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1.
Pharmacoepidemiology and Drug Safety ; JOUR:291-292, 31.
Article in English | Web of Science | ID: covidwho-2083435
2.
ACS Environmental Au ; 2(5):441-454, 2022.
Article in English | Scopus | ID: covidwho-2062151

ABSTRACT

NO2and O3simulations have great uncertainties during the COVID-19 epidemic, but their biases and spatial distributions can be improved with NO2assimilations. This study adopted two top-down NOXinversions and estimated their impacts on NO2and O3simulation for three periods: the normal operation period (P1), the epidemic lockdown period following the Spring Festival (P2), and back to work period (P3) in the North China Plain (NCP). Two TROPOspheric Monitoring Instrument (TROPOMI) NO2retrievals came from the Royal Netherlands Meteorological Institute (KNMI) and the University of Science and Technology of China (USTC), respectively. Compared to the prior NOXemissions, the two TROPOMI posteriors greatly reduced the biases between simulations with in situ measurements (NO2MREs: prior 85%, KNMI -27%, USTC -15%;O3MREs: Prior -39%, KNMI 18%, USTC 11%). The NOXbudgets from the USTC posterior were 17-31% higher than those from the KNMI one. Consequently, surface NO2levels constrained by USTC-TROPOMI were 9-20% higher than those by the KNMI one, and O3is 6-12% lower. Moreover, USTC posterior simulations showed more significant changes in adjacent periods (surface NO2: P2 vs P1, -46%, P3 vs P2, +25%;surface O3: P2 vs P1, +75%, P3 vs P2, +18%) than the KNMI one. For the transport flux in Beijing (BJ), the O3flux differed by 5-6% between the two posteriori simulations, but the difference of NO2flux between P2 and P3 was significant, where the USTC posterior NO2flux was 1.5-2 times higher than the KNMI one. Overall, our results highlight the discrepancies in NO2and O3simulations constrained by two TROPOMI products and demonstrate that the USTC posterior has lower bias in the NCP during COVD-19. © 2022 American Chemical Society. All rights reserved.

