Clinical Outcome of Systemic Lupus Erythematosus during the Covid-19 Omicron Variantwave Compared to Previous Periods: Results from a Single Center Cohort of Puerto Rico

Objectives: Variant-related differences of SARS-CoV-2 have been reported such as higher transmissibility but less disease severity in omicron sublineages when compared to other variants. Although some studies have examined the outcomes of COVID-19 in systemic lupus erythematosus (SLE), most were conducted during the initial waves. Thus, we sought to compare the clinical outcomes of SLE patients with COVID-19 during the omicron and pre-delta/delta periods. Method(s): A cohort of adults with SLE from a single center in Puerto Rico was studied. SARS CoV-2 infection was confirmed by polymerase chain reaction or antigen tests. The pre-delta/delta variants period was defined as March 2020 to November 2021 and the omicron period as December 2021 to October 2022. Demographic parameters, cumulative SLE manifestations, disease activity, disease damage, lupus treatments, comorbidities, COVID-19 symptoms, SLE exacerbations, and hospitalizations were compared between the study periods using bivariate and multivariate analyses. Result(s): Of the entire SLE cohort (n = 347), 151 patients (43.5%) had COVID-19. In those with COVID-19, the mean (SD) age was 46.7 (12.5) years and 96.0% were women. Overall, clinical outcomes were favorable with low rates of hospitalizations (2.6%), lupus flares (3.3%), and mortality (0.7%). In 14.6% of cases, COVID-19 occurred during the pre-delta/delta period and in 85.4% during the omicron wave. Patients that had COVID-19 during the predelta/ delta period were younger and had a significantly higher proportion of oral ulcers, psychosis, anti-Smith antibodies, coronary artery disease, and chronic kidney disease compared to those during the omicron wave. Among COVID-19 symptoms, runny nose, cough, and sore throat were more common in the omicron period, whereas anosmia and anorexia were more frequent in the pre-delta/delta period. In the multivariable analyses adjusted by age, all variables retained significance except for psychosis, anti-Smith antibodies, and coronary artery disease. No significant differences were observed for other variables. Conclusion(s): In this group of Puerto Ricans with SLE, a higher proportion had COVID-19 during the omicron wave compared to previous periods. No differences were seen for severe outcomes such as hospitalizations, lupus flares, and mortality. Furthermore, COVID-19 did not appear to have a negative impact on the short-term clinical outcomes of these patients, regardless of the variant period examined.

A network pharmacology and molecular docking approach in the exploratory investigation of the biological mechanisms of lagundi (Vitex negundo L.) compounds against COVID-19

Coronavirus disease 2019 (COVID-19) is an inflammatory and infectious disease caused by severe acute respiratory syndrome coronavirus 2 virus with a complex pathophysiology. While COVID-19 vaccines and boosters are available, treatment of the disease is primarily supportive and symptomatic. Several research have suggested the potential of herbal medicines as an adjunctive treatment for the disease. A popular herbal medicine approved in the Philippines for the treatment of acute respiratory disease is Vitex negundo L. In fact, the Department of Science and Technology of the Philippines has funded a clinical trial to establish its potential as an adjunctive treatment for COVID-19. Here, we utilized network pharmacology and molecular docking in determining pivotal targets of Vitex negundo compounds against COVID-19. The results showed that significant targets of Vitex negundo compounds in COVID-19 are CSB, SERPINE1, and PLG which code for cathepsin B, plasminogen activator inhibitor-1, and plasminogen, respectively. Molecular docking revealed that alpha-terpinyl acetate and geranyl acetate have good binding affinity in cathepsin B;6,7,4-trimethoxyflavanone, 5,6,7,8,3',4',5'-heptamethoxyflavone, artemetin, demethylnobiletin, gardenin A, geranyl acetate in plasminogen;and 7,8,4-trimethoxyflavanone in plasminogen activator inhibitor-1. While the results are promising, these are bound to the limitations of computational methods and further experimentation are needed to completely establish the molecular mechanisms of Vitex negundo against COVID-19.

