Telemedicine and Otolaryngology in the COVID-19 Era.

OBJECTIVE: The global Coronavirus disease 2019 (COVID-19) pandemic has resulted in an expansion of telemedicine. The purpose of this study is to present our experience with outpatient telemedicine visits within a single institution's Department of Otolaryngology during the initial COVID-19 era. STUDY DESIGN: Retrospective chart review. METHODS: This was a single-institution study conducted within the Department of Otolaryngology at an urban tertiary care center. Data on outpatient visits was obtained from billing and scheduling records from January 6 to May 28, 2020. Visits were divided into "pre-shutdown" and "post-shutdown" based on our state's March 23, 2020 COVID-19 shutdown date. RESULTS: A total of 3447 of 4340 (79.4%) scheduled visits were completed in the pre-shutdown period as compared to 1451 of 1713 (84.7%) in the post-shutdown period. The proportion of telemedicine visits increased (0.7%-81.2%, P < .001). Overall visit completion rate increased following the shutdown (80.2%-84.7%, P < .001). Subspecialties with an increase in visit completion rate were general (76.9%-88.0%, P = .002), otology (77.4%-87.2%, P < .001), and rhinology (80.0%-86.2%, P = .003). Patients with Medicaid and Medicare had higher appointment completion rates following the transition to telemedicine visits (80.7%-85.7%, P = .002; 76.9%-84.7%, P = .001). Older age was associated with decreased appointment cancellation pre-shutdown (OR 0.994 [0.991-0.997], P < .001) but increased appointment cancellation post-shutdown (OR 1.008 [1.001-1.014], P = .015). Mean COVID-19 risk scores were unchanged (P = .654). CONCLUSIONS: COVID-19 has led to major changes in outpatient practice, with a significant shift from in-person to telemedicine visits following the mandatory shutdown. An associated increase in appointment completion rates was observed, reflecting a promising viable alternative to meet patient needs during this unprecedented time.

The Impact of Mindful Meditation on Health Care Workers During the COVID-19 Pandemic.

Background: The COVID-19 pandemic placed a spotlight on health care workers as the world struggled with mental health crises. As the number of COVID-19 cases rose exponentially, this also paralleled health care workers' perceived stress burden and increased risk for mental health trauma. This research project assessed the impact of a mobile mindful meditation application on health care workers' perceived stress levels during a pandemic. Methodology: Through quasi-experimental design, researchers assessed the effect of using a mobile mindful meditation (Synctuition) app on health care workers' stress levels. Participants listened for 20 to 30 minutes daily for 30 days. Participants perceived stress levels were measured with Cohen's Perceived Stress Scale. Results: Of the 100 participants, there was a statistically significant decrease in perceived stress reduction between the groups across various categories. The pretest perceived stress scores were reduced from moderate to low stress postintervention after using the mindful meditation application. Implications for Practice: Reducing stress in health care workers can potentially increase the quality of life for health care workers. and lowering stress levels can potentially improve the quality of care provided.

Evaluating Indoor Air Phthalates and Volatile Organic Compounds in Nail Salons in the Greater New York City Area: A Pilot Study.

The Greater New York City area ranks highest in the United States in the number of nail salon technicians, primarily Asian immigrant women. Nail salon technicians are exposed to toxic phthalates and volatile organic compounds daily in nail salons. The purpose of this pilot study was to measure a mixture of phthalates and volatile organic compounds in nail salons in the Greater New York City area, and to characterize work-related determinants of indoor air quality in these nail salons. Working with four Asian nail salon organizations in the Greater New York City area, we measured indoor air phthalates and volatile organic compounds at 20 nail salons from February to May 2021 using silicone wristbands and passive samplers, respectively. Nail salon characteristics were also examined. We measured six phthalates and 31 volatile organic compounds. Di(2-ethylhexyl) phthalate and Diethyl phthalate had the highest concentrations among the six phthalates measured. Concentrations of toluene, d-limonene, methyl methacrylate, and ethyl methacrylate were higher than that of the rest. Manicure/pedicure tables, the number of customers per day, and application of artificial nail (acrylic) services were positively associated with the levels of phthalates and volatile organic compounds. Given the large number of people employed in the nail industry and the even larger number of customers visiting such establishments, exposures to these toxic chemicals are likely to be widespread.

