Parameters of coagulation in COVID-19 patients: a correlation with clinical severity

Introduction: COVID-19 infection can be complicated by coagulation derangement and a high risk of thromboembolic episodes. Our study aimedto investigate coagulation parameters in COVID-19 patients and their correlation with clinical severity. Methods: We analyzed coagulation parameters PT, APTT, D-Dimer, and Fibrinogen in 98 RT-PCR-confirmed COVID-19 patients admitted to the Government Institute of Medical Sciences, Gautam Buddha Nagar, Uttar Pradesh, India. Results: This study involved 69 males (70.50%), and 29 (29.5%) were females. The mortality rate was 6.12% (n= 06). Forty-six patients (46.94%) had comorbidities. Thirty-four patients had elevated PT, and 7 had high APTT, whereas D-dimer and fibrinogen levels were raised in 68 and 61 patients, respectively. Among all four parameters, D-Dimer levels were significantly associated with disease severity. Conclusion: Derangement of D-dimer levels is significantly associated with disease severity in COVID-19 infection.

Investigation on the risk factores for mortality of patients with COVID-19 and prioritization these factores using neural network in some southern cities of Iran

Background & Aims: Epidemics of human viruses began during the period of Neolithic around 12,000 years ago. Humans developed more densely population which allowed viruses to spread rapidly among communities. Also, plant and livestock viruses increased along with human viruses (2). At the January 2020, the coronavirus disease (COVID-19 7th human coronavirus) was discovered in Wuhan, Hubei province of China. COVID-19 virus caused six million deads in the world to date and cussed infection of more than seven million of cases in Iran (1). This infectious disease caused by the SARS-CoV-2 virus. This virus was contagious and fast-spread. Despite the aquarantine politics, SARS-CoV-2 virus caused many permanent economic and health damages in most countries. Coronaviruses are positive-sense, single- stranded enveloped RNA viruses with helical capsids that infect a wide range of hosts including humans, bats, other mammals, and birds (2). Coronaviruses are belonging to Nidovirales order, Coronaviridae family, Coronovirinae subfamily and four genera of alpha, beta, delta, and gamma. Alpha and beta coronaviruses are known as human infection agents. SARS-COV-2 virus abilities are including: high mortality number, short period of incubation, widespread transmission protocols, asymptomatic infection and affecting on most vital organs (heart, brain, lungs and ...) which have attracted the health system attention and caused neglect to the other chronic and non-communicable diseases (4). Therefore, the disease incidence, prevalence and prioritization around the world may change in the future. From the beginning of COVID-19 pandemic, some symptoms and risk-factors have been introduced to the world as the increase elements of morbidity and mortality. Studies have shown that having any kind of underlying diseases and risk factors will be effective in the COVID-19 disease severity and mortality (6). Some of these important risk factors are including of chronic kidney disease, hypertension, age, gender, obesity, obstructive pulmonary diseases, diabetes, lung diseases, cardiovascular diseases, cancer, and liver disease. Also, each risk factors have different impact in different geographic areas (7). Some factors, such as different viral load kinetics in each individual person, epidemiological history, therapeutic or pharmacological effects and immune response have some major impacts on the laboratory diagnostic results. Due to the successive mutations of the SARS-CoV-2 virus and the high incidence disease, it seems that the vaccination alone cannot prevent the COVID-19 (9). On the other hand, the World Health Organization has warned about the vaccination as the only pandemic control protocol. Therefore, the prevalence of morbidity and mortality have become the public health concerns in the world since the beginning of the COVID-19 epidemic and the vaccination. Recognizing of the risk-factors and symptoms on COVID-19 in different geographic areas can be a helpful source to prevent the mortality. Understanding risk factors can help the world to control of the coronaviruses pandemic period and similar situations in the future. Therefore, the aim of this study was to determine the risk-factors of mortality of COVID-19 patients in three cities of Khuzestan province, Iran. Methods: This research was an analytical cross-sectional study. Some details of 27963 COVID-19 patients such as clinical symptoms, individual characteristics and underlying diseases were gathered from hospitals in Abadan, Shadegan and Khorramshahr cities in Khuzestan province, Iran, from 20 February 2020 to November 2020. All the under-study population was previously investigated in terms of COVID-19 infection by the medical examinations and laboratory methods. This under-study population was categorized into three different groups such as hospitalized, outpatients and dead patients. Hospitalized patients have admitted in general or ICU (Intensive Care Unit) sector. Obtained database of COVID-19 patients was analyzed by IBM SPSS version 22.0 under regression, logistic model (u