Impact of the COVID-19 Pandemic on Gasoline and Natural Gas Prices in the Major Latin American Economies

This paper is aimed at evaluating the impact of the COVID-19 pandemic, measured through the fatality index, on the gasoline and natural gas prices in the main Latin American economies: Brazil, Mexico, Colombia, Peru, Chile and Uruguay. These economies are not only the largest in the region, but also the most affected by the COVID-19 pandemic. Likewise, these countries have shown, in the last decades, a growing demand for gasoline and natural gas. This research uses several panel data models with weekly data (February 2020 - February 2021). Two-way random-effects panel data models suggest empirical evidence that mortality rate growth rates, for all sample countries, have negative effects only on gasoline price growth rates;without any effect on the price of gas. In this research, the exchange rate is used as a control variable due to its relationship with hydrocarbon prices. Data used in the analysis are official without considering the mortality excess by specific cause of COVID-19. This type of analysis in Latin America, as far as the authors know, is novel and contributes to the discussion of the conjuncture between the health crisis and its relationship with volatility of energy prices. ©2022 by authors, all rights reserved.

Factors Associated with Mortality in Patients with COVID-19 from a Hospital in Northern Peru

We aimed to identify the factors associated with mortality in patients with COVID-19 from the hospitalization service of the Cayetano Heredia Hospital, Piura, Peru, from May to June 2020. A prospective study was conducted in hospitalized patients with a confirmed diagnosis of COVID-19 through serological and/or molecular reactive testing. The dependent variable was death due to COVID-19, and the independent variables were the epidemiological, clinical and laboratory characteristics of the patient. The chi-square test and the non-parametric Mann–Whitney U test were used, with a significance level of 5%. Of 301 patients with COVID-19, the majority of them were male (66.1%), and the mean age was 58.63 years. Of the patients analyzed, 41.3% of them died, 40.2% of them were obese and 59.8% of them had hepatic steatosis. The three most frequent signs/symptoms were dyspnea (90.03%), fatigue (90.03%) and a cough (84.72%). Being an older adult (p = 0.011), being hospitalized in the ICU (p = 0.001), overweight (p = 0.016), obese (p = 0.021) and having compromised consciousness (p = 0.039) and thrombocytopenia (p = 0.024) were associated with mortality due to COVID-19. Overall, the mortality rate due to COVID-19 was 41.3%. Having an older age, being hospitalized in the ICU, overweight, obese and having compromised consciousness and thrombocytopenia were positively associated with mortality in patients with COVID-19. These findings highlight the need to establish an adequate system of surveillance and epidemiological education in hospitals and communities in the event of new outbreaks, especially in rural and northern Peru. © 2023 by the authors.

Point-of-care testing devices and clinical skills practical sessions: A blended learning approach

Introduction: For the academic year 2020-21, during the COVID-19 pandemic, the point-of-care testing devices and clinical skills practical sessions for first year undergraduate pharmacy students, were converted to a blended learning approach, combining traditional in person laboratory practical training with pre-laboratory synchronous remote sessions. The practical sessions consisted of 1) three two-hour synchronous pre-laboratory sessions for all the class held using Zoom, and 2) three two-hour in person laboratory sessions for each student held in groups of three students. The in-person laboratory sessions covered: Urinalysis and blood glucose monitoring, Blood pressure, lipid profile and obesity measurements, and Injection techniques. The aim was to evaluate student perception of practical sessions delivered using a blended learning approach. Method(s): A self-administered questionnaire was developed and validated by an eight-member expert panel consisting of pharmacy academics and pharmacy students in other course years. The questionnaire consists of Likert-type questions (1-Strongly Disagree to 5-Strongly Agree). The questionnaire was disseminated electronically to all (N = 24) first year undergraduate pharmacy students at the completion of the sessions. Result(s): Nineteen students (13 female, age range 18 - 21 years) completed the questionnaire. The majority of students gave positive feedback (score of 4 or 5) about the blended learning approach adopted: 'Allowed me to review material covered in the remote sessions on the virtual learning environment as often as necessary and at my own pace to help me prepare for the in-person laboratory sessions' (n = 18), 'helped me to participate more in the in-person sessions' (n = 18), 'provided me with opportunities to pursue my own learning' (n = 16), and 'stimulated critical-thinking' (n = 14). Sixteen students recommended continuation of the blended learning approach for such practical sessions. Conclusion(s): Students had a positive perception of practical sessions delivered using a blended learning approach and reported that the remote sessions supported the in-person sessions.

