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1.
West Indian Medical Journal ; JOUR:20-21, 70(Supplement 1).
Article in English | EMBASE | ID: covidwho-2083601

ABSTRACT

Objective: There are few published reports concerning the impact of the COVID-19 pandemic on children in the Caribbean. The specific impacts of COVID-19 on Caribbean children aged 0-19 are examined. Method(s): Using standardized online questionnaire , primary data and published reports the burden of COVID-19 among children is evaluated. Result(s): Most islands have pediatric specialists, but few have designated pediatric hospitals. The higher number of cases among children is notable in islands with large populations such as Cuba, Jamaica, Trinidad, the Dominican Republic, and Haiti. The proportion of children among all cases in these islands range from 0.6%- 16.9% compared with a global case rate of 20.2%. As of August 2021, there were 33 cumulative deaths among children in Haiti, Jamaica, in Trinidad and Barbados. The case fatality rates (CFR) for 0-9-year-old and 10-19-year-old were 2.8 and 0.7 for Haiti, 0.1 and 0.2 for Jamaica, and 0 and 0.14 for Trinidad compared with and globally. Higher CFRs in Haiti may be related to the testing strategy, which may not identify all cases. However, low socioeconomic status and a poor healthcare system may have had an impact. Conclusion(s): Overall COVID-19 prevalence and mortality in children were consistent with global estimates. A standardized regional assessment and the multidimensional impact of the COVID-19 pandemic among children warrants further examination in light of limited resources and the potential lifelong impact of secondary effects.

2.
Journal of General Internal Medicine ; 37:S663, 2022.
Article in English | EMBASE | ID: covidwho-1995579

ABSTRACT

SETTING AND PARTICIPANTS: Design: Cross-sectional. Setting/ participants: US graduating medical students. Inclusion: US allopathic medical schools with publicly available match data of individual students, 2018-2021. Exclusions: Students matching into preliminary, transitional, combined, or non-residency positions. DESCRIPTION: The COVID-19 pandemic disrupted the 2021 residency match with potential for significant geographic impact as students were unable to attend away rotations or in-person interviews. EVALUATION: Data sources: Association of American Medical Colleges (AAMC;2020), US News and World Report (USWNR) rankings (2020), and official university websites (2018-2021). The unit of analysis was each medical student. Analysis: We used the US Census Region and Division of medical schools and residency programs to calculate the match distance from medical school to residency. 'Match space' was defined by whether an applicant matched at their: home school, home state, adjacent state, same census division, adjacent census division, or skipped 1 or more census division. We defined competitive specialty with a composite variable comprising of US senior fill rate, number of positions, and salary. Ordinal logistic regression examined match distance (dependent outcome) with school, specialty characteristics, and pre/post COVID. Results: 34,672 students representing 66 medical schools from 28 states matched into 26 specialties in 50 states and Canada. 59% of students were from public institutions, and 27% of schools ranked in the top 40 for research. The mean percentage of in-state students by school was 60.3% (range 3- 100%). Match space was lower after the pandemic (adjusted odds ratio [OR] 0.94, 95% CI 0.90 - 0.98;p=0.006), from schools with higher percentage of in-state matriculants (OR 0.74, 95% CI 0.72-0.76), from top NIH-funded institutions (OR 0.88, 95% CI 0.85-0.92), from the Northeast (OR 0.71, 95% CI 0.67-0.75;Midwest reference), and the West (OR 0.67, 95% 0.60-0.74). Match space was higher for students graduating from private schools (OR 1.11, 95% CI 1.05- 1.19) or matching into more competitive specialties (OR 1.08, 95% CI 1.02-1.14). DISCUSSION / REFLECTION / LESSONS LEARNED: After the COVID-19 pandemic, students graduating from US allopathic schools matched closer to their home institution. Students attending public schools and schools with more in-state matriculants also matched closer. School reputation, with research rank as a surrogate, showed a higher match distance relative to those outside of the top 40 ranking. Our study adds insight into how geographic match patterns were influenced by school, specialty choice, and the pandemic.

