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1.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P284-P285, 2022.
Article in English | EMBASE | ID: covidwho-2064422

ABSTRACT

Introduction: A patient with progressive rhino-orbito-cerebral mucormycosis (ROCM) despite maximal therapy survived 2 months after complete discontinuation of treatment. A 35-year-old man with poorly controlled diabetes presented to outside hospital with severe headaches, cough, and hyperglycemia. He was found to be COVID-19 positive and in severe diabetic ketoacidosis. He received neither corticosteroids nor monoclonal antibodies for COVID-19. Empiric therapy with intravenous (IV) antibiotics, antivirals, and antifungals was initiated. Endoscopic sinus debridement revealed fungal invasion;pathology confirmed mucormycosis. Subsequent imaging showed disease progression with intracranial extension despite maximal treatment. The patient elected to stop all treatment and was discharged with home hospice. He continued only metformin and did not make a concerted effort toward glycemic control. After 2 months he presented to Loma Linda Hospital with right eye symptoms;imaging showed persistent disease. IV antibiotics and antifungals were initiated. After endoscopic evaluation and debridement, tissue pathology showed residual mucormycosis. The patient was discharged home after 16 days with a 6-week course of meropenem and lifelong posaconazole. Method(s): A PubMed search for English-language case reports and series from 2000 to present was performed using search terms mucormycosis, survive, rhino-orbitocerebral, rhino-cerebral, and cerebral. Result(s): No reports of long-term survival after discontinuation of therapy were identified. Conclusion(s): This case illustrates a rare situation in which a patient whose ROCM progressed despite maximal therapy survived for over 2 months after halting treatment. ROCM mortality is as high as 85%. Outcomes are improved with surgical and antifungal therapy, and there are many reports of survival with ongoing treatment. However, there appear to be no documented cases of survival with active disease after termination of therapy. This patient's unsuccessful management and 2-month treatment hiatus make his long-term survival surprising.

2.
Investigative Ophthalmology and Visual Science ; 63(7):1418-A0114, 2022.
Article in English | EMBASE | ID: covidwho-2058488

ABSTRACT

Purpose : The COVID-19 pandemic prompted efforts to encourage social distancing and minimize non-urgent in-person eye care. Here, we report the outcomes of a teleophthalmology program for diabetic retinopathy screening at an integrated health system in California that was expanded during the pandemic. Methods : We performed a retrospective review of patients who underwent remote retinal imaging as part of a teleophthalmology program for diabetic retinopathy (DR) screening using Current Procedural Terminology (CPT) codes 92227 and 92228 at the University of California, Davis Health system between May 31st , 2019 and June 8th , 2021. Retinal images were captured at primary care locations using a Topcon NW400, Nikon RetinaStation, or Optos Primary fundus cameras, and image grading were performed by trained ophthalmologists or optometrists using a store-and-forward method. Patient records were reviewed to collect demographic, follow-up, and clinical outcomes information. Results : During COVID19 pandemic, the teleophthalmology program screened 570 individuals (mean age 63.2 ± 13.7). There was a significant increase in the number of patients screened per month prior to and following the COVID-19 lock-down in March 2020 (5.0 ± 3.1 patients screened per month prior to and 39.1 ± 34.8 patients per month following, P = 0.0004). Among these, 204 patients received a recommendation for in-person eye care referral, of which 127 received a referral to the UC Davis Eye Center, 85 appointments were scheduled, and 82 patients were followed in person, with a median time of 108 days between screening and in-person follow-up. Follow-up rates were generally lower during the initial months after the pandemic and increased over time. Among the patients who followed in person (mean age 63.9 ± 13.8), 10% of eyes had mild non-proliferative DR (NPDR), 5% had moderate NPDR, 3% had severe NPDR, 2% had PDR, and 4% had diabetic macular edema (DME), with similar proportions before and after the COVID-19 lockdown. Conclusions : Expansion of a teleophthalmology program during the COVID19 pandemic demonstrated improved DR screening rates, increased referrals, and improved follow-up for diabetic eye care at an integrated health system in Northern California.