Technological Disruption in Grocery Retail: An Overview of the Last Decade (2012–2021)

After grocery retail experienced a radical change with the emergence of the Internet and the use of dot-com in electronic commerce, this sector is once again in a gradual and accelerated process of adaptation and implementation of disruptive technologies. These technologies are the result of automation processes and connectivity implemented by Industry 4.0 tools and recently by the new regulations that brought the impact generated by the COVID-19 pandemic. This research paper uses a systematic literature review, this work was carried out from 50 scientific papers collected in the last 10 years (from 2012 to 2021) and that portray the planning of prototypes and implementation of disruptive technologies in grocery retail. The results gather information from technologies such as the Internet of Things, Artificial Intelligence, Machine Learning, Blockchain, Virtual Reality, Augmented Reality, use of Drones, Big Data, Robotics and Cloud Computing, and their use in the grocery retail industry in specific areas such as Logistics, Warehousing, Customer Service and Assistance, Freight Transport, Supply Chain and Supplier Management. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Routine Opt out Hepatitis C Testing Upon Intake in the Philadelphia Jail System

Background: Hepatitis C (HCV) infection disproportionately affects those in United States' correctional institutions with seroprevalence rates from 17.4-23.1%. Jails have represented a particularly challenging setting for HCV testing and treatment given the short duration of stay and uncertainty of the timing of prisoners' release. Despite recommendations that all incarcerated persons undergo HCV testing, screening is not universally performed. In the Philadelphia jails, 1463 (7.5%) of the 19395 prisoners in 2018 were screened at sentencing. Method(s): On September 3, 2019 the Philadelphia jail partnered with Philadelphia FIGHT Community Health Centers to implement routine opt out HCV testing upon intake. Protocols for testing, result delivery and provider follow up were developed in a collaborative manner between the jail and FIGHT and subsequently adapted to ensure success in response to the COVID-19 pandemic. Herein, we report the findings of the first thirty-two months of routine opt out screening at intake. Result(s): Between September 3, 2019 and April 30, 2022, 27633 individuals entered the jail. 25206 (91.22%) individuals were tested for HCV antibody (ab) upon entry. 2639 (95.72%) of 2757 ab+ individuals had reflexive RNA confirmatory testing and 1892 (68.63%) were chronically infected. Of those, 950 (50.21%) were seen by a linkage coordinator from FIGHT while incarcerated, 1338 (70.72%) were seen by a jail-based HCV provider, and 619 individuals were prescribed HCV treatment. Of the treated persons, 304 (65.84%) were released from jail before completing HCV treatment, but all left jail with a full course of treatment;linkage to care to determine treatment response and ongoing medical care is in progress. Conclusion(s): Establishment of routine opt out HCV screening in a jail setting resulted in more than 90% of individuals entering the jail being screened for HCV and 32% of those with chronic infection initiating treatment. Short duration of incarceration, the need for rapid result delivery, increased linkage coordinator visits, and coordination of treatment between the jail and the community are challenges that must be addressed for successful program implementation in a jail setting. Collaboration between health care providers in the correctional system and community is necessary to coordinate HCV services in a high volume, high turnover urban jail.

