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Background: Long COVID, also known as post-acute sequelae of COVID (PASC), affects more than 144 million people globally. While there is no broadly accepted consensus on a definition for the term "long COVID," studies have found symptoms persist or begin weeks or months after the end of SARS-CoV-2 infection. This study assessed the incidence of codes found in medical claims and hospital chargemasters that were consistent with long COVID symptoms commonly found in the literature. Method(s): Using the HealthVerity database, which provides closed claims and linked hospital chargemaster data on more than 25 million US patients, we examined patients aged 12 and above hospitalized between May 1, 2020 and September 30, 2021 with a diagnosis of COVID-19 who had at least 365 days of closed medical claims enrollment prior to index hospitalization admission and 90 days after admission, and did not have a long COVID diagnosis (ICD-10- CM U09.9) prior to the index hospitalization. Patients were allowed to have symptoms prior to hospitalization. The assessment period for the outcomes, which included 10 symptoms, was 90 days to 270 days after the date of hospitalization. Incidence rate per 100 person-years was calculated as the number of patients with the outcome divided by total person-time contributed (90 days after admission to the minimum of the following: outcome, inpatient death, disenrollment, end of data (April 30, 2022), or 270 days after admission). Result(s): The dataset included 3,661,303 patients with an inpatient hospitalization during the study period. The final study cohort included 44,922 patients hospitalized with COVID-19, 20,627 of whom experienced at least one of the long COVID symptoms. Anosmia and dysgeusia were the rarest events captured in medical claims. More commonly found symptoms were joint pain, fatigue and breathlessness (see table). Conclusion(s): This study examined diagnosed symptoms commonly found posthospitalization among COVID-19 patients and reported the incidence of these symptoms in a representative population. The start period of long COVID used in this study (90 days post hospitalization) is consistent with the WHO definition of long COVID. In the absence of an understanding of the pathophysiology of long COVID, the use of diagnosed symptoms to define long COVID has the advantage of ease of use and availability of data. Further studies of additional symptoms and predictors of long COVID are needed. (Figure Presented).
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As the second largest country in South Asia, Pakistan has succeeded relatively well in tackling COVID-19 after it broke out in 2020. Due to this, it is necessary to inquire into Pakistan's statecraft to find out how it responded to the pandemic issue, first domestically and then globally. As one of the key neighboring countries of China where the large-scale pandemic started, Pakistan has been very vulnerable to the epidemic. However, the Pakistani government led by Imran Khan has achieved a remarkable record in controlling COVID-19. No doubt, the domestic progress in Pakistan is destined to enhance its reputation abroad. For example, the international community has extended encouraging words and deeds to Pakistan, while some developed EU countries have policies designed by Pakistani Goverment because Islamabad has adopted successful social security and financial stimulus strategies. This study aims to give a balanced understanding of what policy, approaches, and strategies have been used by the current ruling elites of Pakistan;and how the domestic achievements have effectively bolstered its prestigious image on the global stage. © The Author(s) 2023.
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The mental health of children and adolescents has been significantly affected by the COVID-19 pandemic, and recent data suggests there had been an upsurge of psychiatric morbidity in this subgroup of population. Nonpharmacological behavioral intervention in the form of play therapy has been regarded as one of the best treatment strategies in children with emotional disorders. During lockdown, we attempted a play therapy via telemedicine. In this case report, we describe the case of a four-year-old girl who had sudden-onset behavioral problems following an unplanned hair cut during the lockdown, which was managed with teleplay therapy. Copyright © 2022, Matrix Medical Communications. All rights reserved.
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Resilience promotes psychological growth and buffers against the effects of negative events, but the factors that promote optimal wellbeing beyond resilience remain poorly understood. The current study addresses this gap through a positive psychology perspective by examining how (i) promotive factors – optimism and hope, and (ii) protective factors – nostalgia and spirituality promote wellbeing. We hypothesized that both factors will be positively related to wellbeing above and beyond that predicted by resilience. A representative sample of six hundred and twenty-six (n = 626;M age = 32.66, SD = 10.11, 43.45% female) Malaysians responded to an online survey at the end of the country’s second wave of the COVID-19 pandemic (June-September 2020). We conducted a series of regression analyses, controlling for resilience, socioeconomic status, age, and perceptions towards government crisis management efforts. Results indicate that optimism and hope positively predicted wellbeing above and beyond that predicted by resilience. Results also showed that the only significant protective factor contributing to wellbeing is spirituality. Nostalgia did not significantly predict wellbeing beyond resilience. The findings are of theoretical relevance for wellbeing and resilience research, and practically beneficial in informing mental health interventions. © belongs to the author(s).
