COVID-19 OUTCOMES IN KOREAN PATIENTS WITH GOUT

BackgroundPatients with autoimmune inflammatory rheumatic diseases are at higher risk for coronavirus disease (COVID)-19 hospitalization and worse clinical outcomes compared with the general population. However, data on the association between COVID-19 outcomes and gout, or gout-related medications are still lacking.ObjectivesWe aimed to compare COVID-19 related clinical outcomes in gout vs. non-gout patients.MethodsWe conducted a retrospective cohort study using the electronic health record-based databases of Seoul National University hospital (SNUH) from January 2021 to April 2022 mapped to a common data model. Patients with gout and without gout were matched using a large-scale propensity score (PS) algorithm. The clinical outcomes of interest were COVID-19 infection, severe COVID-19 outcomes defined as the use of mechanical ventilation, tracheostomy or extracorporeal membrane oxygenation, and death within 30 days of COVID-19 diagnosis. The hazard ratio (HR) for gout vs. non-gout patients derived by Cox proportional hazard models were estimated utilizing a 1:5 PS-matched cohort.Results2,683 patients with gout and 417,035 patients without gout were identified among the patients who visited SNUH. After 1:5 PS matching, 1,363 gout patients and 4,030 non-gout patients remained for the analysis. The risk of COVID-19 infection was not significantly different between patients with gout and those without gout (HR 1.07 [95% CI 0.59-1.84]). Within the first month after the COVID-19 diagnosis, there was also no significant difference in the risk of hospitalization (HR 0.57 [95% CI 0.03-3.90], severe COVID-19 outcomes (HR 2.90 [95% CI 0.54-13.71]), or death (HR 1.35 [95% CI 0.06-16.24]).ConclusionPatients with gout did not have an increased risk of COVID-19 infection or worse clinical outcomes. Updates of temporal trends of COVID-19 outcomes in gout patients are yet warranted as new SARS-CoV-2 variants emerge.References[1]Shin YH, et al. Autoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study. Lancet Rheumatol. 2021 Oct;3(10):e698-e706.[2]Topless RK, et al. Gout and the risk of COVID-19 diagnosis and death in the UK Biobank: a population-based study. Lancet Rheumatol. 2022 Apr;4(4):e274-e281.[3]Xie D, et al. Gout and Excess Risk of Severe SARS-CoV-2 Infection Among Vaccinated Individuals: A General Population Study. Arthritis Rheumatol.2023 Jan;75(1):122-132.Table 1.Clinical outcomes of COVID-19 infection in patients with goutOutcomesUnmatched populationPopulation with PS stratification using 10 strata1:5 PS matched populationHazard ratio (95% CI)p-valueHazard ratio (95% CI)p-valueHazard ratio (95% CI)p-valueCOVID-19 infection1.68 (1.03-2.57)0.031.20 (0.72-1.87)0.461.07 (0.59-1.84)0.82Hospitalization due to COVID-191.92 (0.32-6.05)0.391.63 (0.26-5.77)0.540.57 (0.03-3.90)0.66Severe COVID-19 infection4.72 (1.44-11.28)<0.014.22 (1.17-12.21)0.022.90 (0.54-13.71)0.20Death due to COVID-191.15 (0.07-5.18)0.900.77 (0.04-3.81)0.821.35 (0.06-16.24)0.84Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Anesthesia for penetrating injury of the oropharynx in a child: a case report

BackgroundPenetrating injury of the oropharynx occurs frequently in children, however, anesthetic management is seldom described in such cases.Case presentationA 2-year old child came to the emergency room with a toothbrush impacted in the gingivobuccal sulcus making airway management difficult. We used a simple yet unique approach to secure the airway safely given the lack of pediatric size fibreoptic and videolaryngoscopes in our emergency operation theatre. The patient was kept in Pediatric ICU and watched for any complications and discharged on the 4th postoperative day.ConclusionsThus, ingenious non-invasive techniques to secure the airway can prevent the patient from undergoing surgical tracheostomy.