Immunopathology of SARS-CoV-2 virus infection

Introduction: the daily increase in cases and deaths, the economic losses in the millions suffered by affected nations and the consequent strain on the human resources involved in reversing this situation have made the COVID-19 pandemic an unprecedented international challenge. Background: to describe the orchestrated immune response following SARS-CoV-2 infection. Methods: an up-to-date bibliometric study was conducted on the type of articles stated in the objective, using a total of 30 bibliographies. Documentary review and analysis-synthesis methods were used to prepare the final report. Resources available on the Infomed network were used to select the information, specifically: PubMed and SciELO, through the databases: Medline, Search Premier and Scopus. Development: the core elements in the immunopathology of COVID-19 involve innate immunity, with the sustained increase of pro-inflammatory interleukins associated with failures in the interferon system, which can trigger a potentially fatal cytokine storm. In terms of elements linked to adaptive immunity, there is evidence of marked lymphopenia which, depending on the degree, may indicate the severity of the disease. Conclusions: understanding the orchestrated immune response following SARS-CoV-2 infection and its temporal sequence allows us to choose timely and effective therapies, specifically when selecting anti-inflammatory drugs and the time of their application, as it is difficult to determine when they will be clearly beneficial, that they do not impair the response and that it is not too late, given the irreversibility of the process.

Some features of the coronavirus infection course in bronchial asthma patients

The outbreak of a new coronavirus infection was officially recognized by the World Health Organization as a global pandemic since March 11, 2020. The pandemic is currently gradually receding, the number of patients is also steadily decreasing. However, these circumstances are not grounds to believe that the virus has been definitively and irrevocably defeated. For this reason, the world medical community is still concerned about the coronavirus' impact on the course and outcome of various chronic bronchopulmonary diseases. Bronchial asthma has been recognized as one of the leading forms of human somatic pathology throughout the history of mankind and medicine. It is quite natural that the focus of the researchers' attention turned out to be questions about the SARS-CoV-2 virus' impact on patients suffering from bronchial asthma, starting with the peculiarities of the course of combined pathology and ending with the peculiarities of therapy and subsequent rehabilitation. The issues of coronavirus infection and bronchial asthma pathogenesis were considered. The research data on some features of the development and course of a new coronavirus infection in patients with this profile were analyzed and summarized. The low coronavirus infection prevalence among patients with an allergic bronchial asthma form compared with other phenotypes is shown among such features, data on the effect of eosinophilia on the course of infection are presented, and the basic therapy's positive effect using inhaled glucocorticosteroids and/or monoclonal antibodies (biological therapy) in severe asthma, is shown in the form of a protective effect that provides a lighter coronavirus infection course. The main features of patient management suffering from bronchial asthma in the conditions of a pandemic are the organization of stable medical control in online telemedicine once monthly, regular examinations in accordance with the severity of the course of the disease and the correction of basic therapy to achieve complete control over the course of asthma.

Observational study of imaging findings in COVID -19 related rhino-orbito-cerebral mucormycosis - a tertiary care center study