The protective impact of telecare on persons with dementia and their caregivers during the COVID-19 pandemic

Background Social distancing under the COVID-19 pandemic has restricted access to community services for older adults with neurocognitive disorder (NCD) and their caregivers. Telehealth is a viable alternative to face-to-face service delivery. Telephone calls alone, however, may be insufficient. Here, we evaluated whether supplementary telehealth via video-conferencing platforms could bring additional benefits to care-recipient with NCD and their spousal caregivers at home. Method Sixty older adults NCD-and-caregiver dyads were recruited through an activity centre. The impact of additional services delivered to both care-recipient and caregiver through video conference (n=30) was compared with telehealth targeted at caregivers by telephone only (n=30), over 4 weeks in a pretest-posttest design. Interviews and questionnaires were conducted at baseline and study?s end. Result Supplementary telemedicine had averted the deterioration in the Montreal Cognitive Assessment evident in the telephone-only group (?p2=0.50). It also reversed the falling trend in quality of life observed in the telephone only group (QoL-AD, ?p2=0.23). Varying degrees of improvements in physical and mental health (Short-Form 36 v2), perceived burden (Zarit Burden Interview Scale) and self-efficacy (Revised Caregiving Self-Efficacy Scale) were observed among caregivers in the video-conferencing group, which were absent in the telephone-only group (?p2=0.23?0.51). Conclusion Telehealth by video conference was associated with improved resilience and wellbeing to both people with NCD and their caregivers at home. The benefits were visible already after 4 weeks and unmatched by telephone alone. Video conference as the modus operandi of telehealth beyond the context of pandemic-related social distancing should be considered.

A systematic review of Vaccine Breakthrough Infections by SARS-CoV-2 Delta Variant

Vaccines are proving to be highly effective in controlling hospitalization and deaths associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as shown by clinical trials and real-world evidence. However, a deadly second wave of coronavirus disease 2019 (COVID-19), infected by SARS-CoV-2 variants, especially the Delta (B.1.617.2) variant, with an increased number of post-vaccination breakthrough infections were reported in the world recently. Actually, Delta variant not only resulted in a severe surge of vaccine breakthrough infections which was accompanied with high viral load and transmissibility, but also challenged the development of effective vaccines. Therefore, the biological characteristics and epidemiological profile of Delta variant, the current status of Delta variant vaccine breakthrough infections and the mechanism of vaccine breakthrough infections were discussed in this article. In addition, the significant role of the Delta variant spike (S) protein in the mechanism of immune escape of SARS-CoV-2 was highlighted in this article. In particular, we further discussed key points on the future SARS-CoV-2 vaccine research and development, hoping to make a contribution to the early, accurate and rapid control of the COVID-19 epidemic.

Analysis of response measures and effects of anti-cancer clinical trialon COVID-19 major public health emergency

At the beginning of 2020, with the outbreak of the nationspread coronavirus pneumonia (COVID-19), the national economy and people's lives have been deeply affected, as well as the clinical trial industry, which has brought unprecedented challenges to the management of research institutions and the implementation of clinical trial projects. This study analyzes the measures of chinese major research institutions in response to the requirements of the prevention and control of new coronavirus pneumonia. We select 76-day of 2020.01.23-2020.04.08 as time frame, to sum up the ongoing projects, treatment methods, followup medications, and loss of follow-ups of our research center, and aim to explore the feasibility of reducing the impact of clinical trials during the epidemic, as well as to accumulate experience for the remote execution of clinical trials in the future, and provide a reference for establishing relevant strategy for clinical trials under a special.

SARS-CoV-2-Triggered Mast Cell Rapid Degranulation Induces Alveolar Epithelial Inflammation and Lung Injury (preprint)

SARS-CoV-2 infection-induced hyper-inflammation links to the acute lung injury and COVID-19 severity. Identifying the primary mediators that initiate the uncontrolled hypercytokinemia is essential for treatments. Mast cells (MCs) are strategically located at the mucosa and beneficially or detrimentally regulate immune inflammations. Here we showed that SARS-CoV-2-triggeed MC degranulation initiated alveolar epithelial inflammation and lung injury. SARS-CoV-2 challenge induced MC degranulation in ACE-2 humanized mice and rhesus macaques, and a rapid MC degranulation could be recapitulated with Spike-RBD binding to ACE2 in cells; MC degranulation alterred various signaling pathways in alveolar epithelial cells, particularly, led to the production of pro-inflammatory factors and consequential disruption of tight junctions. Importantly, the administration of clinical MC stabilizers for blocking degranulation dampened SARS-CoV-2-induced production of pro-inflammatory factors and prevented lung injury. These findings uncover a novel mechanism for SARS-CoV-2 initiating lung inflammation, and suggest an off-label use of MC stabilizer as immunomodulators for COVID-19 treatments.

