Disseminated Mucormycosis in a patient on long term immunosuppression: Severe fungal infections as multi-system disorders

Introduction: Mucormycosis is a rare, severe fungal infection with an incidence of 0.005 to 0.17 per million.1 but incidence has risen recently, particularly in the Asian subcontinent, due to use of immunosuppression for Covid19.2 Presentations can vary and are classified into: rhino-orbito-cerebral, pulmonary, cutaneous, disseminated, renal and gastrointestinal. Risk factors include diabetes, immunosuppression, iron overload, malnutrition, and prematurity.1,3 Although mucormycosis has an extremely high mortality rate and disseminated infection is usually fatal, treatment options exist if diagnosed early and surgical debridement may be curative. Objective(s): We present a case of mucormycois in a female patient in her 40s who was immunosuppressed with methotrexate for rheumatoid disease. This case is discussed to increase awareness of critical illness caused by opportunistic invasive fungal infections in immunosuppressed patients and promote timely identification and management. Method(s): We detail the clinical context and management of a patient with mucormycosis and discuss relevant literature. Result(s): A female patient in her 40s who had been experiencing upper respiratory tract symptoms for several weeks, including cough and brown sputum, was admitted with a presumptive diagnosis of methotrexate toxicity after a full blood count performed by the general practitioner demonstrated pancytopenia. Initially, National Early Warning System 2 score (NEWS2) was 2 but became intensely hypertensive during blood transfusion and then profoundly shocked with an escalating NEWS2. Broad-spectrum antibiotics and fluconazole were commenced for neutropenic sepsis and the patient was referred to critical care in multiple organ failure. Computerised tomography (CT) scan of the chest, abdomen and pelvis showed "left upper lobe consolidation, which with neutropenia might represent an angioinvasive aspergillosis". She had multiple areas of skin discolouration and desquamation. Haematology and Infectious Diseases opinions were sought, and a bone marrow biopsy was performed which showed severe toxic effects consistent with sepsis/life threatening infection. Progressive proptosis was noted, and CT scan of her head was requested. Sadly, she was never stable enough for CT transfer. Beta D Glucan and aspergillus antigen serology was negative. Broncho-alveolar lavage demonstrated Candida albicans and then, later, Rhizopus arrhizus was isolated and anti-fungal treatment changed to voriconazole and then amphotericin B. Upon reviewing the notes in light of the positive culture for Rhizopus, the patient had likely been exhibiting symptomatic Mucormycosis sinus infection for some time prior to this admission with disseminated infection. The patient's condition continued to deteriorate and she sadly died. Conclusion(s): * The Early Warning Score significantly underestimated how unwell the patient was upon arrival in ED, a systems-based assessment would have demonstrated that the patient had multiple system dysfunction and significant potential to deteriorate suddenly despite having stable observations * The methotrexate level has no clinical value in diagnosing or refuting a diagnosis of methotrexate toxicity * A full examination of the immunosuppressed patient including ENT is a necessity when searching for a source of infection * Invasive fungal infections can cause multi-system symptoms and atypical presentations * As a greater proportion of patients have received systemic immunosuppression for Covid-19, vigilance for more unusual pathogens, including Mucormycosis by clinicians is advised.

Monkeypox (mpox) is a new problem on a global scale for humanity.