Potential Impact of Hospital at Home on Postoperative Readmissions

The first HAH programs in the United States were developed at Johns Hopkins Hospital in the late 1990s and were initially targeted toward geriatric patients with chronic medical problems.2 Follow-up studies focused on medical patients have been performed in multiple patient populations and health systems.3-9 These studies have demonstrated that for medically ill patients, admission to HAH offers significant benefits compared with inpatient admission, including fewer iatrogenic complications such as delirium, improved patient and caregiver satisfaction, decreased readmission rates, and, in some studies, decreased mortality. [...]diverting postoperative readmissions to at-home care has the unique benefit of freeing surgical beds, which can increase procedural capacity and therefore surgical access and hospital revenue. [...]we estimated the margin from new inpatient capacity that could be generated if the hospital avoided HAH-eligible readmissions and backfilled these beds with new medical-surgical admissions. [...]we estimated the potential financial impact on hospital margin of diverting surgical readmissions to an HAH program.

Oral lesions in patients with severe COVID-19 in the National Institute of Respiratory Diseases in Mexico: Case series

Introduction SARS-CoV-2 is a neurotropic, mucotropic, and sialotropic virus that can affect the salivary glands' function, taste sensations, smell, and oral mucosa integrity.1 The oral cavity is a perfect habitat for SARS-CoV-2 invasion due to the special affinity the virus has for cells with angiotensinconverting enzyme (ACE2) receptors, such as those from the respiratory tract, oral mucosa, tongue, and salivary glands. Aphthous lesions with necrosis and hemorrhagic crusts have been described to manifest more regularly in older adults with immunosuppression and severe COVID-19 infection;one hypothesis for the development of aphthous lesions and/or ulcers is given due to the ACE2 receptor and the SARS-CoV-2 interaction, which could alter the epithelial lining of salivary glands and keratinocytes, causing lesions in the oral cavity.4 At the same time, different etiological factors such as infections, immune system alterations, and direct trauma to the oral mucosa or epithelium,5 may be related to the stress of a prolonged hospital stay.6 Including pressure in the oral cavity conditioned by the prone position, malposition of the endotracheal tube (mainly in the corners of the lips),7 medication-related nutritional deficiencies8 such as lopinavir, and ritonavir, oseltamivir, hydroxychloroquine, among others.9-12 Thrombotic vasculopathy secondary to COVID-19 has also been described, induced by system mediators in the microvascular walls, which impairs endothelial cells, and activates coagulation factors13 and a possible hypersensitivity reaction of the mucosa to the presence of SARS-CoV-2 in the epithelium14,15;there is also the hypothesis that it could be associated with an exanthem pattern induced by the inflammatory action of the SARSCoV-2 virus,16 presented as increased levels of cytokines (including interleukin-1, tumor necrosis facto-a), and arachidonic acid metabolites (prostaglandins) secondary to the stem cell factor production and the basic fibroblast growth factor of keratinocytes from the basal layer, in relation to post-inflammatory pigmentations that could appear in areas previously affected by trauma or chronic inflammation.17 Oral manifestations in COVID-19 patients appear, on many occasions, even before respiratory symptoms, although exanthematic lesions observed in COVID-19 patients can also be observed in other viral processes. Physical examination revealed a patient in a supine position with orotracheal intubation and orogastric tube, with aphthous-type ulcers, some of them had blood crusts of different sizes on the lower lip (both skin and mucosa), dorsum, and lateral edge of the tongue, gum, and vestibular fornix (Figure 3). Initial physical examination shows the patient in a supine position supported by high-flow nasal prongs, upper and lower lips edema and ulcer-like lesions with hematic crusts on both lips (Figure 4), topical management with steroids and GELCLAIRE® Oral Gel (glycyrrhetinic acid and polyvinylpyrrolidone) is observed.