3.
Investigative Ophthalmology and Visual Science ; 63(7):1391-A0087, 2022.
Article in English | EMBASE | ID: covidwho-2058094

ABSTRACT

Purpose : Greater utilization and insurance coverage for tele-retinal screening during the COVID-19 pandemic in 2020 may enhance awareness and expand remote retinal imaging services. In this study, we performed a retrospective, cross-sectional analysis of utilization and insurance payments of tele-retinal imaging services in the United States in 2020. Methods : We examined remote retinal imaging utilization and insurance payments from January 1, 2020, to December 31, 2020, using the OptumLabs® Data Warehouse (OLDW), a comprehensive database of de-identified administrative claims for commercial and Medicare Advantage enrollees in the U.S. We evaluated frequency of claims and insurance payment for services using Current Procedural Terminology codes 92227 and 92228 for remote eye imaging by any provider, and 92250 for fundus photography by non-eye care providers. Results : Use of remote retinal imaging declined rapidly from 3627 claims in February 2020 to 1414 claims in April 2020, but returned to 3133 claims by December 2020, similar to pre-pandemic levels in 2019 (2841 ± 174.8 claims). Proportion of insurance payments for remote imaging increased temporarily from 47.4% in February to 56.7% in April, then returned to 45.9% in December. Conclusions : Utilization of tele-retinal imaging declined steeply while insurance coverage increased during the initial COVID-19 lockdown in 2020, but returned to pre-pandemic levels by end-of-year. Changes in utilization and relaxed restrictions on insurance reimbursements for remote retinal imaging during the COVID-19 pandemic were not sustained.

4.
Electrochimica Acta ; 422, 2022.
Article in English | Scopus | ID: covidwho-1873023

ABSTRACT

We present an open source, fully wireless potentiostat (the “NanoStat”) for applications in electrochemistry, sensing, biomedical diagnostics, and nanotechnology, based on only 2 integrated circuit chips: A digital microcontroller with integrated on board WiFi and file/web server hardware/software, and an analog front end. This versatile platform is fully capable of all modern electrochemisty assays, including cyclic voltammetry, square wave voltammetry, chronoamperometry, and normal pulse voltammetry. The user interface is a web browser connected over http. All the code (firmware, HTML5, JavaScript) is hosted by the NanoStat itself without the need for any additional software. The total size is 4×40×20 mm and battery operation for 6 h is demonstrated, possible to extend to weeks or months in sleep mode. We anticipate that the applications of this could be very broad, from biomedical sensing in the clinic, to remote monitoring of unattended “motes”, to even possibly sensing aerial pathogens such as COVID in large public spaces without the need for anything other than a web browser for remote monitoring from anywhere in the world. Finally, we propose to use this software suite as a basis (kernel) of a fully open source, general purpose, web based electrochemistry software suite, ed from the hardware, which we call “OpenEChem”. © 2022

