Are societies in conflict more susceptible to believe in COVID-19 conspiracy theories? A 66 nation study

Conspiracy theories widely influence our social and political lives. A recent example is the broad impact such theories had on government's efforts to halt the spread of the COVID-19 pandemic. In that context, public's compliance and willingness to get vaccinated was found to be substantially and negatively affected by the belief in conspiracy theories, among various factors. In the present study, we tested whether some countries are more susceptible to conspiracy theories than others. We examined, for the first time, the idea that the degree of intensity of conflict predicts the degree of belief in COVID-19 conspiracy theories. A multilevel analysis across 66 countries (N = 46,450) demonstrated that people living in countries with higher conflict intensity tended to be more susceptible to COVID-19 conspiracy beliefs. These findings are the first large-scale comparative evidence of the profound psychological effects of conflicts on the involved societies. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement The belief in COVID-19 conspiracy theories has severe implications on public's health. Thus, it is important to better understand the reasons behind such beliefs. The present study provides new information which helps to better understand the contexts in which conspiracy belief thrive. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The Cat Is Significantly Correlated to Dlco and 6-Minute Walk Test in Patients with Long-Covid

PURPOSE/HYPOTHESIS: Literature has reported some patients experience long-term impairments in pulmonary function following COVID-19 infection, with the most common abnormality being diffusing capacity for carbon monoxide (DLCO). Research on DLCO's association with other measures has been varied, with some studies demonstrating a significant association with older age, female gender, and disease severity, however these results are not consistent. In pulmonary patients, a DLCO of<40% or a drop in DLCO of >4 units is associated with increased morbidity and mortality, is an independent predictor of decreased exercise capacity, and predicts a more rapid decline in pulmonary function. In COPD patients, every 10% decrease in DLCO was associated with worsening quality of life (QOL), 6MWT, severe exacerbations, symptoms, and COPD assessment test (CAT) scores. CAT scores represent the general health status and include cough, sputum, energy, and ability to perform physical work. Daynes et al found an average of 52% of COVID-19 patients had high CAT scores (>10), which the GOLD guidelines suggest using as a cutoff to indicate symptomatic COPD. They found no significant association between CAT score and hospital length of stay or days on mechanical ventilation, but did find a moderately significant association to anxiety, depression, and self-reported physical activity levels.While a patient's pulmonary function test (PFT) may not be available to a clinician, the CAT is a quick and easy screening tool that can be performed in the clinic. The purpose of this study was to assess possible relationships between PFT measures and outcome assessments that can be performed in the clinic by a physical therapist (PT), which may aid in prognosis. NUMBER OF SUBJECTS: Sixteen subjects (8 male and 8 female with a mean age and BMI of 52 +/- 16 and 32 +/- 5, respectively) diagnosed with long-COVID and referred to pulmonary rehabilitation (PR). MATERIALS AND METHODS: Baseline PFT and CAT scores were obtained during the initial evaluation. Spearman's rho correlation analyses were performed. The 6MWT and DLCO were performed using standardized methods. RESULT(S): The baseline CAT, DLCO, and 6MWT were 22.2 +/- 6.7, 14.1 +/- 7.3 and 292 +/- 144 m, respectively. The CAT was significantly correlated to the DLCO (r-value of -0.63;P = .009) and 6MWT (r-value of -0.52;P = .04). CONCLUSION(S): Self-reported CAT scores were significantly correlated with DLCO and 6MWT in patients with long-COVID. CLINICAL RELEVANCE: DLCO is the most common PFT abnormality observed in patients with long- COVID and can provide useful information to the clinician regarding prognosis and possibly disease severity. However, PTs may not have access to a patient's PFT report. Alternatively, a CAT assessment is free and quick and can be easily performed in the clinic.We found CAT scores were significantly correlated to DLCO and 6MWT, which may allow clinicians to use CAT scores as a surrogate measure to aid in establishing a prognosis and/or understanding of disease severity in patients with long-COVID.