Purpose - to draw attention to an infection that was little known, but has now become a global problem for society;to familiarize readers with the peculiarities of the 2022 monkeypox outbreak and to increase the level of alertness of doctors to this disease. Monkeypox is a global problem because the disease is spreading rapidly, covering 111 countries. Three cases were diagnosed in Ukraine. It is predominantly a self-limited infection, but there are severe and deadly complications. The lethality of this disease ranges from 0% to 11%. The course of the disease is more severe in children and people with reduced immunity. Vertical transmission of the virus from mother to child is possible, resulting in congenital monkeypox. Monkeypox is a zoonotic disease and its natural reservoir is not exactly known, but rodents are most likely to act. In most cases, person-to-person transmission of the virus occurs through close skin to skin contact, often during sexual intercourse. At the beginning of the outbreak 98% of cases of disease were was diagnosed in homo- and bisexuals. Airborne transmission is also possible. Infection is possible through close contact with infectious skin lesions. Clinically, the initial period resembles influenza, but lymphadenopathy is characteristic, which is considered a pathognomonic symptom of mpox. The rash is similar to that of chickenpox, but with more prevalent location on palms and soles than in chickenpox. In the presence of a vesicular rash in a patient, it is necessary to exclude monkeypox. PCR diagnostics of the virus in samples of vesicles or crusts has the greatest diagnostic value. Hygienic skin care is important. Antiviral drugs (tecovirimat, brincidofovir) are recommended only in severe cases. To reduce the spread of infection, international rules apply as for other infections, such as COVID-19. The monkeypox virus vaccine is recommended primarily for groups at risk of infection, including medical personnel who may come into contact with the patient or samples for laboratory testing. Being aware for this infection, following international health regulations, it is possible to prevent the further spread of monkeypox.Copyright © 2023 Tomsk State University. All rights reserved.

XBB.1.16 Omicron subvariant rise to a variant of interest: Implications for global alertness and preparedness.

The emergence of the XBB.1.16 Omicron subvariant of COVID-19 has been a cause for concern for the WHO and health authorities globally. This subvariant, which originated from a hybrid of two BA.2 progeny pedigree, has two amino acid mutations in its spike protein and shares a genetic makeup similar to the XBB.1.5 variant. The WHO initially labeled it as a variant under monitoring before elevating it to a variant of interest after it was found to have caused a surge of COVID-19 cases in India for seven months. The XBB.1.16 subvariant has a proliferative edge and can evade the immune system. It has been spreading rapidly on a global scale and has been linked with a higher effective reproductive number than other subvariants. As such, a concerted international effort to prevent and contain its transmission has been recommended. Health authorities must strengthen their health systems, surveillance, and data collection systems to enable them to detect, track, and respond to emerging and reemerging strains of the virus in a timely and effective manner. Research into the XBB.1.16 subvariant is crucial for alerting and preparing the global populace for a potential outbreak, developing treatment options, and potential vaccines. Implementing the One Health approach can promote greater collaboration between diverse disciplines and societal levels to build a more resilient and sustainable future for all.

Encephalite aigue post-vaccinale covid-19: une revue systematique des cas rapportes

INTRODUCTION: Quoique la vaccination contre le COVID-19 a boulverse l'evolution generale de cette pandemie, mais plusieurs effets secondaires sont un sujet de discussion, et l'encephalite aigue en fait partie. MATERIELS ET METHODES: Ce travail a pour objectif de realiser une revue systematique des cas rapportes dans la litterature dans les grandes bases de donnees (PUBMED-EMBASSE-SCIENCE DIRECT), dans le but de connaitre les caracteristiques demohgraphiques, imageriques et pronostiques de ces patients. RESULTAS: 7 cas sont inclus dans notre revue dont 5 sont des femmes, la moyenne d'age est a 54.65, 3 types de vaccins sont rapportes, mRNA1273 chez 3 patients, ChAdOx1 chez 3 patients et BNT162b2 mRNA chez un seul. La moyenne d'appartitio ndes symptomes est 6.67jours apres la premiere dose. Le signe neurologique commun est la confusion avec les troubles de la vigilance. Le bilan etiologie initiale est negative chez tous les patients. IRM est realisee chez tous les patients, et l'aspect le plus frequent ete les lesions d'hypersignal de la substance blance en sequence T2 flair, qui predominait surtout au niveau de la region temporal chez 4 patients (Figure 1), et au niveau du pons chez 2 malades. EEG est realise chez 6 des patients a montre un rythme theta diffus. Apres la corticotehrapie systemique, l'evolution ete favorable chez 6 patients. DISCUSSION: L'encephalite aigue est generalement secondarie a une infection ou l'origine auto-immune, qui contribuent a environ trois quarts des cas diagnostiques. La vaccination anti-COVID-19 peut etre associee dans des tres rares cas a des complications neurologiques, telles que l'encephalite aigue. Jusqu'au Juin 2022, 7 cas sont rapportes dans la litterature1, ceci peut etre expliquee par une reponse inflammatoire innaproriee2, comme celle observee lors de l'encephalite auto-imune. CONCLUSION(S): Les medecins doivent etre attentifs a l'encephalite apres la vaccination afin de garantir une issue favorable.Copyright © 2023

Amantadine Might be Used as a Drug for SARS-Cov-2 Treatment?

