Reconstruction surgery in head and neck cancer patients amidst the COVID-19 pandemic: Current practice and lessons for the future.

The coronavirus disease 2019 (COVID-19) pandemic has imposed a radical change in daily life and work routine. In this context, health systems have suffered important and serious repercussions in all fields. Among the changes brought about by the state of global health emergency, adjustments to guidelines, priorities, structures, professional teams, and epidemiological data stand out. In light of this, the oncological field has witnessed several changes in the approach to cancer, whether due to delay in diagnosis, screening deficit, personnel shortage or the psychological impact that the pandemic has had on cancer patients. This article focuses on the management of oral carcinoma and the surgical approaches that oral and maxillofacial specialists have had at their disposal during the health emergency. In this period, the oral and maxillofacial surgeons have faced many obstacles. The proximity of maxillofacial structures to the airways, the need of elective and punctual procedures in cancerous lesions, the aggressiveness of head and neck tumors, and the need for important healthcare costs to support such delicate surgeries are examples of some of the challenges imposed for this field. One of the possible surgical 'solutions' to the difficulties in managing surgical cases of oral carcinoma during the pandemic is locoregional flaps, which in the pre-COVID-19 era were less used than free flaps. However, during the health emergency, its use has been widely reassessed. This setback may represent a precedent for opening up new reflections. In the course of a long-term pandemic, a reassessment of the validity of different medical and surgical therapeutic approaches should be considered. Finally, given that the pandemic has high-lighted vulnerabilities and shortcomings in a number of ways, including the issues of essential resource shortages, underinvestment in public health services, lack of coordination and versatility among politicians, policymakers and health leaders, resulting in overloaded health systems, rapid case development, and high mortality, a more careful analysis of the changes needed in different health systems to satisfactorily face future emergencies is essential to be carried out. This should be directed especially towards improving the management of health systems, their coordination as well as reviewing related practices, even in the surgical field.

Potential role of the microbiome in liver injury during COVID-19: Further research is needed.

Although different studies have associated coronavirus disease 2019 (COVID-19) with the occurrence of liver injury, the hepatic injury route during the COVID-19 course is not yet fully understood. In order to better understand the mechanisms of the disease, the human gut microbiota has been the subject of extensive discussion in the context of COVID-19 pathophysiology. However, many questions remain, including the risks of liver injury due to COVID-19 specific populations. Further research in this field could allow the discovery of new personalized treatment strategies aimed at improving the microbiota composition, thereby reducing COVID-19 severity and its complications in different populations. In this article, we discussed basic mechanisms of severe acute respiratory syndrome coronavirus 2 infection and recent evidence on the relationship between COVID-19, the gut microbiome and liver injury as well as proposed recommendations for further research.

Combined use of lactoferrin and vitamin D as a preventive and therapeutic supplement for SARS-CoV-2 infection: Current evidence.

Lactoferrin is a multifunctional protein that exhibits anti-inflammatory, immune regulating and anti-infective properties. One of its receptor sites is located on severe acute respiratory syndrome coronavirus 2. The binding of lactoferrin with heparin sulfate proteoglycans may prevent the first contact between the virus and host cells, thus preventing subsequent infection. Given that lactoferrin may act as a natural mucosal barrier, an intranasal treatment together with its oral intake can be hypothesized to prevent the spread, infection and inflammation caused by coronavirus disease 2019 (COVID-19). Moreover, the literature reports that vitamin D plays an essential role in promoting immune response. With its anti-inflammatory and immunoregulatory properties, vitamin D is critical for activating the immune system's defenses, improving immune cell function. Different studies also demonstrate that lactoferrin is a potential activator of the vitamin D receptor. In this sense, the combined use of lactoferrin (through an association of oral intake and a nasal spray formulation) and vitamin D could represent a valuable therapy for COVID-19 treatment and prevention. However, further randomized clinical trials are needed before recommending/prescribing them.

Oral healthcare-seeking behavior during the COVID-19 lockdown period: A cross-sectional study from Eastern Saudi Arabia

Objective To assess oral healthcare-seeking behaviors during the COVID-19 lockdown period in eastern Saudi Arabia. Methods A cross-sectional questionnaire-based study was conducted from October 2020 to December 2020 at Dental Clinic Complex, College of Dentistry, King Faisal University Al Ahsa, Saudi Arabia. Three hundred and sixty patients who visited the Dental Clinic Complex after relaxation of lockdown and consented to participate were included in this study. Participants were instructed to complete a questionnaire on oral health and dental care during the lockdown period, consisting of five sections. Results Out of 360 participants, 168 reported requiring dental help during the lockdown period;however, only 27 participants contacted a dentist to emergency advice on phone, and 102 participants visited a dentist. ​Most participants used ​toothpaste for sensitive teeth, followed by over-the-counter pain killers, and ​clove oil. In this regard, 72.8% of females used toothpaste for sensitive teeth. A considerable number of participants needed filling, followed by root canal treatment, ​denture repair, and dental extraction. Most participants were treated with pain killers, followed by antibiotics, and referral to a hospital. More than 80% of them expressed that regular visits to the dentist are beneficial. Conclusion A substantial proportion of participants sought oral health care during the lockdown period, mainly for restorative treatment. This was mostly achieved by visiting a dentist, or via telephone consultation to a lesser extent. Analgesics were the most common prescriptions, followed by antibiotics. Dental patients should be encouraged to regularly visit dentists to mitigate the drawbacks that lockdowns may cause in the provision of oral healthcare services. COVID-19;Pandemics;Dental care;Quarantine;Dental health services;Saudi Arabia.