3.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927898

ABSTRACT

Rationale: As a result of the SARS-CoV-2 pandemic, all pediatric pulmonary fellowship programs for the first time conducted virtual interviews in the Fall of 2020. This study aimed to understand applicants' experiences with virtual interviews and whether this format allowed them to gain accurate impressions of their current training program. Methods: A group of pediatric pulmonary fellows and Program Directors designed a REDCap survey. The survey was emailed to all pediatric pulmonary Program Directors for distribution to first-year fellows 6 months into their training. Results: 23/49 (47%) of first-year pediatric pulmonary fellows completed the survey. Because of the virtual interview format, 43% [CI 26-63%] of respondents reported that they applied to more programs and 65% [CI 45-81%] attended more interviews. Applicants with in-person exposure to their future fellowship program (i.e. attended same institution for residency and fellowship or participated in an elective rotation at the fellowship institution) applied to fewer programs (30% CI 11-60% vs. 54% CI 29-77%) and attended fewer interviews (40% CI 17-69% vs. 85% CI 58-96%) than those applicants with virtual-only exposure. 96% of applicants were able to form general impressions about fellowship programs based on their virtual interview. 96% of applicants expressed agreement that their current experience in fellowship matched their virtual interview-derived impression. Further breakdown of applicant ability to form impressions and how those impressions matched current fellowship experience is represented in figure 1. There was congruency between the virtualinterview derived impressions and actual fellowship experience for 19 different factors applicants used to rank programs. Correcting for in-person exposure to their fellowship institution prior to a virtual interview, fewer applicants with in-person exposure experienced a meaningful change in impression 6 months after arrival to their fellowship program (27% vs. 73%). 83% of applicants preferred some form of virtual interview to be included or offered in the future. A tiered interview format (applicants are invited to a virtual interview day followed by an optional in-person second look) was the most popular preference for future interview cycles (48%). Conclusions: Virtual interviews may provide an accurate representation of pediatric pulmonary fellowship programs and should be offered in future application cycles.

4.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-334727

ABSTRACT

The SARS-CoV-2 Gamma variant spread rapidly across Brazil, causing substantial infection and death waves. We use individual-level patient records following hospitalisation with suspected or confirmed COVID-19 to document the extensive shocks in hospital fatality rates that followed Gamma's spread across 14 state capitals, and in which more than half of hospitalised patients died over sustained time periods. We show that extensive fluctuations in COVID-19 in-hospital fatality rates also existed prior to Gamma's detection, and were largely transient after Gamma's detection, subsiding with hospital demand. Using a Bayesian fatality rate model, we find that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates are primarily associated with geographic inequities and shortages in healthcare capacity. We project that approximately half of Brazil's COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization, and pandemic preparedness are critical to minimize population wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries. NOTE: The following manuscript has appeared as 'Report 46 - Factors driving extensive spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals' at https://spiral.imperial.ac.uk:8443/handle/10044/1/91875 . ONE SENTENCE SUMMARY: COVID-19 in-hospital fatality rates fluctuate dramatically in Brazil, and these fluctuations are primarily associated with geographic inequities and shortages in healthcare capacity.

7.
Infect Dis (Lond) ; 54(7): 467-477, 2022 07.
Article in English | MEDLINE | ID: covidwho-1740717

ABSTRACT

BACKGROUND: A considerable proportion of individuals report persistent, debilitating and disparate symptoms despite resolution of acute COVID-19 infection (i.e. long COVID). Numerous registered clinical trials investigating treatment of long COVID are expected to be completed in 2021-2022. The aim of this review is to provide a scope of the candidate treatments for long COVID. A synthesis of ongoing long COVID clinical trials can inform methodologic approaches for future studies and identify key research vistas. METHODS: Scoping searches were conducted on multiple national and international clinical trial registries. Interventional trials testing treatments for long COVID were selected. The search timeline was from database inception to 28 July 2021. RESULTS: This scoping review included 59 clinical trial registration records from 22 countries with a total projected enrolment of 6718. Considerable heterogeneity was exhibited amongst component records with respect to the characterization of long COVID (i.e. name, symptoms- including frequency, intensity, trajectory and duration- mode of ascertainment, and definition of acute phase). In addition, the majority of proposed interventions were non-pharmacological and either targeted multiple long COVID symptoms simultaneously, or focussed on treatment of respiratory/pulmonary sequelae. Multiple interventions targeted inflammation, as well as tissue oxygenation and cellular recovery, and several interventions were repurposed from analogous conditions. CONCLUSIONS: The results of this scoping review investigating ongoing clinical trials testing candidate treatments for long COVID suggest that a greater degree of definitional stringency and homogeneity is needed insofar as the characterization of long COVID and inclusion/exclusion criteria.