Preventions of Novel Coronavirus Pneumonia infections in a hospital ward with advanced kidney disease patients

Patients with advanced kidney disease are more susceptible to Novel Coronavirus Pneumonia (NPC) infection than other people because of the detrimental immune system with the patients. It is important for health professionals to protect the patients with advanced kidney disease in their daily services. This article describes preventive strategies taken by health professionals in the kidney ward in a hospital in Mianyang, Sichuan, China, including establishment of an executive team, development of dialysis procedures, investigation of admitted patients epidemiology history related to NCP, and training of health professionals. Thanks to the implementation of these measures, together with the overall success of control in Mianyang, no NCP infections were detected among the patients in the ward. While these measures might have been affective during NCP epidemic, they may also be effective to control hospital-associated infections in other circumstances.

Annotation of miRNAs in COVID-19 Coronavirus

The COVID-19 coronavirus is a new strain of coronavirus that had not been previously detected in humans. As its severe pathogenicity is concerned, it is important to study it thoroughly to aid in the discovery of a cure. In this study, the microRNAs (miRNAs) of COVID-19 were annotated to provide a powerful tool for the study of this novel coronavirus. We obtained 16 novel coronavirus genome sequences and the mature sequences of all viruses in the microRNA database (miRbase), and then used the miRNA mature sequences of the virus to perform the Basic Local Alignment Search Tool (BLAST) analysis in the coronavirus genome, extending the matched regions of approximately 20 bp to two segments by 200 bp. Six sequences were obtained after deleting redundant sequences. Then, the hairpin structures of the mature miRNAs were determined using RNAfold. The mature sequence on one hairpin arm was selected into a total of 4 sequences, and finally the relevant miRNA precursor prediction tools were used to verify whether the selected sequences are miRNA precursor sequences of the novel coronavirus. The miRNAs of the novel coronavirus were annotated by our newly developed method, which will lay the foundation for further study of this virus.

Coagulation factors and COVID-19 severity: Mendelian randomization analyses and supporting evidence (preprint)

BackgroundThe evolving pandemic of COVID-19 is arousing alarm to public health. According to epidemiological and observational studies, coagulopathy was frequently seen in severe COVID-19 patients, yet the causality from specific coagulation factors to COVID-19 severity and the underlying mechanism remain elusive. MethodsFirst, we leveraged Mendelian randomization (MR) analyses to assess causal relationship between 12 coagulation factors and severe COVID-19 illness based on two genome-wide association study (GWAS) results of COVID-19 severity. Second, we curated clinical evidence supporting causal associations between COVID-19 severity and particular coagulation factors which showed significant results in MR analyses. Third, we validated our results in an independent cohort from UK Biobank (UKBB) using polygenic risk score (PRS) analysis and logistic regression model. For all MR analyses, GWAS summary-level data were used to ascertain genetic effects on exposures against disease risk. ResultsWe revealed that genetic predisposition to the antigen levels of von Willebrand factor (VWF) and the activity levels of its cleaving protease ADAMTS13 were causally associated with COVID-19 severity, wherein elevated VWF antigen level (P = 0.005, odds ratio (OR) = 1.35, 95% confidence interval (CI): 1.09-1.68 in the Severe COVID-19 GWAS Group cohort; P = 0.039, OR = 1.21, 95% CI: 1.01-1.46 in the COVID-19 Host Genetics Initiative cohort) and lowered ADAMTS13 activity (P = 0.025, OR = 0.69, 95% CI: 0.50-0.96 in the Severe COVID-19 GWAS Group cohort) lead to increased risk of severe COVID-19 illness. No significant causal association of tPA, PAI-1, D-dimer, FVII, PT, FVIII, FXI, aPTT, FX or ETP with COVID-19 severity was observed. In addition, as an independent factor, VWF PRS explains a 31% higher risk of severe COVID-19 illness in the UKBB cohort (P = 0.047, OR per SD increase = 1.31, 95% CI: 1.00-1.71). In combination with age, sex, BMI and several pre-existing disease statues, our model can predict severity risks with an AUC of 0.70. ConclusionTogether with the supporting evidence of recent retrospective cohort studies and independent validation based on UKBB data, our results suggest that the associations between coagulation factors VWF/ADAMTS13 and COVID-19 severity are essentially causal, which illuminates one of possible mechanisms underlying COVID-19 severity. This study also highlights the importance of dynamically monitoring the plasma levels of VWF/ADAMTS13 after SARS-CoV-2 infection, and facilitates the development of treatment strategy for controlling COVID-19 severity and associated thrombotic complication.

