Exploring the relationship between physical activity and covid-19 infection in a young, non-hospitalized cohort in the united kingdom

201 Table 1Demographics of cohortVariableCategory/SummaryNegativePositiveOverallORP-value95%CI low95%CI high3043(79.7%)777(20.3%)3820AgeMean/SD21.19/6.7920.93/6.0721.12/6.640.9800.2580.9451.015Median (Q1-Q3)18(15, 27)19(16, 25)18(15, 27)Min-Max14-3614-3614-36BMIMean/SD23.34/4.8924.12/4.9023.48/4.831.068<.0011.0351.103Median (Q1-Q3)22.44(19.9, 25.9)23.39(20.5, 26.8)22.60(20.06, 26.03)Min-Max13.36-55.2514.40-45.9013.36-55.25SexWomen1107(36.3%)250(32.4%)1357 (35.5%)1Men1935 (63.5%)521(67.6%)2456 (64.3%)1.2020.0321.0161.421EthnicityWhite2789(91.65%)707(90.99%)3496(91.5%)Asian89(2.92%)23(2.96%)112 (2.93%)Black53(1.74%)11(1.42%)64 (1.68%)Other112(3.68%)36(4.63%)148 (3.87%)BAME vs. White1.0870.5550.8241.434Group Sedentary495(16.24%)112(14.53%)607 (15.89%)1typeRecreational1331(43.67%)302(39.17%)1633 (42.76%)0.7720.0030.6500.916Elite1222(40.09%)357(46.30%)1579 (41.35%)0.7620.0240.6020.965MET A (0 METs)440 (14.44%)105(13.62%)545(14.27%)1CategoryB (<500 MET-min/week)91(2.99%)12(1.56%)103 (2.70%)0.5540.0700.2921 049C (500-999 MET-min/week)128(4.20%)25(3.24%)153 (4.01%)0.8200.4170.5081.324D (1000-1499 MET-min/week)149(4.89%)37(4.80%)186 (4.87%)1.0780.7220.7121.633E (>1500MET-min/week)2240(73.49%)592(76.78%)2832 (74.16%)1.1220.3300.8901.414 201 Table 2The effects of demographics, physical activity, and symptoms on disease durationORp-value95%CI low95%CI highMen vs. Women0.561<0.0010.4180.753MET categoriesCATEGORY B vs. A1.4360.5490.4414.679CATEGORY C vs. A0.8650.7430.3642.056CATEGORY D vs. A0.5440.0890.2691.098CATEGORY E vs. A0.5320.0020.3560.795Recreational vs. Elite athlete1.698<0.0011.2602.288Sedentary vs. Elite athlete2.255<0.0011.4913.411Sedentary vs. recreational1.3280.185.8732.019Shortness of breath (YES vs. NO)3.558<0.0012.6144.842Chest pain (YES vs. NO)2.341<0.0011.5093.630Chest tightness (YES vs. NO)2.733<0.0011.9143.902Palpitations (YES vs. NO)3.1370.0011.5616.305 201 Figure 1The effect of the available variables on the duration of the disease in COVID-19 positive participants[Figure omitted. See PDF]Conflict of InterestNone

Impact of COVID-19 on Guillain-Barre Syndrome in India: A Multicenter Ambispective Cohort Study.

Introduction/Aims: Studies conducted during the coronavirus disease 2019 (COVID-19) pandemic have reported varied data regarding the incidence of Guillain-Barre syndrome (GBS). The present study investigated demographic and clinical features, management, and outcomes of patients with GBS during a specified period of the COVID-19 pandemic, and compared these features to those of GBS in the previous year. Methods: A multicenter, ambispective cohort study including 26 centers across India was conducted. Data from a pre-COVID-19 period (March 1 to August 31, 2019) were collected retrospectively and collected ambispectively for a specified COVID-19 period (March 1 to August 31, 2020). The study was registered with the Clinical Trial Registry India (CTRI/2020/11/029143). Results: Data from 555 patients were included for analysis: pre-COVID-19 (n = 334) and COVID-19 (n = 221). Males were more commonly affected during both periods (male:female, 2:1). Gastroenteritis was the most frequent antecedent event in 2019 (17.4%), whereas fever was the most common event in 2020 (10.7%). Paraparesis (21.3% versus [vs.] 9.3%, P = 0.001) and sensory involvement (51.1% vs. 41.3%; P = 0.023) were more common during COVID-19 in 2020, whereas back pain (26.3% vs. 18.4%; P = 0.032) and bowel symptoms (20.7% vs. 13.7%; P = 0.024) were more frequent in the pre-COVID period. There was no difference in clinical outcomes between the two groups in terms of GBS disability score at discharge and 3 months after discharge. Independent predictors of disability in the pre-COVID period included areflexia/hyporeflexia, the requirementfor intubation, and time to bulbar weakness; in the COVID-19 period, independent predictors included time from onset to admission, intubation, and intubation requirement. The mortality rate was 2.3% during the entire study period (13/555 cases). Discussion: Results of this study revealed an overall reduction in the frequency of GBS during the pandemic. The lockdown likely reduced the risk for antecedent infections due to social distancing and improved hygiene, which may have resulted in the reduction of the frequency of GBS.