Systemic Immune Inflammation Index & Sysmex Xn-1000 Research White Blood Cell Parameters in Covid-19 Patients

Introduction: Inflammation mechanisms play a critical role in Coronavirus disease 2019 (COVID-19) severity Systemic immune inflammation (SII) index is reported to have a diagnostic value in COVID-19 diagnosis Sysmex XN-1000 analyzer provides during routine full blood count two parameters for neutrophil activation measurement;NE-SSC, which represents the inner complexity of neutrophils and is strongly related to granularity and NE-SFL, which reveals the neutrophil nucleic acid/protein content and is related to production or release of proteins and reactive oxygen intermediates and one parameter for lymphocytes;the high- fluorescent lymphocyte count (HFLC) as antibody-producing plasma cells. The aim of our retrospective study is the evaluation of SSI index and NE-SSC, NE-SFL & HFLC parameters in COVID-19 patients treated with the relevant medical intervention as outpatients or inpatients. Method(s): Patients admitted to our hospital with COVID-19 diagnosed through real-time reverse transcription polymerase chain reaction, and had a complete blood count (on Sysmex XN-1000 hematology analyzer) within 24 hours of diagnosis were included. We retrospectively recorded the demographic data, the laboratory findings upon admission (NE-SSC, NE-SFL & HFLC) retrieved from the hospital electronic database system and calculated the SII index as followed: platelet count x absolute neutrophil count / absolute lymphocyte count Patients were divided in two groups: patients discharged and treated as outpatients (N = 105) and patients hospitalized in COVID-19 inpatient wards (N = 174) Statistical analysis: Mann-Whitney U test was applied P value of < 0.05 was considered significant. Result(s): The two groups do not differ in genders (P = 0.183) but inpatients are older [70 (58-79) vs 60 (39-71) years, P = 0.000]. Results are summarized in Table 1. SII index values are higher in inpatients in a statistically significant degree (P = 0.000). There is no statistically significant difference in NE-SSC, NE-SFL & HFLC values between the two groups (all P >0.05). Table 1. Results (Table Presented) hospitalization present systemic inflammation in a higher degree as compared to outpatients without any differentiation in neutrophil activation or lymphocyte morphology as indicated by morphology - associated white blood cells studied parameters.

The "footprints" of COVID-19 in the tissues: Only in the lungs?

COVID-19 was identified in late 2019 and spread rapidly to become a pandemic. The causative agent is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA-virus, which affects mainly the respiratory tract. SARS-CoV-2 enters the host's alveolar lung cells through the angiotensin converting enzyme (ACE2) receptor. During infection, in addition to abnormal activation of the immune system, an acute decrease in the ACE2 expression level occurs, result-ing in acute respiratory distress syndrome (ARDS) and acute lung damage. Histopathologically, diffuse alveolar damage is observed, and vascular injury appears to be very important, as the pulmonary vessels demonstrate extensive thrombosis with microangiopathy and endothelitis. The virus has also been shown to affect heart tissue, and some patients develop acute cardiovascular syndrome. Endothelitis has also been found in the heart, kidney, spleen, liver and small intestine, and thrombogenic angiopathy is observed in the skin. Vascular injury also affects the brain. In placentas from COVID-19 positive mothers, inflammation and infarcts have been observed. The aim of this literature review is to summarize emerging data on the pathophysiology of SARS-CoV-2 disease in the lungs and other target organs, with an emphasis on microscopic findings in the tissues. Progress in understanding the pathophysiology of COVID-19 is of great importance for comprehension of clinical condition and administration of optimal treatment. Copyright © Athens Medical Society.

Transmission of Cough Aerosols in a Hospital Room Related to COVID-19

The COVID-19 coronavirus outbreak in recent years has become a pandemic across the globe. Which has a significant risk on human health causing nearly 5 million deaths worldwide. Recent research has shown that aerosol transmission is the main cause of COVID-19 virus spread. Sanitization of hands or the 6 feet at a recommended distance by WHO can reduce the virus but people with greater occupancy are needed to be addressed. A vulnerable place for disease infection is a hospital room where many patients have been infected with COVID-19. Transmission of the virus is the main cause of COVID-19 spread. Thus, understanding the flow physics of virus transmission through CFD analysis is necessary. A Euler-Lagrangian model is used to investigate aerosol transmission from an infected person inside a hospital room under the effect of ventilation. Ventilation plays a great role in the removal of aerosols from an enclosed environment. UDF was applied to turn the ventilation on after the coughing. Results have shown that without ventilation the aerosols are reaching the outlets of the room faster, while due to the ventilation effect the same aerosols reach slower due to recirculation. Aerosols travel according to the dominant ventilation flow. If the ventilation is turned off and there is no steady downward movement of air, the particles do not fall to the ground but will evaporate with time. Evaporation of the particles depends on the ambient temperature and relative humidity. The existence of running ventilation is required to prevent the circulation of aerosols. © 2022 IEEE.