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Endometriosis is a chronic condition that affects ~10% of women globally. Its symptoms include chronic pelvic pain, heavy periods and tiredness/fatigue, which have been associated with poorer quality of life and mental health. We aim to explore the impact of the COVID-19 pandemic on pain and fatigue symptoms and their interactions with the impact on mental health in people with endometriosis. This global cross-sectional online survey study collected data from 4717 adults with self-reported surgical/radiological diagnosis of endometriosis between May and June 2020. The survey included questions on the current status and changes of endometriosis symptoms (pelvic pain, tiredness/fatigue, and bleeding patterns), mental health, pain catastrophising, and the impact of the COVID-19 pandemic on the respondents’ lives. Compared to 6 months earlier, Respondents reported a marked worsening of their endometriosis symptoms (endometriosis-associated pain (39.3%;95% CI: 37.7, 40.5), tiredness/fatigue (49.9%;95% CI: 48.4, 51.2) and bleeding patterns (39.6%;95% CI: 38.2, 41)) and mental health (38.6%;95% CI: 37.2, 39.9). Those with a pre-existing mental health diagnosis (38.8%) were more likely to report their symptoms worsening. Worsening of pain and tiredness/fatigue was significantly correlated with worsening of mental health (P < 0.001). The relationship between changes in mental health and (a) change in pain and (b) change in fatigue was found to be weakly mediated by pain catastrophising scores (pain: B = 0.071, lower limit of confidence interval (LLCI) = 0.060, upper limit of confidence interval (ULCI) = 0.082, tiredness/fatigue: B = 0.050, LLCI = 0.040, ULCI = 0.060). This study demonstrates that stressful experiences impact the physical and mental health of people with endometriosis. The findings highlight the need to consider psychological approaches in the holistic management of people with endometriosis.Lay summary: Endometriosis is a chronic condition in which tissue similar to that of the lining of the womb grows outside it. It affects around 10% of women globally, and the symptoms often include persistent pelvic pain, heavy periods and tiredness/fatigue. These symptoms are associated with impaired mental health and life quality. This study used an online questionnaire to assess the experiences of people with endometriosis during the first months of the pandemic. Results from 4717 adults revealed that pelvic pain, tiredness/fatigue and bleeding worsened in more than 39% of the participants. Poor mental health was also exacerbated and associated with worsening in tiredness/fatigue. Further analysis revealed that this relationship could be partially explained by ‘pain catastrophising’, which measures how participants think about their pain. Our results suggest that stressful experiences like the pandemic negatively impact the already burdened mental health of people with endometriosis, who could benefit from psychological interventions.
