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Background. The COVID-19 pandemic has affected respiratory disease epidemiology. Measures to reduce transmission of SARS-CoV-2 (e.g., masking, social distancing, school closures) have reduced the incidence of common infectious diseases. At least one early report described changes in rates of pediatric GAS pharyngitis. We sought to determine the difference in GAS pharyngitis rates before and after the onset of the pandemic at our children's hospital. Methods. Clinical pharyngeal specimens tested for GAS by rapid antigen tests (RADTs) or LAMP methodology (loop-mediated isothermal amplification of GAS DNA) from January 2019 to March 2022 at our children's hospital were analyzed. Clinician's evaluating patients for GAS pharyngitis perform a RADT, when positive the patient is treated for GAS pharyngitis. When the RADT is negative, a LAMP test is performed. Patients were considered test-positive if either test was positive regardless of clinical symptoms. Annual positivity rates were compared using statistical process control (SPC) charts with both 2019 and 2020 as baseline years (i.e., 2019 vs 2020-3/2022;2020 vs 2021-3/2022). The change in GAS incidence rate (positive patients/ 1000 tested) between years was assessed by chi-square tests. Results. 9,896 patients had throat swabs tested for GAS from January 2019 through March 2022. Using SPC with 2019 as a baseline, there was a 15.1% decrease in mean GAS positivity through 3/2022. With 2020 as baseline, there was a 13.0% decrease in mean GAS positivity through 3/2022. The incidence of positive GAS tests decreased significantly: 2019 vs. 2020-3/2022 (x2 = 84.97, p <=0.00001) and 2020 vs. 2021-3/2022 (x2 = 154.01, p <=0.00001). Figure 1. Conclusion. Using throat swab results, the incidence of pediatric GAS pharyngitis at our hospital has decreased significantly during the COVID-19 pandemic. Implications: Pandemic-related riskmitigationmeasures, such asmasking, social distancing, and school closures, were associated with significantly decreased incidence of GAS pharyngitis. It is likely that GAS colonization and invasive infections were also affected.
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Background. COVID-19 affected the epidemiology ofmany respiratory pathogens including GAS. Assessing genetic heterogeneity (emmtype, antimicrobial resistance, virulence factors) can inform treatment recommendations and targets for potential GAS vaccines. We assessed GAS clinical antibiotic susceptibility and performed whole genome sequencing (WGS) among pediatric pharyngeal isolates from 2020-2022. Methods. From 1/2020-3/2022 we collected throat swabs in pediatric clinics and EDs from children aged 3-18 years in Chicago, IL;Atlanta, GA;Portland, OR;and Phoenix, AZ: 1) with acute GAS pharyngitis and 2) among a convenience sample of asymptomatic children to assess for GAS colonization. Swabs were plated on blood agar. E-tests were used to assess clinical susceptibility to erythromycin (ERY) and ciprofloxacin (CIP). emm type and antimicrobial resistance genes (ERY, Clindamycin (CLI), and fluoroquinolones) were assessed by WGS. Results. 1144 pharyngeal swabs were collected: 359/684 (52%) from children with GAS pharyngitis by rapid test and 20/460 (4.3%) from asymptomatic children yielded GAS on culture. Phenotypic resistance: 55/364 (15%) tested isolates were ERY resistant and 5/364 (1.4%) CIP resistant. The proportion of isolates with ERY resistance increased significantly from 2020 (6%) to 2021-2022 (25%) (chi2 = 23.70, p< .00001) (Figure 1). MICs were high among ERY resistant GAS (Table 1). Genotypic resistance: Of 304 sequenced GAS isolates 40/304 (13%) were ERY resistant, 35/304 (11.5%) were both ERY resistant and CLI (inducible or constitutive) resistant, and 4/304 (1.3%) fluoroquinolone resistant. ermB (62%) was the most common gene for ERY resistance and constitutive CLI resistance, followed by ermTR (23%) and ermT (11%) both conferring inducible CLI resistance. Among the 20 isolates from asymptomatic children no ERY, CLI, or CIP resistance occurred, and no resistance genes were identified. emm types 11, 9, 77, 58 and 94 were associated with ERY and CLI resistance. Conclusion. ERY resistance increased from 2020-2022. The high rate of CLI resistance among ERY resistant GAS was associated with erm genes. These results are important to inform treatment recommendations for GAS pharyngitis and targets for vaccine development that can reduce antimicrobial-resistant GAS disease.