Use of Hu-PBL Mice to Study Pathogenesis of Human-Restricted Viruses.

Different humanized mouse models have been developed to study human diseases such as autoimmune illnesses, cancer and viral infections. These models are based on the use of immunodeficient mouse strains that are transplanted with human tissues or human immune cells. Among the latter, mice transplanted with hematopoietic stem cells have been widely used to study human infectious diseases. However, mouse models built upon the transplantation of donor-specific mature immune cells are still under development, especially in the field of viral infections. These models can retain the unique immune memory of the donor, making them suitable for the study of correlates of protection upon natural infection or vaccination. Here, we will review some of these models and how they have been applied to virology research. Moreover, the future applications and the potential of these models to design therapies against human viral infections are discussed.

Propofol and COVID-19 infusion syndrome. Case report

The severe form of SARS-CoV-2 pneumonia (COVID-19) occurs in most cases with acute respiratory distress syndrome (ARDS), requiring the use of sedation during mechanical ventilation, with propofol being the most widely used for its pharmacokinetics and pharmacodynamics. Propofol is a widely used anesthetic in intensive care units (ICU). Its use can cause an infrequent but extremely serious adverse effect, known as propofol infusion syndrome (PRIS), which is closely associated with the speed of infusion coupled with risk factors specific to the patient, the clinical features of PRIS are hemodynamic instability, lactic acidosis and with progression to multi-organ dysfunction. We present a case of SIP in a patient with acute respiratory distress syndrome (ARDS) secondary to SARS-CoV-2 who develops this complication associated with sedation, discusses clinical pathophysiology and considerations that should be taken into account when using it in continuous infusion. Copyright © 2023, Colegio Mexicano de Anestesiologia A.C.. All rights reserved.

Blood serotonin concentration in children with COVID-19

COVID-19 has a risk of thrombotic complications. Serotonin plays an important role in pathogenesis of thrombosis. Purpose. To evaluate level of serotonin and its metabolite in the blood of children with COVID-19. Methods. This study included 72 children aged 3 to 17 years. Of these, 43 patients (mean age 11.2 +/- 4.8 years) diagnosed with COVID-19 without comorbidities made up the study group, 29 healthy children (mean age 11.8 +/- 3.8 years) - the control group. Concentration of serotonin and its metabolite (5-HIAA) in the blood was determined using high performance liquid chromatography with electrochemical detection. Computed tomography data were used to determine severity of lung damage. Results. In our study children with COVID-19 aged 3 to 17 years had significantly higher serotonin and its metabolite levels compared to the control group. Concentration of serotonin in plasma in main group was 20-30 times higher than in the same-age control. The 5-HIAA/serotonin ratio in children with COVID-19 is significantly lower than in the control group. Levels of serotonin and 5-HIAA in children with COVID-19 depending on the severity of CT-scan lung damage showed no significant differences. Conclusion. Serotonin and its metabolite levels in plasma of children with COVID-19 is significantly increased. It may be related to platelet hyperactivation in SARS-CoV-2 infection and increased risk of thrombosis, which requires further research. Copyright © 2022 National Academy of Pediatric Science and Innovation. All rights reserved.