Coronavirus Disease 2019 (COVID-19) infection, the pandemics, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has no known effective radical pharmacotherapy and just supportive approach at present. Amantadine is a drug used in Parkinson's disease and other parkin-sonisms;and is known to increase indirectly dopamine by antagonistic effects at the N-methyl-D-aspartate (NMDA) receptor by increasing the release and blocking the reuptake of dopamine. Initially, amantadine was approved as an antiviral drug. We hypothesize that if amantadine is considered its anti-viral, immunological and neurostimulant effects might be useful in the supportive treatment of SARS-CoV-2 cases, especially those who developed acute respiratory failure with decreased vigilance and are being monitored in the intensive care unit. Further phase III clinical trials are needed.Copyright © 2021 Bentham Science Publishers.

Knowledge, attitudes and perceptions of radiology healthcare workers during the COVID-19 pandemic

Background: Medical imaging is vital in the diagnostic workup and evaluation of patients suspected or confirmed to have COVID-19;hence, radiology healthcare workers (HCWs) were an essential part of the early containment response to the pandemic. Radiology services are facing rising demands to introduce stricter infection control measures, and staff are expected to adhere to the new protocols while coping with a surge in patients. Objective(s): This study aims to identify the knowledge, attitudes and perceptions (KAPs) of radiology HCWs at a single site with regard to workplace preparedness during the COVID-19 pandemic. Method(s): A 26-item questionnaire was conducted with radiographers, radiology nurses, and support staff who had direct patient contact. Questions were concerned with involvement in managing suspected or positive COVID-19 patients, knowledge of infection control measures, and attitudes and perceptions in relation to working during the pandemic. Results were analysed using t-tests, chi-square tests, and Spearman's rank-order correlation, with statistical difference set at p<0.05. Result(s): Radiology HCWs self-reported significantly better knowledge of infection control measures and positive work attitudes. Those who had received the flu vaccine had significantly better perceptions of working during the pandemic. Suggested improvements included better organisational structure and more resources, better staff compliance and vigilance, better education, and a clearer focus on staff wellbeing. Conclusion(s): The findings indicate favourable KAPs among radiology HCWs in Singapore with regard to workplace preparedness during the pandemic, but efforts towards sustainability must be considered. Formulating policies to nurture motivated and resilient HCWs during a pandemic is advocated to foster a resilient workforce that is prepared for the next pandemic.Copyright © The Author(s) 2021.

Acute Transcatheter Aortic Valve Replacement Failure Secondary to Covid-19 Infection

Background Valve thrombosis is a documented cause of prosthetic valve failure. Common features include increased cusp thickness, reduced cusp mobility, and increased transvalvular gradient. Case reports have been published of prosthetic valve thrombosis secondary to COVID-19 infection, but this may represent the first documented case of bioprosthetic transcatheter aortic valve replacement (TAVR) thrombosis in the setting of COVID-19. Case A 90 year-old female with atrial fibrillation on apixaban and severe aortic stenosis status-post TAVR with normal valve function on recent echocardiogram presented in clinic with acute chest pain. She was found to have COVID-19 infection and severe bioprosthetic valvular regurgitation with leaflet thickening, abnormal cusp mobility, and elevated transvalvular gradient. [Formula presented] Decision-making Given the time course of valve failure, COVID-19 infection, and echocardiographic features, the patient was diagnosed with bioprosthetic valve thrombosis secondary to COVID-19. She was optimized with diuresis and continued on apixaban before undergoing valve-in-valve TAVR with resolution of valvular dysfunction. Conclusion This case contributes to a body of literature describing thrombotic complications in patients with valve replacement and COVID-19 infection despite concurrent anticoagulation. Increased vigilance and investigations are warranted to better characterize thrombotic risk and optimal antithrombotic strategies in this patient populace.Copyright © 2023 American College of Cardiology Foundation

Fatigue during Long-Haul Flights of Different Crew Compositions under Exemption from Layover and Flight Time during COVID-19.

