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1.
Int J Womens Dermatol ; 2021 Aug 26.
Article in English | MEDLINE | ID: covidwho-1379123

ABSTRACT

Coronavirus disease 2019 (COVID-19) care requires a team approach, and dermatologists may collaborate with other specialties, especially infectious disease (ID) medicine and obstetrics and gynecology (ObGyn) at every stage of the infection process. A broad spectrum of cutaneous manifestations may occur early in COVID-19, making appropriate dermatologic identification critical for early diagnosis. There is prognostic value in appropriately identifying different types of COVID-19-associated skin manifestations which have been linked to disease severity. Such observations emanated from dermatology research, especially large series and international registry of cutaneous manifestations relating to COVID-19, and impact COVID-19 care provided by most healthcare providers. Also, research based on international registry of skin reactions from COVID-19 vaccines is having an impact across disciplines. An increased risk for severe illness from COVID-19 is encountered in pregnancy, and dermatologists' role is to urge ObGyn and other clinicians to monitor and educate pregnant patients about the potential for some eruptions being a manifestation of COVID-19. ID and ObGyn experts indicate that teledermatology enhanced the interaction among healthcare providers and improved COVID-19 care. Over 40% of all dermatology consults at a tertiary care hospital were done via teledermatology. Future collaborative research involving dermatology and specialties such as ID and ObGyn could help delineate guidelines for dermatology consult in COVID-19 patients and determine cases appropriate for teledermatology.

2.
CMAJ Open ; 9(2): E693-E702, 2021.
Article in English | MEDLINE | ID: covidwho-1278708

ABSTRACT

BACKGROUND: Identification of therapies to prevent severe COVID-19 remains a priority. We sought to determine whether hydroxychloroquine treatment for outpatients with SARS-CoV-2 infection could prevent hospitalization, mechanical ventilation or death. METHODS: This randomized controlled trial was conducted in Alberta during the first wave of the COVID-19 pandemic without direct contact with participants. Community-dwelling individuals with confirmed SARS-CoV-2 infection (by reverse transcription polymerase chain reaction [RT-PCR] viral ribonucleic acid test) within the previous 4 days, and symptom onset within the previous 12 days, were randomly assigned to oral hydroxychloroquine or matching placebo for 5 days. Enrolment began Apr. 15, 2020. The primary outcome was the composite of hospitalization, invasive mechanical ventilation or death within 30 days. Secondary outcomes included symptom duration and disposition at 30 days. Safety outcomes, such as serious adverse events and mortality, were also ascertained. Outcomes were determined by telephone follow-up and administrative data. RESULTS: Among 4919 individuals with a positive RT-PCR test, 148 (10.2% of a planned 1446 patients) were randomly assigned, 111 to hydroxychloroquine and 37 to placebo. Of the 148 participants, 24 (16.2%) did not start the study drug. Four participants in the hydroxychloroquine group met the primary outcome (4 hospitalizations, 0 mechanical ventilation, 4 survived to 30 days) and none in the placebo group. Hydroxychloroquine did not reduce symptom duration (hazard ratio 0.77, 95% confidence interval 0.49-1.21). Recruitment was paused on May 22, 2020, when a since-retracted publication raised concerns about the safety of hydroxychloroquine for hospitalized patients with COVID-19. Although we had not identified concerns in a safety review, enrolment was slower than expected among those eligible for the study, and cases within the community were decreasing. Recruitment goals were deemed to be unattainable and the trial was not resumed, resulting in a study underpowered to assess the effect of treatment with hydroxychloroquine and safety. INTERPRETATION: There was no evidence that hydroxychloroquine reduced symptom duration or prevented severe outcomes among outpatients with proven COVID-19, but the early termination of our study meant that it was underpowered. TRIAL REGISTRATION: ClinicalTrials.gov, no. NCT04329611.