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Introduction: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 can cause cardiovascular dysfunction. We aimed to determine if strain abnormalities persist in MISC patients 3-10 weeks post-discharge, and whether acute markers of clinical severity are associated with lower strain at subacute follow-up. Methods: We performed a retrospective cohort study of MIS-C patients admitted at a single center from 3/2020-3/2021. Demographic and clinical variables during hospitalization were obtained. Global longitudinal strain (GLS), 4-chamber longitudinal strain (4C-LS), mid-papillary circumferential strain (CS), and left atrial strain (LAS) at 3-10 week follow-up were compared to age matched controls (n=10). Bivariate analyses were performed using Spearman rank correlation and twosample t-test or Wilcoxon rank sum test. Results: Sixty MIS-C patients were identified (age 8.9 +/-4 years, 35/60 male, 39% Hispanic, 29% African American). Hypotension (65%), ICU admission (57%), and inotropic support (45%) were common;7% received mechanical ventilation. No deaths or need for ECMO were reported. Median length of stay (LOS) was 7 days. LVEF was <55% in 28% during hospitalization (median 57% [52-61]) and 6% at follow-up (median 65% [61-67]). Peak NT-proBNP (median 5321 pg/ml [IQR 1712, 17400]) and peak CRP (median 17 mg/dl [12, 22]) were significantly associated with hypotension, ICU admission, and total ICU days. Forty-five patients had available follow-up imaging for strain. CS (mean-26.0 vs-28.6;p=0.009) and LAS (mean-34.5 vs-51.2;p=0.001) were lower in MIS-C vs controls, but not GLS or 4C-LS. Lower CS (-24.2 +/-3.1 vs-26.7 +/-2.7;p=0.04) and lower 4C-LS (-19.1 +/-1.9 vs-21.2 +/-3.3;p=0.04) were associated with abnormal EF (<55%) during acute illness. CS was lower in those admitted to ICU (-25.1 +/-2.6 vs-27.5 +/-2.9;p=0.03). Peak CRP correlated with lower CS (r=-0.41, p=0.03) and GLS (r=-0.55, p=0.01) at follow-up. Conclusions: MIS-C patients show abnormal strain during subacute follow-up despite improvement in EF. Lower CS, GLS, and 4C-LS were associated with in-hospital markers of clinical severity. This data may allow for identification of at-risk MIS-C patients and help guide outpatient cardiology follow-up.
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Purpose The stigmatisation of COVID-19 patients or suspected cases is a matter of grave concern across the world, including India. Today, COVID-19 patients or suspected cases are being stigmatised or labelled as "corona carrier" and "corona spreader" because of which they are facing social rejection, mental torture, abusive behaviour and violence in the society. The objectives of the present study are to examine the nature of stigma construction in Indian society during COVID-19 pandemic and to explore its outcome on the well-being of corona-affected people. Design/methodology/approach The study uses content analysis method to explain the COVID-19 stigma. The data have been collected from various Indian newspapers and magazines. The researchers have analysed the content of the news items related to social stigma which were collected from March to September 2020. Findings The study finds that COVID-19 patients or suspected cases are insulted and discriminated rudely by their family members and neighbours, and in many cases, they are not allowed to enter the house or the neighbourhood. The study has also pointed out that many COVID-19 patients or suspected cases have committed suicide as a result of being stigmatisation. Finally, the study explores that this social stigma is spreading due to fake news, lack of awareness and fear of corona infection. Originality/value This is an original paper which is based on content analysis. The present study focuses on the social stigma in Indian society during COVID-19. Basically, the present study has applied the theory of Erving Goffman which is based on stigma to examine the nature and problem of social stigma during COVID-19. The study has found that there are three types of social stigma during the corona pandemic: self-made stigma, family-made stigma and society-made stigma.