Prevalence and diagnostic significance of de-novo 12-lead ECG changes after COVID-19 infection in elite soccer players.

BACKGROUND AND AIM: The efficacy of pre-COVID-19 and post-COVID-19 infection 12-lead ECGs for identifying athletes with myopericarditis has never been reported. We aimed to assess the prevalence and significance of de-novo ECG changes following COVID-19 infection. METHODS: In this multicentre observational study, between March 2020 and May 2022, we evaluated consecutive athletes with COVID-19 infection. Athletes exhibiting de-novo ECG changes underwent cardiovascular magnetic resonance (CMR) scans. One club mandated CMR scans for all players (n=30) following COVID-19 infection, despite the absence of cardiac symptoms or de-novo ECG changes. RESULTS: 511 soccer players (median age 21 years, IQR 18-26 years) were included. 17 (3%) athletes demonstrated de-novo ECG changes, which included reduction in T-wave amplitude in the inferior and lateral leads (n=5), inferior leads (n=4) and lateral leads (n=4); inferior T-wave inversion (n=7); and ST-segment depression (n=2). 15 (88%) athletes with de-novo ECG changes revealed evidence of inflammatory cardiac sequelae. All 30 athletes who underwent a mandatory CMR scan had normal findings. Athletes revealing de-novo ECG changes had a higher prevalence of cardiac symptoms (71% vs 12%, p<0.0001) and longer median symptom duration (5 days, IQR 3-10) compared with athletes without de-novo ECG changes (2 days, IQR 1-3, p<0.001). Among athletes without cardiac symptoms, the additional yield of de-novo ECG changes to detect cardiac inflammation was 20%. CONCLUSIONS: 3% of athletes demonstrated de-novo ECG changes post COVID-19 infection, of which 88% were diagnosed with cardiac inflammation. Most affected athletes exhibited cardiac symptoms; however, de-novo ECG changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.

Prevalence and diagnostic significance of novel 12-lead ecg patterns following COVID-19 infection in elite soccer players