Impact of SARS-CoV-2 on Fetal Malformation During Pregnancy: A Case Report of Fetal Autopsy (preprint)

Background: Little is known about the impact of SARS-CoV-2 on fetal anomalies. Case presentation: We described a case report of fetal anomalies during second-trimester (25+3 weeks) pregnancy. The fetal autopsy was found with abnormal heart anatomy (including ventricular septal defect, oval hole valve missing, and pericardial effusion), polycystic kidney, and acute chorioamnionitis. Conclusions: SARS-CoV-2 infection in second-trimester pregnancy not the direct factor resulted in congenital defects, and multiple risk factors contribute to these changes.   

Clinical and CT manifestations of coronavirus disease 2019

Objective To evaluate the clinical and CT manifestations of coronavirus disease 2019 (COVID-19). Methods Serial clinical and CT data of 11 patients with confirmed COVID-19 were retrospectively analyzed. These data were collected in The Second Affiliated Hospital of Xi'an Jiaotong University from January 24 to February 9, 2020. There were 6 males and 5 females, aged from 17 to 64 years old, with the mean age of 42.27±15.67. Results A majority of the patients fell into mild type and only one was of severe type. Clinical manifestations were mainly fever, fatigue, and dry cough. For laboratory tests, the patients' lymphocyte and eosinophil counts decreased, while their C-reactive protein concentration increased. In terms of CT findings, 7 patients showed bilateral subpleural involvement. The ground glass opacity (GGO) was common in CT findings. Typical crazy paving sign, air bronchogram and halo sign were also found. During the progression of the disease, GGO might be associated with pulmonary consolidation. No enlarged lymph nodes or pleural effusion were seen in all the patients. Conclusion Patients with COVID-19 have distinctly characteristic chest CT manifestations and laboratory examination findings, which play a vital role in diagnosis and prognosis of the disease.

COVID-19 severity is associated with immunopathology and multi-organ damage (preprint)

COVID-19 is characterised by dysregulated immune responses, metabolic dysfunction and adverse effects on the function of multiple organs. To understand how host responses contribute to COVID-19 pathophysiology, we used a multi-omics approach to identify molecular markers in peripheral blood and plasma samples that distinguish COVID-19 patients experiencing a range of disease severities. A large number of expressed genes, proteins, metabolites and extracellular RNAs (exRNAs) were identified that exhibited strong associations with various clinical parameters. Multiple sets of tissue-specific proteins and exRNAs varied significantly in both mild and severe patients, indicative of multi-organ damage. The continuous activation of IFN-I signalling and neutrophils, as well as a high level of inflammatory cytokines, were observed in severe disease patients. In contrast, COVID-19 in mild patients was characterised by robust T cell responses. Finally, we show that some of expressed genes, proteins and exRNAs can be used as biomarkers to predict the clinical outcomes of SARS-CoV-2 infection. These data refine our understanding of the pathophysiology and clinical progress of COVID-19 and will help guide future studies in this area.

Potential Therapeutic Agents for COVID-19 Based on the Analysis of Protease and RNA Polymerase Docking (preprint)

The outbreak of novel coronavirus (COVID-19) infections in 2019 is in dire need of finding potential therapeutic agents. In this study, we used molecular docking to repurpose HIV protease inhibitors and nucleoside analogues for COVID-19, with evaluations based on docking scores calculated by AutoDock Vina and RosettaCommons. Our results suggest that Indinavir and Remdesivir possess the best docking scores, and comparison of the docking sites of the two drugs reveal a near perfect dock in the overlapping region of the protein pockets. After further investigation of the functional regions inferred from the proteins of SARS coronavirus, we discovered that Indinavir does not dock on any active sites of the protease, which may give rise to concern in regards to the efficacy of Indinavir. On the other hand, the docking site of Remdesivir is not compatible with any known functional regions, including template binding motifs, polymerization motifs and nucleoside triphosphate (NTP) binding motifs. However, when we tested the active form (CHEMBL2016761) of Remdesivir, the docking site revealed a perfect dock in the overlapping region of the NTP binding motif. This result suggests that Remdesivir could be a potential therapeutic agent. Clinical trials still must be done in order to confirm the curative effect of these drugs.