5.
PLoS One ; 17(4): e0266967, 2022.
Article in English | MEDLINE | ID: covidwho-1817487

ABSTRACT

INTRODUCTION: Reduced rates of help seeking by those who self-harmed during the COVID-19 pandemic have been reported. OBJECTIVES: To understand changes in healthcare service contacts for self-harm during the COVID-19 pandemic across primary, emergency and secondary care. METHODS: This retrospective cohort study used routine electronic healthcare data for Wales, United Kingdom, from 2016 to March 14, 2021. Population-based data from primary care, emergency departments and hospital admissions were linked at individual-level. All Welsh residents aged ≥10 years over the study period were included in the study. Primary, emergency and secondary care contacts with self-harm at any time between 2016 and March 14, 2021 were identified. Outcomes were counts, incidence, prevalence and proportion of self-harm contacts relative to all contacts in each and all settings, as well as the proportion of people contacting one or more settings with self-harm. Weekly trends were modelled using generalised estimated equations, with differences between 2020 (to March 2021) and comparison years 2016-2018 (to March 2017-2019) quantified using difference in differences, from which mean rate of odds ratios (µROR) across years was reported. RESULTS: The study included 3,552,210 individuals over the study period. Self-harm contacts reduced across services in March and December 2020 compared to previous years. Primary care contacts with self-harm reduced disproportionately compared to non-self-harm contacts (µROR = 0.7, p<0.05), while their proportion increased in emergency departments during April 2020 (µROR = 1.3, p<0.05 in 2/3 comparison years) and hospital admissions during April-May 2020 (µROR = 1.2, p<0.05 in 2/3 comparison years). Despite this, those who self-harmed in April 2020 were more likely to be seen in primary care than other settings compared to previous years (µROR = 1.2, p<0.05). A lower proportion of those with self-harm contacts in emergency departments were subsequently admitted to hospital in December 2020 compared to previous years (µROR = 0.5, p<0.05). CONCLUSIONS: These findings suggest that those who self-harmed during the COVID-19 pandemic may have been less likely to seek help, and those who did so faced more stringent criteria for admission. Communications encouraging those who self-harm to seek help during pandemics may be beneficial. However, this needs to be supported by maintained provision of mental health services.


Subject(s)
COVID-19 , Self-Injurious Behavior , COVID-19/epidemiology , Delivery of Health Care , Electronic Health Records , Humans , Pandemics , Retrospective Studies , Self-Injurious Behavior/epidemiology , Self-Injurious Behavior/psychology , Self-Injurious Behavior/therapy , United Kingdom/epidemiology , Wales/epidemiology
6.
Remote Sensing ; 14(7), 2022.
Article in English | Scopus | ID: covidwho-1792560

ABSTRACT

We present tropospheric nitrogen dioxide (NO2) changes observed by the Canadian Pandora measurement program in the Greater Toronto Area (GTA), Canada, and compare the results with surface NO2 concentrations measured via in situ instruments to assess the local emission changes during the first two years of the COVID‐19 pandemic. In the City of Toronto, the first lock-down period started on 15 March 2020, and continued until 24 June 2020. ECMWF Reanalysis v5 (ERA‐5) wind information was used to facilitate the data analysis and reveal detailed local emission changes from different areas of the City of Toronto. Evaluating seven years of Pandora observations, a clear NO2 reduction was found, especially from the more polluted downtown Toronto and airport areas (e.g., declined by 35% to 40% in 2020 compared to the 5‐year mean value from these areas) during the first two years of the pandemic. Compared to the sharp decline in NO2 emissions in 2020, the atmospheric NO2 levels in 2021 started to recover, but are still below the mean values in pre-pandemic time. For some sites, the pre‐pandemic NO2 local morning rush hour peak has still not returned in 2021, indicating a change in local traffic and commuter patterns. The long‐term (12 years) surface air quality record shows a statistically significant decline in NO2 with and without April to September 2020 observations (trend of −4.1%/yr and −3.9%/yr, respectively). Even considering this long‐term negative trend in NO2, the observed NO2 reduction (from both Pandora and in situ) in the early stage of the pandemic is still statistically significant. By implementing the new wind‐based validation method, the high‐resolution satellite instrument (TROPOMI) can also capture the local NO2 emission pattern changes to a good level of agreement with the ground‐based observations. The bias between ground‐based and satellite observations during the pandemic was found to have a positive shift (5–12%) than the bias during the pre‐pandemic period. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