Subject(s)
COVID-19 , COVID-19/complications , COVID-19/drug therapy , Humans , Research Design , SARS-CoV-2 , Treatment Outcome
8.
Science ; 372(6544):815-821, 2021.
Article in English | EMBASE | ID: covidwho-1735994

ABSTRACT

Cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Manaus, Brazil, resurged in late 2020 despite previously high levels of infection. Genome sequencing of viruses sampled in Manaus between November 2020 and January 2021 revealed the emergence and circulation of a novel SARS-CoV-2 variant of concern. Lineage P.1 acquired 17 mutations, including a trio in the spike protein (K417T, E484K, and N501Y) associated with increased binding to the human ACE2 (angiotensin-converting enzyme 2) receptor. Molecular clock analysis shows that P.1 emergence occurred around mid-November 2020 and was preceded by a period of faster molecular evolution. Using a two-category dynamical model that integrates genomic and mortality data, we estimate that P.1 may be 1.7- to 2.4-fold more transmissible and that previous (non-P.1) infection provides 54 to 79% of the protection against infection with P.1 that it provides against non-P.1 lineages. Enhanced global genomic surveillance of variants of concern, which may exhibit increased transmissibility and/or immune evasion, is critical to accelerate pandemic responsiveness.

9.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-326943

ABSTRACT

COVID-19 pathogen SARS-CoV-2 has infected hundreds of millions and caused over 5 million deaths to date. Although multiple vaccines are available, breakthrough infections occur especially by emerging variants. Effective therapeutic options such as monoclonal antibodies (mAbs) are still critical. Here, we report the development, cryo-EM structures, and functional analyses of mAbs that potently neutralize SARS-CoV-2 variants of concern. By high-throughput single cell sequencing of B cells from spike receptor binding domain (RBD) immunized animals, we identified two highly potent SARS-CoV-2 neutralizing mAb clones that have single-digit nanomolar affinity and low-picomolar avidity, and generated a bispecific antibody. Lead antibodies showed strong inhibitory activity against historical SARS-CoV-2 and several emerging variants of concern. We solved several cryo-EM structures at ~3 Å resolution of these neutralizing antibodies in complex with prefusion spike trimer ectodomain, and revealed distinct epitopes, binding patterns, and conformations. The lead clones also showed potent efficacy in vivo against authentic SARS-CoV-2 in both prophylactic and therapeutic settings. We also generated and characterized a humanized antibody to facilitate translation and drug development. The humanized clone also has strong potency against both the original virus and the B.1.617.2 Delta variant. These mAbs expand the repertoire of therapeutics against SARS-CoV-2 and emerging variants.

10.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-326624

ABSTRACT

Cases of SARS-CoV-2 infection in Manaus, Brazil, resurged in late 2020, despite high levels of previous infection there. Through genome sequencing of viruses sampled in Manaus between November 2020 and January 2021, we identified the emergence and circulation of a novel SARS-CoV-2 variant of concern, lineage P.1, that acquired 17 mutations, including a trio in the spike protein (K417T, E484K and N501Y) associated with increased binding to the human ACE2 receptor. Molecular clock analysis shows that P.1 emergence occurred around early November 2020 and was preceded by a period of faster molecular evolution. Using a two-category dynamical model that integrates genomic and mortality data, we estimate that P.1 may be 1.4-2.2 times more transmissible and 25-61% more likely to evade protective immunity elicited by previous infection with non-P.1 lineages. Enhanced global genomic surveillance of variants of concern, which may exhibit increased transmissibility and/or immune evasion, is critical to accelerate pandemic responsiveness. One-Sentence Summary: We report the evolution and emergence of a SARS-CoV-2 lineage of concern associated with rapid transmission in Manaus.