Poverty and inequality: drivers of migration

Causes that generate migration, establish the differences between the sending and receiving countries of migrants, some 100 million more people fell into extreme poverty as a result of the pandemic (COVID-19), climate change may push up to 132 million people into extreme poverty by 2030, the majority of the poorest people in the world will live in situations characterized by fragility, conflict and violence, triggering large migratory flows, taking as a reference a great inequality. You cannot compare the lifestyles of the developed worlds, especially in Western countries, where waste is common, where money is the god that is venerated. © GKA Ediciones, authors. Creative Commons Reconocimiento-NoComercial-SinObraDerivada.

Factors Intervening in the Development of Socio-Emotional Skills in Childhood, a Case Study

The solidity of social-emotional skills has become a useful tool related to success in the lives of individuals. Some statements claim that a high level of IQ does not ensure assertiveness when acting or making good decisions, but that there must be a balance between it and socio-emotional intelligence. What concerns social-emotional education cannot be simplified as a look inside, but represents a greater complexity, although it leads the subject to self-centeredness;individual concreteness, to discover their inner strength, promote personal growth and the construction of their own identity, its purpose is not individualism, but it is a collective consciousness, where competences such as self-knowledge, self-regulation, autonomy, empathy and collaboration come into play. The present research was carried out in the pandemic situation caused by the COVID-19 virus, it pursues the objectives of a more clearly understanding of socio-emotionalskills development process, in addition to identify the factors that prevent their acquisition, as well as explaining the benefits that individuals can achieve by promoting these abilities. This is channeled by an interpretative paradigm to analyze the phenomena in which the participating subjects are involved;how certain factors interfere with the development of social-emotional skills. This is linked to a qualitative approach, thus focusing on the experiences of the sample in question. The process takes the methodology of the case study due to the small number of students who manifest socioemotional limitations. Data collection was carried out through interviews, observation guides, file research and anecdotal recording. These techniques and instruments made it possible to systematize the information obtained and then schematize them. It was found that there are different factors that influence the development of the emotional intelligence, such as parents, parenting style, teaching intervention, psychological, psychiatric or neurological issues, as well as the disposition and motivation of students. It is concluded that socio-emotional skills are not innate, but it is necessary to activate them, they are influenced, limited or propitiated, by the particular life experience, in the same way they are not acquired at the same pace. Another relevant point is the teaching preparation necessary to achieve a socioemotional solidity, in order to lead students to emerge the best version of themselves.

Case Study - Understanding the Correlation Between the Components of an Emergency Resuscitator

Given the high spread of Covid-19, many hospitals suffered from a shortage of ventilators to treat patients. Consequently, emergency resuscitators (ER) became popular as a cheaper and easier to manufacture option that would satisfy the need for ventilators in hospitals. These devices are characterized by an automated mechanism that tightens a Bag valve mask (BVM), commonly known as a manual resuscitator. The ERs main components are the controller, sensors, the Human Machine Interface (HMI), and the motor. For the effective design of these devices, the team must understand the relationship between components. In the iterative process of designing, changing one part can easily affect the operation of other components. This is the most critical points of the case study presented since it is not feasible to replace a component without considering the requirements of the other parts that make up the final product. Using a resuscitator developed by a Puerto Rican company as an example, if changes were to be made, to keep the current sensors, a Programmable Logic Controller (PLC) should be used as a controller. Changing the PLC affects the sensors and limits the options of the HMIs since many of them are designed to work with the same brand. On the other hand, when selecting the motor, the communication method and compatibility with the controller must be considered. For these reasons, this paper presents a case study to share the compatibility issues that are faced when developing this type of device. © 2022 IISE Annual Conference and Expo 2022. All rights reserved.