Surgical Care Services in inaccessible zones: Targeted Palliative Care Accessibility Models for patients in resource-limited settings.

The coronavirus disease 2019 (COVID-19) pandemic has caused a paradigm shift in the cancer care landscape, shifting from a palliative care approach to a need-based approach. In these current and upcoming future times, patient- and community-centred research becomes the cornerstone of collaborative assessment efforts for understanding and assessing Targeted Palliative Care (TPC) Accessibility Models for patients with oncological malignancies in resource-limited settings. This short communication focuses on the models available for TPC for the continuation of care in oncological settings in resource-limited geographic areas. Some programmes have used a Mixed Method Approach, highlighting their importance based on engagement volunteers and building trust and relationships in the community. Other studies have addressed the care system using a Rural Palliative Supportive Service Model for older adults living with life-limiting chronic illness, showing that home-based treatment for this population is feasible. Moreover, the Home Palliative Care Units (HPCU) model showed promising results in that patients cared for by HPCU had a fewer emergency visits and hospital admissions, in addition to being more likely to die at home with adequate palliation. During the ongoing pandemic, patients have experienced rapid clinical decline, requiring urgent conversations about their care wishes. They have been forced to make decisions on so-called 'Life and death' issues. In this article we discuss the advantages, disadvantages, and possible changes implemented in the context of cancer surgical care in resource-limited settings, in order to create a better assessment of geographic or demographic-based, patient- and community-centred TPC accessibility models for a more holistic development of cancer care programs.

Oral healthcare-seeking behavior during the COVID-19 lockdown period: A cross-sectional study from Eastern Saudi Arabia.

Objective: To assess oral healthcare-seeking behaviors during the COVID-19 lockdown period in eastern Saudi Arabia. Methods: A cross-sectional questionnaire-based study was conducted from October 2020 to December 2020 at Dental Clinic Complex, College of Dentistry, King Faisal University Al Ahsa, Saudi Arabia. Three hundred and sixty patients who visited the Dental Clinic Complex after relaxation of lockdown and consented to participate were included in this study. Participants were instructed to complete a questionnaire on oral health and dental care during the lockdown period, consisting of five sections. Results: Out of 360 participants, 168 reported requiring dental help during the lockdown period; however, only 27 participants contacted a dentist to emergency advice on phone, and 102 participants visited a dentist. â€‹Most participants used â€‹toothpaste for sensitive teeth, followed by over-the-counter pain killers, and â€‹clove oil. In this regard, 72.8% of females used toothpaste for sensitive teeth. A considerable number of participants needed filling, followed by root canal treatment, â€‹denture repair, and dental extraction. Most participants were treated with pain killers, followed by antibiotics, and referral to a hospital. More than 80% of them expressed that regular visits to the dentist are beneficial. Conclusion: A substantial proportion of participants sought oral health care during the lockdown period, mainly for restorative treatment. This was mostly achieved by visiting a dentist, or via telephone consultation to a lesser extent. Analgesics were the most common prescriptions, followed by antibiotics. Dental patients should be encouraged to regularly visit dentists to mitigate the drawbacks that lockdowns may cause in the provision of oral healthcare services.

Fighting Tuberculosis in Africa: The Current Situation Amidst the COVID-19 Pandemic.

Globally, tuberculosis (TB) is one of the leading infectious causes of mortality, with around 4000 deaths daily. Since the emergence of the coronavirus disease 2019 (COVID-19) pandemic in Africa, the region has experienced a lapse in responses directed at TB control, because the priority has shifted to interventions aimed at managing COVID-19. In addition to an unprecedented burden on the region's already overburdened health systems, another major public health concern is the clinical similarities between COVID-19 and TB, making TB diagnosis increasingly challenging, which may lead to poor prognosis, especially in people with TB and COVID-19 co-infection. A likely implication is that TB patients may stop attending health-care facilities due to fear of contracting or being diagnosed with COVID-19 or to avoid being stigmatized, invariably resulting in a disruption in their access to health-care services. Therefore, massive global support should be provided for TB endemic countries to respond synergistically and strongly to the thousands of TB cases as well as the COVID-19 pandemic.

eHealth, telehealth, and telemedicine in the management of the COVID-19 pandemic and beyond: Lessons learned and future perspectives.