11.
Brain Behav Immun ; 101: 93-135, 2022 03.
Article in English | MEDLINE | ID: covidwho-1588234

ABSTRACT

IMPORTANCE: COVID-19 is associated with clinically significant symptoms despite resolution of the acute infection (i.e., post-COVID-19 syndrome). Fatigue and cognitive impairment are amongst the most common and debilitating symptoms of post-COVID-19 syndrome. OBJECTIVE: To quantify the proportion of individuals experiencing fatigue and cognitive impairment 12 or more weeks following COVID-19 diagnosis, and to characterize the inflammatory correlates and functional consequences of post-COVID-19 syndrome. DATA SOURCES: Systematic searches were conducted without language restrictions from database inception to June 8, 2021 on PubMed/MEDLINE, The Cochrane Library, PsycInfo, Embase, Web of Science, Google/Google Scholar, and select reference lists. STUDY SELECTION: Primary research articles which evaluated individuals at least 12 weeks after confirmed COVID-19 diagnosis and specifically reported on fatigue, cognitive impairment, inflammatory parameters, and/or functional outcomes were selected. DATA EXTRACTION & SYNTHESIS: Two reviewers independently extracted published summary data and assessed methodological quality and risk of bias. A meta-analysis of proportions was conducted to pool Freeman-Tukey double arcsine transformed proportions using the random-effects restricted maximum-likelihood model. MAIN OUTCOMES & MEASURES: The co-primary outcomes were the proportions of individuals reporting fatigue and cognitive impairment, respectively, 12 or more weeks following COVID-19 infection. The secondary outcomes were inflammatory correlates and functional consequences associated with post-COVID-19 syndrome. RESULTS: The literature search yielded 10,979 studies, and 81 studies were selected for inclusion. The fatigue meta-analysis comprised 68 studies, the cognitive impairment meta-analysis comprised 43 studies, and 48 studies were included in the narrative synthesis. Meta-analysis revealed that the proportion of individuals experiencing fatigue 12 or more weeks following COVID-19 diagnosis was 0.32 (95% CI, 0.27, 0.37; p < 0.001; n = 25,268; I2 = 99.1%). The proportion of individuals exhibiting cognitive impairment was 0.22 (95% CI, 0.17, 0.28; p < 0.001; n = 13,232; I2 = 98.0). Moreover, narrative synthesis revealed elevations in proinflammatory markers and considerable functional impairment in a subset of individuals. CONCLUSIONS & RELEVANCE: A significant proportion of individuals experience persistent fatigue and/or cognitive impairment following resolution of acute COVID-19. The frequency and debilitating nature of the foregoing symptoms provides the impetus to characterize the underlying neurobiological substrates and how to best treat these phenomena. STUDY REGISTRATION: PROSPERO (CRD42021256965).


Subject(s)
COVID-19 , Cognitive Dysfunction , COVID-19/complications , COVID-19 Testing , Fatigue/etiology , Humans , SARS-CoV-2
12.
Brain Sci ; 11(12)2021 Dec 08.
Article in English | MEDLINE | ID: covidwho-1555010

ABSTRACT

The COVID-19 pandemic has resulted in a predominantly global quarantine response that has been associated with social isolation, loneliness, and anxiety. The foregoing experiences have been amply documented to have profound impacts on health, morbidity, and mortality. This narrative review uses the extant neurobiological and theoretical literature to explore the association between social isolation, loneliness, and anxiety in the context of quarantine during the COVID-19 pandemic. Emerging evidence suggests that distinct health issues (e.g., a sedentary lifestyle, a diminished overall sense of well-being) are associated with social isolation and loneliness. The health implications of social isolation and loneliness during quarantine have a heterogenous and comorbid nature and, as a result, form a link to anxiety. The limbic system plays a role in fear and anxiety response; the bed nucleus of the stria terminalis, amygdala, HPA axis, hippocampus, prefrontal cortex, insula, and locus coeruleus have an impact in a prolonged anxious state. In the conclusion, possible solutions are considered and remarks are made on future areas of exploration.

