Headache Associated with PPE During COVID-19 Pandemic in Health Care Workers.

PURPOSE: In the pandemic coronavirus disease 2019 (COVID-19), health care workers (HCWs) are at very high risk. Personal protective equipment (PPE) and masks are not only difficult to wear while working but also causes various complications. The present self-administered questionnaire- based study aimed to explore the headache and complications in HCWs on wearing PPE during the COVID-19 pandemic. METHODS: The present study was performed by obtaining a self-administered questionnaire from HCWs, which provides evidence of various complications due to the use of a PPE and mask. RESULTS: Out of a total of 329 respondents, 189(57.45%), 67(20.36%), 238(72.34%), 213(64.74%), 177(53.80%), and 34(10.33%) reported headache, breathlessness, suffocation, nose pain, ear pain, and leg pain respectively. Out of 329 respondents, 47(14.29%) had pre-existing headaches. Headache was significantly high for those who wore PPE for 4-6h (121/133; 87.05%) than that of those who wore up to 4h (18/26; 69.23%). Of the 34(24.46%) required medication who reported headaches wearing PPE. Acetaminophen is quite helpful in most health care workers to decrease headaches. Nose-related complications occur frequently in health care workers after regular shifts for more than 6 days. Gelatinous adhesives patch was a wonderful prophylactic remedy as it was helpful to prevent nose- related complications in 24 HCWs out of 25(96%). CONCLUSIONS: More than half of the HCWs reported headache, suffocation, nose pain, and ear pain. Duration of PPE use of more than 4h is significantly associated with headache. Short duration PPE use prevent HCWs from headache and various ill effects.

Wearing N95 masks decreases the odor discrimination ability of healthcare workers: a self-controlled before-after study.

Objective: During the coronavirus disease 2019 (COVID-19) pandemic, the N95 mask is an essential piece of protective equipment for healthcare workers. However, the N95 mask may inhibit air exchange and odor penetration. Our study aimed to determine whether the use of N95 masks affects the odor discrimination ability of healthcare workers. Methods: In our study, all the participants were asked to complete three olfactory tests. Each test involved 12 different odors. The participants completed the test while wearing an N95 mask, a surgical mask, and no mask. The score for each olfactory test was documented. Results: The olfactory test score was significantly lower when the participants wore N95 masks than when they did not wear a mask (7 vs. 10, p < 0.01). The score was also lower when the participants wore N95 masks than surgical masks (7 vs. 8, p < 0.01). Conclusion: Wearing N95 masks decreases the odor discrimination ability of healthcare workers. Therefore, we suggest that healthcare workers seek other clues when diagnosing disease with a characteristic odor.

Survey Regarding Awareness of Continuance of Mask Practices Post Vaccination

Introduction: The knowledge that the use of face masks delays the SARS-CoV-2 transmission is rapidly gaining popularity in the general population. Respiratory masks (RM) are protective devices covering a part of the face. They are designed to protect both the person who wears them and the immediate environment from breathable pollutants. Researchers have used various approaches to develop vaccines that protect against COVID-19 and as a result, they have developed different types of vaccine, including covishield which is found to have efficacy of 71% whereas covaxin has the efficacy rate of 82%. Aim : To evaluate awareness level regarding continuance of mask practices post vaccination among Dental students. Materials And Methods: In this study, a survey was conducted among 100 dental students of a private dental college by circulating a questionnaire. Google forms and links were shared in various social media. 10 questions consisting related to awareness, usage of mask after vaccination were included in the study. Undergraduates, postgraduate students of the private dental colleges were only included in the study. The data was collected and analysed using SPSS software version 23 and the statistical significance was checked using Chi-Square analysis. ( p < 0.05 was considered as statistically significant) Results: It was observed that students are aware of various masks and the importance of masks, vaccination and usage of masks post vaccination. Conclusion: It was noted that there is still a lack of awareness prevailing, hence more updates have to be given among undergraduate students regarding the use of mask practices post vaccination for better knowledge

PPE effect on Hearing, Speech, Breathing and work performance in Health care workers