In this article, we discuss evidence supporting the effective implementation of eHealth, telehealth, and telemedicine during the coronavirus disease 2019 pandemic, with a view towards its permanent future integration in healthcare. We performed a literature search for articles describing the use of telehealth/ telemedicine in the pandemic context using five databases. The articles selected describe the use of telemedicine as its advantages in terms of practicality and cost-effectiveness. This synthesis of articles is applicable to high-, middle- and low-income countries. Some of the notable benefits include breaking down geographical and time barriers, reducing waiting lists and crowding in healthcare facilities, and saving on national healthcare expenditure. However, there are a number of difficulties with the widespread implementation of telemedicine services that mainly relate to bureaucratic and regulatory concerns. Moreover, it is also important to make healthcare professionals and providers aware of the limits of this tool to avoid potential cases of negligence. Patients in turn will have to be made aware of and be educated on the use of this new healthcare modality before it is accepted by them. In the current socio-economic climate, it is therefore essential to implement a telehealth model aimed at efficiency and continuity of healthcare, as well as leading to an improvement in the quality of life of patients, whilst optimising existing resources and reducing costs. In that regard, the adoption of eHealth, telehealth, and telemedicine services should be considered highly timely, despite current existing limitations.

Fostering global data sharing: highlighting the recommendations of the Research Data Alliance COVID-19 working group.

The systemic challenges of the COVID-19 pandemic require cross-disciplinary collaboration in a global and timely fashion. Such collaboration needs open research practices and the sharing of research outputs, such as data and code, thereby facilitating research and research reproducibility and timely collaboration beyond borders. The Research Data Alliance COVID-19 Working Group recently published a set of recommendations and guidelines on data sharing and related best practices for COVID-19 research. These guidelines include recommendations for clinicians, researchers, policy- and decision-makers, funders, publishers, public health experts, disaster preparedness and response experts, infrastructure providers from the perspective of different domains (Clinical Medicine, Omics, Epidemiology, Social Sciences, Community Participation, Indigenous Peoples, Research Software, Legal and Ethical Considerations), and other potential users. These guidelines include recommendations for researchers, policymakers, funders, publishers and infrastructure providers from the perspective of different domains (Clinical Medicine, Omics, Epidemiology, Social Sciences, Community Participation, Indigenous Peoples, Research Software, Legal and Ethical Considerations). Several overarching themes have emerged from this document such as the need to balance the creation of data adherent to FAIR principles (findable, accessible, interoperable and reusable), with the need for quick data release; the use of trustworthy research data repositories; the use of well-annotated data with meaningful metadata; and practices of documenting methods and software. The resulting document marks an unprecedented cross-disciplinary, cross-sectoral, and cross-jurisdictional effort authored by over 160 experts from around the globe. This letter summarises key points of the Recommendations and Guidelines, highlights the relevant findings, shines a spotlight on the process, and suggests how these developments can be leveraged by the wider scientific community.

[Management of COVID-19 in Brazil: a humanitarian catastrophe.] / Gestão da COVID-19 no Brasil: uma catástrofe humanitária

Letter to the editor about the current situation of the COVID-19 pandemic in Brazil.

Cartao ao editor sobre a situação atual da pandemia da COVID-19 no Brasil.

Fear Perception of the COVID-19 Pandemic in Peru

Introduction: Fear is a natural response to something unknown. In the current scenario, it is important to assess it in relation to the coronavirus disease-19 (COVID-19) pandemic in Latin American countries. Objective: To determine the fear perception according to factors associated with the COVID-19 pandemic in Peru. Methods: An analytical cross-sectional study was conducted based on a virtual questionnaire. The main question was "how much fear people had of COVID-19?", using a scale from zero (without fear) to 10 (very fear). This scale was divided into tertiles, and the upper tertile was the reference category (compared to the middle and lower tertiles). Statistical significances between fear perception of COVID-19 and sociodemographic data were calculated. Results: A total of 3887 participants responded the questionnaire about fear perception. In the multivariate analysis was found that women (adjusted prevalence ratio (aPR): 1.37;95% confidence interval (CI) : 1.26-1.48;p<0.001), people aged 20-29 (aPR: 1.84;95% CI: 1.06-1.50;p=0.005), 30-39 (aPR: 1.53;95% CI : 1.28-1.82;p<0.001), 50-59 (aPR: 1.43;95% CI: 1.12-1.84;p=0.005), and with 60 or more years (aPR: 1.46;95% CI: 1.03-2.07;p=0.032), as well as respondents who had some risk for complications due to COVID-19 (aPR: 1.49;95% CI: 1.32-1.69;p<0.001) were very afraid of the disease. On the other hand, people affiliated with evangelical religions (aPR: 0.79;95% CI: 0.65-0.96;p=0.018), agnostics (aPR: 0.80;95% CI: 0.68-0.94;p=0.008), atheists (aPR: 0.67;95% CI: 0.48-0.95;p=0.024), and health professionals (aPR: 0.81;95% CI: 0.70-0.93;p=0.003) were less afraid of COVID-19. Conclusion: There was a notorious fear perception of the COVID-19 pandemic by the Peruvian population. In this context, the fear was associated with important variables. Thus, the provision of further emotional support services for this population should be considered in the face of the current pandemic.