Subject(s)
Ambulatory Care , COVID-19 , Hospitalization/statistics & numerical data , Hydroxychloroquine , Respiration, Artificial/statistics & numerical data , Ambulatory Care/methods , Ambulatory Care/statistics & numerical data , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/mortality , Early Termination of Clinical Trials , Female , Humans , Hydroxychloroquine/administration & dosage , Hydroxychloroquine/adverse effects , Independent Living/statistics & numerical data , Male , Middle Aged , Mortality , Outcome Assessment, Health Care , Preventive Health Services/methods , SARS-CoV-2/isolation & purification , Severity of Illness Index
3.
Bull World Health Organ ; 99(2): 92-101, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1261335

ABSTRACT

Objective: To evaluate how public perceptions and trust in government communications affected the adoption of protective behaviour in Singapore during the coronavirus disease 2019 (COVID-19) pandemic. Methods: We launched our community-based cohort to assess public perceptions of infectious disease outbreaks in mid-2019. After the first case of COVID-19 was reported in Singapore on 23 January, we launched a series of seven COVID-19 surveys to both existing and regularly enrolled new participants every 2 weeks. As well as sociodemographic properties of the participants, we recorded changing responses to judge awareness of the situation, trust in various information sources and perceived risk. We used multivariable logistic regression models to evaluate associations with perceptions of risk and self-reported adopted frequencies of protective behaviour. Findings: Our cohort of 633 participants provided 2857 unique responses during the seven COVID-19 surveys. Most agreed or strongly agreed that information from official government sources (99.1%; 528/533) and Singapore-based news agencies (97.9%; 522/533) was trustworthy. Trust in government communication was significantly associated with higher perceived threat (odds ratio, OR: 2.2; 95% confidence interval, CI: 1.6-3.0), but inversely associated with perceived risk of infection (OR: 0.6; 95% CI: 0.4-0.8) or risk of death if infected (OR: 0.6; 95% CI: 0.4-0.9). Trust in government communication was also associated with a greater likelihood of adopting protective behaviour. Conclusion: Our findings show that trust is a vital commodity when managing an evolving outbreak. Our repeated surveys provided real-time feedback, allowing an improved understanding of the interplay between perceptions, trust and behaviour.


Subject(s)
COVID-19 , Government , Health Knowledge, Attitudes, Practice , Public Opinion , Trust , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , Risk Assessment , Singapore , Surveys and Questionnaires , Young Adult
5.
Trends Analyt Chem ; 133: 116081, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-867147

ABSTRACT

Human coronaviruses (HCoV) are no stranger to the global environment. The etiology of previous outbreaks with reported symptoms of respiratory tract infections was attributed to different coronavirus strains, with the latest global pandemic in 2019 also belonging to the coronavirus family. Timely detection, effective therapeutics and future prevention are stake key holders in the management of coronavirus-induced infections. Apart from the gold standard clinical diagnostics, electrochemical techniques have also demonstrated their great potentials in the detection of different viruses and their correlated antibodies and antigens, showing high sensitivities and selectivities, and faster times for the analysis. This article aims to critically review the multifaceted electrochemical approaches, not only in the development of point-of-care portable devices but also as alternative detection strategies that can be coupled with traditional methods for the detection of various strains of coronaviruses.

8.
Med Hypotheses ; 144: 110147, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-680479

ABSTRACT

Recent data has revealed an association between coronavirus disease-19 (COVID-19) incidence and seasonally regulated androgen sensitivity. This potential relationship between SARS-CoV-2 infection and clock genes, coupled with previously reported effects of night shift work on health, leads us to hypothesize that night shift workers may be at an increased physiological risk of coronavirus disease-19 (COVID-19). Shift work, especially night shift work, has long been associated with several chronic health conditions. The mechanisms that drive these associations are not well understood; however, current literature suggests that the disruption of circadian rhythms may cause downstream hormonal and immune effects that render night shift workers more susceptible to disease. First, circadian rhythms may play a role in the mechanism of viral infection, as viral vaccines administered in the morning elicit greater immune responses than those administered in the afternoon. Next, increased exposure to light at night may inhibit the production of melatonin, which has been observed to enhance DNA repair and shown to upregulate expression of Bmal1, an established inhibitor of herpes simplex virus and influenza. Finally, abnormal immune cell and cytokine levels have been observed following night-shift work. These data suggest that further research is warranted and that high-risk occupations should be taken into consideration as public health policies are introduced and evolve.


Subject(s)
COVID-19/epidemiology , Circadian Rhythm , Disease Susceptibility , Work Schedule Tolerance , ARNTL Transcription Factors/metabolism , COVID-19/diagnosis , Cytokines/metabolism , DNA Repair , Humans , Melatonin/metabolism , Public Health , Risk , SARS-CoV-2 , Sleep/physiology
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