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SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: The COVID-19 pandemic has been full of obstacles for the medical field. Considerable advancements have been made, yet we continue to discover new associations with this novel virus. In this case, we discuss a patient who was hospitalized for COVID-19 on 7/18/2020 in the intensive care unit. He developed a persistent cough with hemoptysis several months after discharge and was found to have active tuberculosis. The COVID-19 pandemic has continued to raise concerns regarding the repercussions of this infection, and as this case shows, includes reactivation of latent tuberculosis infections (LTBI) in affected patients. CASE PRESENTATION: A 59-year-old Latino male never-smoker with a history of diabetes (A1c 8.4%) presented 07/18/2020 for complaints of shortness of breath and cough. At that time, he tested positive for COVID-19. He was escalated to the ICU and required intubation. During his hospitalization, he received remdesivir for 5 days and dexamethasone 6 mg daily for 10 days with taper prior to his discharge. He was able to be extubated and oxygen requirement decreased to 2 liters nasal cannula. Patient was subsequently discharged on 09/14/2020. He began developing a persistent cough with noted hemoptysis in 02/2021 and was referred to pulmonology at that time. High resolution CT scan of the chest was ordered and revealed thick-walled cavitary lesions of various sizes throughout both lungs although with an upper lobe predominance and tree-in-bud nodularity as well as tracheomegaly. AFB and QuantiFERON Gold assay were positive. Patient reported he had done multiple mission trips to endemic areas before COVID pandemic but had not been during the pandemic. Patient underwent quarantine and treatment for active tuberculosis. DISCUSSION: Tuberculosis reactivation results from previous latent bacteria that becomes active either from inducible factors or spontaneously. Risk factors for reactivation include HIV/AIDS, steroid use, diabetes, kidney disease, and smoking. [1] The primary basis of these risk factors is the immunosuppression conferred to the patient. COVID-19 has the potential to cause a disruption of the immune system which could predispose a patient to reactivation of LTBI. Studies have shown that defects or interference of the IFN-γ pathway can cause susceptibility to intracellular infections, including tuberculosis.[2] There may be an acquired disruption in this pathway caused by COVID-19, although more research is required. CONCLUSIONS: The COVID-19 pandemic has raised concerns for increased risk of reactivation of latent infection as well. In this case, the patient had multiple risk factors, but certainly a diagnosis of COVID-19 could weaken the immune system allowing for the reactivation of LTBI. This association will require more research to solidify. It is important, as seen in the case discussed above, to continue to be vigilant in diagnosis and treatment of our patients. Reference #1: Riley L. UpToDate. UpToDate – Evidence-based Clinical Decision Support ;Wolters Kluwer. Published September 15, 2021. Accessed February 2, 2022. https://www.uptodate.com/contents/tuberculosis-natural-history-microbiology-and-pathogenesis?search=tuberculosis&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4 Reference #2: Kampmann B, Hemingway C, Stephens A, et al. Acquired predisposition to mycobacterial disease due to autoantibodies to IFN-gamma. J Clin Invest 115: 2480-2488, 2005. DISCLOSURES: No relevant relationships by Steven Colby No relevant relationships by Radhika Shah
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Purpose : Diabetes predisposes an individual to severe COVID-19. Diabetic cornea is also known to have impaired wound healing, increasing the chances of infection. Earlier, we reported the ability of SARS-CoV-2 to infect conjunctival cells, and the presence of viral RNA and proteins was also detected in the corneas of COVID-19 donors. In this study, we evaluated the effect of diabetes on corneal innate immune response during SARS-CoV-2 infection and sought to determine the underlying mechanisms. Methods : Human primary corneolimbal epithelial cells (HCECs) were isolated from the corneas of three diabetic and three non-diabetic donors. In vitro studies were performed by infecting HCECs with SARS-CoV-2-USA-WA1/2020 strain at MOI 0.5. Viral replication was assessed by viral genome copy number. RNAseq analysis was performed to determine genes/pathways altered by diabetic vs non-diabetic HCECs. qPCR was used to assess the expression of innate inflammatory and antiviral genes. Western blot was performed to detect the protein expression of antiviral signaling molecules. Results : The primary HCECs were found permissive to SARS-CoV-2 infection, as evidenced by increased viral replication which peaked at day 3 p.i. along with an induction of pSTAT1. Interestingly, HCECs from diabetic cornea had higher viral RNA on all three days post-infection. SARS-CoV-2 infected HCECs exhibited induced expression of inflammatory genes and their levels were relatively higher in diabetic cells. RNA-seq analysis revealed significant differences in diabetic vs. non-diabetic SARS-CoV-2 infected cells with alteration in genes regulating viral response, inflammation, and injury. The most affected down-regulated genes are related to lipid metabolism, ferroptosis, and oxidative stress. Conclusions : Our study demonstrates increased SARS-CoV-2 replication and differential innate antiviral and inflammatory response in HCECs from diabetic corneas. These results indicate that diabetes is a potential risk for enhanced infectivity of SARS-CoV-2 for the ocular surface.
