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OBJECTIVES: It is necessary to objectively assess the stress state of workers, from the standpoint of holistic palliative care, in order to determine how the rapid change in work styles in the "live with coronavirus era"-in which people will coexist and live with the coronavirus (COVID-19)-will affect their physical and mental health. The aim of this study is to assess the impact of rapid changes in work patterns during the COVID-19 pandemic on the neuroendocrine stress response of workers. DESIGN AND METHODS: A total of sixteen subjects, 9 telecommuters (2 males, 7 females;age, 37.1+/-2.6 years) and 7 office workers (3 males, 4 females;age, 37.3+/-3.0 years) who provided their informed consent were enrolled in this prospective observational study. Saliva was collected four times a day (after waking, noon, evening, and before bedtime) and three times a week (Monday, Wednesday, and Friday) during May and June 2020. The saliva samples were stored at -20degreeC until measurement. Saliva components were analyzed by ELISA for cortisol, melatonin, s-IgA, and oxytocin. RESULT(S): The diurnal variation of salivary components between telecommuting and office work groups was investigated. Cortisol showed diurnal variation with higher secretion during waking hours and lower secretion toward nighttime in both groups, and no modulation was observed. In the office work group Melatonin showed diurnal variation, with increased secretion at night. In contrast, the telecommuting group showed modulation, with higher secretion at waking and lower secretion at night. s-IgA showed diurnal variation with a high level at waking and a low level thereafter in both groups, and no modulation was observed. The telecommuting group showed higher oxytocin levels in comparison to the office work group. CONCLUSION(S): These results suggest that the absence of commuting in the telecommuting group reduces anxiety due to infection, and that the diurnal variation of melatonin may be due to the alteration of circadian rhythm caused by being at home all day.
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INTRODUCTION: Although high-dose corticosteroids can hypothetically curb the cytokine storm effectively, the clinical benefit of pulse methylprednisolone in coronavirus disease 2019 (COVID-19) remains inconclusive. We compared pulse methylprednisolone therapy with dexamethasone as a COVID-19 treatment. METHOD(S): Using a Japanese multicenter database involving 350 acute care centers, we identified adults aged>=18 years admitted for COVID-19 and discharged between January 2020 and December 2021 who received pulse methylprednisolone (>=250 mg/day) or intravenous dexamethasone (>=6 mg/day) on the day of admission or the next day. One-to-one propensity score matching was performed with age, sex, comorbidities, disease severity, hospital size, and time of admission as covariates. The primary outcome was in-hospital mortality. Secondary outcomes were the length of hospital stay (LOS), insulin-requiring hyperglycemia, and fungal infection. RESULT(S): We included 1,202 (mean age, 62.4+/-16.3;male, 70.9%) and 7,669 (mean age, 61.6+/-16.3;male, 66.0%) patients in the pulse methylprednisolone and dexamethasone group, respectively. After propensity score matching (1,197 pairs), pulse methylprednisolone was associated with higher in-hospital mortality (12.0% vs 8.8%;p=0.011), longer LOS (13.0 [interquartile range: 9.0-22.0] vs 12.0 [8.0-18.0] days;p=0.002), and higher hyperglycemia incidence (16.3% vs 9.7%;p< 0.001), while fungal infection incidence (6.3% vs 4.6%;p=0.339) was not significantly different. In subgroup analysis, among patients who received mechanical ventilation (IMV) on the day of admission or the next day, in-hospital mortality was similar between the two groups (22.2% vs 20.5%;p=0.792). However, among patients without IMV, pulse methylprednisolone was associated with higher mortality (10.3% vs 7.0%;p=0.010). The sensitivity analysis involving patients who received >=1 g/day of methylprednisolone vs 6 mg/ day of dexamethasone showed consistent results. CONCLUSION(S): Compared to dexamethasone, pulse methylprednisolone may be associated with worse COVID-19 outcomes, especially in patients not on IMV. Providers should be aware of the potential consequences according to the type and dose of corticosteroid therapy and tailor the treatment for COVID-19.