Using Personal protective equipment has become an integral part of work for all health care workers during the COVID19 pandemic however they do have an effect on their work performance. Aim(s):This study aimed to determine the effect of Personal Protective Equipment(PPE) on hearing, speech, and breathing on the work performance among the healthcare workers(HCWs) involved in treating COVID patients. Material(s) and Method(s): This is a descriptive cross-sectional survey conducted among the health care workers(HCWs) in a COVID designated hospital in Pondicherry, South India. A semi-structured questionnaire was constructed, and 384 eligible health care workers participated in the study. Their responses were collected in an excel sheet, and the data were analyzed. Result(s): Our survey showed that 79.7% of participants (n=306) had donned PPE for a total of 6 hours, and their work performance was significantly affected by the following factors, such as difficulty in hearing (p=0.053), difficulty in understanding speech (p=0.048), increased efforts in talking to patients and coworkers (p= 0.004) and increased measures of breathing(p=0.057). Conclusion(s): The use of personal protective equipment significantly impairs communication between coworkers and patients.PPE also increases the burden of breathing, and both these entities seem to influence the work performance of the HCWs. Hence we suggest that alternate communication strategies be taught and employed and formulate newer protocols with user-friendly PPEs to decrease the burden on breathing and for better communication for effective work performance. Copyright © 2022, Anka Publishers. All rights reserved.

Fabrication and working of portable PPE kit sterilizer using UV Ozone Sanitization process.

Personnel protective equipment, N95 masks, and filtering facepiece respirators such as goggles, face shields, played a very important rolein the safety of bothvirus-affected persons and as well as medical staff, health workers. As the coronavirus (Covid-19) was increasing exponentially worldwide, healthcare has been the demand for this basic equipment especiallyface protection shields have critical issues. There has been an effort to find out the different ways to conserve PPE kits, to use after the sterilization process. The current work focused onthe fabrication of the Portable PPE Kit Sterilizer model using UV Ozone Sanitization Processto utilize for recycling of N95 masks, goggles. Due to its miniature structure, can be used in public health sectors like the hospital, research centers, schools, and laboratories also. The method adopted was cheap, reuse, well suited for mass sanitization.

Effect of Face Masks on Physiological and Perceptual Responses during 30 Minutes of Self-Paced Exercise in Older Community Dwelling Adults.

This study examined the effects of different types of masks (no mask, surgical mask (SM), and N95-mask) on physiological and perceptual responses during 30-min of self-paced cycle ergometer exercise. This study was a prospective randomly assigned experimental design. Outcomes included workload (Watts), oxygen saturation (SpO2), end-tidal carbon dioxide (PetCO2), heart rate (HR), respiratory rate (RR), rating of perceived exertion (RPE), and rating of perceived dyspnea (RPD). Volunteers (54-83 years (n = 19)) completed two familiarization sessions and three testing sessions on an air braked cycle ergometer. No significant difference was found for condition x time for any of the dependent variables. RPE, RPD, and PetCO2 were significantly higher with an N95-mask vs. no mask (NM) ((p = 0.012), (p = 0.002), (p < 0.001)). HR was significantly higher with the SM compared to the NM condition (p = 0.027) (NM 107.18 ± 9.96) (SM 112.34 ± 10.28), but no significant difference was found when comparing the SM to the N95 condition or when comparing the N95condition to the NM condition. Watts increased across time in each condition (p = 0.003). Initially RR increased during the first 3 min of exercise (p < 0.001) with an overall gradual increase noted across time regardless of mask condition (p < 0.001). SpO2 significantly decreased across time but remained within normal limits (>95%). No significant difference was found in Watts, RR, or SpO2 regardless of mask condition. Overall, the N95mask was associated with increased RPE, RPD, and PetCO2 levels. This suggests trapping of CO2 inside the mask leading to increased RPE and RPD.

