Traditional Chinese Medicine Syndrome Differentiation of Delta and Omicron Variants of SARS-CoV-2 Carriers in Changsha,Hunan.

Objective: To summarize and compare the main traditional Chinese medicineTCMsyndromes of Delta and Omicron variants of severe acute respiratory syndrome coronavirus 2SARS-CoV-2 carriers to provide references for the syndrome evolution and syndrome differentiation of SARS-CoV-2 infection. Method(s):The TCM medical records of imported and local cases of infection with Delta and Omicron variants of SARS-CoV-2 in Changsha since September 23,2021 to March 27,2022 were collected,including 18 Delta variant cases and 36 Omicron variant cases. Their TCM diagnosis information and TCM pathogenesis were analyzed and compared. Result(s): The common manifestations in Delta variant cases were cough,fever,chest distress/shortness of breath,sore muscles,nausea,dry mouth,dry or sore throat,thick and greasy tongue coating,and rapid and slippery pulse. The predominant pathogenesis was dampness-heat in the upper-energizer and heat stagnation in the lesser Yang combined with dampness. The occurrence of chest distress/shortness of breath,greasy tongue coating,slippery pulse,and the proportion of dampness-heat in the upper-energizer syndrome were higher in Delta variant cases than in Omicron variant cases P<0.05. The common manifestations in Omicron variant cases were itchy and sore throat,nasal congestion,running nose,fever,mild aversion to cold,dry mouth,dizziness,slightly reddish tongue with thin white coating,and rapid or wiry pulse. The predominant pathogenesis was wind-dryness invading defensive exterior,and heat stagnation in the lesser Yang. The occurrence of white-coated tongue and the proportion of wind-dryness invading defensive exterior syndrome were higher in Omicron variant cases than in Delta variant casesP<0.05. Conclusion(s): There are certain differences in TCM syndromes and the corresponding pathogenesis between Delta variant and Omicron variant cases in Changsha,Hunan. The Delta variant of SARS-COV-2 tends to induce dampness-heat syndrome, whereas Omicron variant infection tends to elicit wind-dampness syndrome,which is expected to provide a reference for the pathogenesis evolution of SARS-COV-2 infection.Copyright © 2022, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica. All rights reserved.

The Association of COVID-19 Severity with Laboratory Parameters, Radiologic Findings, Maternal and Neonatal Outcomes in Pregnant Women: A Multicenter Study in Indonesia

Objectives: Severe acute respiratory syndrome-coronavirus 2/COVID-19 infection is still a global concern, with pregnant women are considered as vulnerable population. Until now, the characteristics of pregnant women in Indonesia who are infected with COVID-19, as well as pregnancy and neonatal outcomes, are still unknown. This study aims to obtain national data, which are expected to be useful for the prevention and management of COVID-19 in pregnant women in Indonesia. Method(s): There were 1,427 patients recruited in this retrospective multicenter study. This study involved 11 hospitals in 10 provinces in Indonesia and was carried out using secondary patient data from April 2020 to July 2021. COVID-19 severity was differentiated into asymptomatic-to-mild symptoms and moderate-to-severe symptoms. The collected data include maternal characteristics, laboratory examinations, imaging, pregnancy outcomes, and neonatal outcomes. Result(s): Leukocyte, platelets, basophil, neutrophils segment, lymphocytes, monocytes, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), urea, and creatinine were found to be significantly associated with severity differences (p < 0.05). Moderate-severe symptoms of COVID-19 also shown to have suggestive pneumonia findings on chest X-ray findings. Patients with asymptomatic-to-mild symptoms had significantly (p < 0.001) higher recovery rate, shorter hospital stay, less intensive care unit (ICU) admission, and had more vaginal delivery. Neonates from mother with mild symptoms also had significantly (p < 0.001) higher survival rate, higher birth weight, and higher APGAR score. Conclusion(s): Several laboratory and radiology components, as well as maternal and neonatal outcomes are related to the severity of COVID-19 in pregnant women in Indonesia.Copyright © The Author(s). 2023.