Background: There has been a tremendous increase in number of cases of rhino-orbitocerebral involvement with mucor in the COVID era, as reported from India. It is well established that management of ROCM involves early clinical and radiological diagnosis, reversal of underlying risk factors, prompt antifungal therapy and surgical debridement when indicated. Materials &Methods: Multiplanar MR imaging and CT scan were performed for brain, orbit and paranasal sinuses. All the cases were assessed for involvement of the paranasal sinuses, nasal cavities, orbits and brain. Results: 25 cases with ROCM were identified over 8 months. The mean age of the cases was 56.1 years. 18 of the 25 cases had a positive RT-PCR test result at the time of diagnosis with ROCM. 20 cases had poorly controlled diabetes mellitus, 2 had a hematological malignancy, 2 had chronic kidney disease and 1 had ischemic heart disease. There was involvement of the paranasal sinuses, nasal cavities, orbits and brain inclusing necrosis in most of the cases. The number of cases identified during the interval is much higher than the numbers presenting in the prior 2 years during equivalent intervals than those reported in the literature in different settings in the pre-pandemic era. Conclusions: Rhino-orbito mucormycosis can have aggressive necrosis of the involved paranasal sinuses and orbits with or without cerebral extension. Hence, the correct diagnosis is imperative as prompt antifungal drugs and surgical debridement can significantly reduce mortality and morbidity.

Cardiovascular complications in COVID-19 and its vaccines

The COVID-19 pandemic due to SARS-CoV-2 has proven to be a tremendous challenge to the medical community. The greatest challenge since the turn of the century. The authors summarized the main cardiovascular (CV) complications and mechanisms of COVID-19 and its vaccines. COVID-19 has lung tropism, but it has been reported to affect the CV system as well. The presence of comorbidities such as hypertension, CV disease, diabetes, and chronic obstructive pulmonary disease increased the risk of developing serious complications and in turn mortality significantly. The common CV complications include cardiac arrhythmia, myocardial infarction, myocarditis, and cardiac failure, which occurred in around 20% of all COVID-19 patients. The present difficulty in the diagnosis of CV complications were that COVID-19 symptoms often mimic CV events. Furthermore, the rapid diagnosis and management of serious CV events are sometimes overlooked due to COVID-19. Access to medical treatments were sometimes restricted due to the limited healthcare resources during the pandemic. The advent of various covid vaccines have reduced the number of these complications. However, CV events following mRNA vaccines or adenoviral vector vaccines are recognized as well as myocarditis and vaccine-induced immune thrombotic thrombocytopenia. With increasing experience in managing covid patients with CV complications, physicians are becoming better equipped in preventing, detecting, and treating these complications.

Emergency Management of Priapism

Pathophysiology To have an erection, the smooth muscle of the cavernosal arteries and tissue must be relaxed, resulting in increased non-ischemic inflow and decreased venous outflow. The sickling of red blood cells can decrease venous outflow in the corpora cavernosa during an erection leading to low-flow priapism in men with sickle cell disease. Doppler ultrasound can be utilized to observe if blood flow is low or absent, but corporal aspiration is the gold standard. Adjunctive laboratory evaluation should be performed based on the clinical concern for blood dyscrasia or other conditions affecting clinical decision-making.

LGL leukemia patients exhibit substantial protective humoral responses following SARS-CoV-2 vaccination.

Large granular lymphocyte leukemia is a rare chronic lymphoproliferative disorder of cytotoxic cells. Other hematological malignancies such as CLL and multiple myeloma have been associated with poor vaccination response and markedly increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mortality rates, specifically in patients who have undergone immunosuppressive therapy. Given the immunosuppressive therapies often used to treat the disease, large granular lymphocytic (LGL) patients may be especially vulnerable to SARS-CoV-2 infection. A questionnaire was sent to all patients in the LGL Leukemia Registry at the University of Virginia (UVA) to obtain information on vaccination status, type of vaccine received, side effects of vaccination, patient treatment status before, during, and after vaccination, antibody testing, history of coronavirus disease 2019 (COVID-19) infection, and presence or absence of booster vaccination. Antibody testing of 27 patients who had quantitative SARS-CoV-2 Spike Protein IgG levels determined by University of Virginia medical laboratories via the Abbott Architect SARS-CoV-2 IgG II assay were collected. The assay was scored as reactive at a threshold of ≥50.0 AU/mL or nonreactive with a threshold of <50.0 AU/mL. LGL patients without treatment as well as patients who held treatment prior to their vaccination have a robust humoral response to SARS-CoV-2 vaccines. Patients who did not hold their immunosuppressive treatments have signifigantly diminished vaccine response compared to those who held their immunosuppressive treatment. Our findings support a dual strategy of pausing immunotherapy during the vaccination window and administration of the SARS-CoV-2 booster to all LGL leukemia patients to maximize protective antibodies.