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Emergence of COVID-19 (Coronaviruses Disease 2019) has been brought to global concern. Malaysia has reported 6002 cases with 102 deaths as of 30th April 2020.While predictor for mortality for COVID-19 can be common in many countries, risk factors for COVID-19 infections in any outbreak can be different according to various locations and population background. The aim of this study was to describe epidemiology and risk factors of COVID-19 infections in state of Pulau Pinang, Malaysia. A case control study was conducted using secondary data obtained from State Health Department of Pulau Pinang COVID-19 registry. Analysis included 107 confirmed cases and 535 contacts of COVID-19 infection from 5th Match 2020 till 30th April 2020 forming ratio case to control 1:5. Result showed prevalence of COVID-19 infection during study period was 4.6%. Multivariate analysis showed adult age group had 7.35 higher odd of getting COVID-19 infection (aOR= 7.35, 95% CI 1.97,27.33, p=0.003) compared with other age groups. Meanwhile, symptomatic individuals had 8.72 higher odds of getting COVID-19 infection (aOR= 8.72, 95% CI 4.67, 16.25, p=0.001). Person attending mass events with COVID-19 positive individuals had 4-time higher odds of getting COVID-19 infections (aOR= 4.39, 95% CI 1.39,13.86, p=0.012). Study findings supported the current practices of COVID-19 outbreak management which are mandatory quarantine all identified close contacts, prioritize contacts with symptoms for screening and prohibiting mass gathering as major part of control measures in the country. © 2022,Malaysian Journal of Public Health Medicine. All Rights Reserved.
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Background: Systemic AL amyloidosis is an incurable relapsing plasma cell disorder. Despite therapeutic advances, there are no approved treatments for relapse disease. Treatment is often challenging due to underlying organ dysfunction. Belantamab mafodotin is an antibody-drug conjugate targeting B-cell maturation antigen with approval for relapsed refractory myeloma. In multiply pre-treated myeloma, the DREAMM-2 phase II trial showed an overall response rate of 32% for those with 2.5 mg/kg dose administered every three weeks with 2/3rd patients reporting keratopathy. A small case series of 6 patients with relapsed AL amyloidosis (Zhang et al , ASH 2021) was recently reported and a phase 2 trial is recruiting for patients with refractory amyloidosis (NCT04617925). Aims: We report our initial results using Belantamab monotherapy for the treatment of patients with AL amyloidosis with relapsed disease. Methods: Data for consecutive patients who were administered Belantamab at a specialist referral centre, National Amyloidosis Centre, University College London, was analysed. Results: Eleven patients were included 8 male, 3 female. Median age at Belantamab initiation was 65 (range 42-74) years. Eight patients had λ AL-type and three κ AL-type. At diagnosis, median involved free light-chain concentration was 534 (range 73-7181) mg/l. A median of two organs involved at baseline (range 1-3): 4 had cardiac involvement (half Mayo stage 2;half Mayo stage 3a) and 8 had renal involvement. The median prior lines of therapy was 3 (range 2-5) with all exposed to prior immunomodulatory drugs, proteasome inhibitors and 73% to anti-CD38 antibody treatments. Thirty-six percent had relapsed after melphalan-conditioned autologous stem cell transplantation. A median of 3 cycles of belantamab were delivered (range 1-8). The most frequent adverse event was ocular toxicity which was experienced in 8 patients (grade 1-3), necessitating dose modification of the three-weekly schedule. One patient developed transient grade 1 dyspnoea and liver dysfunction. No patients developed cytopenias, unlike previous reports (Zhang et al , 2021), nor infections beyond COVID (2 patients mild with no hospital admissions). The majority of the cohort required dose reduction either at initiation (patient 4, due to end stage renal failure;patient 11, post-renal transplant) or during therapy (n=5;three to 1.9mg/kg, two to 1.25mg/kg) due to ocular toxicity. Only one patient remained on the standard dose of 2.5mg/kg for >3 cycles. Ocular toxicity improved after treatment interruption (drug intervals 4-6 weeks) and no patients required complete treatment cessation. One patient is too early to assess response. Haematological responses (PR or better) were seen in 7 patients with 3 complete responses and two very good partial responses (VGPR) which are ongoing. Both renal patients (patients 4 and 11) commenced a dose of 1.25mg/kg and sustained a VGPR with no additional toxicity. Patient 3 had a 42% reduction in sFLC after two doses but then a prolonged gap due to keratopathy and has lost the response. There were no cardiac or renal toxicities observed. Summary/Conclusion: Belantamab mafodotin demonstrates significant activity in patients with heavily pre-treated AL amyloidosis with 70% achieving a ≥PR. Apart from keratopathy requiring dose modification, no other substantial toxicity was observed. Two patients with renal impairment (stage V CKD and ESRD) and one patient post-renal transplant tolerated treatment with no additional toxicity. Belantamab mafodotin shows promise in treatment of relapsed AL and needs further prospective trials.