GLOBAL IMPACT OF THE COVID19 PANDEMIC ON SUBARACHNOID HEMORRHAGE ADMISSIONS, ANEURYSM TREATMENT AND IN-HOSPITAL MORTALITY: 1 YEAR FOLLOW-UP

Background: Prior studies indicated a decrease in the incidences of subarachnoid hemorrhage (SAH) during the early stages of the COVID- 19 pandemic. We evaluated differences in the incidence, severity of SAH presentation, and ruptured aneurysm treatment modality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional study including 49 countries and 187 centers. We recorded volumes for: COVID-19 hospitalizations, SAH hospitalizations, Hunt-Hess Grade, coiling, clipping, and aneurysmal SAH (aSAH) in-hospital mortality. Diagnoses were identified by ICD-10 codes or stroke databases from January 2019 to May 2021. Results: Over the study period, there were 16,247 aSAH admissions, 344,491 COVID-19 admissions, 8,300 coiling and 4,240 aneurysmal clipping procedures. Declines were observed in aSAH admissions (-6.4% [95%CI -7,-5.8];p=0.0001) during the first year of the pandemic compared to the prior year, most pronounced in high-volume SAH and highvolume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentation of aSAH (mild: -5%[-5.9,-4.3], p=0.06;moderate: -8.3%[-10.2,-6.7], p=0.06) but no difference in higher SAH severity. The clipping rate remained unchanged (30.7% vs. 31.2%, p=0.58), whereas coiling increased (53.97%vs.56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%,p=0.12). Conclusion: During the first year of the pandemic, there was a decrease in aSAH admissions volume driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the coiling rate, but no change in clipping rate, nor change in aSAH in-hospital mortality.

Tolerability and Feasibility Pilot Clinical Study of a Large-Diameter Nerve Cap for Protecting and Preserving Terminated Nerve Ends

The primary objective of this study is to evaluate Axoguard Nerve Cap in large diameter sizes (5mm -7mm) for protecting and preserving terminated large diameter nerve endings after limb trauma or amputation when immediate attention to the nerve injuries is not possible. The secondary objective of this study is to demonstrate proof-of-concept that large diameter nerve caps can prevent or reduce the formation of symptomatic neuromas in large diameter nerve endings after trauma or amputation when immediate attention to the nerve injuries is not possible.

Correlation of cardiac biomarkers with computed tomography severity score in COVID-19 patients

INTRODUCTION: A vast number of COVID-19 cases have been reported worldwide since the initial outbreak in China, and the disease has since become a global pandemic. Knowledge on this predominantly respiratory illness is evolving with studies suggesting myocardial injury reflected by elevated cardiac enzymes portending to more severe disease. CT scoring indices provide visual, semi-quantitative assessment of lung involvement and have aided in determining extent of COVID-19 pneumonia but, none have been validated for prognostication. PURPOSE: Establishing a relationship between these non-invasive diagnostic parameters could provide timely identification and proper allocation of limited medical resources to patients in need of more aggressive therapy. METHODS and RESULTS: A total of 50 COVID-19 patients were retrospectively enrolled and their clinical parameters collected from an electronic medical database. There was a total of 31 patients with troponin I-HS with chest CT scan done and another 42 patients for NT-proBNP and chest CT. The levels of both cardiac biomarkers in patients with clinically severe COVID pneumonia were higher than those with mild and moderate disease. Rank-order analysis showed that both troponin I-HS (moderate, p = 0.0003174) and NT-proBNP (moderate, p = 0.006255) correlated positively with CT severity scores. Furthermore, there is a significant relationship between mortality and septic shock with both Troponin I-HS (p < 0.001;p = 0.002) and NT-proBNP (p = 0.004;p = 0.031). CONCLUSION: The cardiac markers troponin I-HS and NT-proBNP increased significantly at more severe CT scores and more notably, these biomarkers predicted the development of septic shock and mortality in COVID-19 pneumonia.