Combating the COVID-19 Pandemic Using 3D Printed PPE: Challenges and Recommendations

Background: The World Health Organization declared COVID-19 a pandemic in March of 2020. As traditional respiratory personal protective equipment (PPE) was in severe shortage, communities turned to 3D printing to provide printed PPE alternatives;however, certain hurdles need to be addressed to ensure the safety of users. Objective: One main consideration when dealing with 3D printed parts is the presence of pores. Several studies have found the diameter of these pores to range widely from as little as 10µm to over 150 µm, making them larger than the droplets and nuclei through which the virus is transmitted. Methods: Researchers found that altering print settings, such as increasing the extrusion multiplier, may decrease the size and number of these perforating pores. Other challenges include the variable reproducibility of printed PPE, which may be remedied through printer calibration. Storage and sterilization are also a challenge as most 3D printed plastics do not tolerate disinfection methods, such as autoclaves. The use of chemical disinfectants is recommended instead. The rigidity of printed plastics may compromise the fit of masks for varying users. Using 3D scanning may provide personalized masks that seal appropriately. Results: One final issue is the prolonged interaction with 3D printers of inexperienced users, predisposing them to the respiratory tract and skin irritation;thus, adequate ventilation and protection are mandatory. Conclusion: Documenting the benefits and drawbacks of this form of PPE production carries great significance in light of the ongoing COVID-19 pandemic, as well as any future public health emergencies. © 2022 Amir and Amir.

Use of five-layered Adi's cotton face masks with a filter and its commercial application during and after COVID-19

Introduction: COVID-19 is a global pandemic that has led to crisis in the supply of essential goods and services and personal protective equipments including face masks. Aim: The aim of the study is to compare Adi's five-layered cotton face masks with N95 masks and surgical face masks with regard to cost and efficacy. Materials and Methods: After IEC approval, a sample size of 10 was randomly selected. In a closed chamber made up of glass, three plates of blood agar, chocolate agar, and MacConkey Agar (MCA) were kept and at four different times, first without mask (Group D), second with N95 mask (Group N), third with surgical mask (Group S), and finally with Adi's face mask (Group A). Participants at first coughed three times then sang for 3 min and finally spoke for 2 min for each group. Plates were observed for growth after 24 h. Inclusion Criteria: Age 18-40 years of either sex, with no comorbidities. Exclusion Criteria: Anyone having cough, cold, or fever. Results: Group A (Adi's face mask with filter) showed no growth all ten times, Group N (N95 Mask) showed no growth of colonies four times, and one colony growth six times. As far as Group D (Direct speech without mask) is concerned, it showed multiple colonies all ten times and Group S (Surgical mask) showed one colony growth all ten times. Conclusion: Adi's mask is almost equivalent to wearing an N95 mask. It is easy to use, innovative, simple, scientific, and cost-effective. © Medical Journal of Dr. D.Y. Patil Vidyapeeth 2022.

Adverse effects associated with the use of N95 mask among health-care workers at the COVID-19 care units: A cross-sectional study in Sulaimani city, Iraq.

BACKGROUND: Health-care workers have to use the N95 mask as a part of the protection kit during the COVID-19 pandemic. The adverse effects of such practice are not fully elucidated. The study aims to evaluate negative impacts of N95 face masks on health-care personnel at COVID-19 care units. MATERIALS AND METHODS: One hundred and twenty-two health-care workers (aged 20-58 years) from various health-care settings in Sulaimani, Iraq, from January to August 2020, were enrolled in this prospective, cross-sectional study. The physiological variables (blood pressure, heart rate, and oxygen saturation) were recorded before putting on the N95 mask and postremoval of the mask. The incidence of adverse effects such as headache, difficulty breathing, redness, irritation, and dizziness were also reported as a number and percent at the end of the work shift. RESULTS: There was a statistically significant difference in the physiological parameters after removal of the mask compared with baseline. Only diastolic pressure was significantly lower in those working >6 h when compared to those working 1-6 h. The changes in physiological markers were poorly and nonsignificantly associated with the duration of wearing the mask. Moreover, 67.2%-70.5% of the participants complain of headaches and breathing difficulties, while 45.9%-51.6% reported signs of itching, redness, and irritation. However, health-care workers who put on the face mask >6 h showed signs of headache, breathing difficulties, and itching at the exposed areas higher than those working for 1-6 h. CONCLUSION: N95 mask negatively impacts the physiological variables of health-care providers. The adverse effects may lead to excessive exhaustion after long shifts in the intensive care unit during treatment of COVID-19 patients.

"Dentist as Smile Weavers" An Online Survey on Infection Surveillance, Emergency Treatment, Economic Setbacks, and Stress Endured by Periodontists of South India during COVID-19.