Comparing on-scene times and conveyance rates in medical, traumatic and psychiatric presentations to the ambulance service

BackgroundWhilst psychiatric presentations represent 10-12% of ambulance service demand, research into such presentations is disproportionately sparce. This study builds on literature which explores psychiatric dispositions by comparing conveyance rate and on-scene times with other common ambulance service presentations.MethodsThis study was a single centre retrospective observational study investigating on scene time and conveyance rate variances between medical, traumatic and psychiatric presentations to the ambulance service. Call timings and disposition were recorded from computer aided dispatch data and clinical impressions from associated electronic patient records were used to categorise cases. 720 records were sampled between January and December 2019, consisting of 20 randomised cases per month per case type.ResultsAnalysis of variance identified a statistically significant effect of case type on on-scene time (F(2,717) = 7.14), p = 0.001, η2 = 0.02) and conveyance rate (F(2,717) = 8.59, p < 0.001, η2 = 0.02). Across all dispositions patients medical cases required 8.18 fewer minutes (p < 0.001, 95% CI[3.65,12.7]) on-scene than psychiatric cases and 6.67 fewer minutes (p = 0.004, 95% CI[2.14,11.19]) than trauma cases. Psychiatric on-scene times were 9.9 (p = <0.001, 95% CI [3.53, 16.29]) and 10 (p = 0.001, 95% CI [4.37, 15.70]) minutes longer than medical and trauma cases where patients were not conveyed to hospital. Conveyance rates were 15% (p = 0.001, 95% CI[-0.23, -0.06]) lower and 17% (p < 0.001, 95% CI[-0.26, -0.08]) lower in psychiatric and trauma cases respectively than medical cases.ConclusionPsychiatric on-scene times were longer than medical presentations irrespective of conveyance and longer than both medical and traumatic presentations where patients were not conveyed. Conveyance rates in psychiatric presentations were lower than medical cases. Further research is required to understand factors which may contribute to this variation and how this may impact on service and care delivery.

Aftermath of COVID-19 pandemic on mental health and wellbeing of patients with thalassemia major in Pakistan: a qualitative study

BackgroundChronic patients with thalassemia major were mainly recognized as more prone to bad mental health during COVID-19 pandemic. However, why this populace has confronted these detrimental effects, how they have skilled them and the way they have coped, stays under-explored.AimThe aim was to evaluate the aftermath of COVID-19 pandemic on mental health and wellbeing of patients with thalassemia major and to identify the coping strategies to overcome the effects.MethodsThe present qualitative study was conducted through in-depth face-to-face semi-structured interviews held with 21 patients with thalassemia major selected through probability consecutive sampling. All interviews were recorded, transcribed, and analysed with reflexive thematic analysis.ResultsThe most commonly described mental health condition was depression and concern of overall health status.Seven associated pandemic elements contributed in deterioration of mental health: i) Isolation at home, ii) Disrupt transfusion services, iii) Change in appetite and interests, iv) Uncertainty and lack of control, v) Intensive media coverage, vi) Worsening of chronic health problems, vii) Difficulty in sleeping.Four coping strategies were identified for maintaining mental health: i) Practicing gratitude ii) Engaging in hobbies and activities, iii) Stay connected with others, iv) Discern social support.ConclusionsThalassemia major patients had been negatively affected during the pandemic. However, it seems a temporary respite for few, drew upon reserves of resilience and tailored their coping techniques to hold high quality wellbeing.