Covid-19 agent-based model: An epidemiological simulator applied in vaccination scenarios for quezon city, philippines

COVID-19 vaccines are rolling out in the Philippines but the supply remains limited;there is a need to optimize the distribution. In this study, we developed a COVID-19 agent-based model for Quezon City, a COVID-19 hotspot in the country. This model, in conjunction with a multi-objective linear programming model for equitable vaccine distribution, was then used to simulate four vaccination scenarios. Experiments were conducted with the front-line workers always added to the groups: mobile workers, elderly and low-income. Main results are: prioritizing the mobile workers minimizes infections the most (by 4.34%), while prioritizing the low-income groups minimizes deaths the most (by 1.93%). These results demonstrate that protecting the population with the most interactions (mobile workers) effectively reduces future infections. On the other hand, protecting the most vulnerable population (low income and elderly) decreases the likelihood of death. These results may guide the policy-makers in Quezon City. © International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences - ISPRS Archives

Services for people with disabilities at risk: Reflections from rehabilitation counseling internship students

In Puerto Rico, services offered by professionals providing aid to people with disabilities were affected as a result of the COVID-19 pandemic. One of the professional groups in training impacted in the past year and a half was rehabilitation counselors. The responsibility assumed by the professors and internship supervisors has been crucial in the preparation and completion of the degree of the students enrolled in the course. Additionally, in order to comply with the requirements of the Graduate Rehabilitation Counseling School and the standards of the Council for Accreditation of Counseling and Related Educational Programs (CACREP), the manner in which the different services were offered to the population with disabilities was adapted. This brought about a series of ethical dilemmas in the different work settings that represented a great challenge for all the people involved, such as, for example, the distance counseling relationship using virtual methods and its impact on the therapeutic alliance;the proper handling of confidential information that is shared using technology;the establishment of work limits to comply with a fixed schedule of work from home and the establishment of self-care plan, among others. The adaptation and learning process was arduous;however, the decisions that were made in the internship settings of the rehabilitation counselors are based on the ethical principles that regulate the profession and seek the well-being of people with disabilities.

Provision of hepatitis c care in a federally qualified health center during the COVID-19 pandemic and beyond

Background: In response to the challenges of providing Hepatitis C care during the COVID-19 pandemic, the Hepatitis C program at Philadelphia FIGHT Community Health Centers, a Federally Qualified Health Center, transitioned to a modified patient centered model of hepatitis C (HCV) care and social service provision in March of 2020. Methods: Beginning on March 15, 2020, the HCV program initiated a modified approach to providing HCV care for patients. Interventions included telemedicine for initial evaluation and medication adherence support, outreach for medication delivery, mobile phlebotomy, and collaboration with treatment facilities. Patients were referred from substance use treatment programs, the Philadelphia Department of Prisons, and self-referral for primary care. A weekly multidisciplinary team huddle was among the clinical team. Herein, we report the experience of our program during the first year. Results: Between March 15, 2020 and March 14, 2021, 148 patients were engaged in HCV services and 134 (90%) patients initiated treatment. Among our HCV patients, 11 (7%) patients were born between 1945 and 1965, 97 (66%) patients were born between 1966 and 1985, and 40 (27%) were born after 1985. 99 (67%) identify as male and 49 (33%) identify as female. Twenty-three (16%) patients identify as Black or African American, 114 (77%) identify as White, and 11 (7%) declined to specify. 19 (13%) identify as Hispanic or Latino. Eighty-five (57%) patients received only telemedicine services, 53 (36%) patients received a hybrid of telemedicine and in-person services, and 11 (7%) received medical services exclusively in-person in the health center. Of the patients who initiated treatment, 90% received HCV medication delivered to their homes or inpatient and outpatient substance use treatment programs. Thirty patients (22%) have achieved SVR. Conclusion: The COVID-19 pandemic has forced changes in the approach to the management of chronic HCV infection, particularly for patients with a history of substance use disorder. In our FQHC, a creative team approach utilizing telemedicine and medication delivery to patients enabled us to initiate and complete HCV treatment without the requirement for in office visits. Maintenance and expansion of services developed during the COVID pandemic will lead to a focus on increasing HCV treatment for patients in substance use treatment programs and increased rates of SVR confirmation.