Loop ileostomy closure as a 23-hour stay procedure: a randomized controlled trial

Background: Loop ileostomy closure is associated with low complication rates, consisting mostly of postoperative ileus, but is still leading to significant length of hospitalization. Hence, decreased length of stay could be achieved by decreasing ileus rates. The purpose of this study was to assess the safety and feasibility of ileostomy closure performed in a 23-hour hospitalization setting using a standardized enhanced recovery pathway. Methods: This randomized controlled trial included healthy adults undergoing elective ileostomy closure. All patients were enrolled in a standardized enhanced recovery pathway specific to ileostomy closure, including daily irrigation of the efferent limb with an enteral nutritional formula for 7 days preoperatively. Once surgery was completed, patients were randomized to either conventional hospitalization (CH) or to 23-hour stay (23HS). Primary outcome was total length of stay in days, and secondary outcomes were 30-day rates of readmission, postoperative ileus, surgical site infection, postoperative morbidity and mortality. Owing to COVID-19 limiting access to surgical beds, the study was terminated early. Results: A total of 47 patients were randomized;23 in the CH arm and 24 in the 23HS arm. Patients in the 23HS arm had a shorter median length of stay (1 d v. 2 d, p = 0.015) and similar readmission rates (4% v. 13%, p = 0.348), postoperative ileus (0% in both arms), surgical site infection (0% v. 4%, p = 0.489), postoperative morbidity rates (17% v. 22%, p = 0.724) and mortality rate (0% in both arms). Conclusion: This study suggests that loop ileostomy closure as a 23-hour stay procedure in a standardized enhanced recovery pathway is feasible and safe.

S6 Timing of pneumothorax post-CT-guided thoracic biopsy in a tertiary referral centre: implications for the ambulatory pneumothorax pathway

S6 Table 1Study population characteristicsn % Total number of procedures 641 - Male 371 57.9% Female 270 42.1% Median age (years) 71.0 - Lesion site RUL 177 27.61% RML 22 3.43% RLL 109 17.00% LUL 151 23.56% LLL 104 16.22% Anterior mediastinal 29 4.52% Pleural 40 6.24% Chest wall 9 1.40% Median lesion size (mm) 41 - Total pneumothorax incidence 223 34.8% Timing of pneumothorax T = 0 hours 186 83.41% T = 0-2 hours 37 16.59% T = 2 hours - 7 days 0 0.00% Pneumothorax management(% of n=223) Conservative 144 64.57% Aspiration 47 21.08% Chest drain 31 13.90% Pleural vent 1 0.45% Total pneumothorax needing intervention (% of n=223) 79 35.43% Immediate pneumothorax management (% of n=186) Conservative 111 59.68% Aspiration 46 24.73% Chest drain 28 15.05% Pleural vent 1 0.54% Immediate pneumothorax needing intervention (% of n=186) 75 33.63% Delayed pneumothorax management (% of n=37) Conservative 33 89.19% Aspiration 1 2.70% Chest drain 3 8.11% Pleural vent 0 0.00% Delayed pneumothorax needing intervention (% of n=37) 4 10.81% ConclusionsThis study demonstrates that the incidence of delayed-onset pneumothorax requiring intervention is low in a tertiary centre setting. The optimal time for patient observation post-CTGB remains unknown. The authors acknowledge a high incidence of pneumothorax in the study cohort, which they postulate may be due to a higher volume of complex procedures in a tertiary setting, higher sensitivity of CT for reporting trivial post-biopsy pneumothorax, and the diversion of more complex lung cancer patients to the CTGB route during the COVID pandemic to avoid aerosol-generating procedures.ReferenceHeerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol 2017;Jan;27(1):138–148.