Introduction: The SARS-CoV-2 virus introduction and subsequent COVID-19 pandemic have had a profound impact on normal dentistry, particularly periodontal treatment, around the world. This cross-sectional study aimed to evaluate the infection surveillance, emergency treatment, economic setbacks, and stress endured by periodontists of South India during COVID-19. Methods: A cross-sectional study was conducted from March to July 2021 among periodontists in South India. A total of 300 periodontists were chosen through the randomized sampling technique. The data were collected using a self-reported closed-end questionnaire consisting of 38 questions through Google Forms. The information was entered into a database and analyzed using SPSS program version 16.0. Results: A total of 300 people took part in the survey, 277 (92.3%) dentists responded to the survey in its entirety. Periodontists and postgraduates made up 24.18% and 75.9% of those who responded, respectively. For all of the questions asked, there was a statistically significant difference among the responses. The majority of respondents agreed on questions about periodontists' knowledge, practice, mentality, and financial setbacks concerning the COVID-19 epidemic. Conclusion: Most of the periodontists that we surveyed have adequate knowledge about SARS-CoV-2 and have been taking adequate measures in preventing the spread of the disease. This pandemic has a negative impact on the periodontists. This study indicates a high level of depression among a significant number of periodontists. It is important to monitor and address the mental health needs of practitioners during the pandemic. The knowledge, awareness, and attitudes regarding teledentistry were found to be satisfactory among the periodontists.

Wearing mask in children: Do's and Don'ts

Due to COVID-19 disease, children of all ages seem susceptible to COVID-19;thus. preventing children from COVID-19 disease is a serious duty. One of the preventive strategies in children is the behavior of mask-wearing. Recently, many parents have stated concerns to doctors and social media about whether masks may be harmful for their children. Incorrect news about the negative effects of face masks has also been increasing. Therefore. this letter aims at answering the most common and most important parents' worries about children's wearing face masks.

Comparative study of the effect of N95 facemask and Powered Air-purifying Respirator (2 fans, N95 filter) on cardiovascular parameters of healthy individuals during exercise.

N95 masks filter 95% of the small particles and respiratory droplets (>0.3 µm diameter). Therefore, they are widely used both by general public and health workers during pandemic. When physical activity or exercise is performed wearing N95 mask, it induces hypercapnic environment. The heat burden is also increased leading to discomfort and reduced compliance. This study was done to compare physiological effects and subjective perceptions while wearing N95 mask and powered air-purifying respirator (PAPR) (2 fans, N95 filter) during incremental exercise. ECG, respiratory movement, SpO2, temperature inside the mask were recorded and perception of discomfort was also assessed. Heart rate variability (HRV) values during baseline were within normal limits in both the mask conditions signifying that cardiac autonomic tone is comparable. During incremental exercise, fall in SpO2 was significantly lesser in PAPR as compared to N95 mask at 60-70% and 70-80% of maximum achievable heart rate. The temperatures inside both the mask conditions were significantly higher than ambient temperature. The scores of humid, hot, breath resistance and fatigue were significantly lower in PAPR than N95 mask. In conditions where prolonged use of mask is required with strenuous physical exertion or exercise, PAPR could be preferred over N95 mask.

Assessment of dry eye disease in N95 versus surgical face mask wearers during COVID-19.

Purpose: Investigating the effect of different face masks on dry eye disease (DED) among healthcare workers during the COVID-19 pandemic. Methods: This was a comparative, cross-sectional study. Participants were included into two groups: group 1 (n = 30) wore surgical masks, and group 2 (n = 30) wore N95 masks with face shields. Demographic and ocular surface disease index questionnaires (OSDI) were performed. In addition, Tear break-up time (TBUT), corneal and conjunctival fluorescein staining, and meibography to assess meibomian gland loss (MGL) were performed on all participants. Independent T-test was used to compare continuous parameters and Chi-square test for categorical variables. The relationship between continuous variables was tested using bivariate Pearson correlation. Results: Sixty healthcare workers participated in this study (36 females and 24 males). The mean (±SD) age of the surgical mask and N95 groups was 35.33 (±14.94) and 36.63 (±10.64) years, respectively. Both masks caused dryness according to TBUT, MGL, and OSDI scores. DED per DEWS II definition was observed in 14 (46.7%) and 16 (53.3%) patients in groups 1 and 2, respectively. Comparing the two groups, N95 mask caused significantly more dryness according to TBUT (P = 0.042) and fluorescein staining (P = 0.038 for the right eye and P = 0.015 for the left eye). Conclusion: Physicians should be aware of the potential dry eye signs secondary to face mask wear during the COVID-19 pandemic. Further attention should be taken in patients who suffer from preexisting dry eye syndrome and in patients who undergo intraocular operations.