Pilot fatigue and alertness are critical for civil aviation safety. Intercontinental pilots are more prone to fatigue and sleepiness due to jet lag, prolonged workdays, and disrupted rhythms. The Civil Aviation Administration of China excused enlarged flight crews from mandatory layovers and reimposed flight duration restrictions during COVID-19. This study investigates the sleep quality and attentional performance of pilots on intercontinental flights. The fifteen pilots who performed intercontinental flights in different crew compositions wore a body movement recorder, which has been proven to accurately estimate sleep duration and sleep efficiency. The crew's attentional performance and self-report were monitored at specified flight phases. In conclusion, the larger crews slept longer and more efficiently on board, particularly pilots in charge of takeoff and landing responsibilities. Crews on four-pilot layover flights were more alert before the takeoff of the inbound flights than exempt flights, but there was no significant difference towards the end of the mission. The new long-haul flight organization did not result in fatigue or decreased attention in the pilots. This study expands on the research by validating a novel intercontinental flight operation model under the COVID-19 scenario and highlighting critical spots for future fatigue management in various crew compositions.

Control and elimination in an SEIR model for the disease dynamics of COVID-19 with vaccination

COVID-19 has become a serious pandemic affecting many countries around the world since it was discovered in 2019. In this research, we present a compartmental model in ordinary differential equations for COVID-19 with vaccination, inflow of infected and a generalized contact rate. Existence of a unique global positive solution of the model is proved, followed by stability analysis of the equilibrium points. A control problem is presented, with vaccination as well as reduction of the contact rate by way of education, law enforcement or lockdown. In the last section, we use numerical simulations with data applicable to South Africa, for supporting our theoretical results. The model and application illustrate the interesting manner in which a diseased population can be perturbed from within itself. © 2023 the Author(s), licensee AIMS Press. is an open access article distributed un.

CASE REPORT: A RARE CASE OF ALVEOLAR HEMORRHAGE AFTER COVID-19 VACCINATION IN A PATIENT WITH RENAL-LIMITED ANTINEUTROPHIL CYTOPLASMIC ANTIBODYASSOCIATED VASCULITIS

The coronavirus disease 2019 (COVID-19) vaccination campaign has progressed worldwide. Rare but severe adverse events of COVID-19 vaccination such as anaphylaxis and myocarditis have begun to be noticed. Of note, several cases of new-onset antineutrophil cytoplasmic antibody-associated vasculitis (AAV) after COVID-19 mRNA vaccination have been reported. In contrast, relapse of AAV in remission has not been recognized enough as an adverse outcome of COVID-19 vaccination. We report, to the best of our knowledge, a first case of renal-limited AAV in remission using every 6-month rituximab administration that relapsed with pulmonary hemorrhage, but not glomerulonephritis, following the first dose of the COVID-19 vaccine. Notably, the patient received the COVID-19 vaccine more than 6 months after the last dose of rituximab according to the recommendations. Ironically, his CD19 positive B cell counts were found to be increased after admission, indicating that our case might have been prone to relapse after COVID-19 vaccination. Although our case cannot establish causality between AAV relapse and COVID-19 mRNA vaccination, a clinical vigilance for relapse of AAV especially in patients undergoing rituximab maintenance therapy following COVID-19 vaccination should be maintained. Furthermore, the elapsed time between rituximab administration and COVID-19 mRNA vaccination should be carefully adjusted based on AAV disease-activity (Nishioka et al. Front Med 2022. in press).