13.
Atherosclerosis ; 340: 12-22, 2022 01.
Article in English | MEDLINE | ID: covidwho-1536439

ABSTRACT

BACKGROUND AND AIMS: The atherosclerotic plaque microenvironment is highly complex, and selective agents that modulate plaque stability are not yet available. We sought to develop a scRNA-seq analysis workflow to investigate this environment and uncover potential therapeutic approaches. We designed a user-friendly, reproducible workflow that will be applicable to other disease-specific scRNA-seq datasets. METHODS: Here we incorporated automated cell labeling, pseudotemporal ordering, ligand-receptor evaluation, and drug-gene interaction analysis into a ready-to-deploy workflow. We applied this pipeline to further investigate a previously published human coronary single-cell dataset by Wirka et al. Notably, we developed an interactive web application to enable further exploration and analysis of this and other cardiovascular single-cell datasets. RESULTS: We revealed distinct derivations of fibroblast-like cells from smooth muscle cells (SMCs), and showed the key changes in gene expression along their de-differentiation path. We highlighted several key ligand-receptor interactions within the atherosclerotic environment through functional expression profiling and revealed several avenues for future pharmacological development for precision medicine. Further, our interactive web application, PlaqView (www.plaqview.com), allows lay scientists to explore this and other datasets and compare scRNA-seq tools without prior coding knowledge. CONCLUSIONS: This publicly available workflow and application will allow for more systematic and user-friendly analysis of scRNA datasets in other disease and developmental systems. Our analysis pipeline provides many hypothesis-generating tools to unravel the etiology of coronary artery disease. We also highlight potential mechanisms for several drugs in the atherosclerotic cellular environment. Future releases of PlaqView will feature more scRNA-seq and scATAC-seq atherosclerosis-related datasets to provide a critical resource for the field, and to promote data harmonization and biological interpretation.


Subject(s)
Coronary Artery Disease , Pharmaceutical Preparations , Coronary Artery Disease/drug therapy , Coronary Artery Disease/genetics , Gene Expression Profiling , Humans , RNA-Seq , Sequence Analysis, RNA , Single-Cell Analysis , Software , Workflow
14.
PUBMED; 2021.
Preprint in English | PUBMED | ID: ppcovidwho-292866

ABSTRACT

The SARS-CoV-2 Gamma variant spread rapidly across Brazil, causing substantial infection and death waves. We use individual-level patient records following hospitalisation with suspected or confirmed COVID-19 to document the extensive shocks in hospital fatality rates that followed Gamma's spread across 14 state capitals, and in which more than half of hospitalised patients died over sustained time periods. We show that extensive fluctuations in COVID-19 in-hospital fatality rates also existed prior to Gamma's detection, and were largely transient after Gamma's detection, subsiding with hospital demand. Using a Bayesian fatality rate model, we find that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates are primarily associated with geographic inequities and shortages in healthcare capacity. We project that approximately half of Brazil's COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization, and pandemic preparedness are critical to minimize population wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries. Note: The following manuscript has appeared as 'Report 46 - Factors driving extensive spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals' at https://spiral.imperial.ac.uk:8443/handle/10044/1/91875 . One sentence summary: COVID-19 in-hospital fatality rates fluctuate dramatically in Brazil, and these fluctuations are primarily associated with geographic inequities and shortages in healthcare capacity.

15.
Psychiatry Res ; 303: 114086, 2021 09.
Article in English | MEDLINE | ID: covidwho-1303645

ABSTRACT

Herein we evaluate the impact of COVID-19 restrictions on antidepressant effectiveness of intravenous (IV) ketamine in adults with treatment-resistant depression (TRD). We conducted a case series analysis of adults with TRD (n = 267) who received four ketamine infusions at an outpatient clinic in Ontario, Canada, during COVID-19 restrictions (from March 2020 - February 2021; n = 107), compared to patients who received treatment in the previous year (March 2019 - February 2020; n = 160). Both groups experienced significant and comparable improvements in depressive symptoms, suicidal ideation, and anxiety with repeated ketamine infusions. Effectiveness of IV ketamine was not attenuated during the COVID-19 period.