Emergency visits of otorhinolaryngology department during COVID-19 pandemic, Saudi Arabia, 2020

Aim: In this study, we aimed to assess the frequency of patient emergency visits to the Otorhinolaryngology (ORL) Department during coronavirus COVID-19 pandemic and compare it with that before coronavirus COVID-19. Material(s) and Method(s): A retrospective comparative study was performed at Al-Al-Hada Armed Forces Hospital, Taif (Saudi Arabia), and data regarding various diagnoses of ORL cases were collected from medical records of patients who visited/admitted to ORL-ED during the lockdown (Group 1) and those who visited/ admitted to ORL-ED before the pandemic (Group 2). Result(s): Group 2 had a significantly higher percentage of cases who had no ENT-related disorders, hypertrophy inferior turbinate (HIT), stridor, obstructive sleep apnea (OSA), epistaxis and who had no complications, had general ENT, foreign body ingestion-aspiration, trauma, otology and who had more than one disorder and Group 1 had a significantly higher percentage of those having nasal obstruction, tonsil hypertrophy grade 3, had emergency head and neck cancer, had deep neck space infections and who had complicated. Discussion(s): During coronavirus COVID-19 pandemic period, cold ENT visits were much less and foreign body ingestion remains the highest reason for ENT visits. Additionally, telemedicine has been shown to be effective in reducing ED visits during the pandemic period. Furthermore, older cases with chronic ENT problems who had regular follow-up ENT visits were less likely to visit ED during the pandemic.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Covid-19 Infection Presenting as Acute Pancreatitis

Purpose of study Introduction COVID-19 emerged at the end of 2019 as an epidemic of respiratory disease in Wuhan, China that later spread globally and was declared as pandemic. The common clinical manifestations of COVID-19 infection include fever, cough, myalgias, headache, sore throat, anosmia, nasal congestion, fatigue and chest pain. The most serious complications include bilateral multifocal pneumonia and acute respiratory distress syndrome. Acute pancreatitis is rarely reported in association with COVID-19 infection. We report a case of acute pancreatitis secondary to COVID-19 infection. Case Report: A 69-year-old man with past medical history of hyperlipidemia and seizure disorder presented with two days of epigastric pain radiating to back. The patient reported fever, malaise and dry cough for the last 3 days. Home medication included atorvastatin and carbamazepine for 10 and 15 years respectively. The patient denied smoking and alcohol use. COVID- 19 PCR was positive. Labs showed WBC of 3800/muL, hgb 11.8 g/dL, calcium 8.4 mg/dL , lipase 426 U/L, D-Dimer 179 ng/ml DDU, High sensitivity C-reactive protein 27.5 mg/L (normal <5 mg/L) ALT 26 U/L, AST 31 U/L, alkaline phosphatase 103 U/L and total bilirubin 0.3 mg/dL. Ultrasound of the right upper quadrant and CT abdomen showed normal pancreas, common bile duct and gallbladder with no evidence of gallstones. Triglyceride level was 70 mg/dL (<149 mg/dL) on the lipid panel. The patient was diagnosed with acute pancreatitis and received treatment with IV fluids and pain medication. The symptoms improved gradually and the patient was discharged home with resumption of home medications. Methods used Case Report Summary of results The common differentials for acute pancreatitis include alcohol use, gallstones, hypertriglyceridemia, viral infections like mumps and measles, hypercalcemia and medication-related, etc. Normal AST, ALT, alkaline phosphatase and total bilirubin along with absence of gallstones and normal common bile duct ruled out alcoholic and biliary pancreatitis. Normal calcium level and triglyceride level rule out hypercalcemia and hypertriglyceridemia as the cause of pancreatitis. Carbamazepine has rarely been reported to cause acute pancreatitis typically soon after the initiating the therapy or with increase in the dose. The use of carbamazepine for more than 15 years without any recent dose change makes this unlikely as the cause of pancreatitis. The onset of acute pancreatitis during the timeline of COVID-19 constitutional symptoms and absence of other risk factors suggests that COVID-19 infection is responsible for acute pancreatitis in our patient. Conclusions We report a case of acute pancreatitis secondary to COVID-19 infection. Further studies are warranted to better understand the etiology and the pathophysiology of acute pancreatitis secondary to COVID-19 infection.