The Experiences of Parents of Children with Thalassemia Major in Turkey: A Qualitative Study

Background: Invasive medical procedures and their complications of Thalassemia Major still affect the quality of life of all patients and their caregivers. Aim: This study evaluates the experiences of parents of children with Thalassemia Major. Method: The qualitative phenomenological method was used to determine the parents' experiences. The study sample included 14 parents who met the inclusion criteria. Individual interviews, an introductory information form and a semi-structured interview form were used for data collection. The data were analyzed with Colaizzi's sevenstep method. Results: Four themes of the interviews were established: unprecedented psychosocial distress, social support, financial burden and concern about children in the future Parents stated that they experienced shock, sadness, fear, stress, depression, death anxiety, fatigue and burnout. Especially with the COVID-19 epidemic in our country, parents stated that their lives became more difficult and their concerns about their children increased. Conclusions: Healthcare staffs need to understand parents' psychosocial distress and coping strategies to provide support and guidance from the outset of treatment and care. It is recommended that interventions be planned and implemented in a way that maximizes the quality of life of children and families.

Omission of day 11 methotrexate in regimen for the prophylaxis of graft-versus-host disease after haploid hematopoietic stem cell transplantation.

BACKGROUND: The regimen of cyclosporin combined with four times of short-range methotrexate is still recognized as the classic prevention regimen for acute graft-versus-host disease. Previous studies have shown that whether day 11 methotrexate is used in sibling transplantation has no effect on the incidence of acute graft-versus-host disease. However, the effect of reducing day 11 methotrexate on the incidence of acute graft-versus-host disease in haploid hematopoietic stem cell transplantation patients remains unclear. OBJECTIVE: To investigate the efficacy of the omission of day 11 methotrexate in the regimen for the prophylaxis of graft-versus-host disease in haploid hematopoietic stem cell transplantation. METHODS: The clinical data of 63 patients with malignant hematologic diseases who received haploid hematopoietic stem cell transplantation from January 2017 to December 2019 were retrospectively analyzed. The graft-versus-host disease prevention regimen was cyclosporine combined with methotrexate 15 mg/m² on day 1, 10 mg/m² on day 3, day 6 and day 11. In the observation group (n=19), oral mucositis was grade III-IV at day 11, and day 11 methotrexate was cancelled. In the control group (n=44), oral mucositis was grade 0-II at day 11, and day 11 methotrexate was applied. The implantation situation, incidence of acute graft-versus-host disease, overall survival rate, and recurrence rate of the two groups were analyzed. RESULTS AND CONCLUSION: (1) The median follow-up time was 30(3-54) months and all neutrophils were successfully implanted in both groups. The median implantation time was 12(9-29) days and 12(8-25) days, respectively, showing no significant difference (P=0.682). There was one patient with poor platelet implantation in the observation group, and four patients with poor platelet implantation in the control group. The median time of platelet implantation was 12(9-18) days and 13(9-31) days in the two groups, respectively, (P=0.71), showing no statistical difference. (2) The overall incidence of acute graft-versus-host disease was 44.4%, and grade II-IV acute graft-versus-host disease was 28.6%. The incidence of II-IV acute graft-versus-host disease in the observation group and control group was 31.5% and 27.3%, respectively, (P=0.728), and there was no statistical difference between the two groups. (3) The results showed that for haploid hematopoietic stem cell transplantation, the omission of day 11 methotrexate did not increase the incidence of acute graft-versus-host disease compared with the standard methotrexate regimen. (English) [ FROM AUTHOR] 背景：环孢素联合4次短程甲氨蝶呤方案仍是目前公认的、经典的预防急性移植物抗宿主病方案，以往研究显示在同胞全相合移植后第11 天是否应用甲氨蝶呤对于急性移植物抗宿主病的发生率没有影响，但减少第11天甲氨蝶呤对单倍体造血干细胞移植患者急性移植物抗宿主 病发生率的影响仍不清楚。 目的：探讨移植物抗宿主病预防方案中去除第11天甲氨蝶呤的应用对单倍体造血干细胞移植患者发生急性移植物抗宿主病的影响。 方法：回顾性分析 2017年1月至2019年12月接受单倍体造血干细胞移植治疗的 63例恶性血液病患者的临床资料，移植物抗宿主病预防方案 为环孢素联合甲氨蝶呤15 mg/m²(第1天)，10 mg/m2(第3，6，11天)。在第11天时发生严重口腔黏膜炎(Ⅲ-Ⅳ级)的患者，取消第4次甲氨蝶 呤应用，归为观察组，共19例；在第11天时发生轻度口腔黏膜炎(0-Ⅱ级)的患者，按标准方案继续第4次甲氨蝶呤应用，归为对照组，共 44例。对两组植入情况、急性移植物抗宿主病发生率、总体生存率及复发率进行分析。 结果与结论：①中位随访时间 30(3-54)个月，两组患者中性粒细胞全部植活，中位植入时间分别为 12(9-29) d 和12(8-25) d，差异无显著 性意义(P=0.682)；观察组1例血小板植入不良，对照组4例血小板植入不良，可分析数据两组中位植入时间分别为 12(9-18) d 和13(9-31) d， 差异无显著性意义(P=0.71)；②急性移植物抗宿主病总体发生率为 44.4%，Ⅱ-Ⅳ度急性移植物抗宿主病为28.6%；观察组及对照组Ⅱ-Ⅳ度 急性移植物抗宿主病发生率分别为31.5%，27.3%，差异无显著性意义(P=0.728)；③结果表明，对于单倍体造血干细胞移植，与标准甲氨蝶 呤预防方案比较，去除第11天甲氨蝶呤的应用并不引起急性移植物抗宿主病发生率升高。 (Chinese) [ FROM AUTHOR] Copyright of Chinese Journal of Tissue Engineering Research / Zhongguo zu zhi gong cheng yan jiu is the property of Chinese Journal of Tissue Engineering Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Comparative study between COVID-19 Outcomes for Patients on Chronic Immunosuppressive Drugs, Patients on Active chemotherapy and Non-Immunosuppressed Patients: A Single-Center Egyptian Experience