3.
Chest ; 162(4):A1084, 2022.
Article in English | EMBASE | ID: covidwho-2060766

ABSTRACT

SESSION TITLE: Atypical Cases of Sepsis SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Pasteurella multocida is a Gram-negative coccobacillus that causes infections after animal bites or scratches. It typically manifests as cellulitis but severe infections are possible though rare. We present a case of an immunocompetent man with COVID-19 who developed septic shock due to P. multocida bacteremia and pneumonia with no evidence of wound infection. CASE PRESENTATION: A 59-year-old Hispanic man with a history of anxiety and HLD presented with 10 days of nausea, vomiting, chills, and nonproductive cough. He was initially afebrile, on room air but tachycardic. His physical exam was unremarkable. Labs revealed WBC 10x10*3/uL, procal 3.3 ng/mL, negative lactic acid, and positive COVID-19. CT chest showed a right upper lobe consolidation with bilateral patchy infiltrates. He was admitted for sepsis secondary to COVID and superimposed bacterial pneumonia. Ceftriaxone, azithromycin, remdesivir, and dexamethasone were started. Overnight, the patient desaturated to low 80s and required HFNC FiO2 65%. In the morning, FiO2 increased to 80%. ICU was called and upon their assessment, the patient was febrile, tachycardic, tachypneic, hypotensive, and saturating 87-88% on HFNC FiO2 70%. Labs showed WBC 3.1 with left shift, Cr 1.7 mg/dL, lactic acid 5 mmol/L, and procalcitonin >100. He was intubated given persistent hypoxia and increased work of breathing. Antibiotics were broadened to vancomycin, pip/tazo, and azithromycin. The patient acutely decompensated after intubation, requiring multiple high-dose pressor support. Prelim blood cultures grew Gram-negative bacteria so antibiotics were broadened to meropenem. TTE was negative for endocarditis. Pressors were eventually weaned and the patient was extubated. Blood cultures grew P. multocida in 4/4 bottles so meropenem was narrowed to penicillin. His family reported that he was living at a friend's house with cats around but was unaware of any bites or scratches and he had no history of splenectomy. No portal of entry was noted upon careful skin examination. The patient continued to improve clinically with procal that rapidly downtrended. He was eventually discharged home. DISCUSSION: The mortality for severe P. multocida presentations is about 25-30%. Severe cases are generally reported in elderly, immunocompromised, or young immunosuppressed patients. We report what is to our knowledge, the first case of a severe P. multocida infection in an immunocompetent middle-aged man in the background of a COVID-19 infection. It is unclear the degree of COVID contribution and if his bacteremia preceded the pneumonia. His morbidity was primarily driven by the P. multocida bacteremia and pneumonia given the localized right upper lobe consolidation, elevated procal that rapidly decreased with antibiotics, and quick improvement and extubation. CONCLUSIONS: P. multocida infection should be considered in any patient with septic shock and exposure to animals. Reference #1: Blain H, George M, Jeandel C. Exposure to domestic cats or dogs: risk factor for Pasteurella multocida pneumonia in older people? Journal of the American Geriatrics Society. 1998;46(10):1329-1330. Reference #2: Tseng HK, Su SC, Liu CP, Lee CM. Pasteurella multocida bacteremia due to non-bite animal exposure in cirrhotic patients: report of two cases. Journal of microbiology, immunology, and infection= Wei mian yu gan ran za zhi. 2001;34(4):293-296. Reference #3: Kofteridis DP, Christofaki M, Mantadakis E, et al. Bacteremic community-acquired pneumonia due to Pasteurella multocida. International Journal of Infectious Diseases. 2009;13(3):e81-e83. doi:10.1016/j.ijid.2008.06.023 DISCLOSURES: No relevant relationships by Joanne Lin No relevant relationships by Harjeet Singh No relevant relationships by Jose Vempilly No relevant relationships by Joshua Wilkinson

4.
IEEE Sensors Journal ; : 1-1, 2022.
Article in English | Scopus | ID: covidwho-2052056

ABSTRACT

With the growth of smart medical devices and applications in smart hospitals, home care facilities, nursing, as well as the Internet of Medical Things (IoMT) are becoming more ubiquitous. It uses smart medical devices as well as cloud computing services, as well as basic Internet of Things (IoT) technology, to detect key body indicators, monitor health situations, as well as generate multivariate data to provide just-in-time healthcare services. In this paper, we present a novel collaborative disease detection system based on IoMT as well as captured image data. The system can be based on intelligent agents, where each and every agent explores the interaction between different medical data obtained by smart sensor devices using reinforcement learning as well as targets to detect diseases. The agents then collaborate to make a reliable conclusion about the detected diseases. Intensive experiments were conducted using medical data. The results show the importance of using intelligent agents for disease detection in healthcare decision-making. Moreover, collaboration increases the detection rate, with numerical results showing the superiority of the proposed framework compared to baseline solutions for disease detection. IEEE

5.
Journal of Pediatric Infectious Diseases ; 2022.
Article in English | Scopus | ID: covidwho-2050630

ABSTRACT

Objective Acute respiratory tract infection (ARTI) is one of the main diseases in childhood. This study aimed to monitor the distribution of respiratory tract viruses in children with ARTI in the impact of coronavirus disease 2019 (COVID-19). Methods We conducted surveillance of 2019 novel coronavirus, human metapneumovirus, respiratory syncytial virus, human adenovirus, human parainfluenza virus 1-3, and influenza A and B virus by using quantitative real-time polymerase chain reaction. Results During the winter of 2020 to 2021, among the 1,442 throat swabs we collected, 937 (64.98%, 937/1,442) were positive for respiratory viruses. Respiratory syncytial virus was the most frequently detected respiratory virus (34.12%, 492/1,442) and 2019 novel coronavirus and influenza A and B virus were not detected in the study period. Coinfection was observed in 156 positive samples including 149 samples of double infection and 7 of triple infection. The positive rate of viral respiratory tract infection in infants less than 6 months was the highest (72.95%) in the study period. Conclusion There are some differences in the distribution of respiratory viruses in children after the outbreak of COVID-19 in Hangzhou, China. © 2022 Georg Thieme Verlag. All rights reserved.