A Rare Presentation of Pseudomembranous Colitis in a COVID-19 patient

Introduction/Objective Recent reports suggest that though COVID-19 is predominantly a respiratory pathogen, one of its presenting features can be gastrointestinal symptoms. We hereby present a case of a female with COVID-19 infection whose hospital course was complicated by colonic pseudo-obstruction caused by pseudomembranous colitis resulting in an emergent hemicolectomy. Methods A 59-Year-old female with history of hypertension, diabetes, and breast cancer post mastectomy presented with pneumonia and was confirmed to be COVID-19 positive. She was admitted to the hospital and was treated with Azithromycin for 6 days. Patient developed constipation on day six of hospitalization and started having abdominal pain on day eight with elevated WBC count. Imaging showed distension of cecum and proximal colon. She underwent exploratory laparotomy which revealed a necrotic appearing cecum that was massively dilated and had a serosal tear. These findings prompted emergent hemicolectomy with loop ileostomy. Grossly cecum was black/green, dilated, thin walled with a 5 x 5 cm yellow green raised plaques. Microscopy of the plaques revealed focal erosion of colonic mucosa with overlying acute inflammatory cells, fibrin deposits, mucus, and necrotic epithelial cells consistent with pseudomembranous colitis. Conclusion Review of literature shows no reported cases of intestinal pseudo-obstruction due to pseudomembranous colitis in a COVID-19 patient. Not only this, but there are also only a limited number of case studies of pseudomembranous colitis presenting as intestinal pseudo-obstruction without diarrhea. Though this patient's presentation could be from Clostridium difficile infection secondary to Azithromycin, it is not a common antibiotic to cause this. Also, one of the known causes of pseudomembranous colitis is ischemia. Given that COVID-19 infection is a pro-thrombotic condition, possible ischemia secondary to COVID-19 infection related coagulopathy should also be a consideration.

Effect of COVID-19 pandemic on children undergone percutaneous endoscopic gastrostomy due to neurologic diseases

Aim: To investigate the effects of SAR-CoV-2 infection on nutritional status in patients who underwent percutaneous endoscopic gastrostomy (PEG) for neurological disorders.Methods: The clinical and laboratory follow-up data of the patients who underwent PEG in our clinic between 2002 and 2018 were evaluated before and during the pandemic. The results were analyzed statistically.Results:Twenty patients were included. They were 70.9±64.4 months old at the time of PEG, 97.9±67.8 months before the pandemic, and 105.5±60.8 months during the pandemic (p=0.048). Weight for age at the time of PEG increased from 10.7±4.6 kg to 15.6±7.2 kg before the pandemic. Hemoglobin was 12.3±1.4 g/dl at the time of PEG, 13.5±1.6 g/dl before the pandemic (p=0.045). Vitamin D was 24.1±8.9 ng/ml at the time of PEG and increased to 45.7±9.7 ng/ml during the pandemic (p=0.018). The annual number of visits before the pandemic was 9.8±5.7 and decreased to 2±1.7 during the pandemic (p=0.003). Twelve (%60) of the patients developed PEG complications, 6(30%) had their PEG replaced. Those who had developed PEG complications had low levels of albumin (3.3±0.4 vs 4±0.4 g/dl, p=0.022) and vitamin B12 (578±199 vs 1299±533 pg/ml, p=0.007).Conclusions:Even if PEG is applied late, it provides a partial improvement in patients, but the COVID-19 pandemic reversed these benefits and caused an increase in PEG complications. In order for the patient to get the maximum benefit from PEG, close follow-up is essential.

Establishing Minimally Invasive Colorectal Unit at a Tertiary Care Indian Centre in Covid-19 Second Wave

Aim: Minimally invasive cancer surgery is the becoming the standard of care in colorectal oncology. With the growing interest in the use of tailored approach to improve the outcomes, colorectal oncology demands sub-specialised care. Method(s): This is a description of establishment of a dedicated colo-rectal oncology unit at a newly built tertiary care centre in the country, Tata Memorial Centre (Varanasi) with special emphasis on the introduction of laparoscopy for standard and extended colo-rectal surgery. Result(s): Over a period of 4 months, from February 2021 to May 2021, 35 colo-rectal surgeries have been done with 5 emergency cases and the remaining in elective setting. Operative procedures included -10 colectomies, 5 stoma/ostomy creations, 7 rectal resections in standard TME plane, 2 total pelvic exenterations, 11 extended rectal resections. 22 of these 35 surgeries (62.8%) were done using laparoscopic approach. Laparoscopy has been used across all procedures, specifically 5 colectomies, 7 standard TME rectal surgeries, 5 extended rectal resections and 1 total pelvic exenteration. Clavein dindo Grade 3 or higher morbidity was seen in 5.7% cases. Joint clinic session dedicated to colorectal oncology is conducted to provide a tailor-made individualized care to appropriate patients. Conclusion(s): Use of minimally invasive approach in colorectal oncology along with a sub specialized unit is the need of the hour to improve the outcomes in this cohort of patients.