Post COVID condition phenotypes-Role in clinical practice?

Introduction/Aim: Post COVID conditions are highly heterogenous and pose significant challenges to healthcare systems. The aim of this study was to identify and characterise symptom clusters at 6-months following COVID illness. Method(s): Symptom burden was assessed in a COVID respiratory clinic 6-months following diagnosis. K-mean cluster analysis was utilised to identify clusters and validated assessment tools for dyspnoea [MMRC], mood [PHQ-4], fatigue [FSS] and pain [WPI]were used to characterise clusters. Result(s): 58 patients (median age 59 years, 31 males) attended 6-month follow up. Cluster 4 represented patients experiencing high symptom burden with high fatigue, pain, depression and anxiety scores. A high proportion of Cluster 2 reported no symptoms but had high dyspnoea scores. Results for PHQ-4, FSS and WPI are presented as means (95%confidence interval) Cluster (n) Symptoms MMRC >1 (n%) PHQ-4 FSS WPI 1(8) anosmia, headache, fatigue, memory, concentration 3(5.1) 1(1,2) 31(17,45) 5(-1,10) 2(42) Isolated Dyspnoea 15(25.9) 1(1,2) 22(18,26) 1(0,1) 3(3) fatigue, nasal congestion, chest pain 3(5.1) 5(-10,21) 36(-26,98) 7(-11,24) 4(4) high symptom burden 4(6.9) 7(0,13) 51(36,66) 12(2,21) Conclusion(s): This exploratory analysis identified 4 possible post COVID condition phenotypes with unique symptom profiles. Larger scale phenotyping may facilitate a streamlined and customised approach to managing this evolving chronic and highly heterogenous clinical condition.

Comprehensive evaluation of otorhinolaryngological symptoms in COVID-19 patients

Introduction: The aim of this study is to comprehensively evaluate the incidence and natural course of otorhinolaryngological symptoms of COVID-19 infection and its relations to each other and patient's demographics. Method(s): This is a prospective study conducted on symptomatic adult patients proven to be infected with COVID-19. Detailed history was taken from each patient including onset of symptoms. Symptoms were followed up tightly. We focus on otorhinolaryngological (ORL) symptoms and their duration and onset in relation to other symptoms. Data were collected and analyzed in detail. Result(s): Six-hundred eighty-six patients were included in the study, their age ranged from 19-75 years old, and of them 55.1% were males. Cough was found in 53.1% of cases followed by sore throat in 45.8%, anosmia/ hyposmia in 42.3%, headache in 42%, rhinorrhea in 19.5%, dry mouth in 7.6%, globus in 6.1%, epistaxis in 4.4%, and hearing loss in 0.6%. In non-ORL symptoms, fever was found in 54.2%, malaise in 55.1%, dyspnea in 49.3%, and diarrhea in 27.2%. The first symptom was anosmia in 15.7% of cases, sore throat in 6.1 %, cough in 7.9%, and headache in 13.4% of cases. Fever was the first symptom in 22.7%, malaise in 25.1%, and diarrhea in 6.4%. Headache occurred for 5.5 +/- 2 days, anosmia/hyposmia 3 to > 30 days, sore throat 4.1 +/- 1.2 days, rhinorrhea 4.3 +/- 1.1, cough 7.4 +/- 2.5 days, fever 4.7 +/- 2 days, and malaise 6.5 +/- 2.4 days. The cluster of COVID-19-related symptoms showed nine principal components. Conclusion(s): Otorhinolaryngological symptoms are main symptoms in COVID-19 infection, and they should be frequently evaluated to detect suspected cases especially in pauci-symptomatic patients and to properly manage infected patients.Copyright © 2022, The Author(s).