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Background: Recreational swimming/diving is the most common physical activity among US children and a significant cause of preventable morbidity across the United States. There are an estimated 50 million Americans that participate in swimming per year, 16 million of whom are children. Despite the popularity of swimming and diving, there are few up-to-date national divingrelated injury analyses, and no comprehensive injury analysis has been performed since the institution of International Swimming Pool •Spa Code (ISPSC) in 2012, which regulate diving equipment and design. This study offers a much-needed update on the national epidemiology of diving-related orthopedic injuries. Methods: The Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) database was queried for patients aged 0-18 from 2008- 2020 who presented to any of the approximately 100 NEISSparticipating emergency departments (EDs) for a diving-related injury. The patient cohort was identified using a search for consumer product code-1278 (diving). Injuries involving diving accessories, running, hitting, or tripping over the diving board, and injuries resulting from contact between two or more divers, were excluded. Infections were excluded. Dive characteristics such as dive height, dive skill, dive direction, and dive sequence were determined from case narratives. Descriptive statistical analysis was performed using Stata 16. Results: From 2008-2020 there were 1,157 cases of diving-related injury corresponding to a national estimate of 35,648 injuries (CI=28,067 - 43,230;Table 1). Children aged 10-14 accounted for 42% of all injuries, while adolescents aged 15-19 accounted for 38%. Nearly twice as many injuries occurred in boys compared to girls (64.2% vs 35.8% of total injuries, respectively). From 2008-2012, there were an average estimated 3,191 injuries per year. From 2013-2019, the yearly average decreased to 2,633 injuries (Figure 1). Due to the COVID-19 pandemic, there were relatively few (1,261) injuries in 2020. Compared to 2012, there were an estimated 1,081 fewer diving injuries in 2013, the first year the ISPSC codes were widely adopted. Lacerations were the most reported diagnosis for all years (24.9% of injuries). The head and neck were the mostinjured body parts (46.4% of injuries), followed by the face (17.4% of injuries), and lower extremities (16.6% of injuries). Concussions and nerve injury accounted for 6.7% and 0.1% of injuries, respectively. When the mechanism of injury was reported, unintentional contact with the diving board or platform was the most common cause (27.2% of injuries). Conclusion: Diving injuries are common in children and adolescents, especially in boys aged 10-19. Since the 2012 adoption of international safety standards for swimming pool design and operation, the average number of yearly divingrelated injuries has fallen by nearly 600 injuries/year. There was a significant reduction in diving-related injury corresponding with the COVID-19 pandemic.
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We train a deep learning algorithm to flag potential covid-19 infected in chest x-rays. The deep learning algorithm used is a Convolutional Neural Network that is 121 layers deep. Due to the lack of a large open-source of covid-19 infected x-ray images, we combine data from five different sources. Combined, the dataset has 17,194 images that are used for training procedure. The model classifies a given chest X-ray image as either a "Normal", "Covid-19", or a 'Pneumonia"infection. The trained model has a 0.93 F1 Score and 93.496% accuracy. © 2022 IEEE.