Specialist Nurses' Experience of COVID-19 in the United Kingdom

In the 6 months preceding the pandemic, the Deputy Chief Nurse and Consultant Nurse for Trauma and Orthopaedics had worked with this group of staff to find commonalities among their roles, and outline the development required to ensure they were recognized for the clear contribution they made to high-quality patient care and improved patient outcomes. The pain management and acute pain management specialist nurses were deployed to critical care, primarily because their workload centered on pain management post-surgery, and many elective procedures had stopped. Both acknowledged the lack of family presence at the end of life was very distressing. If the situation were to arise again, both indicated they would return to critical care: one because overall she felt this was a learning experience, and the other because of the fear of how a refusal may be perceived by others.

Swallowing Dysfunction and its Impact on Patients Undergoing Oncological Treatment

Loco-regional control rates and tumour response have increased as a result of advancements in Head and Neck Cancer (HNC) therapy. [...]mortality is still high despite advancements in treatment and diagnostic methods. Keywords: Covid-19 pandemic * Nigeria situation * Global perspective Introduction Loco-regional control rates and tumour response have increased as a result of advancements in Head and Neck Cancer (HNC) therapy. [...]mortality is still high despite advancements in treatment and diagnostic methods. [...]we may divide the variables that predict dysphagia into three categories: treatment-related, patient-related, and tumour-related. [...]for specific procedures such as arytenoid cartilage and base of the tongue resections, dysphagia may be precisely anticipated. According to Taberna, anatomical reasons and the food consistency of dysphagia are related.

Impact of internet plus health education on urinary stoma caregivers in coping with care burden and stress in the era of COVID-19.

Objective: To explore the impact of "Internet Plus Health Education" on coping with care burden and pressure in urinary stoma caregivers in the era of COVID-19. Materials and methods: Eighty caregivers of patients with urinary ostomy were equally randomized to experimental and control groups. Caregivers in the experimental group received digital nursing education intervention, which involved nursing intervention of Internet Plus Health Education (IPHE), and those in the control group received conventional care instructions. Six months later, care burden and emotional pressure were assessed in all caregivers using the Zarit Caregiver Burden Interview (ZBI) and the Simplified Coping Style Questionnaire (SCSQ). Results: Before the intervention, the ZBI and SCSQ scores were comparable between both groups (p > 0.05). After the intervention, the ZBI scores in the experimental group were significantly higher than in the control group and vice versa for SCSQ scores (p < 0.01). Furthermore, after the intervention, the family care satisfaction scale (FCSS) of the experimental group was significantly higher than the control group. Conclusion: Providing "Internet Plus Health Education" to urinary stoma caregivers can reduce their care burden and enhance their pressure-coping ability in the COVID-19 era.

Two-year outcomes of using a stepwise thrombolysis protocol for the management of acute non-malignant portomesenteric thrombosis