Background: Patients with hematological disorders especially those who underwent bone marrow transplantation are known for having some degree of immune system derangement and cytokine signaling instability as well as patients who were diagnosed with active malignancy and needed chemotherapy. Objective: The study aimed to compare the outcome between patients infected with COVID 19 who use immune suppression (either acute or chronic immune suppression) to fight COVID infection and how our different bodies and immune systems can handle it versus the normal population. Patients and Methods: This study was a cross-sectional study in December 2020 conducted on 96 subjects who caught COVID-19 infection, the subjects were categorized into three groups: Group 1: consists of 32 patients who underwent BMT (patients on chronic immunosuppressive drugs), Group 2: consists of 32 patients with hematological diseases (patients on chemotherapy or acute immunosuppressive drugs), and Group 3: control group (non-immunosuppressed patients) consists of 32 patients with patients had symptomatic COVID-19 infections requiring hospital admission. Results: We found improved overall survival in group 1 with 4 out of the total 32 patients succumbed to their deaths, 2 of the 4 patients were in the peri-engraftment period with the statistically significant improved OS when compared to patients in group 2 with a P-value of 0.038. Conclusion: Acute immune suppression is done by chemotherapy worsen the outcome of COVID-19 infection, while chronic immunosuppression had the best outcome in COVID-19 patients even better than the normal population due to loss of immune cell signaling and absent cytokines storm that might occur. [ FROM AUTHOR] Copyright of Egyptian Journal of Hospital Medicine is the property of Egyptian Journal of Hospital Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The Impact of the COVID-19 Pandemic on the Organization of Cardio-Hematology Care-A Polish Single Center Experience.

Background and Objectives: We present a retrospective report on the cardio-hematological care of hematology patients at a university hospital in Poland during the COVID-19 pandemic. Materials and Methods: The number of hospitalizations at the Hematology Department and cardio-hematology consultations throughout 2019 and 2020 was analyzed. The types of cardiac procedures, risk factors, and complications were also assessed. Results: A significant reduction in the number of hospitalizations was observed in 2020 as compared to 2019. However, there were no significant differences in the incidence of hematological diseases between both of the analyzed years. In 2019, 299 cardiac consultations were performed in hematological patients, and there was a total of 352 such consultations performed in 2020 (p = 0.042). Less high-risk tests (transesophageal and stress echocardiography) were performed in 2020, in favor of the use of cardiac computed tomography in cardiac diagnostics as it was safer during the pandemic. At least one cardiovascular risk factor during cardiac consultation was noted in 42% and 48% of hematological patients in 2019 and 2020, respectively. Among 651 examined hematological patients, the most common findings were mild cardiac complications of hemato-oncological treatment, which were found in 57 patients. Conclusions: This study seems to confirm that during a pandemic there is an increased demand for well-organized cardio-hematology consultations.