2 Table 1Clinical Characteristics and CMR and 31P-MRS findings HV n=15 Isolated AS n=63 Diabetes and AS n=25 P value Age, y 71±4 71±12 72±7 0.73 Female, n (%) 6(40) 7(28) 25(40) 0.3 BMI, kg/m2 26±2* 27±4€ 31±4 <0.0001 Systolic BP, mmHg 136±9 132±17 131±20 0.44 HbA1c, mmol/mol 37±3* 37±4€ 56±14 <0.0001 NT- proBNP, ng/L 67[21-112] * 1411[629-2194]† 1376[390-2362] <0.0001 Euro Score II - 1.13 1.14 0.27 Rockwood Score - 2.15 2.22 0.23 CARDIAC STRUCTURAL AND FUNCTIONAL CHANGES LV end-diastolic volume indexed to BSA, mL/m2 78±15 80±22 84±21 0.53 LV end-systolic volume indexed to BSA, ml/m2 28±6 32±22 35±19 0.24 LV mass, g 102±25* 147±41† 164±59 0.0003 LV mass to LV end-diastolic volume, g/mL 0.66±0.11* 0.99±0.26† 0.96±0.25 <0.0001 LV stroke volume, ml 95±22 94±22 100±20 0.42 LV ejection fraction,% 64±3 64±12 60±12 0.25 LV maximal wall thickness, mm 10±1* 14±3† 14±3 <0.0001 RV end-diastolic volume indexed to BSA, mL/m2 83±12 79±18 78±20 0.36 RV end-systolic volume indexed to BSA, ml/m2 32±7 37±14 37±16 0.6 RV stroke volume, ml 97±17† 82±20 84±22 0.03 RV ejection fraction,% 62±5* 55±9† 54±10 0.01 LA biplane end-systolic volumes, mL 72±20 95±50 100±44 0.16 Biplane LA EF,% 59±11* 45±17 39±19 0.008 Global longitudinal strain, (-),% 16±4* 13±4† 11±4 0.001 Peak systolic circumferential strain, (-),% 21±2 1 ±5 18±5 0.11 Peak longitudinal diastolic strain rate, s-1 0.79±0.2 0.83±0.3 0.65±0.2€ 0.04 Mean native T1, (ms) 1209±79 1232±88 1262±84 0.16 Extra cellular volume, (%) 24±3 24±2 25±4 0.54 LGE, (%) - 3.1±2 3.4±4 0.85 MYOCARDIAL ENERGETICS AND PERFUSION PCr/ATP ratio 2.17±0.5* 1.74±0.4† 1.39±0.25€ <0.0001 Increase in RPP,% 25 23 25 0.5 Stress MBF, ml/min/g 2.14±0.66* 1.68±0.6† 1.24±0.3€ <0.0001 Rest MBF, ml/min/g 0.66±0.11 0.73±0.2 0.68±0.22 0.4 MPR 3.83±1.8* 2.4±0.78† 1.78±0.47€ <0.0001 € signifies p<0.05 between AS DM and AS Control, * signifies p<0.05 between AS DM and HV, † signifies p≤0.05 between AS Control and HV.Values are mean ±standard deviations or percentages. BSA indicates body surface area;LV, Left ventricle;RV, right ventricle;DM, type 2 diabetes mellitus;HCM, hypertrophic cardiomyopathy;LV, left ventricular;LA, left atrial;LA EF, left atrial ejection fraction;PCr, phosphocreatine;ATP, adenosine tri-phosphate;RPP, rate pressure product;MBF, myocardial blood flow;MPR, myocardial perfusion reserve. 2 Figure 1Cumulative incidence of the clinical events after valve replacement (AVR) is shown in the top row. Differences in myocardial PCr/ATP ratio, global stress myocardial blood flow and global longitudinal strain between healthy volunteers, patients with isolated severe AS and patients with severe AS and DM before the AVR in PCr/ATP ratio;global stress myocardial blood flow (ml/min/g) and global longitudinal strain are shown in the middle row. Changes in energetics, stress MBF and GLS after AVR are shown in the bottom row.[Figure omitted. See PDF]Conclusion3% of elite soccer players demonstrated novel ECG changes post COVID-19 infection, of which almost 90% were diagnosed with cardiac inflammation during subsequent investigation. Most athletes with novel ECG changes exhibited cardiac symptoms. Novel ECGs changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.Conflict of InterestNone

Current synopsis on siRNA therapeutics as a novel anti-cancer and antiviral strategy: Progress and challenges.

Currently, a popular era in nanomedicine is the implementation of RNA nanoparticles for various diseases and their diagnosis. RNA interference (RNAi) involves the arrangement of gene mediating mechanisms where coding and non-coding are carried out. The targeted control of gene utterance via siRNA system by nanocarriers showed an epic impact on modifying therapeutic efficacy. The article endeavours to highlight the mechanism of siRNA with concern to possible applications which are established on cancer therapy. In the current scenario to discuss the possible anti-viral effectiveness of nanoparticles with particular reference to SARS-CoV. Self-assembled nanoparticle (NP) is developed and it competently delivers to small interfering RNA (siRNA) intravenously to the tumour. The nanoparticle was found by mixing with siRNA, carrier, DNA, and lipids, preceded by after-change. Newly FDA appreciation of the first polymer-drug and additional ones in the clinically linked RNA polymer has to be highly therapeutic and diagnostic value. It has been established to be a particularly useful means for cell-type definite delivery of other RNA therapeutics like siRNA. While RNAi has helped speed up the discovery and understanding functions of a gene, it also has great potential as a therapeutic and potentially prophylactic modality. This article stated the development in the RNA polymer and also provides some examples of their diagnostic applications and therapeutics special emphasis on the anti-cancer and antiviral strategy. Patisiran and Givosiran are the recently approved si-RNA based products available in the market.