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BackgroundA team was assembled at the National Aeronautics and Space Administration’s (NASA) Johnson Space Center (JSC) to help navigate the shifting COVID-19 pandemic. Their goal was to mitigate the impact of COVID on astronauts, other essential personnel, and the human spaceflight program. This team supplemented the JSC Pandemic Incident Response Group, whose function is to set policy for the overall management of JSC’s COVID-19 mitigations for all onsite mission-essential and mission-critical activities, including health policy.ContextThe first mission to return to Earth from the International Space Station at the start of the pandemic returned when there was limited information about the transmission and prevention of COVID-19. The medical leadership at JSC determined that a dedicated team was required to navigate the uncharted waters of the pandemic.Description of ActivitiesIssues tackled by this panel included: prevention of COVID-19 transmission during altitude, dive, and spacecraft training – activities that require prolonged close contact between multiple individuals who often cannot safely wear face masks;mitigating the risks of domestic and international travel for essential personnel;securing COVID-19 testing from local and foreign hospital systems;acquiring antigen and PCR analyzers for in-house testing;and the development of quarantine policies for crewed spacecraft launches and landings in Kazakhstan and the United States. The panel also provides clinical return-to-work guidance for cases of COVID-19 in essential personnel.
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The impact of the Covid-19 pandemic has had a far-reaching effect on higher education institutions, and individual student assessments have garnered much attention during the pandemic. This study aimed to validate Science, Technology, Engineering, and Mathematics (STEM) application instruments using the Rasch analysis employing Winsteps version 3.73. A survey was conducted with 201 respondents from two provinces in Indonesia. The students were selected by convenience sampling and answered the adopted STEM application instrument. The STEM application instruments were adapted, and these were divided into seven sub-constructs derived from STEM disciplines. Rasch Modelling was employed for data analysis using Winsteps version 3.7.3 to analyse reliability, separation, item fit statistics, unidimensionality, and rating scale calibration. Each sub-construct fulfilled a minimum of 0.65 for Cronbach alpha, item, and person reliability, and most of them had more than 1.5 person and item separation. In general, each item had a good score of the mean square, Z-tolerated standard, and point measure correlation, indicating fulfilment of the Rasch measurement model. The analysis also showed unidimensionality assumption and an excellent rating scale. This study contributed to the body of STEM knowledge by using Rasch Modelling to test the validity and reliability of STEM application instruments. © 2022 Society for Research and Knowledge Management. All rights reserved.
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BACKGROUND AND AIMS: Cases of collapsing glomerulopathy in association with COVID-19 infection have been reported worldwide, frequently referred to as COVAN (COVID-19 Associated Nephropathy). Affected patients are almost exclusively of Black ethnicity, likely associated with APOL-1 renal risk variants. There remains a paucity of data on patient outcomes, however, and it is unclear how the natural history of this disease may vary from HIV-associated nephropathy (HIVAN) and other non-viral causes of collapsing FSGS. Here, we present a case series of seven patients with presumed COVAN from a single tertiary UK renal centre;highlighting patient demography, biopsy findings, clinical management and short-term renal outcomes. METHOD: We identified all adult patients presenting to our centre with nephrotic syndrome and a renal biopsy demonstrating collapsing glomerulopathy, in association with a positive COVID-19 PCR swab result. Detailed case note reviews were undertaken using electronic health records to extract data relevant to patient demography, co-morbidities, COVID -19 symptoms, renal biopsy findings, treatment and biochemical parameters, both at the time of presentation and during follow-up at 1, 3, 6 and 12 months respectively (where available). RESULTS: In total, we identified seven patients with presumed COVAN. Three of the seven patients were male, median age was 60 years (range 25-80 years). Six of the seven patients were of Black ethnicity and one patient was of South Asian ethnicity (renal transplant recipient with donor ethnicity unknown). All seven patients had a background of hypertension, 5/7 had known chronic kidney disease (CKD), 5/7 had type 2 diabetes mellitus (T2DM) and 4/7 were obese (BMI > 30). In the vast majority of cases, associated COVID-19 symptoms were mild. All patients had profound nephrotic syndrome at the time of renal biopsy, with median urine ACR 1085 mg/mmol (range 682-1380 mg/mmol) and median serum albumin 15 g/L (range 8-20 g/L). Two of seven patients had mild AKI (stage 1) and 5/7 patients had severe AKI (stage 3), with 3 of these patients receiving acute haemodialysis therapy. Management of glomerulopathy was supportive in all cases, including diuresis and anticoagulation (two patients received a short course of oral dexamethasone for their COVID-19 symptoms). ACE inhibitors/angiotensin receptor blockers were re-introduced in two patients and newly commenced in two further patients during follow-up. At 6 months follow-up, one patient remained dialysis dependant and one patient had ongoing decline in renal function (renal transplant recipient);all other patients achieved at least partial remission, with > 50% reduction in urine ACR and some (but not complete) recovery in renal function (Fig. 1). There were no viral particles identified on direct examination of renal biopsy specimens, but 4/7 biopsies exhibited tubulo-reticular inclusions, suggesting an interferon-driven systemic inflammatory process. CONCLUSION: In this case series of seven COVAN cases from a single tertiary UK centre, we noted that in keeping with reports from North America, Black ethnicity patients were disproportionately affected. Partial remission was achieved in most of our cases with supportive treatment only;however, ongoing monitoring of this cohort is required to better understand longer-term patient outcomes. Testing for APOL-1 gene mutations and molecular testing of biopsy samples for this cohort is also ongoing to facilitate better insights into pathophysiology and risk factors associated with this novel disease. (Figure Presented).
