Waste Workers and Pickers: Neglected High-risk Groups in Developing Countries during the COVID-19 Pandemic

The COVID-19 pandemic has induced some negative environmental issues, especially in the waste management sector. In developing countries, handling waste is carried out by two groups: waste workers and waste pickers who are exposed to possible hazards of infected waste. In the present narrative review, we searched for high-quality English publications in PubMed, Scopus, and Embase databases. The COVID-19 pandemic led to several problems in waste management systems, especially in developing countries. Due to poor management systems, waste workers and pickers are likely exposed to health risks related to unhealthy waste handling. The support of governments is urgently required to properly inform ordinary people about the correct ways of disposing of PPE and also train sanitation workers and waste pickers to reduce the hazardous possibilities. Additionally, financial support can also act as a suppressive agent to reduce the number of waste pickers. © 2023 Authors. All rights reserved.

Diffuse large B-cell lymphoma transformation mimicking a recurrence of colorectal cancer in a patient with multiple malignancies attributable to BRCA1 positivity

Introduction: Our knowledge of genetic contributions to malignancy risk has increased greatly over the past two decades. It is now known that BRCA1 gene mutation is associated with a 50% lifetime risk of developing malignancy.Women who carry a BRCA1 mutation have a 47-66% lifetime risk of developing breast cancer, a 63% chance of developing cancer in the contralateral breast at 25 years, and a 35-46% lifetime risk of developing ovarian cancer.1,2 BRCA1 mutation carriers also have increased rates of pancreatic cancer (odds ratio [OR], 2.26), leukemia, and lymphomas (OR, 2.6).3,4 There is conflicting evidence regarding the effect of BRCA1 mutation on a patient's risk of developing colorectal cancer, but it may increase the risk up to 1.5 times.5,6 Independent of known genetic syndromes, cancer survivors are 14% more likely to be diagnosed with a new malignancy than those who have not had a previous cancer.1 Patients with colorectal cancer at stage two or three have a 40% recurrence rate after primary therapy, with more than 90% of recurrences occurring within the first 5 years.7 Transformation of follicular lymphoma to diffuse large B-cell lymphoma (DLBCL) occurs in up to 24% of cases, although it is less common in patients who have achieved clinical remission. Overall, this improved knowledge has resulted in increased surveillance for recurrence and associated malignancies. Case report: A 77-year-old woman underwent colonoscopy after lymphoma surveillance screening incidentally revealed a positron emission tomography-avid cecal lesion. This was on a background of previous colorectal cancer, managed with a left hemicolectomy and adjuvant chemotherapy with 5-fluorouracil and leucovorin in 1995. The patient was overdue for colonoscopy surveillance due to delays attributed to the COVID-19 pandemic. She was asymptomatic, with no weight loss, fevers, or night sweats. She denied change in bowel habit, with daily motions without the presence of tenesmus, melena, or rectal bleeding. Her past medical history was also significant for known BRCA1 positivity, which was diagnosed following bilateral breast cancer, affecting the right breast in 1981 and left breast in 1991. This was treated with bilateral mastectomy and axillary dissection. The patient received prophylactic hysterectomy and bilateral salpingo-oophorectomy in 2000. She previously had stage IIIa low-grade follicular lymphoma and received six cycles of bendamustine plus rituximab in 2018 and was considered in remission, with ongoing 6-monthly surveillance imaging. The patient's other medical conditions included metabolic syndrome, gastroesophageal reflux disease, osteoporosis, depression, left lacunar infarct, epilepsy, and cataracts. Examination revealed a non-tender abdomen with central adiposity. There was no palpable abdominal mass or evidence of hepatosplenomegaly or lymphadenopathy. She had a normal cardiovascular and respiratory examination. Colonoscopy showed a large two-thirds circumferential non-obstructing mass in the cecum. There was no evidence of bleeding, and the mass was biopsied. Histology showed that atypical lymphoid cells were present at an ulcer base with surrounding necrotic tumor cells. These cells were strongly positive for BCL2, CD45, CD20, and CD79a within the nodular lymphoid aggregate and negative for AE1/3 and CAM5.2. This appearance was consistent with a diagnosis of high-grade DLBCL. The patient had her care transferred to her hematologist, who confirmed a diagnosis of DLBCL and instigated six cycles of modified R-CHOP regimen for chemotherapy. Conclusion(s): This is a rare case of colorectal lymphoma and illustrates the well-documented risk of progression from follicular lymphoma to the more sinister DLBCL. It highlights the complexity of cancer genetics, justifies the increased need for malignancy surveillance within these groups, and confirms the importance of biopsy for all abnormal colorectal lesions.

