patients were not pointedly asked about cognitive impairment post covid and all mentions were unprompted. References to post-cognitive impairment were analyzed for statistical and qualitative significance. Results: 20/46 (43%) of patients reported cognitive impairment after the acute phase of their covid illness. 8/20 of these individuals (40%) were self identified long-haul covid patients. Patients identified three patterns of impairment: (1) memory;(2) attention;and (3) mental stamina. These new cognitive deficits impacted daily life in four key ways: (1) failure to adhere to daily responsibilities;(2) necessitated decrease in employment responsibilities;(3) insecurity in social interactions;and (4) development of coping strategies. Conclusions: Post covid cognitive impairment significantly impacted both acute and long-haul covid patients. It is therefore critical to acknowledge this potential long-term effect as an outcome for anyone who experiences Covid-19 for improved understanding of patient illness experience and development of covid-19 treatment post-acute infection.

Covid-19 Associated Extreme Fatigue Effects on Activities of Daily Living in Mild and Long-Haul Infections: Patient Perspectives from a Remote Patient Monitoring Program

Objective: Here, we report the impact of COVID-19 associated extreme fatigue on activities of daily living from the patient perspective in both mild and long haul COVID-19 patients. This narrative emphasis will offer opportunities for the development of neurological protocols and interventions for the treatment and support of affected individuals. Background: Extreme fatigue has been shown to be a neurological effect of COVID-19 infection. It is critical to better understand the impact this symptom has on daily functioning across the spectrum of morbidity associated with COVID-19 infection. Patient perspective on extreme fatigue affords deeper insight into illness experience, clinical course of COVID-19 associated fatigue, and opportunities for neurological and social intervention. Design/Methods: 46 Patients in a COVID-19 Remote Patient Monitoring Program (Precision Recovery: Mount Sinai Health System) were interviewed regarding their experience with COVID-19. Patients were asked about their experiences navigating COVID-19 diagnoses, the health care system, and their recovery process. References to fatigue were analyzed for statistical and qualitative significance. Results: 34/46 patients (74%) reported extreme fatigue as a symptom of their COVID-19 infection. 16/34 patients (47%) were self-reported long haul COVID-19 patients, which represented 16/18 (89%) of the long haul patients in the study. Patients reported three categories of impact on activities of daily living: (1) care for self;(2) care for others;and (3) employment responsibilities and continuation. The critical secondary effects of this fatigue included: (1) barrier to healthcare;(2) social isolation;(3) malnutrition;(4) necessity of outside caretakers for children;and (5) employment termination. Conclusions: COVID-19 extreme fatigue had debilitating effects on activities of daily living for both mild and long-haul patients. This is critical to acknowledge, not only for development of protocol and interventional treatment, but also for the development of social support for impacted individuals, including food access, child care, and employment response.

Opportunities and Threats Facing Early-Stage Digital Startups During the COVID-19 Pandemic

The Coronavirus disease 2019 (COVID-19) pandemic has significantly influenced entrepreneurship and new venture creation to this point. Besides, it has caused consumer lifestyle modifications as well as alterations in business products and services, leading to paradigm shifts in the market. In this respect, startups have been also coping with numerous challenges and prospects in this period, and COVID-19 has even resulted in the rise and fall of many companies. This condition has been far more for early-stage startups, particularly the ones in their infancy life cycle. On the other hand, thanks to the changes in people’s lifestyles, digital and online businesses have gained much popularity. For this purpose, the present study aimed to identify and analyze opportunities and threats encountering early-stage digital startups during the COVID-19 pandemic. Accordingly, in-depth interviews were conducted with a total number of 30 members working in 13 startup teams, and their data were finally examined using thematic analysis. Ultimately, 13 opportunities and 19 threats within 4 categories of “market and marketing,” “startup team,” “operational and management issues,” and “financial and economic activities” were introduced. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

HUMAN-INFRASTRUCTURE INTERACTIONAL DYNAMICS: SIMULATING COVID-19 PANDEMIC REGIME SHIFTS

When subject to disruptive events, the dynamics of human-infrastructure interactions can absorb, adapt, or, in a more abrupt manner, undergo substantial change. These changes are commonly studied when a disruptive event perturbs the physical infrastructure. Infrastructure breakdown is, thus, an indicator of the tipping point, and possible regime shift, in the human-infrastructure interactions. However, determining the likelihood of a regime shift during a global pandemic, where no infrastructure breakdown occurs, is unclear. In this study, we explore the dynamics of human-infrastructure interactions during the global COVID-19 pandemic for the entire United States and determine the likelihood of regime shifts in human interactions with six different categories of infrastructure. Our results highlight the impact of state-level characteristics, executive decisions, as well as the extent of impact by the pandemic as predictors of either undergoing or surviving regime shifts in human-infrastructure interactions.