Pediatric ovarian torsion: A diagnostic challenge in covid-19 times

Ovarian torsion is a rare gynecological emergency in children and an early surgical intervention is needed to salvage the ovary. Herein, we present a case of eight year old girl who presented with complaints of lower abdominal pain during ongoing COVID-19 pandemic. She was diagnosed as a case of ovarian torsion on right side. She underwent exploratory laparotomy and ovarian cystectomy was performed. Delay in diagnosis and treatment of ovarian torsion may have grave consequences, resulting in functional loss of the ovary. Copyright © 2020, Kathmandu University. All rights reserved.

The effect of entrepreneurship education on the determinants of entrepreneurial behaviour among higher education students: A multi-group analysis

Entrepreneurship is generally considered the engine of social and economic development. Therefore, its promotion is of the utmost importance, especially in a context of crisis, such as the one currently experienced due to the COVID-19 pandemic. In order to identify the best approaches to foster entrepreneurship, this study aims to understand how entrepreneurship education impacts the development of entrepreneurial skills and behaviors in students. The results of this study show that the behavior associated with promoting new ventures can be predicted by specific individual characteristics. More specifically, individuals with greater prior knowledge, entrepreneurial alertness, opportunity recognition, entrepreneurial motivation, and entrepreneurial intention exhibit greater entrepreneurial behavior. In addition, the results of the multi-group analysis indicate that the proposed model works differently in students with some type of entrepreneurship training and in those with none. More specifically, students enrolled in entrepreneurship education are more likely to use prior knowledge and alertness to recognize new business opportunities and align their motivations toward starting a new venture than other students. © 2023 The Authors

Candida auris candidemia in COVID-19 and post-COVID-19 patients in a tertiary care hospital in North India

Introduction: Candida spp.accounts for 70%-80% of invasive bloodstream fungal infections.It is most commonly spread in long-term care facilities, caring for people with severe medical conditions. Patients hospitalized for COVID-19 are at risk for healthcare-associated infections like candidemia. Candida auris is an emerging, multidrug-resistant, healthcare-associated fungal pathogen. Candida auris is currently one of the most common clinical fungal pathogens, causing nosocomial infections. Due to its higher drug-resistance rate, C. auris is more difficult to treat, requires longer hospitalization periods, and results in higher morbidity and mortality than other Candida species. Aim and Objectives: To analyze the risk factors associated with C. auris candidemia in COVID-19 and post-COVID-19 patients at tertiary care center. Material(s) and Method(s): We prospectively analyzed all positive blood samples which were received in the Microbiology department at SGPGI, Lucknow for a period of 1 year (March 2020-March 2021).Blood samples were inoculated and cultured in BACTECBottles (BD) andincubated for 5days at 37degreeC.The bottles whichflagged positive, aGram's stain wasperformed and were sub-cultured on SDA for isolation of yeast colonies. Isolated yeasts were identified by phenotypic method and confirmed by MALDI-T OF MS. Demographics details of the patients were collected and recorded. The significant associated risk factors with C. auris candidemia were analyzed. Result(s): A total of 13 000 blood samples were received during the 1-year study period from different departments of the hospital.1.25% (n = 163) of the blood culture samples were positive for candidemia. Out of 163 Candida culture-positive blood samples, 27.61% (n = 45) were C. auris. A total of 64% (n = 29) C. auris candidemia was seen in non-COVID-19 patients, 31.1% (n = 14) in COVID-19patients, and twopatients had ahistory ofpost-COVID-19 infection.Theassociated risk factors included the use of broad-spectrum antibiotics, intravenous catheterization, underlying respiratory illness, mechanical ventilation, use of steroids, and dialysis. A total of 46.6% (n = 21) mortality was seen with C. auris candidemia. Conclusion(s): Candida auris candidemia continues to be a threat in hospitalized patients. This study shows prevalence of C. auris candidemia in COVID-19 and post-COVID-19 patients with 47% mortality. Candida auris is continuously reported from different departments in our institute, especially from intensive care units with high morbidity and mortality.An alertness, awareness and infection control practices by the healthcare personnel will help in early diagnosis and appropriate antifungal therapy and control the spread of C. auris.