6.
Journal of the Canadian Academy of Child and Adolescent Psychiatry ; 31(2):52-63, 2022.
Article in English | EMBASE | ID: covidwho-2030778

ABSTRACT

Objective: As a result of the COVID-19 pandemic, public health agencies and school boards across Canada enacted new protocols, including face masks, physical distancing and enhanced hygiene, to support the safe reopening of inperson school. This study explored the experiences and perceptions of teachers instructing children and adolescents in person during a two-day school simulation. Method: This study was part of a large school simulation exercise conducted in Toronto, Ontario. Kindergarten to grade 12 teachers taught in classrooms with either masked students, or students who were un-masked or only masked when physical distancing was not possible. A qualitative descriptive phenomenology approach was utilized, and data were collected via virtual focus groups. Qualitative data analysis involved multiple rounds of inductive coding to generate themes. Results: The sample included 14 teachers (92.9% female;85.7% White), with a median of 9.5 years teaching experience. Three primary themes emerged: 1) learning to navigate public health measures, 2) needing to adapt teaching strategies and 3) striving to manage conflicting priorities. The majority of teachers reported that mask-wearing and physical distancing impacted their classroom teaching, communication and connection with students. Conclusions: As schools transition to in-person instruction, teachers will be required to play dual roles in education and public health, with implications on safety, teaching and professional identity. Public health agencies and school boards are encouraged to engage teachers in ongoing conversations regarding in-person school planning and operations. Furthermore, evidence-based interventions, including increased teaching development programs, are recommended to support teachers during the COVID-19 pandemic.

7.
2021 2nd International Conference on Machine Learning and Computer Application, ICMLCA 2021 ; : 1154-1160, 2021.
Article in English | Scopus | ID: covidwho-2012679

ABSTRACT

In the context of the COVID-19 epidemic, the development and popularization of vaccines have effectively alleviated people's panic. Twitter, as one of the world's largest social platforms, promptly reflects the trend of emotional changes in screen names. Currently, vaccines such as Pfizer, Sputnik, and Moderna have successfully made a large number of people gain high immunity against the COVID-19 virus. However, a few cases of death due to vaccines have caused some people to question and worry about the safety of vaccines. A comprehensive understanding of progress of vaccine popularization is conducive making wiser decisions and calming people's panic. Since the large number of Tweets updated daily on Twitter can represent attitudes of netizens on the progress of vaccination, we used Bert model to predict and classify emotion categories to which different Tweets belong, with an accuracy rate of 80%. It is found that with the promotion of vaccination, fluctuation of netizen sentiment for vaccine progress has gradually decreased. Tweets with neutral sentiment still account for a majority of proportion, and the proportion of tweets with positive sentiment has gradually increased. In addition, we used LSTM model to predict the growth of cases with MSE less than 0.001. The growth of new cases in most countries gradually decreased to less than 10, 000 people per day after June. Therefore, most vaccines have made significant progress in both winning public support and preventing COVID-19 infection. © VDE VERLAG GMBH · Berlin · Offenbach.

8.
Mobile Networks & Applications ; 2022.
Article in English | Web of Science | ID: covidwho-2003754

ABSTRACT

To solve the problem of inaccurate entity extraction caused by low application efficiency and big data noise in telemedicine sensing data, a deep learning-based method for entity relationship extraction in telemedicine big data is proposed. By analyzing the distribution structure of the medical sensing big data, the fuzzy function of the distribution shape is calculated and the seed relationship set is transformed by the inverse Shearlet transform. Combined with the deep learning technology, the GMM-GAN data enhancement model is built, the interactive medical sensing big data features are obtained, the association rules are matched one by one, the noiseless medical sensing data are extracted in time sequence, the feature items with the highest similarity are obtained and used as the constraint to complete the feature entity relationship extraction of the medical sensing data. The experimental results show that the extracted similarity of entity relations is more than 70%, which can handle overly long and complex sentences in telemedicine information text;the extraction time is the shortest and the volatility is low.