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Background. The risk and benefits of coronavirus disease 2019 (COVID-19) vaccination during pregnancy are under investigation. Pooled evidence regarding neonatal and maternal outcomes in relation to COVID-19 vaccination during pregnancy is scarce. Methods. We searched PubMed and EMBASE databases in April 2022 without language restrictions. We included Prospective trials and observational studies comparing the women who received at least one COVID-19 vaccination during pregnancy with those who did not and reporting neonatal outcomes. Two independent investigators extracted relevant data from each study. Odds ratios (ORs) were calculated using random-effects models. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The primary outcomes were the neonatal outcomes, including preterm birth, small-for-gestational-age (SGA), low Apgar score (< 7 at 5 min), neonatal intensive care units (NICU) admission, and intrauterine fetal death (IFD). The secondary outcomes were maternal outcomes, including maternal SARS-CoV-2 infection, cesarean delivery, postpartum hemorrhage, and chorioamnionitis. Results. Nine observational studies involving 81,349 vaccinated (mean age, 32.0 +/-4.6 years) and 255,346 unvaccinated women during pregnancy (mean age, 30.5+/-5.1 years) were included. COVID-19 vaccination during pregnancy was associated with lower risk of NICU admission (OR, 0.88;95% confidence intervals [CI], 0.80-0.97) and IFD (OR, 0.73;95% CI, 0.57-0.94), whereas it was not associated with preterm birth (OR, 0.89;95% CI, 0.76-1.04), SGA (OR, 0.99;95% CI, 0.94-1.04), and low Apgar score (OR, 0.94;95% CI, 0.87-1.02). COVID-19 vaccination during pregnancy was associated with a lower risk of maternal SARS-CoV-2 infection (OR, 0.46;95% CI, 0.22-0.93), but not associated with increased risk of cesarean delivery (OR, 1.05;95% CI, 0.93-1.20), postpartum hemorrhage (OR, 0.95;95% CI, 0.83-1.07), and chorioamnionitis (OR, 0.95;95% CI, 0.83-1.07). Flowchart of study selection Forest plots showing the odds ratio of neonatal outcomes a: neonatal intensive care units admission, b: intrauterine fetal death, c: preterm birth, d: small for gestational age, e: low Apgar score Forest plots showing the odds ratio of maternal outcomes a: maternal SARS-CoV-2 infection, b: cesarean delivery, c: postpartum hemorrhage, d: chorioamnionitis Conclusion. COVID-19 vaccination during pregnancy did not increase the risk of peripartum outcomes but decreased the risk of NICU admission, IFD, and maternal COVID-19 infection. COVID-19 vaccination should be encouraged for pregnant women.
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SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Coronavirus disease 2019 (COVID-19) often causes radiological and functional pulmonary sequelae. However, evidence on 1-year follow-up of pulmonary sequelae is limited. This study aimed to elucidate (1) the proportion of residual computed tomography (CT) abnormalities 1 year after COVID-19 recovery;(2) characteristics of the remaining CT findings at 1-year follow-up;and (3) the relationship between the disease severity and time course of radiological sequelae. METHODS: We searched PubMed and EMBASE databases on February 25, 2022, and included studies with CT findings at the 1-year follow-up. We collected CT and pulmonary function tests (PFT) data at 1-year follow-up. The residual findings at mid-term (4-7 months) follow-up were also collected when available. The extracted data on CT and PFT findings were analyzed using a one-group meta-analysis. We further analyzed the data in relation to the COVID-19 severity, improvement rate, and lung function. RESULTS: Fifteen eligible studies (N = 3,134) were included. One year after COVID-19, 1,495 patients underwent CT, and 46.0% (95% confidence interval [CI] 32.7-59.4, I2 = 96.9%) presented with residual CT abnormalities. Ground-glass opacity (GGO) and fibrotic-like changes were frequently observed in 27.3% (95% CI 20.1-34.4, I2 =86.7%) and 26.1% (95% CI 14.2-38.0, I2 =94.6%) of the patients, respectively. While the proportion of GGO decreased from the mid-term to long-term follow-up (34.0% [23.4-44.5] to 27.3% [20.1-34.4]), fibrotic-like changes (14.9% [5.1-24.8] to 26.1% [14.2-38.0]), bronchiectasis (12.5% [4.1-20.9] to 