Drug Shortage Concepts Among Stakeholders in Saudi Arabia

Objectives: To identify stakeholders' understanding of drug shortage and the internal process of reporting a drug shortage to the Saudi Food & Drug Authority (SFDA). Evaluate the clarity of the communication channels and the stakeholder's satisfaction. A secondary objective was to explore the impact of COVID-19 on drug shortage in Saudi Arabia. Method(s): A cross-sectional study consisting of three separate surveys targeting: Health care providers, National Unified Procurement Company (NUPCO) registered in Saudi-vigilance, and pharmaceutical companies/storage that are registered in (RSD). Descriptive analysis such as percentages and frequencies was preformed to describe the knowledge and the practice of the targeted stakeholders Results: Drug shortages was defined by healthcare institutions as the unavailability of the product in the agent's stocks and by NUPCO as zero stock, and confirmation by pharmaceutical companies of product unavailability. Positive Feedback on drug availability services;55% supplying agents compliance, 69% drug availability improvement and 89% SFDA contribution to facilitate drug availability. Satisfaction on reporting system was reported by (47%) of healthcare institutions and (43%) of pharmaceutical companies' .COVID-19 pandemic impact on drug shortages: Most pharmaceutical company identified highest impact on different medication groups (39.7%) and antibiotics (22.2%). Most Healthcare institutions identified highest impact on antiviral medications (80%). Conclusion(s): Most of the stakeholders had a positive feedback and satisfaction rate on services of SFDA drug availability department. For the COVID-19, as expected, COVID-19 had a noticeable impact on drug shortages and demands in Saudi Arabia. Copyright © 2022

Impact Of Different Antimicrobial Stewardship Strategies For Reducing Antimicrobial Resistance And Antimicrobial Uses - A Systematic Literature Review

Antimicrobial resistance (AMR) is a serious global warning to social wellbeing. Antimicrobial stewardship Intervention is evident to provide a good effect on AMR. Antimicrobial Stewardship Programs (ASPs) have been established to minimize the usage of antibiotics, antibiotic resistance, and healthcare expenditure. Prospective audits with feedback, formulary restriction/preauthorization along with many other supportive elements are found effective techniques of antimicrobial stewardship programme. However, the proportional effect of different techniques is unclear. This ASP strategies utilization is compared in hospital setting and adult hospital units implementing ASP have provided much evidence demonstrating their value. This study includes the effectiveness of various explicit AMS strategies, measuring the outcome in various clinical setups such as reducing antibiotic resistance and antibiotic use.The death toll from COVID-19 is the highest of any other respiratory virus outbreak but Multiple Drug Resistant (MDR) and deadly resistant pathogens outbreaks could be at any point of time.Even in this present antibiotic era required primarily require combat it andstrong vigilance is also desired. The primary objective of this study is to enhance patient care and to lower medical expenses, but the ultimate objective is to safeguard already available and newly developed antibiotics against the threat of AMR. It has been noted that Prospective Audit and Feedback (PAF) intervention is one of the most often employed strategies among all other interventions of AMS. Although this is time-taking, it is accepted by physicians for more than formulary restrictions and pre-authorization procedures. There have been several digital initiatives to support antimicrobial stewardship (AMS), while they have been concentrated on individual interventions.Pre-authorization or recommended formulary limitation was found in 31% of all trials. 20% of these studies implemented this intervention independently, and many trials were also undertaken in conjunction with other interventions mostly in addition to training and education. Using the available pool information, we observed in various strategies a significant reduction in antimicrobial resistance and a reduced Days of Therapy (DOT)/Length of Treatment (LOT) ratio. Formulary restriction limited the use of broad-spectrum antibiotics without any major causality. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Effective mechanical thrombectomy in a patient with stroke and SARS-Cov-2 infection with fatal outcome

Ischemic stroke has been reported in patients with SARS-CoV-2 infection. It is not clear if COVID-19 is causal or simply coexists or triggers the onset of stroke. Stroke is relatively rare in the context of COVID-19 and mostly occurs in the elderly with vascular risk factors. The underlying mechanism of stroke is multiple. We present an 84-year-old male with a stroke due to large vessel occlusion coincident with severe COVID-19 infection, that despite an initial successful mechanical thrombectomy, had a fatal outcome due to respiratory complications and contralateral massive cerebral infarction due to early recurrence. Consequently, vigilance in this type of patients should be extreme since ischemic stroke with active SARS-CoV-2 infection may have a poor prognosis. Copyright © 2022 Fundacion para la difusion neurologica en Ecuador - FUNDINE. All rights reserved.