Impact of the COVID-19 Pandemic on the Frequency, Clinical Spectrum and Outcomes of Pediatric Guillain-Barré Syndrome in India: A Multicentric Ambispective Cohort Study.

Objective: To study impact of COVID-19 pandemic on frequency, clinical/electrophysiological profile and treatment outcomes in pediatric Guillain-Barré syndrome (GBS). Background: GBS is the most frequent cause of pediatric acute flaccid paralysis. The effect of the COVID-19 pandemic on pediatric GBS is unclear in the literature. Methods: We conducted an ambispective, multicentric, cohort study involving 12 of 27 centres in GBS Consortium, during two periods: pre-COVID-19 (March-August 2019) and during COVID-19 (March-August 2020). Children ≤12 years who satisfied National Institute of Neurological Diseases and Stroke criteria for GBS/variants were enrolled. Details pertaining to clinical/laboratory parameters, treatment and outcomes (modified Rankin Scale (mRS) at discharge, GBS Disability score at discharge and 3 months) were analysed. Results: We enrolled 33 children in 2019 and 10 in 2020. Children in 2020 were older (median 10.4 [interquartile range 6.75-11.25] years versus 5 (2.5-8.4) years; P = 0.022) and had more sensory symptoms (50% versus 18.2%; P = 0.043). The 2020 group had relatively favourable mRS at discharge (median 1 (1-3.5) versus 3 (2-4); P = 0.042) and GBS disability score at 3 months (median 0 (0-0.75) versus 2 (0-3); P = 0.009) compared to 2019. Multivariate analysis revealed bowel involvement (P = 0.000) and ventilatory support (P = 0.001) as independent predictors of disability. No child in 2020 had preceding/concurrent SARS-CoV2 infection. Conclusions: The COVID-19 pandemic led to a marked decline in pediatric GBS presenting to hospitals. Antecedent illnesses, clinical and electrophysiological profile of GBS remained largely unchanged from the pre-pandemic era.

Twin combination of Omicron and Delta variants triggering a tsunami wave of ever high surges in COVID-19 cases: A challenging global threat with a special focus on the Indian subcontinent.

The emergence of Omicron (B.1.1.529) variant of SARS-CoV-2 has resulted into a very massive surge in COVID-19 cases worldwide. Due to continuous emergence of multiple variants of SARS-CoV-2, the ongoing pandemic has caused severe morbidity and mortality in last two years. The rate of infectivity of Omicron variant is much higher than Delta variant and in a very quick time Omicron has displaced the Delta variant and now become a dominant variant across the globe. The twin combination of Omicron and Delta variant is triggering a Tsunami wave of ever high surges in COVID-19 cases worldwide. This article highlights the global threats and challenges posed by Omicron, and strategies to counter it with a particular focus on Indian sub-continent.

Practical Consensus Recommendations for Optimizing Risk versus Benefit of Chemotherapy in Patients with HR Positive Her2 Negative Early Breast Cancer in India.

Breast cancer is a public health challenge globally as well as in India. Improving outcome and cure requires appropriate biomarker testing to assign risk and plan treatment. Because it is documented that significant ethnic and geographical variations in biological and genetic features exist worldwide, such biomarkers need to be validated and approved by authorities in the region where these are intended to be used. The use of western guidelines, appropriate for the Caucasian population, can lead to inappropriate overtreatment or undertreatment in Asia and India. A virtual meeting of domain experts discussed the published literature, real-world practical experience, and results of opinion poll involving 185 oncologists treating breast cancer across 58 cities of India. They arrived at a practical consensus recommendation statement to guide community oncologists in the management of hormone positive (HR-positive) Her2-negative early breast cancer (EBC). India has a majority (about 50%) of breast cancer patients who are diagnosed in the premenopausal stage (less than 50 years of age). The only currently available predictive test for HR-positive Her2-negative EBC that has been validated in Indian patients is CanAssist Breast. If this test gives a score indicative of low risk (< 15.5), adjuvant chemotherapy will not increase the chance of metastasis-free survival and should not be given. This is applicable even during the ongoing COVID-19 pandemic.

Efficacy of Nebulized Glycopyrrolate on Lung Hyperinflation in Patients with COPD.