Ensitrelvir for Mild-to-Moderate Covid-19: Phase 3 Part of Phase 2/3 Study

Background: Ensitrelvir is a SARS-CoV-2 3CL protease inhibitor approved in Japan under emergency regulatory approval system as an oral treatment for COVID-19. Here we report the key analysis results of 125 mg group of phase3 part (SCORPIO-SR). Method(s): This study was a multicenter, randomized, double-blind, placebocontrolled study. Regardless of SARS-CoV-2 vaccination status and presence of risk factors for severe disease, patients with mild-to-moderate COVID-19 within 120 hours from onset were randomized to oral administration of ensitrelvir 125 mg (375 mg loading dose on Day1), ensitrelvir 250 mg (750 mg loading dose on Day1), and placebo once daily, for 5 days. The primary endpoint was time to resolution of 5 symptoms of COVID-19 (stuffy or runny nose, sore throat, cough, feeling hot or feverish, and low energy or tiredness), and the key secondary endpoints include change from baseline on Day4 in the amount of SARS-CoV-2 viral RNA and time to first negative of viral titer. The primary population for the primary and key secondary endpoints was patients with <72 hours from onset to randomization. Result(s): Median time to resolution of 5 symptoms was significantly shorter in 125 mg group (n=336, 167.9 hours) than placebo group (n=321, 192.2 hours) (p=0.0407). Mean change of viral RNA levels from baseline (log10 copies/mL) on Day4 was significantly greater in 125 mg group (-2.48) than in placebo group (-1.01) (p< 0.0001). The time to first negative of viral titer was significantly shorter in 125 mg group (n=199, 36.2 hours) compared to placebo group (n=211, 65.3 hours) (p< 0.0001). Mean changes from baseline in viral titers [log10(TCID50)/mL] were significantly greater in 125mg group on Day2 (-0.807, n=196) and Day4 (-1.108, n=197) than in the placebo group (-0.395, n=208 and -0.850, n=207, respectively) (p< 0.0001). (Table Presented) In the patients randomized within 120 hours of onset, median time to resolution of 5 symptoms was 189.7 hours in 125 mg group (n=582) and 200.3 hours in placebo group (n=572) (p=0.4352). No deaths or serious adverse drug reactions were reported in either group, and the incidence of serious adverse events between the two groups was comparable. Conclusion(s): Ensitrelvir demonstrated a significant reduction in the time to resolution of 5 typical symptoms of COVID-19, robust antiviral effects and good tolerability.

The Impact of Early Outpatient Treatments for Covid-19: A Retrospective Study

Background: Oral antivirals (nirmatrelvir/ritonavir and molnupiravir), intravenous short treatment of remdesivir and anti-SARS-CoV-2 monoclonal antibodies (mAbs) have been used for early COVID-19 treatments in high risk of disease progression patients. Little is known about the impact of therapies on post-acute COVID-19 (PACS). We aimed to compare the efficacy of these therapies in terms of death, hospitalization rate and PACS at 3 months. Method(s): We conducted a retrospective observational study including all eligible outpatients aged >=18 evaluated from April 2021 to March 2022 at our COVID-19 Clinic. Patients were stratified into 3 groups: mAbs, antivirals (oral and short-course remdesivir) and controls (eligible patients who refused treatment). Persistence of symptoms (fever, dysgeusia/anosmia, cough, pharyngodynia, dyspnea, chills, nasal congestion, myalgia, headache, gastrointestinal disease, and neuro-behavioural symptoms, such as asthenia, anxiety/mood disorder, memory and concentration deficit) were evaluated after 3 months. We estimated the associations between each considered outcome and treatment through univariate and multivariable logistic models adjusted by sex, age, vaccination, early COVID treatment, treatment group and number of comorbidities (when appropriate). Result(s): We included 649 patients (51.6% males, median age 67 years, 14% unvaccinated): 242 patients were treated with mAbs, 197 with antivirals and 210 received no treatment. Overall, 36.7% of subjects had cerebro-cardiovascular disease, 22% were obese and 50% had more than one comorbidity. Overall, 29 patients (4.5%) died or were hospitalized. Death or hospitalization was positively associated only with older ages with a significant linear trend (p for trend: 0.033). Data on PACS at 3 months were available for 323 (49.8%) patients. Females showed a positive association with long COVID, with an OR of 2.14 (95% CI: 1.30-3.53) as compared to men. Patients treated with antiviral drugs showed an inverse association with long COVID (OR: 0.43, 95% CI: 0.21-0.87 as compared to not treated patients). Patients who were treated with monoclonal antibodies showed an OR of 0.48 (95% CI: 0.25-0.92) as compared to those in the control group (Table 1). Conclusion(s): The impact of early COVID-19 therapies on PACS is unknown. Our results showed that these treatments, in particular mAbs, can reduce persistence of neuro-behavioural symptoms at 3 months. (Table Presented).