Clinical Profile and Outcome of Children Ages 1 Month to 18 Years with Critical Covid-19 at the Philippine Children's Medical Center

BACKGROUND AND AIM: The clinical spectrum of COVID-19 in children extends from the usual asymptomatic to moderate to the very few severe to critical disease. In the Philippines, there is paucity of local data with regards pediatric patients with critical COVID-19. This study will describe the clinical profile and outcome of patients with critical disease associated with COVID-19 in a tertiary pediatric specialty hospital. METHOD(S): Retrospective cross-sectional study of all cases with critical COVID-19 in a tertiary pediatric specialty hospital from March 2020 to February 2021 was done. Forty two cases underwent chart review. Data was described using means and standard deviations from continuous variables and frequency and counts and percentages for discrete or categorical variables. RESULT(S): Most of the patients were female with a median age of 8 years old and with normal nutritional status. Majority of the patients had known comorbidities. The most common presenting manifestations are fever and cough. Hemodynamic instability and hypoxia are the most common reasons for admission to the PICU. Organ dysfunction was seen in most patients with elevated serum inflammatory markers. Treatment is mostly supportive. The median hospital stay is 12 days. The mortality rate is 24% with casualties having a median hospital stay of 5 days. CONCLUSION(S): Clinical and diagnostic data about critical COVID-19 is variable. Sex, nutritional status or pre-existing co-morbidities had no significant relationship to PICU admission or referral.

Quality of life and intrinsic capacity in patients with post-acute COVID-19 syndrome is in relation to frailty and resilience phenotypes

Background. The objective of this study was to characterize frailty and resilience in people evaluated for Post-Acute COVID-19 Syndrome (PACS), in relation to quality of life (QoL) and Intrinsic Capacity (IC). Methods. This cross-sectional, observational, study included consecutive people previously hospitalized for severe COVID-19 pneumonia attending Modena (Italy) PACS Clinic from July 2020 to April 2021. Four frailty-resilience phenotypes were built: 'fit/resilient', 'fit/non-resilient', 'frail/resilient' and 'frail/non-resilient'. Frailty and resilience were defined according to frailty phenotype and Connor Davidson resilience scale (CD-RISC-25) respectively. Study outcomes were: QoL assessed by means of Symptoms Short form health survey (SF-36) and health-related quality of life (EQ-5D-5L) and IC by means of a dedicated questionnaire. Their predictors including frailty-resilience phenotypes were explored in logistic regressions. Results. 232 patients were evaluated, median age was 58.0 years. PACS was diagnosed in 173 (74.6%) patients. Scarce resilience was documented in 114 (49.1%) and frailty in 72 (31.0%) individuals. Table 1 shows demographic, anthropometric and clinical characteristics, comorbidities and patient-reported outcomes according to four frailty-resilience phenotypes. With regards to study outcomes, Figure 1 depicts in radar graphs, mean scores of each domain of SF-36 (1A), EQ-5D5L (1B) and IC (1C). Figures shows polygon areas for each frailty/resilience phenotypes. Progressive increase of mean scores of each domain are plotted in the vertices of polygons, from the lowest (near the center) in frail and non-resilient, to highest (towards periphery) in fit and resilient. Multivariate logistic analyses were used to identify predictors of the total scores of SF-36 (Figure 2A), EQ-5D5L (Figure 2B) and IC (Figure 2C). Conclusion. Resilience is complementary to frailty in the identification of clinical phenotypes with different impact on wellness and QoL. Frailty and resilience should be evaluated in hospitalized COVID-19 patients to identify vulnerable individuals to prioritize urgent health interventions in people with PACS. Funding. This study is supported by a Gilead Sciences Inc. unrestricted grant.

A Multifaceted and Multi-Institutional Analysis of the COVID19-Associated Mucormycosis Outbreak in the Delhi Area Indicates the Simultaneous Convergence of Multiple Risk Factors