Finasteride in Hospitalized Adult Males with COVLD-19: ARisk Factor for Severity of the Disease or an Adjunct Treatment: A Randomized Controlled Clinical Trial

Background: There is controversy about the efficacy of 5-alpha-reductase inhibitors in COVID-19 patients. Some assumed that finasteride might be a risk factor for deterioration and others proposed it as a possible adjunct treatment for moderate to severe COVID-19 infection in the elderly. Methods: We performed a randomized controlled clinical trial (registration ID IRCT20200505047318N1) on 80 hospitalized male patients aged >50 years diagnosed with COVID-19 pneumonia in a tertiary hospital in Qazvin (Iran) from April to July 2020. The patients were randomized into one of the 2 treatment groups using simple randomization. Treatment group patients underwent routine drug therapy and 5 mg finasteride once daily for 7 days. The primary endpoint was mortality rate and length of hospital stay (LOS), and secondary endpoints were peripheral capillary oxygen saturation, respiratory rate, and inflammatory markers changes. The study protocol was approved by the medical ethics committee of Qazvin University of Medical Sciences (registration ID IR.QUMS.REC.1399.080). Data were analyzed by statistical tests and SPSS version 25. Also, p<0.05 was considered to be statistically significant. Results: We found a significant difference on O2saturation among the 2 study groups on fifth day compared with the admission time (p= 0.018). The results did not show significant differences in mortality rate (2.5% vs 10%;p= 0.166) and LOS (p= 0.866) between patients in the finasteride and the control group. Conclusion: A short course of finasteride administration partially improves O2 saturation but does not influence other outcomes in hospitalized male patients aged >50 years with COVID-19 pneumonia. Further research in a large scale with longer follow-up is required to help clarify the role of finasteride in this setting. Copyright© Iran University of Medical Science

The Structure of Nursing Legislation in Iran From the Perspective of Nursing Policymakers: A Qualitative Study

Background: In many developing and developed countries, the profession of nursing is directly affected by the country's legislative structure and associated governance arrangements. Thus, nursing policymakers, practitioners, and educators should understand the way nursing legislation is created and implemented, as well as its impact on the nursing profession. Purpose: The purpose of this study was to describe the structure of nursing legislation in Iran from the perspective of nursing policymakers. Methods: For this qualitative study, a content analysis approach was used. Data were collected through semi-structured interviews conducted with nursing policymakers (N = 15). Additionally, the content of Iranian government websites was used as collected data in the process of data analysis. Result: Three main categories emerged from the data: (a) the role of competent authorities, (b) the advancement of the nursing profession, and (c) the emergence of new diseases as an opportunity for developing nursing policy. Conclusion: Although the involvement of competent authorities plays a crucial role in structuring Iranian nursing policy, the role of nursing in treating emerging diseases also brings opportunities for nursing policymakers to revise current legislation and develop new practice acts. © 2021 National Council of State Boards of Nursing

Concomitant increase in alkaline phosphatase and gamma-glutamyl transferase levels in COVID-19 positive patient

Background: Coronavirus disease 2019 (COVID-19) is a worldwide pandemic that has affected millions of lives since December 2019 Research is being done to determine the impact COVID-19 has on different organ systems There is limited information of Covid-19's impact on the liver as manifested by abnormal hepatic test results Methods: Clinical Case Report Results: Patient is a 70-year-old male with history of Parkinson's disease, chronic obstructive pulmonary disease, diabetes mellitus, hyperlipidemia, and benign prostatic hyperplasia who presented with fever and weakness and was admitted for sepsis versus COVID-19 infection Patient reported fevers of 104 F Patient tachypneic, tachycardic, with oxygen saturating at 94% room air at admission COVID-19 PCR test positive Patient was admitted to medical intensive care with progressive respiratory insufficiency. ABG PH 7.399, PCO2 34, PO2 78. WBC 6.63, H&H 13 1/36 9, Platelets 147, Sodium 132, Potassium 3 4, Chloride 96, CO2 23, Anion gap 16, Glucose 330, BUN/ creatinine 11/0 88, Total Bilirubin 0 8, Alk Phos 141, AST 33, ALT 33 CT angiogram negative for pulmonary embolism Initial chest x ray showed bibasilar atelectasis/infiltrates. Repeat chest x ray's showed unresolved bibasilar opacities Blood cultures negative Patient was treated with Azithromycin and IV Ceftriaxone Patient's Alkaline Phosphatase showed upward trend from Day 7 At admission, Alkaline Phosphatase was 141, Day 2 145, Day 3 119, Day 4 124, Day 5 163, Day 6 154, Day 7 245, Day 8 361, Day 9 520, Day 10 696, Day 11 835, Day 12 1266, and Day 13 1324 RUQ u/s had normal size common bile duct at 4 5 mm GGT of 1298, indicating liver etiology of Alkaline Phosphatase elevation Day 13 AST 65 and ALT 53 Ceftriaxone and Azithromycin were discontinued and transitioned to meropenem on Day 9 Patient was started on meropenem for empiric coverage of possible biliary infection, but with no improvement On Day 12, Vit C, zinc, and meropenem discontinued to ensure lab abnormalities not secondary to agents Day 13 Alkaline Phosphatase continued to increase The etiology of his lab abnormalities remains unclear Differential includes COVID related pathology or medication induced Day 13, patient died after being placed on comfort care due to cardiac arrest secondary to hypoxic respiratory failure secondary to COVID 19 pneumonia with moderate to severe ARDS Conclusion: Data on liver abnormalities on COVID-19 patients is limited Recent literature only highlights an increase in ALT and AST due to target of COVID-19 on ACE 2 positive cholangiocytes in the liver To date, research has only noted elevated levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin, and gamma-glutamyl transferase levels to more than 3× the upper limit of normal in COVID-19 patients The sole elevation of Alkaline Phosphatase with concomitant rise of GGT is the first documented here.