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The first incidence of corona virus was reported in China in December of 2019, and the virus quickly spread over the world, eventually being designated a pandemic in March of 2020. It has had a disastrous impact on the global healthcare system. Virus has claimed the lives of 5,298,933 people through December 2021. As a result of the pandemic, there was a boost of research into diagnostic and therapeutic methods to infection. Gradually, the world has discovered new vaccine candidates and medicinal repurposing strategies that have a significant influence on mortality, by which there has been a drop-in death rates over the world since July, 2021. Many patients, particularly those who have been hospitalized due to a viral infection, experience complications beyond discharge that have a significant influence on their lives. Post COVID-19 complications are problems that last longer than 3-4 weeks following a viral infection. There is currently no specific treatment accessible for post COVID-19 problems because whatever medications are available or repurposed are limited to disease prophylaxis and therapeutics. As a result, we're looking for a remedy employing natural substances using the In-Silico technique (molecular docking) and recent research from reputable journals. Allicin, Berberine, Epigallocatechin, Rosmarinic acid and Withaferin-A were docked against ACE (PDB ID: 1O8A), IL-6 (PDB ID: 1ALU), NADPH Oxidase (PDB ID: 2CDU) and TNF-alpha (PDB ID: 2AZ5) using Autodock.
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BackgroundA team was assembled at the National Aeronautics and Space Administration’s (NASA) Johnson Space Center (JSC) to help navigate the shifting COVID-19 pandemic. Their goal was to mitigate the impact of COVID on astronauts, other essential personnel, and the human spaceflight program. This team supplemented the JSC Pandemic Incident Response Group, whose function is to set policy for the overall management of JSC’s COVID-19 mitigations for all onsite mission-essential and mission-critical activities, including health policy.ContextThe first mission to return to Earth from the International Space Station at the start of the pandemic returned when there was limited information about the transmission and prevention of COVID-19. The medical leadership at JSC determined that a dedicated team was required to navigate the uncharted waters of the pandemic.Description of ActivitiesIssues tackled by this panel included: prevention of COVID-19 transmission during altitude, dive, and spacecraft training – activities that require prolonged close contact between multiple individuals who often cannot safely wear face masks;mitigating the risks of domestic and international travel for essential personnel;securing COVID-19 testing from local and foreign hospital systems;acquiring antigen and PCR analyzers for in-house testing;and the development of quarantine policies for crewed spacecraft launches and landings in Kazakhstan and the United States. The panel also provides clinical return-to-work guidance for cases of COVID-19 in essential personnel.