Background. A major outbreak of COVID19-associated mucormycosis (CAM) in India in spring 2021 aggravated the death toll of COVID19. As the causes of that CAM outbreak remain unclear, we performed a multifaceted study of host, pathogen, environmental, and heath care-related factors in adult CAM patients (pts) in the metropolitan New Delhi area. Methods. We reviewed the records of all pts diagnosed with culture- or biopsyproven CAM at 7 hospitals in the New Delhi area (April 1 - June 30, 2021). We used a multivariate logistic regression model to compare clinical characteristics of either all CAM cases (analysis 1, n = 50) or only pts with CAM after moderate or severe COVID19 (analysis 2, n = 31). As controls for both analyses, we used 69 COVID19-hospitalized contemporary pts. Selected hospital fomites were cultured for Mucorales. Additionally, we compared meteorological data and fungal spore concentrations in outdoor air before the CAM outbreak (January-March 2021) and during the outbreak (April-June 2021). Mucorales isolates from CAM pts were identified by MALDI-TOF-MS and ITS sequencing. A subset of 15 isolates underwent whole genome sequencing (WGS). Results. Risk factors for CAM in both analyses were newly diagnosed diabetes mellitus (odds ratio [OR] 8.26/5.67) and active cancer (OR 5.98/5.68) (Figure 1). Supplemental oxygen for COVID19 was associated with a lower CAM risk in both analyses (OR 0.13/0.17). Another significant CAM risk predictor identified only in analysis 1 was severe COVID19 (WHO score >= 6, OR 4.09), while remdesivir therapy (OR 0.40) and ICU admission for COVID19 were protective (OR 0.41) (Figure 1). No Mucorales were cultured from hospital fomites. The CAM incidence peak coincided with a significant uptick in environmental spore concentrations but was not linked to specific meteorological factors. Rhizopus was the predominant Mucorales genus (64%) identified by MALDI-TOF-MS and ITS sequencing;WGS found no clonal population of isolates but detected 2 cases of the rare pathogen Lichtheimia ornata. Figure 1 Conclusion. An intersection of host, environmental, pathogen and healthcare-related factors might have contributed to the emergence of CAM. Surrogates of access to advanced treatment of COVID19 were associated with lower CAM risk.

SARS-CoV-2 Associated Multisystem Inflammatory Syndrome in Adults (MIS-A): a Multicenter Case Series

Background. MIS-A frequently presents with symptoms including fevers, cardiovascular, gastrointestinal mucocutaneous, and neurologic involvement in both children and adults. Predominantly occurs in previously healthy children and young adults, disproportionately affecting individuals of African, Latino and Asian descent. Represents one of the most significant and yet under-recognized clinical consequences of SARS-CoV-2 infection. Methods. A retrospective review was performed of the identified MIS-A cases admitted to two institutions between January 2020-December 2021. Included cases required evidence of present or previous SARS-CoV-2 infection by either PCR or antigen testing;and meeting the CDC definition for MIS-A. After case identification, we collected clinical and laboratory data to analyze demographics, clinical symptoms, laboratory result, imaging, length of hospitalization and therapeutic interventions. Results. Ten cases were identified in the established period of time. The average interval to hospital admission was 31days. Clinical symptoms included fever, malaise, gastrointestinal complaints, dyspnea, diffuse rash. Males outnumbered females in a ratio of 7:3, with African American and Latino patients comprising 80% of the cases. All patients had elevated inflammatory markers and the most commonly manifesting organ dysfunction was cardiovascular system. Conclusion. This case series helps reinforce the characterization of an as yet incompletely understood and challenging clinical syndrome, providing insight to guide diagnosis and treatment of MIS-A. A greater understanding of MIS-A may facilitate earlier syndromic recognition in order to improve outcomes, reduce unnecessary antimicrobial use, and reduce costs.

Dengue - SARS-CoV-2 co-infection: Experience in hospitalized patients during COVID-19 pandemic