INTRODUCTION: Lung hyperinflation in chronic obstructive pulmonary disease (COPD) is associated with activity limitation, impaired cardiac output, and mortality. Several studies have demonstrated that long-acting muscarinic antagonists (LAMAs) delivered by dry powder inhalers can promote lung deflation; however, the potential of nebulized LAMAs on improving hyperinflation in COPD is currently unknown. METHODS: This single-center, randomized, double-blind, two-way crossover study (NCT04155047) evaluated the efficacy of a single dose of nebulized LAMA [glycopyrrolate (GLY) 25 µg] versus placebo in patients with COPD and lung hyperinflation. Patients with moderate-to-severe COPD and a residual volume (RV) ≥ 130% of predicted normal were included. The primary endpoint was changed from baseline in RV at 6 h post-treatment. Other endpoints included changes from baseline in spirometric and plethysmographic measures up to 6 h post-treatment. RESULTS: A total of 22 patients (mean pre-bronchodilator RV, 153.7% of predicted normal) were included. The primary objective of the study was not met; the placebo-adjusted least squares (LS) mean [95% confidence interval (CI) change from baseline in RV with GLY at 6 h post-treatment was - 0.323 l (- 0.711 to 0.066); p = 0.0987]. A post hoc evaluation of the primary analysis was conducted after excluding a single statistical outlier; substantial improvements in RV with GLY compared with placebo was observed after exclusion of this outlier [placebo-adjusted LS mean change from baseline (95% CI) in RV was - 0.446 l (- 0.741 to - 0.150)]. Improvements from baseline were also observed with GLY compared with placebo in spirometric and plethysmographic measures up to 6 h post-treatment. GLY was generally safe, and no new safety signals were detected. CONCLUSIONS: This is the first study to evaluate the effect of nebulized GLY on lung deflation. Nebulized GLY resulted in marked improvements in RV up to 6 h post-treatment, compared with placebo. Improvements were also observed with GLY in spirometric and plethysmographic parameters of lung function. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT04155047.

Resident-as-teacher to provide multidisciplinary online medical education on Instagram.

Instagram is an easy-to-use smartphone-based program and an increasingly popular platform for medical education. A total of 17 weekly structured resident-led education sessions that cover 15 different medical specialities were hosted on an Instagram account (@medskldotcom) to publish clinical "pearls" - short pieces of free standing, evidence-based, clinically relevant information designed specifically for medical students. With the cancellations of out-of-province clerkship electives during COVID-19 pandemic, the number of resident-led Instagram accounts to promote residency programs have increased. Our initiative can be easily adapted by residents or even clinicians to provide medical education to medical students, showcase residents, and attract followers on Instagram.

Instagram, application facile à utiliser sur téléphone intelligent, est une plateforme de plus en plus populaire pour l'enseignement médical. Au total, 17 séances d'enseignement structurées couvrant 15 spécialités médicales différentes et animées par des résidents ont été publiées à raison d'une par semaine sur un compte Instagram (@medskldotcom). Ces « perles ¼ cliniques sont de courtes capsules d'information autonomes, fondées sur des données probantes et pertinentes sur le plan clinique, conçues spécialement pour les étudiants en médecine. En raison des annulations des stages hors province pendant la pandémie de la COVID-19, le nombre de comptes Instagram lancés par des résidents pour promouvoir les programmes de résidence a augmenté. Notre initiative peut être facilement adaptée par les résidents ou même les cliniciens pour offrir un enseignement médical aux étudiants en médecine, pour mettre en valeur le travail des résidents et pour attirer des adeptes sur Instagram.

Enteric Coronavirus Infection and Treatment Modeled With an Immunocompetent Human Intestine-On-A-Chip.