Two years follow up study of the psychological effect of COVID19 pandemic on neuromyelitis optica spectrum disorder patients, the dramatic effect of vaccination

Background: Coronavirus 2019 (COVID19) created a pandemic since early 2020. NMOSD patients are more affected by psychological effects of the pandemic such as anxiety and fear because they may be worried about suffering COVID19 infection. They often concern about their treatment protocol and disease relapses during the pandemic too. Aim(s): In this study we tried to show some psychological complications epidemic on NMOSD patients in Isfahan province, Iran. the first aim of the study was to evaluate the presence and the prevalence of anxiety among NMOSD patients during the first year from epidemic beginning and also in post vaccination phase after 24 months. The second goal was to see the level of respecting preventive measures among the same group. The follow up period is 2 year after declaring COVID19 epidemic in our country Iran, since late February 2020. Method(s): The objective of the study was to evaluate the anxiety due to COVID19 infection, 3, 12 and 24 months after beginning of epidemic. The study was done in NMOSD Clinic of Isfahan Kashani hospital. We first asked patients if they were anxious or afraid of the pandemic subjectively.To investigate the objective level of anxiety, we benefited Hospital Anxiety and Depression Scale(HADS-A) questionnaire. We asked them about respecting general health cautions to prevent infection. Result(s): Study included 120 patients(96 female) with mean age of 36.37+/-9.69 and mean duration of disease 8.49+/-5.35 years. 96 cases(80%) experienced anxiety during the first 3 months of pandemic and 66 patients(55%) were anxious after a year. The point is that their level of anxiety decreased significantly in post vaccination phase after 24 months and just 35 patients (29.16%) showed anxiety subjectively on the third survey. Based on HADS-A score, 92 patients (76.66%) were anxious on the third month while after one year of epidemic 70 cases(58.33%) and in post vaccination survey just 53(44.16%) were anxious. Respecting preventive measures increased in the first year but decreased after vaccination. Conclusion(s): Results showed that prevalence of anxiety was almost high in the first months of epidemic but it decreased gradually during a year and had a dramatic decline after vaccination. The level of alertness and attention seems to remain high and they respected the sanitary rules. We concluded that vaccination against COVID19 have positive impact on peoples mental health and reduced psychological distress.

Customised virtual reality (VR) on mood disorders in nursing homes and long term care unit: A case study on a resident with moderate cognitive impairment