Background. Dengue fever and COVID-19 co-infection constitute a significant public health concern in Latin America, becoming a clinical challenge to distinguish these two entities in early stages of the disease. Clinical outcomes of coinfected hospitalized patients have not been well established. Methods. A cross-sectional study was conducted. We included suspected patients diagnosed with COVID-19/dengue co-infection admitted at Hospital Fundacion Valle del Lili, Cali - Colombia, from March 2020 to March 2021. All dengue patients had positive NS1 and/or IgM dengue antibodies. SARS-CoV-2 infection was confirmed by RT-PCR or antigen rapid test from nasopharyngeal swab. Laboratory and clinical data were recollected from the clinical laboratory database, clinical charts, and institutional COVID-19 registry. Results. A total of 90 COVID-19 patients were included. 72 patients were confirmed only with COVID-19, and 18 with dengue co-infection. Most patients were male: 46 (63.9%) vs. 13 (72.2%). None of these study patients were vaccinated against COVID-19 or dengue. The median time from symptoms onset and the diagnosis was five days, and fever was the most common symptom for both groups. There were significant differences between COVID-19 patients and coinfected patients regarding presence of dyspnea (22.2% vs. 61.1%;p=0.003), desaturation (13.4% vs. 53.3%;p=0.002) and a higher neutrophil/lymphocyte ratio (NLR) (3.84 vs. 5.59;p = 0.038). The co-infection was associated with a worse presentation of the COVID-19 infection (p=0.002), an increased requirement of initial supplemental oxygen therapy (p=0.007), mechanical ventilation (p=0.0004), ICU management at the admission (p=0.002), and ICU final management (p=0.002). Overall mortality in patients with co-infection was 44.4% vs. 6.9% in only COVID-19 infected patients (p< 0.001). Conclusion. Despite the pandemic era, the possibility of co-infection of these two entities must be considered. Admitted coinfected patients were associated with worse clinical outcomes and higher mortality. According to our results, patients with co-infection present with severe respiratory symptoms and an elevated NLR. The impact of the Covid 19 vaccination on this coinfection is unknown.

A look at COVID-19 and transgender youth through a psychoanalytic lens

The arrival of COVID-19 pandemic led to a much-publicized mental health crisis for American youth. A subgroup of those youth particularly affected were transgender and gender diverse (TGD) children and adolescents. Yet, a psychoanalytic eye cast on these youth revealed not a crisis, but a dialectic: from a relational and intrapsychic perspective, it was the best of times and the worst of times for TGD young people. This article applies Winnicott's concepts of mirroring and the author's constructs of the true gender self, false gender self, and gender creativity to information gleaned from survey studies and clinical observation. These data were then used to analyze why some TGD children and adolescents experienced the shutdown phase of the pandemic as an opportunity to consolidate their gender self, while others experienced the shutdown as a significant environmental impingement and threat to their gender self and overall well-being. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Brief Educational and Process Change Quality Improvement Intervention Increases HIV, Hepatitis C, and Syphilis Screening in Psychiatric Inpatients Admitted from a Psychiatric Emergency Service

Background: Psychiatric disorders increase risk for infection with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and syphilis, and these infections carry implications for psychiatric symptoms and treatment (Campos, 2008). At the University of New Mexico Psychiatric Center (UNMPC), no standardized protocol existed for HIV, HCV, and syphilis screening among patients admitted for psychiatric hospitalization. Method(s): In January 2020, residents and faculty at UNMPC began a quality improvement intervention aimed at increasing screening rates of HIV, HCV, and syphilis among patients admitted for hospitalization from the psychiatric emergency service. The intervention consisted of four components: Safe Zone training for residents;addition of HIV, HCV, and syphilis testing prompts to the admission orders in the electronic health record (EHR);resident education about screening and consent;and posted reminders at resident workstations. Retrospective evaluation of de-identified EHR admissions data compared screening rates over the nine months post-intervention versus the nine months pre-intervention. Secondary evaluations investigated whether onset of the COVID-19 in New Mexico in March 2020, or the start of the new resident class in July 2020, affected screening rates post-intervention. Pearson chi-square analyses tested for screening rate differences. This study was approved by the UNM Human Research Protections Office. Result(s): Screening rates for all conditions increased post-intervention. HIV screening increased from 7.7 to 14.4%, X2 (1, 1838) = 20.89, p <.001, HCV from 4.9 to 15.3% X2 (1, 1838) = 54.66, p <.001, and syphilis from 15.6 to 21.5%, X2 (1, 1838) = 10.60, p =.001. Neither COVID-19, X2 (1, 488) = 0.31, p =.579, nor start of the new resident class, X2 (1, 679) = 0.03 p =.863, impacted screening rates post-intervention. Discussion(s): This brief quality improvement intervention significantly increased screening rates for HIV, HCV, and syphilis in psychiatric inpatients admitted from the psychiatric emergency service. However, even post-intervention, screening rates remained low. These findings mirror previously published data on the impact of a low-intensity administrative advocacy and in-service training intervention on HIV screening rates in psychiatric inpatients (Shumway, 2018). Conclusion/Implications: In light of the bidirectional risks of psychiatric disorders and infection with HIV, HCV, and/or syphilis, and in keeping with United States Preventive Service Task Force guidelines pertaining to screening for these infectious diseases, further quality improvement initiatives remain necessary for increasing screening amongst persons admitted for psychiatric hospitalization (USPSTF, 2022). References: Campos LN, Guimaraes MD, Carmo RA, et al. HIV, syphilis, and hepatitis B and C prevalence among patients with mental illness: a review of the literature. Cad Saude Publica. 2008 24(Suppl 4):s607-20 Shumway M, Mangurian C, Carraher N, et al. Increasing HIV testing in inpatient psychiatry. Psychosomatics 2018 59(2):186-192 United States Preventive Services Taskforce. (n.d.). Retrieved April 3, 2022, from Copyright © 2022