Data Analysis of Crime and Rates of Hospitalization due to COVID-19

There has been an increasing concern that African American community has been disproportionately impacted during the coronavirus pandemic. This paper analyzes why the African American community is disproportionately impacted during the coronavirus pandemic and compares the COVID-19 data with hospitalizations, real estate, school closings, and crime data. Human behavior was impacted as a result of lockdown due to COVID pandemic and it lead to a shift in crime dynamics. We analyze shifts in crime types by comparing crimes before and after the COVID pandemic in Baltimore. There was a significant decline in total crimes during the time period immediately following stay at home orders. Findings show that the disproportionality among the African American community is significantly influenced by factors such as living in more crowded housing situations, working in consumer-facing serviced industries, having higher rates of preexisting medical conditions, and lack of insurance or a consistent care source.

HIGHER RATES OF LONG COVID SYMPTOMS IN PATIENTS WITH MILD COVID-19

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has affected over 61 million U.S. citizens, and up to 30-80% of COVID-19 survivors may go on to develop post-acute sequelae of SARS-CoV-2 (PASC). These sequelae can be debilitating and often impair quality of life and daily function. Although it has been suggested that severity of acute COVID-19 infection is directly related to PASC development, this association remains unclear. METHODS: This prospective cohort study was conducted through consecutive recruitment of confirmed and probable COVID-19 patients with persistent symptoms lasting ≥3 weeks from disease onset or positive SARS-CoV-2 test from academic PASC clinics at Emory University and Grady Memorial Hospital in Atlanta, GA during January-December 2021. Sociodemographic, comorbidity, and acute COVID-19 data were collected. Severe acute COVID- 19 was defined as requiring hospitalization, and critical acute COVID-19 required intensive care. New or worsening symptoms persisting ≥3 weeks from COVID-19 onset were collected using a standardized review of systems, and confirmed by clinician interview. Differences in PASC symptom type were assessed by calculating risk ratios (RR) and 95% confidence intervals (CI) using the Taylor series, and difference in PASC duration was assessed using student's t-test. Two-tailed p-values ≤0.05 were considered significant. RESULTS: Of 269 enrollees, median age was 52 years (range 18-93) and there were more women (74%) than men (26%). There were 152 (57%) African American, 76 (28%) White, and 21 (8%) Hispanic. Among PASC patients, the most common symptoms were dyspnea (68%), fatigue (63%), brain fog (48%), dizziness (27%), chest pain (25%), cough (23%) and headache (23%) with a median PASC duration of 132 days (range 21-523). Acute COVID-19 severity was asymptomatic in one participant, mild in 149 (55%), severe in 95 (35%), and critical in 23 (9%). Asymptomatic- mild acute COVID-19 patients had more persistent dyspnea (RR: 1.33, 95%, CI: 1.09- 1.61), fatigue (RR: 1.53, 95%CI: 1.22-1.91), brain fog (RR: 2.00, 95%CI: 1.44-2.67), dizziness (RR: 2.03, 95%CI: 1.27-3.25), and headache (RR: 2.07, 95%CI: 1.22-3.48) compared with severe-critical acute disease, who had a non-significant trend towards more cough and chest pain. Asymptomatic-mild participants were further from incident infection (153 days) compared to severe-critical participants (110 days) (p=0.04). CONCLUSIONS: Contrary to previous observations, COVID-19 survivors who experienced asymptomatic-mild infections may develop higher rates of prevalent PASC symptoms compared to those with severe- critical antecedent infections. These findings are not attributable to PASC duration, as longer PASC duration has been previously associated with fewer symptoms. To ensure early identification and linkage to specialized care, clinicians should be aware of PASC in patients with antecedent asymptomatic-mild acute COVID-19 infections.