Factors associated with anemia in post-cesarean with and without COVID-19 at the Hospital Nacional Alberto Sabogal Sologuren

Objective. To know the intrinsic and extrinsic factors associated with anemia in post-cesarean women treated in the COVID-19 and non-COVID-19 obstetric area of the Alberto Sabogal Hospital. Methods. The study was observational, retrospective and cross-sectional, quantitative approach, explanatory level, casecontrol model, applied to 358 puerperal women;of which 179 were the cases, that is, those puerperal women with postpartum anemia and 179 were controls, taken from both areas. The data were processed with the SPSS 25 statistic. Results. The intrinsic factors: diet without variation, overweight or morbid obesity, parity of 4 or more, number of cesarean sections of 3 or more, and the intergenetic period of less than 2 years, were conditions that represented a double risk of producing anemia in the puerperium among women in the study, in relation to those who did not have these characteristics. Also, the intrinsic factor or condition of having had anemia during pregnancy, resulted in a 5 times greater probability of producing anemia in the puerperium among the women in the study (Odds Ratio 5.156), compared to the women who did not have anemia. Folic acid intake was 3.4 times less likely (Odds Ratio of 3.408) to develop anemia compared to those who did not, and complications in the immediate puerperium (Odds Ratio of 3.397) were associated with anemia in puerperal women. Conclusions. Intrinsic factors such as the diagnosis of anemia during pregnancy and extrinsic factors such as folic acid not ingest and complications in the immediate puerperium were associated with anemia in puerperal women in the COVID-19 and non-COVID-19 obstetric area of Hospital Alberto Sabogal.

Temporary incapacity for work (sick leave) in the times of COVID-19, preventive aspects and consequences

Introduction: Temporary disability due to COVID-19 was expressly regulated, through various rules and instructions, covering both isolation by contact, by infection or for sensitive workers. It involved the integration of preventive labor protection covered by its protection in a financial benefit with the highest amount. Analyzing the consequences of the pandemic in the first wave, confinement, de-escalation and return to normality, months from March to October, the ..collapsing.. impact of COVID-19 on the health system led to the paralysis and increase of waiting lists for tests, operations and non-urgent consultations of the rest of pathologies, and consequently a high increase in the average duration of sick leave for all processes, in confinement and de-escalation in 84.48% and in 25.27% the prolonged casualties that reached more than 365 days. Consequently, COVID-19 as a collateral effect led to a poor evolution of the rest of the processes, prolonging the duration of temporary disabilities, which implies a worsening of occupational health, a greater risk of not returning to work that occurs during sick leave long, higher risk of unemployment, higher spending on benefits and economic decline for companies and the self-employed. Temporary disability due to COVID-19 accounted for 38.73% of all casualties at the end of October 2020. Conclusions: The pandemic forced to prioritize resources around COVID-19, collapsing the care of the rest of pathologies, except for emergencies or vital treatments. This meant an increase in waiting lists for non-urgent consultations, tests or surgical interventions, as well as the cancellation or postponement of consultations or treatments and therefore an increase in the longer duration of sick leave and also the worsening of occupational health, consequently, by not being able to have treatment in a timely manner. In confinement and de-escalation, the average duration of casualties increased by 84.48%;by processes, the increase was 503.58% in respiratory diseases, 215.88%, in infectious diseases, 60.73% in endocrine diseases, 45;42% of blood diseases, 45 09% for digestive diseases, 35.63% for osteomyoarticular disorders, 34.12% for neoplasms, 33.37% for circulatory diseases, 31.94% for ..procedures.., and 29.56% of mental disorders. Long-term sick leave (PIT) that reached 365 days increased by 25.27%, compared to the month of October of the previous year. Prolonged sick leave due to endocrine and nutritional diseases increased by 28.50, from mental disorders by 28.20%, from musculoskeletal disorders by 26.70, from neoplasms by 26.49%, from respiratory diseases in 24.27%, for diseases of the nervous system in 22.79%, for cardiovascular diseases in 20.48%, and for digestive diseases in 19.24%. As a consequence of COVID-19, the working population was exposed to an added and new risk;health and social health workers suffered the disease as a direct consequence of their work due to illness of an undoubted professional nature. The effects of COVID-19 on the delay of tests, surgeries or treatments in ..No COVID-19.. processes and the difficulties of contact with care worsened occupational health, prolonging disability situations and increasing the risk of prolonged non-COVID-19 disabilities, return to work due to the expected poor evolution of any process when it cannot be treated and attended to early.