Bring on BCON! The Unmet Need of Bladder Cancer Patients Unsuitable for Chemoradiation Treated with Radical Radiotherapy Alone

Purpose: To retrospectively review patients with bladder TCC treated with radical radiotherapy alone in the last 5 years who may have benefited from carbogen +/- nicotinamide radiosentisation at a large cancer centre in the north of England. Method(s): Electronic records were reviewed for 175 patients who had received radiotherapy to the bladder for TCC between 2017 and 2022. Patients who had radical radiotherapy (RT) alone without radiosensitisation were scrutinised to ascertain whether they would have been candidates for carbogen and nicotinamide using the inclusion/exclusion criteria previously defined in the BCON trial [1]. Result(s): We analysed 175 patients. Of these, 133 had radical RT without radiosensitisation. The most common reason for not offering radiosensitisation was the presence of co-morbidities (27.8%). Of interest, the proportion of patients having chemotherapy radiosensitisation did not change after COVID-19 in March 2020 (21.5% pre- versus 27.5% post;P = 0.32 chi2). Conversely, the proportion of patients receiving neoadjuvant chemotherapy reduced, but failed to reach significance (12.6% pre- versus 5% post;P = 0.08 chi2). After review of the notes and criteria from the original BCON trial, 106 patients (79.6%) could have benefited from carbogen +/- nicotinamide. Of these, 14 patients (13.2%) could have been offered carbogen alone due to poor renal function. The most common reason for not being eligible for BCON was respiratory disease with reduced respiratory drive (44%). Conclusion(s): NICE state that all radical radiotherapy for bladder TCC should be with a radiosensitiser. Due to logistical and departmental issues, the BCON regimen is not currently offered as a standard alternative to radiosensitisation with chemotherapy. BCON has been shown to be tolerable and, whilst updated follow-up data failed to demonstrate statistical significance for overall survival, meta-analysis of hypoxia modification has shown significant improvement in overall survival compared to RT alone [2] Hypoxia modification with carbogen +/- nicotinamide should be considered for all patients unsuitable for chemotherapy radiosensitisation. References [1] Hoskin PJ, Rojas AM, Saunders MI, Bentzen SM, Motohashi KJ. Carbogen and nicotinamide in locally advanced bladder cancer: early results of a phase-III randomized trial. Radiother Oncol 2009;91(1):120-5. [2] Overgaard J. Hypoxic radiosensitization: adored and ignored. J Clin Oncol 2007;25(26):4066-74. Copyright © 2022 The Royal College of Radiologists

Social Determinants of Health Associated with Intimate Partner Violence in an Urban Obstetric Population