Evaluation of the effects on SpO2 of N95 mask (FFP2) on dental health care providers: a cross-sectional observational study.

OBJECTIVE: The purpose of this cross-sectional observational study was to evaluate the effects of SpO2 in a sample of dental health care providers who wear a N95 mask or Filtering Face Piece (FFP2) for four consecutive hours, measured by a pulse oximeter before donning the mask and again after four hours of work and to offer some strategies to minimize discomfort and improve communication with their patients while wearing the mask. MATERIALS AND METHODS: A 17-item questionnaire was sent via Google Drive to various practitioners in Italy and the USA. A sample of 162 questionnaires were returned from dentists, orthodontists, dental hygienists and dental assistants who committed to wearing a FFP2 for 4 consecutive hours during a work day and then measuring the oxygen saturation by way of a pulse oximeter before and after the 4 working hours. The final analysis was performer on 147 viable questionnaires returned. The sample was composed of 62 males and 85 females with an average age of 42.9 ± 12.0 years. RESULTS: For the entire sample population, the baseline saturation was 98.6 ± 1.2 and, after four hours of mask wearing, there was a significant decrease in oxygen saturation to 97.0 ± 2.9 (p < 0.01). No statistical differences in SpO2 were found across specialties or across types of procedures performed during the 4 h. Heart rates were not significantly different before and after the 4 h in all categories. The 3 most frequent reported complaints were: fatigue (64%), headache (36%) and external ear pain (31%). The most common additional personal protective equipment (PPE) was a mask shield (78%) and those who wore the mask continuously reported more communication difficulty with patients, compared with those who took the mask off more often, in fact, 64% of the subjects reported that using the mask influenced their communication with their patients. Based on the results of the questionnaire, a list of breathing and vocal folds health strategies was devised and proposed, along with strategies to augment communication with patients. CONCLUSIONS: This study highlights a significant decrease in oxygen saturation after only 4 h of work (except for smokers) while wearing a FFP2, and confirms the widespread symptoms of fatigue, headache and pain behind the ears that dental professionals experience. But it also highlighted how mask wearing impaired communication with patients and wearing additional masks and a facial shield may add to those communications difficulties. This aspect and the need for better communication can lead the operators to remove the mask to improve breathing and communication, thus putting themselves at a risk of infection. Of all the aspects explored in this study, the most interesting was indeed the impact on fatigue and communication and the strategies proposed in this article can easily be implemented to reduce headache and fatigue by improving breathing efficiency and by aiding communication while donning a mask by improving voice quality and by using augmentative communication tools.

The effect of N95 and surgical masks on mucociliary clearance function and sinonasal complaints.

PURPOSE: The aim of this study was to reveal the effect of N95 and surgical masks on mucociliary clearance function and sinonasal complaints. METHODS: Sixty participants were enrolled in this study, including 30 people in N95 mask group and 30 people in surgical mask group. Two interviews, three days apart, were performed with all participants. The participants were asked not to use any mask before the first interview while they were asked to use the determined mask just before the second interview for 8 h. In both interviews, the mucociliary clearance times (MCTs) were measured and participants were asked to score ten distinct sinonasal complaints using visual analog scale (VAS). Data obtained from first interview were named pre-mask data, data obtained from second interview were called after-mask data. In both groups, pre-mask MCTs and VAS scores were compared with after-mask MCTs and VAS scores. RESULTS: After-mask MCTs (mean = 13.03 ± 6.05 min) were significantly longer than pre-mask MCTs (mean = 10.19 ± 4.21 min) in N95 mask group (p = 0.002). No significant difference was found between after-mask and pre-mask MCTs (mean = 12.05 ± 5.21 min, mean = 11.00 ± 5.44 min, respectively) in surgical mask group (p = 0.234). When after-mask VAS scores were compared with pre-mask VAS scores, it was found that N95 mask use increased nasal blockage and postnasal discharge, surgical mask usage increased nasal blockage. CONCLUSION: While the use of N95 mask leads to nasal blockage and postnasal discharge, surgical mask use results in nasal blockage. N95 masks cause impairment in mucociliary clearance function. But all these effects are mild. Surgical masks have not been found to have any effect on mucociliary clearance function.