This Week in the Journal

The clinician must pay close attention to the patient history, aided by the development of molecular diagnostic tests, to distinguish infections from other causes. see Review Article, N Engl J Med 2022;386:463-477 Lisch Nodules A 40-year-old man with a history of neurofibromatosis type 1 presented for a routine eye examination. Six weeks before jaundice developed, he had been hospitalized with Covid-19. see Clinical Problem-Solving, N Engl J Med 2022;386:479-485 Using Economics to Inform Public Health Policy Although public health practitioners and researchers focus primarily on improving health, economists view health as but one important component of what people may value. [...]substantial neutralization of the omicron variant was detected in samples from participants who had received three doses. see Correspondence, N Engl J Med 2022;386:492-494 Preliminary Data on Vaccine Protection against Omicron Using a test-negative study design focused on the period of dominance of the B.1.1.529 (omicron) variant in South Africa, investigators found that two doses of the BNT162b2 vaccine had an efficacy of 50 to 70% against hospitalization caused by omicron in Gauteng province. see Correspondence, N Engl J Med 2022;386:494-496

COVID-19 pandemic: impact on the clinical trials and management of the patients with multiple myeloma and other hematologic malignancies

The COVID-19 pandemic has created unprecedented obstacles to the delivery of care to patients with cancer. Patients with hematologic malignancies appear to have a greater risk of SARS-CoV-2 infection and severe disease due to myelosuppression and lymphopenia. The first challenge, therefore, is how to continue to deliver effective therapy to vulnerable patients and at the same time to avoid exposing them, and their health care teams (HCT), to SARS-CoV-2. An additional challenge is the timely completion of the procedures required for diagnosis and staging to formulate appropriate treatment plans. Deferred procedures and avoidance of multiple trips to the surgical wards, diagnostic units, and laboratories require same day consolidation of all procedures. With laboratory medicine absorbed by the need to deploy large scale COVID-testing, the availability of routine molecular tests is seriously affected. Finally, we are increasingly faced with the challenge of making complex treatment decisions in SARS-CoV-2 positive patients with aggressive but potentially curable blood cancers. When to treat, how to treat, when to wait, how long to wait, how to predict and manage toxicities, and how to avoid compromising cure rates remains unknown. In this article, we attempt to provide some practical suggestions on the management of patients with hematologic malignancies during the COVID-19 pandemic. The manuscript briefly covers practical issues such as delays in diagnosis, deferral of chemotherapy, impact on the clinical trials, utilization of SCT, modifications of maintenance treatments, access to and utilization of supportive measures, role and safety of targeted therapies.

COVID-19 vaccines and cancer patients: acceptance, attitudes and safety

Purpose: Recommendations and guidelines consider cancer patients a high-priority population for COVID-19 immunization. Vaccination process in Serbia began in January 2021 with four available vaccines. We have conducted a cross-sectional study investigating cancer patients' acceptability of anti SARS-COV2 vaccines.

Cultivating the calm within the chaos: Self-care should be priority for APPs

Research shows health care workers may have increased anxiety, depression, insomnia and distress. Building momentum with gratitude In a world filled with social injustices, political divide and economic instability, life may feel overwhelming and chaotic. Caring for patients with blood disorders and cancer reminds me to celebrate the small victories of life, whether it is a patient with prolonged pancytopenia who finally has a neutrophil count, or the child on hospice who wants one more ride on her tricycle while her patient-controlled analgesia pump is tucked in her backpack.