9.
Journal of General Internal Medicine ; 37:S137, 2022.
Article in English | EMBASE | ID: covidwho-1995730

ABSTRACT

BACKGROUND: The COVID-19 pandemic has necessitated a rapid uptake of telemedicine in primary care. However, a comprehensive evaluation of such programs is currently lacking and there are substantial differences between telemedicine programs rolled out in different practices. We undertook this study to understand patients' and providers' experiences with telemedicine in primary care. METHODS: We conducted semi-structured interviews with primary care providers (n=21) and patients (n=65) with a chronic disease in three PCORnet sites in New York City, North Carolina and Florida. We specifically asked about barriers to and facilitators of, as well as benefits of and challenges with, telemedicine use. Three coders developed the code key and coded transcripts individually. Codes were compared and discrepancies resolved. Data was analyzed using interpretive description. RESULTS: Of the primary care providers, 62% were female and 9% selfi dentified as Black, 48% White, 24% Asian, 14% Hispanic and 5% Other. Of the patients, 60% were female and 25% self-identified as Black, 42% were White, 23% Hispanic, 1% Asian and 9% Other. Patients and providers both agreed that the benefits of telemedicine included increased convenience particularly for patients, eliminating travel hassle and time constraints. Primary challenges associated with telemedicine were the inability to do a physical exam, decreased patient-physician rapport and some concern about quality of care. Technology (internet difficulties, lack of access to video capability), lower technology literacy, complicated telemedicine platforms were seen as challenges to telemedicine use. Both patients and providers recommended more technological and ancillary support as well as increased education about telemedicine would facilitate telemedicine use. CONCLUSIONS: Patients and providers report several benefits of telemedicine during the COVID pandemic but telemedicine cannot fully replace in-person visits for a variety of reasons. Telemedicine can both exacerbate and ameliorate disparities in healthcare, and technology issues and improving technological and ancillary support may increase telemedicine use and reduce disparities in care.

10.
Journal of General Internal Medicine ; 37:S286-S287, 2022.
Article in English | EMBASE | ID: covidwho-1995618

ABSTRACT

BACKGROUND: The health and financial burdens faced by cancer survivors, compounded by the significant disruption in care and their increased risk for morbidity and mortality during the COVID-19 pandemic, emphasize the need to assess the mental health impact of the pandemic in this population. We examined the association between beliefs about COVID and posttraumatic stress disorder (PTSD) symptoms among breast and prostate cancer survivors. METHODS: Participants from two longitudinal cohort studies completed surveys assessing their beliefs about COVID- 19, as well as stress and PTSD symptoms. COVID beliefs were assessed using questions adapted from a previous coronavirus survey developed through an iterative process. PTSD symptoms were assessed using the PTSD Checklist (PCL-5). Participants with PCL-5 scores ≥ 33 were classified as having COVID-related PTSD symptoms. Surveys were completed between May 2020 and June 2021 and were categorized into four time points: season 1 from May 2020 to August 2020, season 2 from September 2020 to November 2020, season 3 from December 2020 to February 2021 and season 4 from March 2021 to June 2021. Chi-square, Fisher, Signed Rank Wilcoxon tests and general linear models were performed to assess the relationships between COVID beliefs and PTSD symptoms. RESULTS: Participants were 276 older cancer survivors (mean age 67 years), of whom 157 (57%) were female and had breast cancer and 118 (43%) were male with prostate cancer. Seventy (25%) self-identified as Black, 147 (53%) as White, and 36 (13%) identified as Latinx. Twenty-four participants (7%) had COVID-related PTSD symptoms. Participants with PTSD symptoms were more likely to be very worried about getting COVID (65% vs. 33%, p=0.007), more likely to think that ≥10% of people with COVID would die (75% vs. 40%, p=0.006), and that it was very likely that they or someone they know will get sick from COVID (64% vs. 23%, p=0.006). As the pandemic drew on, cancer survivors' beliefs about COVID changed such that fewer respondents reported that COVID changed their daily routine a lot in season 4 compared to season 1 (88% vs 65%, p <0.001), and fewer were very worried about getting COVID (38% vs. 19%, p=0.056). Temporality was also significantly associated with a decrease in PTSD symptoms with average PCL-5 scores decreasing from 14.2 to 8.9 in season 1 compared to season 4 (p <0.0001). CONCLUSIONS: As the pandemic progressed, cancer survivors tended to have decreased levels of PTSD symptoms, were less likely to have their routines disrupted and were less worried about getting COVID. However, among participants who had PTSD symptoms, concerns about COVID were significantly higher than among those without PTSD symptoms, emphasizing the need for mental health screening and counseling to better support survivors' coping with the impacts of the pandemic.