Implementation of routine opt out hepatitis c testing in the philadelphia jail system

Background: Hepatitis C (HCV) infection disproportionately affects those in United States' correctional institutions with seroprevalence rates from 17.4-23.1%. Jails have represented a particularly challenging setting for HCV testing and treatment given the short duration of stay and uncertainty of the timing of prisoners' release. Despite recommendations that all incarcerated persons undergo HCV testing, screening is not universally performed. In the Philadelphia jails, 1463 (7.5%) of the 19395 prisoners in 2018 were screened at sentencing. Methods: On September 3, 2019 the Philadelphia jail partnered with Philadelphia FIGHT Community Health Centers to implement routine opt out HCV testing upon intake. Protocols for testing, result delivery and provider follow up were developed in a collaborative manner between the jail and FIGHT and subsequently adapted to ensure success in response to the COVID-19 pandemic. Herein, we report the findings of the first twenty-one months of routine opt out screening at intake. Results: Between September 3, 2019 and May 31, 2021, 21187 individuals entered the jail. 19352 (91.34%) individuals were tested for HCV antibody (ab) upon entry. 2188 (98.83%) of 2214 ab+ individuals had reflexive RNA confirmatory testing and 1471 (67.23%) were chronically infected. Of those, 699 were seen by a linkage coordinator from FIGHT while incarcerated, 953 were seen by a jailbased HCV provider, and 322 individuals were prescribed HCV treatment. Of the treated persons, 212 (65.84%) were released from jail before completing HCV treatment, but all left jail with remaining medication;linkage to care to determine treatment response and ongoing medical care is in progress. Conclusion: Establishment of routine opt out HCV screening in a jail setting resulted in more than 90% of individuals entering the jail being screened for HCV and 22% of those with chronic infection initiating treatment. Short duration of incarceration, the need for rapid result delivery, increased linkage coordinator visits, and coordination of treatment between the jail and the community are challenges that must be addressed for successful program implementation in a jail setting. Collaboration between health care providers in the correctional system and community is necessary to coordinate HCV services in a high volume, high turnover urban jail.

Global impact of the COVID-19 pandemic on subarachnoid hemorrhage

Introduction: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The objective was to examine whether subarachnoid hemorrhage(SAH) hospitalizations and ruptured aneurysm coiling interventions demonstrated similar declines. Methods: We conducted a global, retrospective, observational study across 6 continents, 37 countries, and 140 comprehensive stroke centers. Patients with diagnosis of SAH, ruptured aneurysm coiling interventions, COVID-19 were identified using ICD-10 codes or by prospectively maintained stroke databases. The 3-month cumulative volume, monthly volumes for SAH hospitalizations and ruptured aneurysm coiling procedures were compared for the period before (1- year and immediately before) and during the COVID-19 pandemic (March 1 to May 31, 2020). Results: There was a significant decline in SAH hospitalizations with 2,044 admissions in the 3 months immediately before and 1,585 admissions during the pandemic, representing a decline of 22.5% (95%CI, -24.3 to -20.7, p<0.0001). Embolization of ruptured aneurysms declined with 1,170 to 1,035 procedures, respectively, representing an 11.5%(95%CI, -13.5 to -9.8, p=0.002) drop. Hospitals with higher COVID-19 hospitalization burden demonstrated greater declines in SAH and ruptured aneurysm coiling compared to lower COVID-19 burden. A relative increase in coiling of ruptured aneurysms was noted in low coiling volume hospitals of 41.1% (95%CI, 32.3-50.6, p=0.008) despite a decrease in SAH admissions in this tertile. Conclusions: There was a global decrease in subarachnoid hemorrhage admissions and ruptured aneurysm embolizations during the COVID-19 pandemic. Among low-volume coiling SAH hospitals, there was an increase in the ruptured aneurysm coiling intervention. These findings in SAH are consistent with a global decrease in other emergencies such as stroke and myocardial infarction.