Cerebral venous thrombosis after ChAdOx1 nCoV-19 vaccination: a systematic review

OBJECTIVE: To perform a systematic review of case reports or case series regarding thrombosis with thrombocytopenia syndrome (TTS) and cerebral venous thrombosis (CVT) related to ChAdOx1 nCoV-19 vaccination to address the clinical features, laboratory findings, treatment modalities, and prognosis related with CVT. SUBJECTS AND METHODS: We included 64 TTS patients from 19 articles, 6 case series and 13 case reports, in which thrombosis occurred after the first dose of ChAdOx1 nCoV-19 vaccination published up to 30 June 2021 in Embase, ePubs, Medline/PubMed, Scopus, and Web of Science databases. RESULTS: Of the 64 TTS patients, 38 (59.3%) had CVT. Patients with CVT were younger (median 36.5 vs. 52.5 years, p<0.001), had lower fibrinogen levels (130 vs. 245 mg/dL, p=0.008), had more frequent history of intracerebral hemorrhage (ICH), and had higher mortality rate (48.6% vs. 19.2%, p=0.020) than that of patients without CVT. In multivariable analysis, the possibility of presence of CVT was higher in younger age groups [odd ratio (OR): 0.91, 95% confidence interval (CI): (0.86-0.97, p<0.001)] and those with accompanying intracerebral hemorrhage (ICH) (OR: 13.60, 95% CI (1.28-144.12, p=0.045). CONCLUSIONS: Our study demonstrated that CVT related to ChAdOx1 nCoV-19 vaccination was associated with younger age, low levels of fibrinogen, presence of ICH and more frequent mortality compared to those of non-CVT. If TTS occurs after ChAdOx1 nCoV-19 vaccination, the presence of CVT in patients with young age or ICH should be considered.

Cerebral venous thrombosis after ChAdOx1 nCoV-19 vaccination: a systematic review.

OBJECTIVE: To perform a systematic review of case reports or case series regarding thrombosis with thrombocytopenia syndrome (TTS) and cerebral venous thrombosis (CVT) related to ChAdOx1 nCoV-19 vaccination to address the clinical features, laboratory findings, treatment modalities, and prognosis related with CVT. SUBJECTS AND METHODS: We included 64 TTS patients from 19 articles, 6 case series and 13 case reports, in which thrombosis occurred after the first dose of ChAdOx1 nCoV-19 vaccination published up to 30 June 2021 in Embase, ePubs, Medline/PubMed, Scopus, and Web of Science databases. RESULTS: Of the 64 TTS patients, 38 (59.3%) had CVT. Patients with CVT were younger (median 36.5 vs. 52.5 years, p<0.001), had lower fibrinogen levels (130 vs. 245 mg/dL, p=0.008), had more frequent history of intracerebral hemorrhage (ICH), and had higher mortality rate (48.6% vs. 19.2%, p=0.020) than that of patients without CVT. In multivariable analysis, the possibility of presence of CVT was higher in younger age groups [odd ratio (OR): 0.91, 95% confidence interval (CI): (0.86-0.97, p<0.001)] and those with accompanying intracerebral hemorrhage (ICH) (OR: 13.60, 95% CI (1.28-144.12, p=0.045). CONCLUSIONS: Our study demonstrated that CVT related to ChAdOx1 nCoV-19 vaccination was associated with younger age, low levels of fibrinogen, presence of ICH and more frequent mortality compared to those of non-CVT. If TTS occurs after ChAdOx1 nCoV-19 vaccination, the presence of CVT in patients with young age or ICH should be considered.

The moderated mediating effect of gender in the relationship between unemployment, depression, and suicide during the COVID-19 pandemic: An examination based on big data

Introduction: The COVID-19 pandemic, and the consequent recession, have caused a decline in the job market, with the resultant job insecurity increasing the risk of depression. While this affected all genders, suicidal thoughts were observed to be more common among women than men, suggesting that the impact of unemployment on depression varies by gender, with gender differences affecting the outcome of depression. Objective(s): This study aims to verify the moderating effect of gender on the structural relationship between unemployment, depression, and suicide during the COVID-19 pandemic by using online search trend data. Method(s): The study utilized the search trend data from Naver's Data Lab service, by analyzing the searches of men and women under 65, between March, 2020 and September 12, 2021. The search terms were "unemployment," "depression," and "suicide." The analysis examined 1121 searches using the Model 7 research model through the SPSS Process Macro to verify the moderating effect of gender on the mediating pathways for unemployment, depression, and suicide. Result(s): We observed that searches for "unemployment" significantly increased with searches for "depression" (B=1.860, p<.001) and "suicide" (B=.860, p<.001). The analysis further revealed that the correlation between the increase in searches relating to depression and unemployment was seen more in women than men. This resulted in an accompanying increase in the volume of searches for suicide (B=2.341, p<.001). Conclusion(s): The job insecurity caused by the COVID-19 pandemic led to varying degrees of depression according to gender. Thus, social security measures related to unemployment, depression, and suicide interventions require a gender-specific approach.