Knowledge and Practices of Disinfectants and Sanitizers Use during COVID-19 Pandemic in Jordan

Background: The use of antimicrobials has been expanded during the COVID-19 pandemic. This study aims to assess the knowledge and practices of disinfectants and sanitizers use among Jordanian people during the (COVID-19) pandemic. Methods: A web-based cross-sectional descriptive questionnaire was distributed across Jordan between August and September 2020. The questionnaire consisted of three sections inquiring about demographics and general characteristics of the surveyed sample, evaluating the respondents' knowledge about disinfectants, as well as respondents' practices. The questionnaire was completed by 403 literate adult respondents. Results: Our results indicate that Jordanian adults have used disinfectants increasingly during the COVID-19 outbreak. Knowledge of our study sample was considerably affected by gender (p=0.044), income (p=0.001), and profession (p<0.001). 80.8% of those participants reported skin-related side effects due to disinfectant use during the pandemic. The most used disinfectants were ethanol, followed by soap and water. Generally, study respondents showed positive practices toward the use of disinfectants during the time of the pandemic with few high-risk practices reported. Interestingly, the positive practices applied by Jordanian adults were minimally and not significantly affected by the knowledge about antimicrobials' safe and effective use. Conclusions: There is an urgent need for a structured effort to increase public awareness regarding the safe and effective use of disinfectants against SARS-CoV-2 transmission. © 2023 DSR Publishers/The University of Jordan.

Side Effects of the Sinopharm/BBIBP COVID-19 Vaccine among Iranian Healthcare Workers: A Gender Assessment

Background: Since the outbreak of COVID-19, vaccination has been considered as an important measure against it. Side effects have always been an inseparable component of vaccination, which in this study, Sinopharm vaccine, its side effects and the differences of their manifestation amongst men and women have been investigated. Objective(s): This study aimed to compare the side effects of the Sinopharm vaccine among men and women working in some medical centers in Tehran, Iran. Method(s): This cross-sectional descriptive-analytical study on 890 healthcare workers of 7 medical centers in Tehran within 2 months, from late June to late August 2021. The samples were selected by the complete enumeration method, and the required data were collected using a questionnaire. Only those who received the Sinopharm vaccine at least 10 days before the study were included. Result(s): Of 890 participants, 22.96% and 77.30% were women and men, respectively, and 65.8% of women and 78.1% of men were in the age range of 20-29 years. It was revealed that 74.75% of women and 26.16% of men had at least one side effect. The incidence of at least one side effect was significantly higher in women than in men (P<0.001). It was also found that 12 side effects were significantly higher in women than in men. Most men and women had side effects within the first 24 h after vaccination. There was no significant difference in taking therapeutic measures to reduce or minimize the post-vaccination complications between men and women;however, 9.4% of men and 27.2% of women reported a decline in their ability to perform daily activities as they were unable to do their everyday tasks the day after vaccination which was significantly different between the two groups (P<0.001). Conclusion(s): The results showed that the occurrence rate of side effects after receiving the Sinopharm vaccine was significantly higher in women than in men. Moreover, women were significantly less able to perform daily routines than men.Copyright © 2022, Author(s).

Clinical and Epidemiological Characterization of COVID-19 Disease in Sandino Municipality, year 2020.