11.
Kexue Tongbao/Chinese Science Bulletin ; 67(21):2509-2521, 2022.
Article in Chinese | Scopus | ID: covidwho-1993426

ABSTRACT

The novel coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a public health emergency of international concern. Exposure to droplets produced in the coughs and sneezes of infected individuals has been perceived as the dominant transmission mode for COVID-19. However, increasingly more evidence supports claims of COVID-19 having airborne transmission. An in-depth understanding of the transmission pathways and influencing factors of SARS-CoV-2 is of great significance for formulating more effective intervention strategies. A large number of epidemiological investigations into the influence of atmospheric environmental conditions on virus transmission have been conducted. In this paper, we review current understandings of the association between COVID-19 and atmospheric environmental conditions. We first summarize the epidemiological investigations on the impact of atmospheric environmental factors (including solar radiation, temperature and humidity, wind speed, particulate matters, and gaseous pollutants) on the spread of COVID-19, and 164 epidemiological investigations are included, in which air temperature and relative humidity received the greatest attention. However, the impact of these factors on the prevalence of COVID-19 remains largely uncertain. 56% and 41% of investigations of temperature and humidity, respectively, show that cold and dry weather promotes COVID-19 transmission, while some studies come to the opposite conclusion, and still others do not show a significant relationship between them. Investigations of solar radiation are limited, but have come to the consistent conclusion that weak solar radiation is linked to increased severity of COVID-19 infection. Investigation of the impact of air pollution mainly focuses on particulate matters, and more than 70% of investigations indicate that PM2.5 likely contributes to the spread of COVID-19. Similarly, 62%, 51%, and 31% of investigations of NOx, O3, and SO2, respectively, indicate that the exposure to severe pollution can aggravate COVID-19 transmission. Therefore, the available findings reveal the complexity of the impact of atmospheric environmental conditions on the spread of COVID-19. We further discuss their mechanisms from three perspectives: (1) Atmospheric environmental conditions influence the generation of virus-laden aerosols and the occurrence of SARS-CoV-2 in the atmosphere. Relative humidity can affect the evaporation process of water on virus-laden aerosol, and thus affect its atmospheric life and probability of being inhaled by human body. (2) Atmospheric environmental conditions directly affect the stability of infection activity of SARS-CoV-2. Generally, high temperature, medium relative humidity, and intense solar radiation promote the inactivation of SARS-CoV-2. (3) Atmospheric environmental conditions indirectly affect the infection ability of SARS-CoV-2 by changing the defense ability of host cells. Air pollutants, especially PM2.5, can affect human susceptibility to the virus by increasing the expression of the SARS-CoV-2 receptor (angiotensin converting enzyme 2) in host cells. Meanwhile, meteorological conditions and air pollution can lead to respiratory system and other diseases in the human body, thus reducing human immunity and increasing the risk of virus infection, as well as the numbers of severely infected and fatal cases. All three mechanisms may contribute to the prevalence of COVID-19, but the dominant mechanism remains unclear. Finally, future directions of in-depth studies regarding the association between the epidemic and atmospheric conditions are proposed. © 2022 Chinese Academy of Sciences. All rights reserved.