13.3% [7.7-18.9]), and interlobular septal thickening (13.2% [2.9-23.5] to 12.8% [7.1-18.5]) did not improve. Furthermore, the frequency of CT abnormalities at 1-year follow-up was higher in the severe/critical cases than in the mild/moderate cases (54.8% [40.6-69.0] vs. 32.2% [1.6-62.7]). In particular, fibrotic-like changes were frequently observed among severe/critical patients 1 year after COVID-19 (30.4% [11.3-49.5]). Regarding pulmonary function tests, 29.9% (22.5-37.3) and 8.0% (5.4-10.6) of the patients presented reduced (< 80% of predicted value) diffusing capacity of the lung for carbon monoxide (DLCO) and total lung capacity (TLC) at 1-year follow-up. These residual PFT abnormalities were more prevalent in severe/critical cases (DLCO: 30.1% [21.1-39.0], TLC: 10.5% [5.0-16.0]) than mild/moderate cases (DLCO: 21.5% [9.6-33.3], TLC: 5.6% [2.6-8.6]). CONCLUSIONS: Our meta-analysis indicated that residual CT abnormalities were common in COVID-19 patients 1 year after recovery, especially fibrotic changes in severe/critical cases. CLINICAL IMPLICATIONS: Physicians should be aware of the high frequency of lung sequelae even 1 year after COVID-19. As these sequelae may last for a long time, vigilant observations and more extended follow-up periods are warranted. DISCLOSURES: no disclosure on file for Koichi Fukunaga;No relevant relationships by Masao Iwagami No relevant relationships by Hiroki Kabata No relevant relationships by Toshiki Kuno No relevant relationships by Matsuo So No relevant relationships by Hisato Takagi No relevant relationships by Atsuyuki Watanabe
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Rationale. Invasive fungal infection secondary to the coronavirus disease 2019 (COVID-19) has been increasing. Whereas COVID-19-associated pulmonary aspergillosis has been shown to be associated with high mortality, less is known about COVID- 19-associated mucormycosis (CAM). The overall mortality of non-COVID-19 mucormycosis ranges from 20% to 100%, depending on the infection site. Delayed diagnosis, neurological symptoms, and pre-existing malignancies are associated with worse outcomes. Herein, our study aimed to elucidate the characteristics, risk factors, and outcomes of CAM. Methods. We searched all observational studies reporting CAM through PubMed and EMBASE on September 13th, 2021. Case reports, case series, and observational studies without clearly documented diagnostic criteria for COVID-19 or mucormycosis were excluded. We collected data on the comorbidities, initial symptoms, site of infection, treatment for COVID-19, frequency of orbital exenteration, and mortality. One-group meta-analyses were performed for the potential risk factors, orbital exenteration, and mortality. Results. Our systematic review identified 32 eligible observational studies. The largest number of studies were conducted in India, followed by Egypt, Iran, and Turkey. A total of 4,463 patients were included in the analysis. The most common initial presentation was ocular symptoms: 78%, followed by facial: 48%, nasal: 21%, constitutional: 12%, oral: 4.4%, neurological: 1.1%, and others: 0.4%. Diabetes mellitus (DM) and glucocorticoid therapy were present in 81% (95% CI, 76-86;I2=96%) and 79% (95% CI, 75-84;I2=91%), respectively. Among those with DM, the percentage of newly-diagnosed DM was 30% (216/711). Diabetic ketoacidosis, malignancy, and immunosuppression were found in 4.9% (165/3353), 0.7% (25/3471), and 0.6% (18/2921), respectively. Regarding the outcomes, orbital exenteration was performed in 17% (95% CI, 13-21;I2=83%) of the patients. Pooled estimate of mortality of CAM was 29% (95% CI, 22-36;I2=94%). Conclusion. The most prevalent type of CAM was rhino-orbital-cerebral mucormycosis. In addition to DM, severe hyperglycemia and immune dysregulation provoked by excessive corticosteroid therapy may have played a critical role in the recent rise of mucormycosis cases among COVID-19 patients. This systematic review and meta-analysis revealed a high frequency of orbital exenteration and mortality. The development of CAM can be associated with poorer prognoses in COVID-19 patients. Keeping the possible risk factors in mind and paying attention to the usual clinical presentation will be crucial to suspect CAM as early as possible.