Many patients infected with coronaviruses, such as SARS-CoV-2 and NL63 that use ACE2 receptors to infect cells, exhibit gastrointestinal symptoms and viral proteins are found in the human gastrointestinal tract, yet little is known about the inflammatory and pathological effects of coronavirus infection on the human intestine. Here, we used a human intestine-on-a-chip (Intestine Chip) microfluidic culture device lined by patient organoid-derived intestinal epithelium interfaced with human vascular endothelium to study host cellular and inflammatory responses to infection with NL63 coronavirus. These organoid-derived intestinal epithelial cells dramatically increased their ACE2 protein levels when cultured under flow in the presence of peristalsis-like mechanical deformations in the Intestine Chips compared to when cultured statically as organoids or in Transwell inserts. Infection of the intestinal epithelium with NL63 on-chip led to inflammation of the endothelium as demonstrated by loss of barrier function, increased cytokine production, and recruitment of circulating peripheral blood mononuclear cells (PBMCs). Treatment of NL63 infected chips with the approved protease inhibitor drug, nafamostat, inhibited viral entry and resulted in a reduction in both viral load and cytokine secretion, whereas remdesivir, one of the few drugs approved for COVID19 patients, was not found to be effective and it also was toxic to the endothelium. This model of intestinal infection was also used to test the effects of other drugs that have been proposed for potential repurposing against SARS-CoV-2. Taken together, these data suggest that the human Intestine Chip might be useful as a human preclinical model for studying coronavirus related pathology as well as for testing of potential anti-viral or anti-inflammatory therapeutics.

Lung transplantation for post-COVID-19 pulmonary fibrosis.

COVID-19 has affected over a billion people around the world, with over 2 million losing their lives (Worldometer). About 10% of patients infected with COVID-19 develop a serious illness, including respiratory failure, that require advanced life-supporting measures. Mortality among this subgroup exceeds 60%. We present a case of an otherwise healthy 34-year-old male who developed end-stage pulmonary fibrosis following COVID-19 infection. He achieved haemodynamic stability with mechanical ventilation and extracorporeal membrane oxygenation (ECMO) but did not show any sign of weaning off ECMO; however, he successfully underwent bilateral lung transplantation.

High throughput detection and genetic epidemiology of SARS-CoV-2 using COVIDSeq next-generation sequencing

The rapid emergence of coronavirus disease 2019 (COVID-19) as a global pandemic affecting millions of individuals globally has necessitated sensitive and high-throughput approaches for the diagnosis, surveillance, and determining the genetic epidemiology of SARS-CoV-2. In the present study, we used the COVIDSeq protocol, which involves multiplex-PCR, barcoding, and sequencing of samples for high-throughput detection and deciphering the genetic epidemiology of SARS-CoV-2. We used the approach on 752 clinical samples in duplicates, amounting to a total of 1536 samples which could be sequenced on a single S4 sequencing flow cell on NovaSeq 6000. Our analysis suggests a high concordance between technical duplicates and a high concordance of detection of SARS-CoV-2 between the COVIDSeq as well as RT-PCR approaches. An in-depth analysis revealed a total of six samples in which COVIDSeq detected SARS-CoV-2 in high confidence which were negative in RT-PCR. Additionally, the assay could detect SARS-CoV-2 in 21 samples and 16 samples which were classified inconclusive and pan-sarbeco positive respectively suggesting that COVIDSeq could be used as a confirmatory test. The sequencing approach also enabled insights into the evolution and genetic epidemiology of the SARS-CoV-2 samples. The samples were classified into a total of 3 clades. This study reports two lineages B.1.112 and B.1.99 for the first time in India. This study also revealed 1,143 unique single nucleotide variants and added a total of 73 novel variants identified for the first time. To the best of our knowledge, this is the first report of the COVIDSeq approach for detection and genetic epidemiology of SARS-CoV-2. Our analysis suggests that COVIDSeq could be a potential high sensitivity assay for the detection of SARS-CoV-2, with an additional advantage of enabling the genetic epidemiology of SARS-CoV-2.

Mucormycosis and COVID-19: An epidemic within a pandemic in India.