False Information as a Threat to Modern Society: A Systematic Review of False Information, Its Impact on Society, and Current Remedies

False information and by extension misinformation, disinformation and fake news are an ever-growing concern to modern democratic societies, which value the freedom of information alongside the right of the individual to express his or her opinions freely. This paper focuses on misinformation, with the aim to provide a collation of current research on the topic and a discussion of future research directions. It argues that a major current issue is the lack of reliable verified datasets and, by extension, the algorithmic learning models based on them. Through the understanding of different variations of false information, it has been possible to see the impact this absence is currently having on society. At the core is a focus on misinformation. A deeper investigation shows that artificial intelligence-based techniques are widely used to counter the effects and confusion caused by misinformation. Potential consequences of misinformation are being highlighted to allow insight into potential issues that may arise from this form of false information to highlight the severity of the issue and to demonstrate the growing need for reliable detection and prevention systems.

An uncommon case of hypoxia in a pediatric patient

INTRODUCTION: Pulmonary arteriovenous malformations (PAVM) are typically associated with hereditary hemorrhagic telangiectasia. Isolated PAVM are uncommon and usually present between the 4th-6th decades of life;they are rarely seen in children and infrequently necessitate ICU admission. DESCRIPTION: A healthy 3-year-old boy presented to his pediatrician with a 3 day history of fever and rhinorrhea. He was hypoxic (SpO2=85%), so was placed on oxygen and transferred to an outside ED where he was found to have (non-COVID) coronavirus. He was admitted for supportive care but clinically deteriorated over the next 24 hours requiring intubation, ventilatory support with 100% FiO2, and inhaled nitric oxide. Despite these interventions he remained hypoxic. Echocardiogram demonstrated a structurally normal heart. Computed tomography angiogram showed multiple large peripheral PAVM in the left lower and upper lobes and no differentiation between arterial and venous phases indicating pulmonary shunting. He was transferred to our quaternary ICU for intervention. He underwent embolization of ~70% of his PAVM (limited due to contrast load). He initially improved, but 2 days post-intervention he declined with worsening hypoxia likely secondary to pulmonary vascular remodeling following intervention and residual shunt burden within the left lung. Given his instability, as well as an oxygenation index of 34, he was cannulated for venoarterial extracorporeal membrane oxygenation (ECMO). Following cannulation, his remaining PAVM were embolized. ECMO support was subsequently weaned and he was decannulated after 4 days. His ventilator support was weaned, and he was transferred back to the referring hospital on minimal settings. He was extubated the next day and quickly weaned to room air. He was discharged after 2.5 weeks and was doing well (SpO2=95%) at his pediatrician follow-up. DISCUSSION: This is the first case of a previously healthy child requiring cannulation for ECMO due to PAVM. This case is unique among patients with PAVM due to the early presentation, likely related to an acute respiratory illness disturbing previously well-compensated ventilation-perfusion mismatch. As highlighted in this case, ECMO can be used to support patients who require interventions for PAVM and during the transition to a new physiologic state.

The effects of aging services and the supplemental nutrition assistance program on food insecurity among older Georgians: 2018-2020

Using administrative data from Georgia covering January 2018-August 2020, we estimated the effect of services provided through the Older Americans Act (OAA) and the Supplemental Nutrition Assistance Program (SNAP) on food insecurity among older Georgians. Our sample included those who received services prior to and during the coronavirus disease 2019 (COVID-19) pandemic. For the entire sample period, we found home-delivered meals and other OAA services reduced food insecurity by 3% and 4%, respectively. During COVID-19, the effect of SNAP on reducing food insecurity significantly increased from 2.1% to 4.7%, while the loss of "traditional" congregate meals services increased food insecurity by 7%.