12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 43(8): 1237-1240, 2022 Aug 10.
Article in Chinese | MEDLINE | ID: covidwho-1994239

ABSTRACT

Objective: To study the infection rate of secondary close contacts of COVID-19 patients, and assess the infection risk in the contacts. Methods: COVID-19 patients' close contacts (with a clear exposure time to index case) with negative nucleic acid test results and secondary close contacts were surveyed in continuous isolation and medical observation in this prospective study. The dynamic nucleic acid test results of the close contacts and secondary contacts of COVID-19 patients were collected to assess their risk of infection. Results: A total of 4 533 close contacts were surveyed, in whom 14 were confirmed as COVID-19 patients with overall secondary attack rate of 0.31%, and 4 201 secondary contacts were tracked, in whom no subsequent infections occurred. Conclusion: Close contacts of COVID-19 patients entered in centralized isolation for medical observation with negative nucleic acid tese results,the secondary close contacts of COVID-19 patients have no risk of infection.


Subject(s)
COVID-19 , Nucleic Acids , COVID-19/epidemiology , Contact Tracing , Humans , Incidence , Prospective Studies , SARS-CoV-2
13.
Frontiers in Psychiatry ; 13, 2022.
Article in English | EMBASE | ID: covidwho-1987558
14.
JOURNAL OF GENERAL INTERNAL MEDICINE ; 37(SUPPL 2):137-137, 2022.
Article in English | Web of Science | ID: covidwho-1935223
15.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925524

ABSTRACT

Objective: To investigate the impact of the COVID-19 pandemic on clinical trials in the field of neurology. Background: The COVID-19 pandemic and initiatives to curtail its spread disrupted the conduction of clinical research, forcing reimagination of the existing frameworks to execute scientifically sound human subjects research. In this study, we quantify the impact of the pandemic on clinical trial initiation and trial withdrawal in the field of neurology. Design/Methods: We used the largest publicly available database of clinical trials, clinicaltrials.gov, to compute the annual rate of change in clinical trial initiation and withdrawal in the field of neurology from January 2010 to December 2020 compared to the anticipated rate. Results: Our analysis showed a significant decrease in neurology clinical trial initiation in 2020 compared to pre-pandemic years [decrease by 12.4% in 2020 contrasted with the projected 9.7% overall increase (p < 0.0001)]. Significant decreases were maintained across all analyzed neurological subspecialties and study phases, except for combined Phase II/Phase III. Early Phase I (observed = -39.6%, expected = +37.3%, p < 0.05) and Phase I studies (observed = -20.4%, expected = +3.8%, p < 0.05) saw the greatest decreases. Study subtype analysis also revealed significant decreases in both interventional (observed = -12.4%, expected = +9.5%, p < 0.001) and observational studies (observed = -13.6%, expected = +10.3%, p < 0.01). In the analyzed time period from 2010 to 2020, 2020 was the only year demonstrating trial initiation declines compared to the preceding year. Conclusions: Our analysis demonstrated a significant reduction in neurology clinical trial initiation in the 2020 calendar year when compared to prior years, and that this pattern was seen across clinical research in neurology subspecialties. These data further demonstrate the inclusion of human subjects research in neurology as another consequence of SARS-CoV-2.