Reflections of Health Care Workers on Their In-Hospital Experiences During the Onset of COVID-19

The early stages of the COVID-19 pandemic intensified the role of healthcare workers in hospitals. This study examines how healthcare workers reflected on their in-hospital experiences in the early stages of the pandemic in North America. Audio diary entries from The Nocturnist podcast recorded from March – June 2020 were analyzed using epistemic network analysis (ENA) and heat map models. Overall, there was a shift from responding to immediate needs in March 2020 (such as Anger with Policies and Fear with Resource Availability) to deeper reflections in May-June 2020, more focused on Psychosocial Support and Purpose and more complex emotions involving Sadness and Compassion. Uncertainty was a prominent emotion throughout the May – June 2020 period. These results help document the complexity of reflections early in the pandemic, while informing ways to better support health care workers in future crisis. © 2022, Springer Nature Switzerland AG.

The impact of the COVID-19 pandemic on depression in community-dwelling older adults: a prospective cohort study

Background There are growing concerns about the impact of the COVID-19 pandemic on the mental health of older adults. We examined the effect of the pandemic on the risk of depression in older adults. Methods We analyzed data from the prospective cohort study of Korean older adults, which has been followed every 2 years. Among the 2308 participants who completed both the third and the fourth follow-up assessments, 58.4% completed their fourth follow-up before the outbreak of COVID-19 and the rest completed it during the pandemic. We conducted face-to-face diagnostic interviews using Mini International Neuropsychiatric Interview and used Geriatric Depression Scale. We performed generalized estimating equations and logistic regression analyses. Results The COVID-19 pandemic was associated with increased depressive symptoms in older adults [b (standard error) = 0.42 (0.20), p = 0.040] and a doubling of the risk for incident depressive disorder even in euthymic older adults without a history of depression (odds ratio = 2.44, 95% confidence interval 1.18-5.02, p = 0.016). Less social activities, which was associated with the risk of depressive disorder before the pandemic, was not associated with the risk of depressive disorder during the pandemic. However, less family gatherings, which was not associated with the risk of depressive disorder before the pandemic, was associated with the doubled risk of depressive disorder during the pandemic. Conclusions The COVID-19 pandemic significantly influences the risk of late-life depression in the community. Older adults with a lack of family gatherings may be particularly vulnerable.

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.

Student Emotions in the Shift to Online Learning During the COVID-19 Pandemic

The COVID-19 pandemic saw sudden measures to stop the spread of the virus, closing schools and forcing a shift to remote learning. This study examines the emotions exhibited by students around factors of online learning as they transitioned abruptly from in-person instruction. Student responses to a New York Times writing prompt in March 2020 were analyzed using frequencies and epistemic network analysis (ENA) models. About half of the responses contained positive emotional valence, but more than three quarters had negative emotional valence. The strongest connection was observed between negative emotional valence for instructional format and focus. More specifically, anxiety between the format, focus, and workload were strongly connected, indicative of the difficulties faced by students to maintain focus and balance assignments on learning activities while being at home. At the same time, there was a significant connection between positive and negative emotional valence regarding the instructional format, attributed to mixed and changing emotions with adjusting to online learning. When students did exhibit positive emotions, it was interest in the instructional format linked with interest in schedule, indicating that the scheduling flexibility of the online format was the factor students liked most. © 2021, Springer Nature Switzerland AG.

Providing essential clinical care for non-COVID-19 patients in a Seoul metropolitan acute care hospital amidst ongoing treatment of COVID-19 patients.

We assessed infection control efforts by comparing data collected over 20 weeks during a pandemic under a dual-track healthcare system. A decline in non-COVID-19 patients visiting the emergency department by 37.6% (P<0.01) was observed since admitting COVID-19 cases. However, patients with acute myocardial infarction (AMI), stroke, severe trauma and acute appendicitis presenting for emergency care did not decrease. Door-to-balloon time (34.3 (± 11.3) min vs 22.7 (± 8.3) min) for AMI improved significantly (P<0.01) while door-to-needle time (55.7 (± 23.9) min vs 54.0 (± 18.0) min) in stroke management remained steady (P=0.80). Simultaneously, time-sensitive care involving other clinical services, including patients requiring chemotherapy, radiation therapy and haemodialysis did not change.