False Information in a Post Covid-19 World

The Covid-19 pandemic has greatly impacted the landscape of modern society. This holds implications when considering how false information may be used in a post Covid-19 world. When considering scenario that false information could affect such as medical information, vaccinations, and propaganda there is a clear need for deepened understanding and reaction as it happens, to combat potential catastrophic outcomes. Combining this with the stamping out of false information on social media platforms, as well as more traditional media outlets such as newspapers, reliable medical advice can be distributed in a concise and effective way being of great benefit to the wider public health. Understanding how false information could impact the post Covid-19 world through examining specific scenario and by extension the resulting impact, it is possible to prepare and potentially reduce the effect false information may have leading to a safer post Covid-19 society for all. In this chapter, we have highlighted different aspects of false information in the context of covid-19. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Rapid implementation of a novel embedded senior medical student program, as a response to the educational challenges of covid-19

As with many OECD countries, graduating medical students have been choosing specialist careers at a greater rate than ever before. Generalism in the form of family (general practice) and more generalist medical specialties have been trending down resulting in distributional geographic challenges. With the advent of COVID-19 in March 2020, medical schools and in particular the Joint Medical Program situated in a regional and rural area in NSW Australia had the unique opportunity to rethink the penultimate year curriculum when the previous rapid rotation model through numerous medical specialities became untenable. The need to vision a new practical pragmatic curriculum spurred a rapid revaluation of assessment, placement length and model with a pivot to an "embedded senior student placement" agnostic of discipline and supported by a competency-based learning portfolio. This article explores the barriers and enablers and identifies the potential elements of this type of placement which can be adapted to community and smaller rural sites. The positive student and supervisor experience also enabled an employment model to be woven into the students learning and ensured on hand medical student workforce for hospitals throughout the rural footprint. The capacity of these placements to celebrate variation in experience and support students to learn on the job have now caused a revision of the penultimate year with expectation of gains in students' satisfaction and in employability. It has also opened up options to deliver and increase the inherent value of generalist placements with likely long term workforce benefit. © 2021 Coventry University. All rights reserved.

Transmission of SARS-COV-2 in the hospital setting: Who is infecting whom?

Introduction: A better understanding of the relative importance of different transmission pathways of SARS-CoV-2 in hospital settings has the potential to help improve targeting of control measures aimed at reducing nosocomial spread. Objectives: To quantify the associations between risks of nosocomial SARS-CoV-2 infection and exposure on the same ward to infected healthcare workers (HCWs), to patients likely to have been infected nosocomially, and to patients with community onset COVID-19. Methods: Ward-level data were collected from four teaching hospitals in Oxfordshire, UK, over an 8 month period in 2020. SARS-CoV-2 infections were identified using both PCR results from symptomatic and asymptomatic testing and serological data coupled with symptom recall. A series of statistical models were used to quantify associations between exposures and probable hospital transmission events. Results: Risk to patients of probable nosocomial acquisition was most strongly associated with exposure to other patients with hospitalacquired SARS-CoV-2 (aOR, 1.76, 95%CI 1.51, 2.04), followed by the presence of an infected HCW on the same ward (aOR 1.45, 95%CI 1.22,1.71). The association with patients with community onset COVID- 19 was weaker (aOR 1.12, 95%CI 0.96,1.26). Transmission to HCWs was associated with exposure to other infectious HCWs and patients with hospital-acquired SARS-CoV-2 (aOR 1.66, 95%CI 1.55,1.78 and aOR 1.45, 95%CI 1.32,1.58 respectively). The introduction of more stringent infection prevention and control measures which included testing all patients for SARS-CoV-2 by PCR on admission and at weekly intervals was associated with substantial reduction in transmission risk to both patients (adjusted odds ratio, aOR 0.25, 95%CI 0.14, 0.42) and HCWs (aOR 0.43, 95%CI 0.34, 0.53). Conclusion: Patients who acquired SARS-CoV-2 in the hospital and, to a lesser degree, infectious HCWs likely working prior to the onset of symptoms, were the most strongly associated with increased risk of SARSCoV- 2 transmission. In contrast, exposure to patients who had acquired SARS-CoV-2 in the community was associated with, at most, modest increases in the daily risk of infection for both healthcare staff and the other patients.