16.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925368

ABSTRACT

Objective: We present two patients with neurological complications following COVID-19 mRNA vaccination. Background: Post-vaccinal myelitis and demyelination is well described. We investigated two patients presenting inflammatory demyelination following mRNA based vaccination against COVID-19. Design/Methods: Patients were referred to the treating neurologist for a second opinion as possible cases of multiple sclerosis. Clinical neurological evaluation, MRI imaging of brain and spine as well as serum and cerebrospinal fluid (CSF) analysis was performed. Results: In case 1, the patient developed left-side numbness and difficulty walking six weeks post-second dose of the Moderna mRNA COVID-19 vaccine. She was found to have an enhancing thoracic cord lesion on MRIs, and CSF ELISA studies showed highly elevated IgG levels against the spike protein receptor-binding domain (S1-RBD) of COVID 19. In case 2, the patient began to hiccup and vomit, developed diplopia, and right-side weakness and numbness around two days post-second dose of the Moderna vaccine. MRIs showed two lesions on her brain and a C4 enhancing lesion on her spinal cord. CSF showed oligoclonal bands. However, further analysis of her spinal fluid showed highly elevated IgG antibodies to the S1-RBD. Conclusions: Initially, case 1 was diagnosed with transverse myelitis and possible multiple sclerosis, and case 2 with multiple sclerosis. Both patients likely would have received long-term immunosuppressive therapy had vaccine complications not been suspected. The presence of CSF antibodies to the S1-RBD protein suggests an immune response to the mRNA COVID-19 vaccinations crossing over to the CNS as the likely cause of these neurological complications. In patients developing acute neurological complaints in the period following vaccination, even with the presence of oligoclonal bands, CSF should be analyzed for reactivity against the S1-RBD. Further investigation is required to explain the mechanism of this response and subsequent complications. Both patients are clinically improving and will continue to be managed by a neurologist.

17.
Obstetrics and Gynecology ; 139(SUPPL 1):17S, 2022.
Article in English | EMBASE | ID: covidwho-1925355

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has caused mental health distress among health care professionals. This study aimed to evaluate the psychological impact of COVID-19 on medical students interested in obstetrics and gynecology at medical schools in two early epicenters of COVID-19. METHODS: This study was approved by the Weill Cornell Medicine Institutional Review Board. An online questionnaire was distributed to allopathic medical students in Washington and New York. The survey assessed mental health from March to April 2020 via the Patient Health Questionnaire, Generalized Anxiety Disorder Questionnaire, and questions on self-rated mental health. RESULTS: Out of 1,139 students who completed the survey, 63 reported a plan to pursue residency training in obstetrics and gynecology. Forty-six (74%) reported an overall deterioration in mental health, 34 (59%) reported depressive symptoms, and 38 (65%) reported anxiety symptoms. Seventeen (28%) students met criteria for major depressive disorder and 16 (27%) for anxiety disorder. Twenty-three (37%) reported at least one close contact with symptoms or diagnosis of COVID-19 and 7 (11%) reported at least one close contact with COVID-19-related death. Commonly cited self-care tactics included staying in touch with friends/family (92%), entertainment (81%), and fitness (65%). When compared to the overall population of students, there were no significant differences in responses for students interested in obstetrics and gynecology. CONCLUSION: Students in this study experienced high levels of depressive and anxiety symptoms. Medical trainees are already at an increased risk for depression and anxiety relative to the general population, making it critical for medical schools to understand students' perspectives and prioritize mental health.

18.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925348

ABSTRACT

Objective: Our ongoing single-center study aims to determine CoV2 spike protein-T-cell reactivity in fully vaccinated, B-cell depleted MS patients treated with rituximab or ocrelizumab, two well-characterized anti-CD20 monoclonal antibody drugs. Background: Many patients with multiple sclerosis (MS) undergo immunosuppressive B-cell depleting therapies which can severely limit their humoral immunity against SARS-CoV-2 (CoV2) infection or response to vaccination. While robust antibody production is seen in immunocompetent individuals, recent studies show that B-cell depleting therapies inhibit efficient production of antibodies against CoV2 proteins due to a reduction in circulating Bcells. It is unknown how these disease modifying therapies affect T-cell responses after CoV2 vaccination, and whether there is a correlation between CoV2 antibody levels and T-cell immunity. Design/Methods: We collected peripheral blood mononuclear cells (PBMCs) and serum samples from anti-CD20-treated MS patients and from healthy control individuals at 15-93 days after completing vaccination. CoV2 IgG response was determined using anti-spike protein-based serology, and levels of proinflammatory cytokine (IL-2 and INF-γ) release after protein-specific T-cell stimulation were measured ex vivo using an ELISpot assay. Results: We observed that out of 45 vaccinated anti-CD20-treated MS patients studied, 37 (82.2%) showed defective humoral immunity. Interestingly, most CoV2 spike IgG negative patients (35 out of 37, 94.6%) presented a T-cell response with positive expression of at least one cytokine. Conclusions: Our results suggest the generation of a partial adaptive immune response to CoV2 vaccination in B-cell depleted individuals, driven by a functionally competent T-cell arm. Investigation into the role of T-cell response in these individuals is crucial to identifying their levels of protection against COVID-19.