Objective: Intimate partner violence (IPV) is pervasive and can lead to severe health consequences. In the US, 25% of women have experienced sexual violence, physical violence, and/or stalking by an intimate partner. However, less is known about the frequency and risk factors for IPV in the obstetric population. Study Design: Nested case-control study from a prospective cohort survey study of 606 parturients at a single academic medical center from 2011-2022. Structured surveys were administered to consented patients during their postpartum hospital stay to gather information on social determinants of health (SDoH) and birth outcomes. The case group included participants who reported forced sex causing pregnancy, verbal abuse before or during pregnancy, or physical abuse during pregnancy. The control group reported none of these. Odds ratios were used to quantify the relationship between IPV and maternal sociodemographic characteristics, pregnancy factors, and levels of perceived support and discrimination. Result(s): Of 606 study participants, 568 (94%) had data on IPV. Of those, 20.4% reported IPV (case) and 80.6% reported no IPV (control). 74.6% of the study population was enrolled pre-pandemic. Unmarried status, low income, food insecurity, housing insecurity, substance use during pregnancy, higher gravidity, unintended pregnancy, low social support, and racial and gender discrimination were all significantly associated with IPV;maternal race and pregnancy during the COVID-19 pandemic were not. Conclusion(s): IPV is common, reported by 1 in 5 parturients in our population. Although maternal race was not associated with IPV in this perinatal cohort, experiencing racism was. Initiatives aimed to address SDoH such as substance use, family planning, and access to food and housing remain key opportunities to support pregnant patients experiencing IPV. The connection between perceived discrimination and IPV found here highlight the importance of addressing the influence of racism and gender-based violence on adverse birth outcomes in the US. [Formula presented] [Formula presented] Copyright © 2022

Accessible funerals and people with intellectual disability

This chapter briefly outlines Western funeral practices and then describes how funeral participation is important to successful grieving and meaning making of others' death. It examines research on funeral attendance and barriers, involving adults with intellectual disability. COVID-19 has restricted funeral participation for all, highlighting how people with disabilities have often been excluded from these rituals long before the pandemic. Experiences of both exclusion and participation are conveyed in several individual stories. The significance of emotional, social and spiritual supports linked to funerals (and the impact of being denied these) is discussed so that people with disabilities can be better supported to engage with and meaningfully participate in others' funerals, and have a say in their own funeral arrangements if they wish to. A list of resources is provided. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Income inequality and population health: A panel data analysis

The dissertation examines the link between income inequality and population health indicators, including life expectancy, infant mortality, and COVID-19 mortality. It aims to determine if an unequal income distribution poses a hazard to the health status of individuals in society. Using a large international panel dataset from the newest version of the Standardized World Income Inequality Database, the study re-examines the relative income hypothesis and solves such methodological challenges as countries' stratification and heterogeneity bias. Pooled time-series cross-section and country fixed-effects models estimates, based on a sample of developed and developing countries, indicate that income inequality is negatively associated with life expectancy at birth and does not play a significant role in determining infant mortality. Furthermore, the results indicate different effects of income inequality depending on a country's economic standing. Once countries were divided into income groups, the association between income inequality and life expectancy was found only relevant for the group of low-income countries. On the contrary, in the case of infant mortality, a significant association was observed for high-income countries only, thus supporting the relative income hypothesis for the most developed countries. Finally, examining the role of income inequality as a possible driver of health inequities during the COVID-19 pandemic indicates a positive and statistically significant association between the country's Gini coefficient and the number of excess deaths during the first year of the COVID-19 pandemic. The findings emphasize the need to develop strategies to address income inequality as a critical socio-economic factor and target interventions beneficial for the population in the lowest part of the income distribution. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Case report of Candida parapsilosis sepsis detected in peripheral blood smear

Introduction During long periods of hospitalization, debilitated and immunosuppressed patients are prone to contracting nosocomial fungal infections, such as Candida parapsilosis, which can cause sepsis. Candida parapsilosis, indeed, is able to form firm and persistent biofilms in central venous catheters (CVC) in addition to other medical devices, thus threatening patients undergoing invasive medical procedures [1]. We report a case of Candida parapsilosis sepsis detected in the peripheral blood smear and by the change of the cytograms of the hematology analyzer before to blood culture positivization. Case presentation An 89-year-old woman, positive for the Sars-Cov2 virus, was admitted at the San Donato hospital (Arezzo) for 40 days for Covid symptoms. Laboratory tests show an increase in C reactive protein (10.6 mg/dL), gamma GT (76 U/L), total bilirubin (2.31 mg/dL) and direct (1.46 mg/ dL), creatinine (1.00 mg/dL ) and reduction of glomerular filtrate (50.4 mL/min /1.73 mq). In addition, at the CBC anemia is detected with hemoglobin of 102 (g/L) and thrombocytopenia (32 x 10