7.
Psychiatr. Psychol. Klin. ; 21(4):293-296, 2021.
Article in English | Web of Science | ID: covidwho-1791640

ABSTRACT

An eating disorder presenting simultaneously in identical twins remains a rarity in the literature. In this case report, we describe monozygotic twins who presented simultaneously with anorexia nervosa as a psychological effect of COVID-19 home quarantine. Both twins were previously well but developed food restriction, exercise, and mutual surveillance behaviours in competition with each other over three months in early 2020. There were no features of other mood, anxiety or psychotic disorders, and there was no organic disease. However, a strong family history of anxiety disorders and highly permeable familial boundaries were identified. Non-pharmacological management modalities including family therapy and psychotherapy were implemented, and tailored to the twins. We discuss the unique genetic and psychological interactions that conceivably explain the aetiology of this simultaneous presentation of an eating disorder in a pair of twins and examine a simple psychodynamic formulation of this simultaneous emergence. Lastly, we look at the sequelae of COVID-19 related quarantines and isolation as potentiators of eating disorders in adolescents whose education and potential employment were drastically curtailed by movement restrictions.

8.
Journal of Bacteriology and Virology ; 51(3):89-102, 2021.
Article in English | Scopus | ID: covidwho-1538679

ABSTRACT

The ongoing coronavirus disease-2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus-2. COVID-19 severity is related to the cytokine storm phenomenon, which is amplified by pro-inflammatory cytokines and chemokines;it may cause extensive pulmonary damage. Among these cytokines, interleukin (IL)-17, produced mainly by T helper 17 (Th17) cells, is responsible for the immunopathological responses present in acute respiratory distress syndrome. This review discusses the roles of IL-17 and Th17 responses in the pathophysiology of COVID-19. Dysregulated Th17-responses, linked to various risk factors, may contribute to pathological inflammation through the amplification of multiple inflammatory cytokines and chemokines, as well as augmentation of neutrophil infiltration in the lungs of severe COVID-19 patients. A more detailed understanding of the roles of Th17 responses, as well as the mechanisms underlying altered IL-17 production and signaling, may improve therapeutic strategies for severe or critically ill COVID-19 patients by targeting the IL-17 pathway. © 2021 Journal of Bacteriology and Virology.

9.
International Journal of Chinese & Comparative Philosophy of Medicine ; 18(2):159-166, 2020.
Article in Chinese | Web of Science | ID: covidwho-1022885

ABSTRACT

My response to Professor Fan's essay mainly deals with two issues. Firstly, through a simplified analysis of the history and basic ideas of Confucianism, Fan's paper did not grasp the basic idea of "Ren" and "empathy of the Heart/mind of ren "as well as the theoretical structure of "ren-li-de" in Confucianism. Hence, his thesis on Familism and Confucian Virtue Ethics was not based on solid Confucian texts and arguments. Secondly, Principlism is nothing as extreme as Fan described and his analysis on the Covid-19 pandemic are fairly rational and reasonable. The management of the pandemic in the West does have serious defects, but it has nothing to do with Principlism and liberalism. It is mainly due to the misunderstanding and misjudgment of the nature of this new pandemic by specialists and common folks. Lastly, I present a brief outline on how Confucianism could join with democracy and liberty in fighting against Covid-19 effectively performed by Taiwan people.

10.
12th ACM International Conference on Automotive User Interfaces and Interactive Vehicular Applications, AutomotiveUI 2020 ; : 102-105, 2020.
Article in English | Scopus | ID: covidwho-876983

ABSTRACT

A worldwide pandemic has brought many challenges in numerous areas of everyone's life. The AutomotiveUI 2020 has also been moved to a virtual conference. Although the situation seems to be improving in some parts of the world, the impacts that the pandemic has brought to the research and academia may last long even after the pandemic is over. In the AutomotiveUI community, there is more than one aspect that should be taken into consideration. Ironically, the situation brought about both risks and opportunities including research methods, collaboration, interaction manners, and diversity and inclusion. With this background, the goal of this workshop is to discuss the impact of the COVID19 pandemic on the AutomotiveUI community from the perspective of the diversity and inclusion and to discuss the direction of collaborative activities of our community with researchers from various groups. We will organize three virtual workshop sessions accomodating different time zones. © 2020 Owner/Author.

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