IMPORTANCE: Coronavirus disease (COVID-19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. We evaluated clinical features, predisposing factors, diagnosis and outcomes for mucormycosis among patients with COVID-19 infection. METHODS: This prospective, observational, multi-centre study included 47 consecutive patients with mucormycosis, diagnosed during their course of COVID-19 illness, between January 3 and March 27, 2021. Data regarding demography, underlying medical conditions, COVID-19 illness and treatment were collected. Clinical presentations of mucormycosis, imaging and biochemical characteristics and outcome were recorded. RESULTS: Of the 2567 COVID-19 patients admitted to 3 tertiary centres, 47 (1.8%) were diagnosed with mucormycosis. Mean age was 55 ± 12.8years, and majority suffered from diabetes mellitus (n = 36, 76.6%). Most were not COVID-19 vaccinated (n = 31, 66.0%) and majority (n = 43, 91.5%) had developed moderate-to-severe pneumonia, while 20 (42.6%) required invasive ventilation. All patients had received corticosteroids and broad-spectrum antibiotics while most (n = 37, 78.7%) received at least one anti-viral medication. Mean time elapsed from COVID-19 diagnosis to mucormycosis was 12.1 ± 4.6days. Eleven (23.4%) subjects succumbed to their disease, mostly (n = 8, 72.7%) within 7 days of diagnosis. Among the patients who died, 10 (90.9%) had pre-existing diabetes mellitus, only 2 (18.2%) had received just one vaccine dose and all developed moderate-to-severe pneumonia, requiring oxygen supplementation and mechanical ventilation. CONCLUSIONS: Mucormycosis can occur among COVID-19 patients, especially with poor glycaemic control, widespread and injudicious use of corticosteroids and broad-spectrum antibiotics, and invasive ventilation. Owing to the high mortality, high index of suspicion is required to ensure timely diagnosis and appropriate treatment in high-risk populations.

Medical care and first aid: an interassociation consensus framework for organised non-elite sport during the COVID-19 pandemic.

The cessation of amateur and recreational sport has had significant implications globally, impacting economic, social and health facets of population well-being. As a result, there is pressure to resume sport at all levels. The ongoing prevalence of SARS-CoV-2 and subsequent 'second waves' require urgent best practice guidelines to be developed to return recreational (non-elite) sports as quickly as possible while prioritising the well-being of the participants and support staff.This guidance document describes the need for such advice and the process of collating available evidence. Expert opinion is integrated into this document to provide uniform and pragmatic recommendations, thereby optimising on-field and field-side safety for all involved persons, including coaches, first responders and participants.The nature of SARS-CoV-2 transmission means that the use of some procedures performed during emergency care and resuscitation could potentially be hazardous, necessitating the need for guidance on the use of personal protective equipment, the allocation of predetermined areas to manage potentially infective cases and the governance and audit of the process.

Screening of Potential Cardiac Involvement in Competitive Athletes Recovering From COVID-19: An Expert Consensus Statement.

As our understanding of the complications of coronavirus disease-2019 (COVID-19) evolve, subclinical cardiac pathology such as myocarditis, pericarditis, and right ventricular dysfunction in the absence of significant clinical symptoms represents a concern. The potential implications of these findings in athletes are significant given the concern that exercise, during the acute phase of viral myocarditis, may exacerbate myocardial injury and precipitate malignant ventricular arrhythmias. Such concerns have led to the development and publication of expert consensus documents aimed at providing guidance for the evaluation of athletes after contracting COVID-19 in order to permit safe return to play. Cardiac imaging is at the center of these evaluations. This review seeks to evaluate the current evidence regarding COVID-19-associated cardiovascular disease and how multimodality imaging may be useful in the screening and clinical evaluation of athletes with suspected cardiovascular complications of infection. Guidance is provided with diagnostic "red flags" that raise the suspicion of pathology. Specific emphasis is placed on the unique challenges posed in distinguishing athletic cardiac remodeling from subclinical cardiac disease. The strengths and limitations of different imaging modalities are discussed and an approach to return to play decision making for athletes post-COVID-19, as informed by multimodality imaging, is provided.

Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians.

SARS-CoV-2 is the causative virus responsible for the COVID-19 pandemic. This pandemic has necessitated that all professional and elite sport is either suspended, postponed or cancelled altogether to minimise the risk of viral spread. As infection rates drop and quarantine restrictions are lifted, the question how athletes can safely resume competitive sport is being asked. Given the rapidly evolving knowledge base about the virus and changing governmental and public health recommendations, a precise answer to this question is fraught with complexity and nuance. Without robust data to inform policy, return-to-play (RTP) decisions are especially difficult for elite athletes on the suspicion that the COVID-19 virus could result in significant cardiorespiratory compromise in a minority of afflicted athletes. There are now consistent reports of athletes reporting persistent and residual symptoms many weeks to months after initial COVID-19 infection. These symptoms include cough, tachycardia and extreme fatigue. To support safe RTP, we provide sport and exercise medicine physicians with practical recommendations on how to exclude cardiorespiratory complications of COVID-19 in elite athletes who place high demand on their cardiorespiratory system. As new evidence emerges, guidance for a safe RTP should be updated.