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DIAGNOSTIC TESTS FOR SARS-COV-2: A CRITICAL REFLECTION. The new coronavirus, called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was discovered in late December 2019 after cases were reported in the city of Wuhan, China. In January 2020, the World Health Organization (WHO) officially declared the Coronavirus Disease 2019 (COVID-19) as a pandemic, which has an official record of around 500 million cases and more than 6.0 million deaths in worldwide. An important factor in controlling the pandemic is the development of more effective and efficient diagnostic tests. In this context, this review has as its main proposal to discuss the effective differences between the possible diagnostic tests, the implications of molecular and serological methods available on the market and the analytical and clinical parameters involved in the development and application of these methods.
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Background. The impact of COVID-19 has been profound with >170,000,000 confirmed cases worldwide and emerging variants being a cause of global concern. Defects in T-cell function and trafficking have been described among those with severe illness, and immunodeficiency is a risk factor for persistent viral shedding and prolonged symptoms. Because of our prior clinical data demonstrating that allogeneic, off-the-shelf virus-specific T cells (VSTs) can safely and effectively treat viral infections, we investigated the feasibility of targeting COVID-19 using banked, SARS-CoV-2-specific VSTs. Methods. We first screened PBMCs from convalescent individuals against 18 structural and non-structural/accessory (NSPs/APs) SARS-CoV-2 proteins and identified 5 [Spike (S), Membrane (M), Nucleoprotein (N), NSP4, and AP7a] as immunodominant which were then advanced to our VST production process. Results. Using overlapping peptide libraries spanning these antigens as a stimulus, we achieved a mean 7.6±0.9 fold expansion (n=13) of VSTs (96±0.5%), with a mixture of cytotoxic (CD8+) and helper (CD4+) T cells that expressed activation and central/effector memory markers. These VSTs were potent, Th1-polarized and polyfunctional, producing IFNγ, TNFα, GM-CSF and Granzyme B. Moreover, the VSTs were able to kill pepmix-loaded autologous targets with no evidence of auto- or alloreactivity, attesting to their virus selectivity and safety for clinical use (Figure 1). Finally, though initially generated against the reference strain NC-045512.2 (Wuhan), these VSTs were able to recognize other clinically important variants including B1.1.7 (UK), B1.351 (South Africa) and P1 (Brazil). This demonstrates the cross-reactive potential of these polyclonal and diverse VSTs, which were developed to provide potent antiviral effects and minimize the risk of immune escape due to sequence variation. Figure 1: SARS-CoV-2 Specific T cells Have Demonstrated Selective Cytolytic Activity against SARS-CoV-2 While Leaving Non-Virus Infected Targets Intact. Conclusion. In conclusion, it is feasible to generate polyclonal SARS-CoV-2 VSTs that provide coverage against variant strains using GMP-compliant manufacturing methodologies. We have advanced this product to the bedside for administration in a Phase I, randomized clinical trial [VSTs+ standard of care (SOC) vs SOC] in high-risk patients hospitalized with COVID-19 (NCT04401410).
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As covid-19 spread worldwide, the growing trend to reduce people's mobility and the establishment of new lifestyles such as remote work, contactless communication systems have been required. Using a projected hand makes it possible to realize remote communication with a sense of presence without loading a user's physical body. However, conventional projected hand systems have a problem that the relative brightness of the hand image in a bright living room is low. Therefore, we propose a configuration that combines a video call system and a contour-based projected hand by a laser scanning projector. In addition, we incorporate a haptic feedback system with a tablet PC to improve the sense of contact with remote objects. To enhance the sense of contact in remote areas, we focus on providing the transition between hovering and contact states of the contour-based projected hand and users' hands. According to the experiment, we confirmed that there is a possibility to express hovering and contact even with simple swinging flat-panel feedback and visual effects of the contour-based projected hand. © 2022 Owner/Author.
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The COVID-19 pandemic has had a global effect on higher education. Overnight, entire degree programs had to be moved online. Whereas this meant that teaching and learning in political science and international relations also went into "emergency e-learning" mode, as a recent teacher spotlight in PS: Political Science & Politics termed it, moving online also offered opportunities. One opportunity is collaborative online international learning (COIL) that enables students from universities in different countries to work on a common project. This article argues that working together collaboratively online not only mitigates the pandemic's physical restrictions and sustains a global space of learning;it also provides for a particular active and affective learning in an intercultural virtual environment that substantiates classroom experiences even in post-pandemic higher education. To support this argument, this article reflects on the experiences of a British-Japanese COIL project that investigated political responses to COVID-19.