Subject(s)
COVID-19 , Depressive Disorder, Major , Depressive Disorder, Treatment-Resistant , Ketamine , Adult , Depression , Depressive Disorder, Major/drug therapy , Depressive Disorder, Treatment-Resistant/drug therapy , Humans , Infusions, Intravenous , Ketamine/therapeutic use , Ontario , Pandemics , SARS-CoV-2
16.
J Affect Disord ; 290: 364-377, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1244755

ABSTRACT

BACKGROUND: The COVID-19 pandemic represents a public health, economic and mental health crisis. We hypothesized that timely government implementation of stringent measures to reduce viral transmission would benefit mental health, as evidenced by reduced rates of depressive symptoms (i.e., Patient Health Questionnaire [PHQ]-9≥10, PHQ-2≥3). METHODS: The systematic review herein (PROSPERO CRD42020200647) evaluated to what extent differences in government-imposed stringency and timeliness of response to COVID-19 moderate the prevalence of depressive symptoms across 33 countries (k=114, N=640,037). We included data from six lower-middle-income countries, nine upper-middle-income countries, and 18 higher-income countries. Government-imposed stringency and timeliness in response were operationalized using the Oxford COVID-19 Government Response ("Stringency") Index. RESULTS: The overall proportion of study participants with clinically significant depressive symptoms was 21.39% (95% CI 19.37-23.47). The prevalence of clinically significant depressive symptoms was significantly lower in countries wherein governments implemented stringent policies promptly. The moderating effect of government response remained significant after including the national frequency of COVID cases at the time of study commencement, Healthcare Access and Quality index, and the inclusion of COVID patients in the study. LIMITATIONS: Factors that may have confounded our results include, for example, differences in lockdown duration, lack of study participant and outcome assessor blinding, and retrospective assessment of depressive symptom severity. CONCLUSIONS: Governments that enacted stringent measures to contain the spread of COVID-19 benefited not only the physical, but also the mental health of their population.


Subject(s)
COVID-19 , Pandemics , Communicable Disease Control , Depression/epidemiology , Government , Humans , Mental Health , Retrospective Studies , SARS-CoV-2
17.
Journal of Vascular and Interventional Radiology ; 32(5):S61-S62, 2021.
Article in English | EMBASE | ID: covidwho-1222966

ABSTRACT

Purpose: To describe the reaction of interventional radiology (IR) residency programs to COVID-19 by way of social media, virtual sub-internship and virtual open house opportunities for applicants Materials and Methods: A list of integrated IR residencies was obtained from ERAS, identifying 89 programs. Twitter, Instagram, and Facebook presence of each program was reviewed between September 9 and 13, 2020. Social media accounts were assigned to programs only if “interventional” or “IR” was included in the account username or description. Shared diagnostic radiology/IR accounts were included only if the above criteria were met. Date of creation of social media accounts and virtual sub-internship and open house opportunities offered to students were recorded. VSAS was reviewed for virtual opportunities. Each program’s date of initial accreditation was obtained from ACGME. Results: Of the 89 programs, 61 (68%) had a social media presence and 107 total social media accounts were identified. All programs with social media presence had been accredited for at least two years. Social media characteristics of programs are profiled in the Table. Three programs (3%) offered virtual sub-internships on VSAS, and no sub-internship opportunities were identified on any social media accounts. Twelve programs had updated their websites to reflect changes in protocol due to COVID-19. Conclusions: COVID-19 has altered the way we conduct business within graduate medical education. Given the ubiquitous restrictions in place pertaining to sub-internships and visitations, social media has become a cornerstone of recruitment and knowledge for residency programs and prospective applicants alike. Individuals and institutions have potential to engage with those outside their normal scope owing to increased social media outreach and efforts. Perhaps this shift toward digital engagement will persist and have lasting impact. [Formula presented]