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Background/Purpose: The craniofacial team meeting represents a critical timepoint at which a diverse group of disciplines assemble in quorum to discuss the complex medical and psychosocial issues facing their patients and create treatment plans to address them. Professionals from not only different disciplines but from entirely different fields must efficiently amalgamate their expertise to create one intricate plan for their unique patient population. It is this diversity of disciplines represented and the complexity of subject matter that makes craniofacial team meetings ideal for studying team functioning during multidisciplinary meetings. The global pandemic necessitated a shift of these complex meetings to the virtual setting. While providing direct patient care (i.e. tele-health) has been studied extensively, the literature on virtual team meetings is lacking. The authors of this study evaluated the team functioning of one craniofacial team by studying their virtual team meetings. Methods/Description: Ten virtual team meetings, including 94 patient case discussions, from a 3-month period in late 2020 were recorded and scored individually by three members of the research team using modified versions of the standardized multidisciplinary team Meeting Observational Tool (MOT) and the Metric of Decision-Making (MODe). The mean score amongst the three observers for each category of team functioning was used for analysis. Participants' subjective assessments of team meetings were elicited through monthly Qualtrics surveys. Results: Our results indicate that team functioning during virtual team meetings was high for providing case history, exhibiting optimal team behavior, and providing a treatment plan for individual case discussions. Patient-centered and psychosocial categories received lower scores. Survey respondents generally regarded their team as highly functioning during team meetings, with lower marks given only for decision-making efficiency and full participation from all disciplines. The meeting technology and equipment received a high score on average. Additionally, participants indicated that the virtual format did not enhance or hinder team functioning during team meetings. Conclusions: Amidst the ongoing COVID-19 pandemic it is important to study the effectiveness of multidisciplinary team meetings held in a virtual format. Our findings suggest that virtual setting allows for high team functioning as measured by both objective and subjective assessments and should therefore be considered a viable alternative to in-person meetings. The team performed best in discussing clinical topics, generating treatment plans, and team behavior, including equality among disciplines. Psychosocial matters and patient perspectives were not discussed as extensively as clinical topics and the team overestimated their coverage of both psychosocial matters and patient perspectives, consistent with previous studies on team functioning.
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In adults, COVID-19 infection increases the risk of thrombotic events. Hospitals worldwide reported a poorer prognosis for patients who did not receive venous thromboembolism (VTE) prophylaxis, in comparison to those who did. This finding instigated UK hospitals to form their own local policies on VTE prophylaxis in COVID-19 positive patients, to prevent death and complications secondary to clot formation. Due to older age, multiple co-morbidities, decreased mobility and increased frailty, nursing home residents with confirmed COVID-19 have an increased thrombotic risk. Therefore, a primary thromboprophylactic (TP) strategy was formulated (see figure 1) and applied to COVID-19 positive residents in Islington nursing homes. This included the prescribing of apixaban 2.5 mg twice daily if there were no contraindications. The guideline included a risk versus benefit assessment tool, prescribing advice and monitoring recommendations. It was also stated that the prescribing of apixaban for this indication would be considered as off-label use. The guideline was amended following the role out of the COVID-19 vaccination programme with the addition of 'residents who have been doubly vaccinated and become COVID positive but are asymptomatic will not require VTE prophylaxis as the vaccines have demonstrated some protection against severe illness from COVID-19'. The aim of this service evaluation is to review the implementation of this thromboprophylactic strategy. This included the number of residents prescribed TP, the incidence of bleeding or thrombotic complications, as well as number of deaths relating to COVID-19. Data were retrospectively collected from six nursing homes between November 2020 and April 2021 from GP electronic medical records (EMIS). Fifty-one residents tested positive for COVID-19 during this time. Six deceased residents were eliminated from the audit as their electronic records were not available to determine thromboprophylactic status. Additionally, two residents were excluded as they were admitted to hospital and 12 residents were already in receipt of anticoagulation. The 12 residents who were already prescribed anticoagulation prior to their positive COVID test were on anticoagulation for the treatment of AF. From these 12 residents, three died with COVID-19 reported on their death certificates. Of the 31 residents included, there were 12 males and 19 [SZ4] females and the median age was 79 years (range: 46-101). All residents had at least one co-morbidity which would increase their VTE risk. Twenty-three (74%) residents were prescribed TP in line with the guidelines. Of these, three died from COVID-19. The remaining eight residents were not prescribed TP. Of these eight, two died from COVID-19. The most common reasons for not prescribing thromboprophylaxis included residents on end-of-life care, high bleeding risk or lack of locum GP awareness of the guidelines. There were no reported bleeding events in residents prescribed TP. There were no thrombotic events in residents prescribed TP. The accuracy of the cause of death recorded for the deceased residents was limited, due to the absence of postmortem examinations. The numbers of residents included in this audit was too small to provide statistical relevance. Apixaban may be a safe option for residents in nursing homes who are COVID-19 positive and are considered to have a high risk of thrombosis..