IntroductionAcute extensive non-malignant non-cirrhotic portomesenteric thrombosis can lead to bowel infarction and frequently does not resolve with anticoagulation. In 2019 we published our first case series of a stepwise thrombolysis protocol involving the use of low dose tissue plasminogen activator (L-tPa) followed, if indicated, by Catheter-Directed Thrombolysis (CDT) and Transjugular Intrahepatic Portosystemic Shunt (TIPSS). We present an updated series, aiming to explore the recanalization rates, symptom resolution and any adverse events for patients who received this protocol.MethodWe retrospectively reviewed the clinical records of patients who received the stepwise regimen at Royal Free Hospital between December 2019 & March 2022.ResultsA total of 35 patients were included with a mean age of 47 (SD=14) years;63% were males. Thrombophilia was identified in 13 (37%) cases and 14 (40%) had other local or systemic causes for thrombosis (1 had COVID-19;3 received ChAdOx1 vaccination). Three patients had underlying chronic liver disease. All patients had ongoing abdominal pain despite anticoagulation. Occlusive portal vein thrombosis (PVT) was found in 30 (86%) patients with 18 (51%) having thrombosis of all three vessels (PVT + splenic vein + superior mesenteric vein). While all patients received L-tPa within a median of 15 (IQR =18) days of symptoms, CDT was applied in 17 (49%) patients and TIPSS was inserted in 15 (43%). CDT was delivered through EKOS™ endovascular system in 11/17 (65%). A degree of recanalization was observed in 24 (69%). TIPSS was patent at discharge in 14/15 (93%).The majority 28 (80%) were maintained on warfarin and 11 had concomitant anti-platelet therapy. Fifteen patients had imaging follow-up available [median duration of 9 (IQR = 11) months]. Recanalization was maintained in 9/15 (60%) and TIPSS remained patent in 6/9 (67%). At a median follow up of 6.5 (IQR = 9) months, complete symptom resolution was achieved in 30/34 (88%).Nine patients underwent bowel resection within a median duration of 11 (IQR= 10.5) days from presentation;mean length of bowel resected was 67 cm (SD = 50). One patient was discharged on parenteral nutrition and had a stoma. One patient died during the initial admission (related to bowel ischemia) and 1 had intracranial haemorrhage. Minor bleeding was recorded in 8 patients.ConclusionOur protocol resulted in good recanalization and patency rates with the majority achieving symptom resolution. While some patients required surgical intervention, bowel continuity was maintained and only one patient had a stoma.

Representation of inflammatory bowel disease on UK television

O2 Table 1Number of television programmes matching each search term (original search)Table includes all matches to given term, and is not adjusted for overlap where more than one search led to the same programme.Search term Total programmes in two-year period ‘Relevant’ clips (score >6) Crohns 189 43 Colitis 92 18 ‘Inflammatory bowel disease’ 32 6 Stoma 71 4 Ileostomy 12 6 O2 Table 2Themes identified within ‘relevant’ programmesClassifications relate to the final non-overlapping list (n=58), but a given programme may feature in more than one category.Term Description Number of programmes REAL Someone on a reality TV programme mentions their IBD 12 MED A factual/reality medical programme shows IBD 13 FAM A ‘famous’ person is interviewed and discusses their IBD 11 MAG A TV magazine programme has a section about an IBD-related issue 7 DOC A documentary with main focus of IBD or related issue 10 NEWS A news programme 13 HOLB A medical drama mentioning IBD 6 COVID A person with IBD is featured in the context of the impact of the pandemic on people with chronic conditions 7 AMY Documentary, interviews etc with Strictly Come Dancing performer Amy Dowden 4 CIRCLE Episodes of The Circle and subsequent interviews featuring contestant Georgina Elliott, with IBD and previously a stoma 2 DRAMA NON medical drama or comedy with IBD mention 1 Summary and ConclusionsIBD is underrepresented on television compared to other chronic conditions. Notwithstanding different search terms may lead to the same programme, there were fewer than 396 IBD-related clips identified in a two-year period. This is significantly lower than other conditions such as diabetes (3,138), asthma (2,236) and epilepsy (959).Only 58 of the IBD-related clips were assessed as relevant for this project.Depictions of IBD mainly featured in news, factual medical or documentary programmes with few fictional portrayals in dra a or comedy.Despite focus on the fear and uncertainty of living with IBD, there were also positive messages concerning the value of open communication with family and friends, and having goals to focus on.Framing living with IBD using more extreme language may be due to television’s desire for compelling narratives, rather than an accurate reflection of people’s lived experience. However, children and young people with IBD may still benefit from seeing well-known role models discussing their condition and achieving their ambitions despite the challenges.Further research into use of and benefit of TV and social media in support and education should be considered.