Introduction: The World Health Organization defined dementia as a syndrome in which there is deterioration in cognitive function beyond what might be expected from the usual consequences of biological aging. Currently, 55 million people live with Alzheimer's in the world. Unfortunately, there isn't any drug treatment to cure the degenerative disease although clinical trials are promising regarding the use of monoclonal antibodies. But, Alzheimer's disease and associated diseases lead to behavioral and psychological symptoms (anxiety, apathy, depression) which can be frequent in nursing homes. In the context of pandemic, these conditions are amplified because of the sanitary restrictions. Since the beginning of the sars-cov2 pandemic, residents have felt alone, sad and more anxious. Nowadays, non-drug interventions are recommended by health organizations for the treatment of behavioral and mood disorders in the elderly with cognitive disorders. Reminiscence therapy is a non drug intervention which has been shown to be effective in the treatment of mood disorders on elderly. Many nursing homes use this non pharmacological treatment for their residents. Some studies take interest in reminiscence and virtual reality. The use of new technologies is innovative in geriatric care and it can be used as a personalized support for reminiscence therapy. The "Bien Vieillir Nice 2030" Project of Nice's University Hospital supports this research on virtual reality and mood disorders in nursing homes/long term care unit. Objective(s): The objective of this study (University Hospital of Nice, CoBTeK France) is to evaluate the effects of personalized virtual reality on reduction of mood disorders in nursing homes residents with minors and moderates neurocognitive disorders. The secondary objectives are to assess the acceptability of the device, the emotional valence and the resident's quality of life. Method(s): A single case study is presented to illustrate reminiscences and emotions protocol. Participants are randomized into two groups: neutral versus personalized. The neutral videos consist of unknown places like random streets or public gardens while the personalized videos are known places that mattered to the residents. Places are filmed with a camera GoPro Fusion 360degree. The healthcare team and families are actively involved in the research protocol. Their help is invaluable in targeting memories related to the resident's life history. A clinical psychologist specializing in gerontology is in charge of the virtual reality sessions. The therapeutic alliance is central to our study. A humanistic method of person-centered approach allows communication with the resident to offer him to participate in the sessions. The sessions always start and end in the same way in order not to cause stress in the resident. The hardware is tested before the protocol starts, for familiarization purpose. Potential side effects related to virtual reality are identified using a cybermalaise questionnaire. The sessions are held in a sitting position for the participant's safety. In this paper, Mr. G, 92 years old benefits from personalized video according to his life story. He has moderate cognitive impairment as well as mood disorders. He received ten virtual reality sessions over a period of six weeks. The exposure time varies between five to ten minutes. We use an Oculus Rift S headset and a computer in partnership with C2Care. Variables were measured before and at the end of the protocol. We performed a visual analysis of the scores. Result(s): The results indicated a decrease on mood rating scales scores (Geriatric Depression Scale, Apathy Inventory, Neuropsychiatric Inventory and Hamilton Depression Rating scale). The interventions produced pleasure and alertness in connection along with the emergence of positive memories. The headset was well tolerated by the participant, but we did not observe any effect on quality of life. Conclusion(s): There is an interest in the use of reminiscence therapy using virtual reality to improve participants' mood. Future results will allow us to conclude on the method and on its indication in nursing homes after the inclusion of 30 participants. Copyright © 2022 Elsevier Masson SAS

Frequency of reported thrombotic adverse events and clinical outcomes associated with three COVID-19 vaccines

Background: During the first quarter of 2021, several European countries suspended the use of the Oxford-AstraZeneca vaccine amid reports of blood clot events and the death of a vaccinated person. This was followed by several reports of fatalities related to pulmonary embolism and other thrombotic events including thrombocytopenia which has been referred to as vaccine-induced immune thrombotic thrombocytopenia (VITT). Aim(s): This study investigated the occurrence of thrombotic adverse events and their clinical outcomes of the three approved and most used COVID-19 vaccines namely Moderna, Pfizer and Oxford-AstraZeneca, using one of the largest spontaneous adverse events databases, namely EudraVigilance. Method(s): A retrospective descriptive analysis was conducted of spontaneous reports for Moderna, Pfizer and Oxford-AstraZeneca COVID-19 vaccines submitted to the EudraVigilance database in the period from 17 February to 14 June 2021. Result(s): There were 729,496 adverse events for the three vaccines, of which 3420 were thrombotic, mainly Oxford-AstraZeneca (n = 1988, 58 1%) followed by Pfizer (n = 1096, 32 0%) and Moderna (n = 336, 9 8%). As serious adverse events, there were 705 reports of pulmonary embolism for the three vaccines, of which 130 reports (18 4%) were for Moderna, 226 reports (32 1%) for Pfizer and 349 (49 5%) for Oxford-AstraZeneca vaccines. The occurrence of pulmonary embolism is significantly associated with a fatal outcome (p = < 0 001). Sixty-three fatalities were recorded (63/3420, 1.8%), of which Moderna (n = 6), Pfizer (n = 25) and Oxford-AstraZeneca (n = 32). Conclusion(s): Thrombotic adverse events reported for the three vaccines remains extremely rare with multiple causative factors reported elsewhere as precipitating these events. Practicing vigilance and proper clinical management for the affected vaccines, as well as continuing to report adverse events, are essential. More than 4 89 billion doses of different COVID-19 vaccines have been administered across the globe. On the basis of scientific evidence showing that benefit outweighs risk, people continue to be urged to accept the vaccination when offered.