First sighting of a pelagic seabird entangled in a disposable COVID-19 facemask in the Mediterranean Sea

Seabirds are increasingly recognized as important bio-indicators of marine ecosystems that are useful in assessing environ-mental disturbance on the marine biota. Over the period 2020-22 and during the first national systematic recording of the sea wa-ters surrounding the Republic of Cyprus, we recorded the spatio-temporal presence, abundance and behaviour of seabirds using the ESAS (European Seabirds At Sea) methodology. Here we present the observation of an accidentally entangled pelagic seabird in COVID-19 material which to the best of our knowledge is the first incident in the Mediterranean Basin. The systematic recording of entangled marine birds in personal protective equipment (PPE) used to prevent COVID-19 transmission worldwide seems to be of crucial importance for one of the most important emerging threats for the conservation of seabirds at global scale.

Barriers to access and utilisation of perinatal mental healthcare in the UK

Background Lack of access to mental health services during the perinatal period is a significant public health concern in the UK. Barriers to accessing services may occur at multiple points in the care pathway. However, no previous reviews have investigated multilevel system barriers or how they might interact to prevent women from accessing services. Aims and Objectives To explore: 1) the barriers affecting women's access to PMH care at different points in the care pathway, 2) how women's access to and experience of PMH care has been affected by the COVID-19 pandemic. Methods Findings from two studies will be presented: 1) A systematic review of women, their family members', and healthcare providers' perspectives of barriers to accessing PMH care in the UK;2) A qualitative study with women's (n = 18) experiences of accessing PMH services during the COVID-19 pandemic, in an ethnically diverse population in South East London. Results The systematic review identified several key barriers that affected help seeking and treatment during the perinatal period. Barriers were identified at four levels: Individual (e.g. stigma, poor awareness), organisational (e.g. resource inadequacies, service fragmentation), sociocultural (e.g. language, cultural barriers) and structural (e.g. unclear policy). Interviews with women highlighted that pandemic restrictions and social distancing created additional difficulties and disruptions to accessing PMH care, and increased feelings of anxiety and isolation. Women expressed mixed feelings about remote delivery of PMH. Interpretation/Discussion Complex interlinked barriers to accessing PMH care exist within the UK and services have been further disrupted by the COVID-19 pandemic. To improve access to mental healthcare for women during the perinatal period, multilevel strategies are recommended which address individual, organisational, sociocultural and structural-level barriers at different stages of the care pathway. Conclusions To address barriers and reduce inequity in access to care, multilevel national strategies combined with targeted approaches to identifying and responding to local population needs are required.

Budd-chiari syndrome secondary to SARS-COV-2 infection

INTRODUCTION: SARS-CoV-2 is a novel coronavirus with potentially severe multi-organ complications. Currently, a major discussion revolves around the thrombotic risk of this disease, though little is known about this risk within the gastrointestinal tract and portal system. The below case describes a patient with SARS-CoV-2 subsequently diagnosed with Budd-Chiari syndrome. CASE DESCRIPTION/METHODS: A 50-year-old male with a history of alcohol-associated cirrhosis presented to the emergency department with altered mental status. On exam he was somnolent and jaundiced, with ascites but no focal neurologic deficits. Initial blood work revealed a leukocytosis with elevated transaminases, bilirubin and INR (Table 1), resulting in a MELD-Na score of 29 and a discriminant function over 32. Nasal swab detected SARS-CoV-2. His presentation was consistent with decompensated cirrhosis complicated by alcoholic hepatitis and hepatic encephalopathy. Paracentesis showed no evidence of spontaneous bacterial peritonitis. He was started on empiric antibiotics, prophylaxis for deep venous thrombosis, lactulose and rifaximin for hepatic encephalopathy, and prednisolone for alcoholic hepatitis. After initial clinical improvement, he developed right upper quadrant abdominal pain and recurrent elevation in his liver enzymes. An abdominal ultrasound was performed showing poor flow through the portal venous system. Subsequently, an abdominal CT demonstrated extensive veno-occlusive disease involving the inferior vena cava and hepatic veins, consistent with Budd-Chiari syndrome (Figure 1). To minimize bleeding risk, he underwent variceal band ligation prior to initiation of anticoagulation. DISCUSSION: Budd-Chiari syndrome is a rare, veno-occlusive condition characterized by obstruction of the hepatic veins;treatment often involves anticoagulation. In most cases, there is an underlying disorder generating a hypercoagulable state. Recent studies have raised concerns about the thrombotic nature of SARS-CoV-2, especially due to the high incidence of infarcts, emboli, and strokes seen in this population. In the absence of other known risk factors for thrombotic disease in this patient, it is likely SARS-CoV-2 was the predisposing pro-thrombotic factor. In patients with SARS-CoV-2 infection and new or worsening liver findings, early consideration of and testing for hepatic veno-occlusive disease and timely initiation of anticoagulation may help prevent serious complications.