18.
Open Forum Infectious Diseases ; 7(SUPPL 1):S256, 2020.
Article in English | EMBASE | ID: covidwho-1185737

ABSTRACT

Background: Patients with COVID-19 may be at increased risk for secondary bacterial infections. At our quaternary care hospital in New York City, the rapid escalation of COVID-19 cases was accompanied by a massive surge in the need for hospital and critical care capacity. During this time, we noted a increase in infections caused by carbapenemase-producing Enterobacterales (CPE). Methods: We retrospectively assessed microbiology data to identify patients with positive testing for SARS-CoV-2 who had clinical cultures with meropenem-resistant and/or carbapenemase gene-positive Enterobacterales. We obtained microbiological and clinical data by manual chart review. Available clinical isolates underwent long-range genomic sequencing using the MinION (Oxford) for rapid genotyping, resistance gene detection, and phylogenetic analysis. Results: From March 1 to May 18, we identified 33 CPE isolates from 13 patients, including 29 Klebsiella pneumonia and four Enterobacter cloacae. Most patients (11/13) had a positive respiratory culture, and 7/13 developed bacteremia. All patients had prolonged, complex hospitalizations with extensive antibiotic exposure. We performed long-range sequencing on 19 isolates from 12 patients. 15/16 K. pneumoniae isolates belonged to sequence type (ST) 258 encoding KPC (14 KPC-2;1 KPC-3);one ST70 isolate encoded KPC-2. All four E. cloacae isolates belonged to ST270 and encoded NDM-1. Phylogenetic analysis of ST258 isolates including historical isolates from our hospital revealed a distinct lineage of isolates from COVID-19 patients (72% bootstrap support), with expected clustering of isolates from the same patient and patients that were cohorted together. Conclusion: While CPE have declined substantially in New York City in recent years, increased detection in patients with COVID-19 may signal a reemergence of these highly resistant pathogens in the wake of the global pandemic. System-level factors, such as the rapid scale-up of critical care capacity, while clearly needed to address the unprecedented reach of COVID-19, may have contributed to isolate clustering in these patients. Increased surveillance and antimicrobial stewardship efforts will be needed to mitigate the impact of CPE in the future.

19.
Revista Ibérica de Sistemas e Tecnologias de Informação ; - (E40):330-338, 2021.
Article in Portuguese | ProQuest Central | ID: covidwho-1055484

ABSTRACT

Abstract: The objective of this study is to present long-term forecasts of the accumulated number of confirmed cases and deaths from COVID-19 per million inhabitants from the first confirmed case to day 350 in each South American country, using the logistic growth model with three parameters. Comparing the forecasts of the number of confirmed cases and deaths, it was observed that Paraguay, Peru and Argentina will take longer to significantly reduce the number of confirmed cases and Argentina in the number of deaths. [...]Venezuela and Uruguay present the number of confirmed cases and deaths accumulated almost constantly, that is, there will be no significant increases during the following months. Keywords: logistic growth model;COVID-19 SARS-COV2, Nonlinear Mixed Effects Models. 1.

20.
Nature Machine Intelligence ; 2(10):566-572, 2020.
Article in English | Scopus | ID: covidwho-885531

ABSTRACT

The COVID-19 pandemic has changed our world and impacted multiple layers of our society. All frontline workers and in particular those in direct contact with patients have been exposed to major risk. To mitigate pathogen spread and protect healthcare workers and patients, medical services have been largely restricted, including cancellation of elective surgeries, which has posed a substantial burden for patients and immense economic loss for various hospitals. The integration of a robot as a shielding layer, physically separating the healthcare worker and patient, is a powerful tool to combat the omnipresent fear of pathogen contamination and maintain surgical volumes. In this Perspective, we outline detailed scenarios in the pre-, intra- and postoperative care, in which the use of robots and artificial intelligence can mitigate infectious contamination and aid patient management in the surgical environment during times of immense patient influx. We also discuss cost-effectiveness and benefits of surgical robotic systems beyond their use in pandemics. The current pandemic creates unprecedented demands for hospitals. Digitization and machine intelligence are gaining significance in healthcare to combat the virus. Their legacy may well outlast the pandemic and revolutionize surgical performance and management. © 2020, Springer Nature Limited.

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