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Emerging retrospective analyses show that cancer patients are more likely to develop severe COVID-19. Thecauses for these worse outcomes are unclear, but data suggest that cancer therapies, which can suppress theimmune system, are not responsible for increased COVID-19 severity. An alternative hypothesis is that commonmolecular pathways are altered in cancer and COVID-19, resulting in worsened disease outcomes. Our previouswork demonstrated that activated renin angiotensin signaling (RAS) modulates the tumor microenvironment, resulting in worse outcomes and therapy resistance. Inhibition of this pathway using angiotensin receptor blockers(ARBs) or angiotensin converting enzyme inhibitors (ACEIs) can improve the outcomes of cancer therapies.Similarly, there is great interest in understanding the implications of RAS in COVID-19 progression because a keycomponent of this system, ACE2, is also the docking site for the SARS-CoV-2 virus. Indeed, multiple clinical trialsare currently evaluating whether ARBs/ACEIs benefit or harm COVID-19 patients. To help guide administration ofthese drugs, we adapted our existing computational modeling framework of the cancer microenvironment usingavailable data to simulate COVID-19 progression in patients. Using a systems biology approach, we mechanisticallymodeled the interaction of the RAS and coagulation pathways with COVID-19 infection. We further explored theefficacy of various antiviral, antithrombotic, and RAS-targeted treatment regimens to identify synergisticcombinations as well as optimal schedules for therapy. The system is complex, given that viral binding of ACE2interferes with its antiinflammatory signaling. When ACE2 is bound by the virus, its local activity decreases, leadingto immune dysregulation and risk of coagulopathy, predictors of COVID-19 severity and mortality. To optimizecombination treatments for cancer patients who contract COVID-19, multiple simulations were run by combiningdifferent therapeutics currently in clinical trials to predict their effects on viral load, thrombosis, oxygen saturation, and cytokine levels. These include ARBs, ACEIs, antiviral drugs, antithrombotic agents, and anti-inflammatory drugs(e.g., anti-IL6/6R). Our simulations predict that i) there is an optimal timing for treatment with antiviral drugs such asremdesivir, related to immune activation;ii) combinations of antiviral and antithrombotic drugs are able to preventlung damage, increase blood oxygen levels, and inhibit thromboembolic events;and iii) RAS modulators can have apositive effect when added to the treatment regimen. Effective strategies for COVID-19 treatment identified by this insilico analysis will be further analyzed in combination with cancer therapeutics (e.g., immune checkpoint blockers, chemotherapy) to provide guidelines for optimal clinical management of both cancer and COVID-19.
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Purpose: As we know that whole world is facing global pandemic or COVID-19 for past six months including India. It has created many psychosocial problems among the millions of people of the society. Committing suicide is one of them owing to COVID-19, and it is the matter of grave concern for the social psychologists. This study is based on secondary data. The purpose of this paper is to understand the nature of suicides in Indian society during COVID-19 and to explore the factors affecting committing suicides during COVID-19. Design/methodology/approach: The secondary data have been collected for the study of suicide because of COVID-19 through various newspapers and monthly magazines. The cases of suicide because of COVID-19 have been collected between March 2020 and July 2020. The authors have used content analysis method to analyse the cases related to suicide because of COVID-19. Findings: This study finds that the nature of committing suicide is anomic, egoistic and altruistic in the current pandemic. The study also points out that most of individuals have committed suicide in this current pandemic owing to fear of corona infection and economic crises because of nationwide lock down. Originality/value: This is an original paper which is based on content analysis. Basically, the present paper has examined the nature of suicide in India because of COVID-19 and nationwide lockdown using Durkheim’s perspective of suicide. © 2020, Emerald Publishing Limited.
ABSTRACT
Thrombectomy for large-vessel-occlusion stroke is a highly impactful treatment. The spread of coronavirus 19 (COVID-19) across the United States and the globe impacts access to this crucial intervention through widespread societal and institutional changes. In this document, we review the implications of COVID-19 on the emergency care of large-vessel occlusion stroke, reviewing specific infection-control recommendations, available literature, existing resources, and expert consensus. As a population, patients with large-vessel occlusion stroke face unique challenges during pandemics. These are broad in scope. Responses to these challenges through adaptation of stroke systems of care and with imaging, thrombectomy, and postprocedural care are detailed. Preservation of access to thrombectomy must be prioritized for its public health impact. While the extent of required changes will vary by region, tiered planning for both escalation and de-escalation of measures must be a part of each practice. In addition, preparations described serve as templates in the event of future pandemics.