19.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925130

ABSTRACT

Objective: NA Background: Previous case reports have described 3 cases of autoimmune encephalitis and 1 case of new-onset refractory status epilepticus (NORSE) following COVID-19 viral vector vaccinations. However, no cases have been documented in association with COVID-19 mRNA vaccinations. We describe a case of NORSE after vaccination with Pfizer-BioNTech COVID-19 vaccine. Design/Methods: Case report. Results: A 56 year old healthy man presented with three days of fever, fatigue, and aphasia beginning 2 weeks after he received his first dose of the Pfizer-BioNTech COVID-19 vaccine. Video EEG showed temporally predominant seizures occurring independently bilaterally (right greater than left). Clinical seizures were characterized by head turn to the left and right hand movements. He then developed sustained right frontotemporal spike and slow wave activity consistent with non-convulsive status epilepticus. CSF demonstrated mild lymphocytic pleocytosis with WBC 16 cells/mm3, protein 24, glucose 76, and an opening pressure of 47. CSF bacterial and viral encephalitis panels, HSV, lyme, West Nile virus, and VDRL were all negative. Oligoclonal bands, paraneoplastic panel, and encephalopathy panel were negative. Systemic malignancy workup was negative. Initial MRI brain was unremarkable, but 1 week after symptom onset he developed bilateral hippocampal edema. The patient was empirically treated with broad spectrum antibiotics and antivirals which were later discontinued. Due to presumed diagnosis of autoimmune encephalitis, he was treated with high dose steroids, plasmapheresis, IVIG, and rituximab. He was treated with progressively escalating anti-seizure medications including midazolam, propofol, and ketamine continuous infusions and eventually stabilized on levetiracetam, lacosamide, phenobarbital, clobazam, zonisamide, oxcarbazepine, and perampanel. At the time of discharge, mental status had improved and aphasia resolved. Conclusions: To our knowledge, this is the first case of NORSE reported after Pfizer COVID-19 vaccination. While no test exists to definitively establish causality, these findings warrant further investigation of the possible association between COVID-19 vaccination and autoimmune encephalitis.

20.
Evidence-Based Practice in Child and Adolescent Mental Health ; 2022.
Article in English | EMBASE | ID: covidwho-1895734

ABSTRACT

The COVID-19 pandemic created compounding stressors for school-aged children, parents, and teachers and underscored the urgent need to widely implement evidence-based programs for promoting youth mental and behavioral health. In two community-engaged studies, we piloted psychoeducational workshops that taught behavior management and stress management strategies to parents and teachers. The research team partnered with a northern California school district to develop and implement these psychoeducational workshops. In study 1, parents (N = 165) participated in a series of workshops on behavior management. Parents perceived the strategies covered in each workshop to be acceptable, appropriate, and feasible and were able to accurately describe behavior management strategies following each workshop. In study 2, teachers (N = 113) participated in workshops on behavior management and stress management. Teachers perceived the strategies covered in each workshop to be acceptable, appropriate, and feasible and were able to accurately describe the strategies following each workshop. Findings suggest that psychoeducational workshops may be a promising avenue for promoting youth mental and behavioral health. Lessons learned from conducting this community-engaged research are discussed, as well as future directions for widely implementing psychoeducational workshops for parents and teachers.

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