Holy Simplicity: The Physician’s Role in End-of-Life Conversations

Early initiation of end-of-life (EOL) conversations has been shown to improve patient agency in dying, increase early access to hospice care, and facilitate a dignified death. Despite the benefits of early initiation, EOL conversations do not occur as readily as physicians or patients wish. While medicine is commonly considered both a science and an art, increasing medicalization may narrow a clinician’s focus towards procedures or specialized clinical frameworks rather than a patient’s end-of-life wishes. Since physicians are ambassadors of clinical knowledge and are trusted patient advocates, it is important they facilitate EOL conversations early in the dying process. Patients desire their physicians to convene these conversations. However, physicians are often hesitant to do so. Notable theologians, philosophers, and physicians offer a broad framework outlining the importance of physician-led EOL conversations.

Nurse leader pleads for funding as staffing shortage forces closure of 900 age d-care beds

The voluntary standards (https://tas.health.nz/assets/Health-of-Older-People/ARRC-Agreement-2021-22-effective-1-August-2021-.pdf) (see pp56, 58 and 70-71) for our aged-care facilities state each resident only needs half an hour of nursing care per day - but with residents in recent years coming in older, sicker and in need of more acute care, this is nowhere near enough. Aged care 'fastest-growing' sector The level of care provided in many aged residential care (ARC) facilities includes: * Hospital-level * Accident Compensation Corporation (ACC) transitional/rehabilitative/serious injury * End-of-life * Assisted dying * Mental health and addiction * Cognitive impairment requiring a secure environment We nurses who work in aged care and the community must also support our older people to stay independent as long as possible, whether in their own home or in a care home, for their own wellbeing but also to reduce pressure on hospitals and ARC facilities. [...]one man under 65 was recently admitted with end-stage lung cancer, no social or family support and a long history of trauma, mental health issues and a distrust of health professionals. The New Zealand Aged Care Association has estimated $94 million is needed to pay ARC nurses (enrolled and registered) on a par with hospital nurses - but this would rise to $166 million after the Health NZ/NZNO pay equity settlement rates are implemented.

PREGNANCY ASSOCIATED SARS-COV-2 AND ZIKA INFECTIOUS CONDITIONS – RECENT DATA AND OUTCOMES

Since the Zika virus outbreak in the United States, Centers for Disease Control and Prevention (CDC) concluded that among people with confirmed or possible Zika virus infection during pregnancy, Zika-associated birth defects occured in 5% of babies [4]. According to cohorts from Colombia, Puerto Rico, and French Guiana, the cumulative risk of ZIKV infection for pregnant women living in epidemic areas ranged from 21 to 44 percent [5]. Blood donors who were asymptomatic and Zika virus RNA positive were found in Florida and Texas in 2017 [7]. [...]Zika virus sexual transmission is possbile from both asymptomatic and symptomatic infections through genital, oral and anal intercourse [7]. According to these data, pregnant women in the US are more likely than non-pregnant women of reproductive age to get SARS-CoV-2 infection and accompanying symptoms [12].

ORAL MANIFESTATIONS ASSOCIATED WITH COVID‑19 PATIENTS IN SAUDI ARABIA

COVID-19 was recognized by the World Health Organization (WHO) as a pandemic disease since most of the countries reported significant numbers of deaths and infected people starting with December 2019 (WHO, 2020). The diversity of COVID-19 manifestations can be attributed to the sites where the SARS-Cov-2 receptors Angiotensin-converting Enzymes 2 (ACE2) were found, which include, but were not limited to, lung, kidney, salivary glands and gastrointestinal tract [1,12-14]. Dealing with COVID-19 had shown that many oral manifestations could be in direct relation to the infection itself. [...]another study [15] reported that at least one oral manifestation concerning the oral cavity and salivary gland was found on 67.2% of the 58 observed patients, in whom a dry mouth had the highest prevalence and gingival bleeding - the lowest. A P-value < 0.05 was considered significant. 3.RESULTS The link was distributed to a total of 515 patients tested positive with COVID-19, 512 of them having responded to the questionnaire (a response rate of 99%).