A wearable AIEgen-based lateral flow test strip for rapid detection of SARS-CoV-2 RBD protein and N protein.

Accurate and rapid detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is significant for early tracing, isolation, and treatment of infected individuals, which will efficiently prevent large-scale transmission of coronavirus disease 2019 (COVID-19). Here, two kinds of test strips for receptor binding domain (RBD) and N antigens of SARS-CoV-2 are established with high sensitivity and specificity, in which AIE luminogens (AIEgens) are utilized as reporters. Because of the high brightness and resistance to quenching in aqueous solution, the limit of detection can be as low as 6.9 ng/mL for RBD protein and 7.2 ng/mL for N protein. As an antigen collector, an N95 mask equipped with a test strip with an excellent enrichment effect would efficiently simplify the sampling procedures. Compared with a test strip based on Au nanoparticles or fluorescein isothiocyanate (FITC), the AIEgen-based test strip shows high anti-interference capacity in complex biosamples. Therefore, an AIEgen-based test strip assay could be built as a promising platform for emergency use during the pandemic.

To Study Acute Changes in Brain Oxygenation on MRI in Healthcare Workers Using N95 Mask and PPE Kits for Six Hours a Day.

Background Due to long working hours wearing an N95 mask and PPE kit during the COVID-19 pandemic, the healthcare workers (HCWs) complained of headaches, confusion, and exhaustion. This study was therefore performed to study the changes in brain oxygenation. Aim To compare brain oxygenation in health care workers wearing an N95 mask with a PPE kit versus a three-ply mask during an intensive care setting for 6 hours. Materials and Methods Thirty clinicians and 30 paramedical staff participated in the study. The control (three-ply mask) and subject (N95 mask with PPE) groups included 15 clinicians and 15 paramedical staff. A comparative analysis of brain oxygenation using a 3T magnetic resonance imaging (MRI) machine was performed in these two groups at the beginning and the end of their work shift. Results The mean age of the individuals in the control and subject groups was 30.8 and 30.13 years, respectively. The median value of brain oxygenation in the control and subject groups in the pre-shift was between 33 and 31 and post-shift was 30 and 24. The drop in brain oxygenation in subjects was more than the controls ( p = 0.004) in the post-shift assessments. The cerebral blood flow (CBF) in the bilateral middle cerebral artery (MCA) using arterial spin labeling (ASL) showed a rise in CBF in both groups post-shift as compared with the pre-shift values. The median values of the right and left MCA in the control and subject groups pre-shift were 82.75/83.45 and 89.75/106.65. The post-shift median values of both MCAs of the control and subject groups were 115.65/115.55 and 109.60/119.49. Conclusion MRI-BOLD imaging revealed a significant drop in brain oxygenation in the subject group as compared with the control group. Multiphasic-ASL showed a compensatory rise in CBF in both groups.

METHODS FOR DECONTAMINATION AND REUSE OF THE N95 RESPIRATOR DURING THE SARS-COV-2 PANDEMIC

The SARS-CoV-2 pandemic threatens public health around the world, and healthcare professionals are at increased risk due to their close contact with patients. NIOSH certified N95 masks, can filter 95% of particles in the air and are therefore currently recommended by the Center for Disease Control for use by health professionals in the face of the pandemic. The shortage of protective equipment, including N95 respirators, has generated the need for rationing this resource. The objective of this systematic review is to identify effective methods for the decontamination of the N95 respirator, which maintain its filtration and fit properties for reuse. A earch of digital resources was carried out in databases: Pubmed, medRxiv, IJOS, Scielo, Elsevier;systemic analysis, meta-analysis, clinical trials were accepted. Based on the results obtained, it can be determined that vaporized hydrogen peroxide and ultraviolet germicidal irradiation are the most recommended methods, due to their germicidal efficacy, and they also maintain the filtration and adjustment capacity of the respirator. More research is needed to generate protocols that allow the safe reuse of this resource.