Introduction: COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020 due to its complexity and rapid global expansion. Sandino municipality presented its first positive case on October 6, 2020. Objective(s): To characterize the clinical-epidemiological behavior of COVID-19 in Sandino municipality, in 2020. Method(s): A descriptive and cross-sectional research was conducted from March 11 to December 31, 2020. With the information obtained from clinical-epidemiological records, virological results, home and work screening, care for acute respiratory infections in clinics and polyclinics, and the daily reports of the Municipal Health Directorate, a statistical analysis was carried out whose information was inserted in an Excel database. Result(s): The incidence rate was 528.23 per 100 000 population;no deaths. Most of the cases occurred in the city of Sandino. There was a higher frequency of patients in the ages from 41 and 60, and the male sex;while 55.73 % were asymptomatic at diagnosis. The most common symptoms were cough, fever and nasal congestion. Between one and 13 cases per day were diagnosed during the 63 days that there was positivity. Family transmission was 68.23 % and occupational transmission was 50.52 % of cases. Conclusion(s): COVID-19 had a high incidence in Sandino municipality, and this predominated in places with higher population density with intense family and work transmission in a short period of time;also, in the male sex, the age group in working ages, and in the asymptomatic patients.Copyright © 2023, Editorial Ciencias Medicas. All rights reserved.

Risk signals mining of ribavirin and interferon-alpha based on the US FDA Adverse Event Reporting System database.

Objective: To identify which induced the symptoms/signs and laboratory abnormal findings occurred in patients with novel coronavirus pneumonia, by disease itself or by ribavirin and interferon-alpha treatments, through mining the adverse events (AEs) signals of the 2 antivirus agents. Method(s): According to the symptoms/signs and laboratory abnormal findings of novel coronavirus pneumonia mentioned in the literature and "Diagnosis and Treatment scheme of Novel Coronavirus Pneumonia (trial version 5)", AEs in this study were selected. Related data were collected from the U.S. FDA Adverse Events Reporting System (FARES) from Jan 1, 2004 to Dec 31, 2019, and the reporting odds ratio (ROR) method was used for signals detection for the above-mentioned 2 drugs. Result(s): A total of 7 582 463 AEs related to drugs were reported in the FAERS database, of which 31 775 related to ribavirin and 2 345 related to interferon-alpha. The results showed that AEs related to ribavirin in respiratory, thoracic, and mediastinal disorders were nasal congestion, cough, laryngeal pain, pharyngeal oedema, productive cough, and dyspnoea;AEs related to interferon-alpha were laryngeal pain and haemoptysis. In other system organ class, AEs related to above 2 drugs were pyrexia, feeling cold, pyrexia, nausea, vomiting, diarrhoea, headache, arthralgia, myalgia, and rash. AEs of laboratory abnormal results related to ribavirin were white blood cell/platelet count decrease and aspartate/alanine aminotransferase increase;AEs related to interferon-alpha were white blood cell/platelet count decrease, aspartate/alanine aminotransferase increase, and lymphocyte count decrease. Conclusion(s): Some AEs induced by ribavirin and interferon-alpha were similar to symptoms/signs and laboratory abnormal findings of novel coronavirus pneumonia, which should be distinguished in the clinical practice.Copyright © 2020 by the Chinese Medical Association.

Novel Framework for Neurocognitive Covid-19 Assessment

Background The neurotrophic effects of Covid-19 are becoming increasingly recognized, with altered mental state now being the second most common presenting complaint insert numbers. A key question is whether this has long term consequences. Cognitive problems are commonly reported in patients 3 months after acute infection as part of the so called Long-Covid syndrome. However, the underlying cause is not well understood. Candidate explanations include legacy from encephalitis and stroke;however, other complications such as the sequelae, delirium, remain underexplored. Furthermore, little consideration has been given to functional cognitive disorders and the cognitive consequences of depression, anxiety and fatigue. Aims We propose a structured approach to clinical assessment for clinicians reviewing late cognitive complaints after COVID 19. Methods We created our own unique framework for neurocognitive Covid assessment based upon a review of the literature. Results Covid status- Any positive test. If not review of core symptoms such as breathlessness, headache, anosmia, nasal obstruction, cough, myalgia, or gustatory dysfunction;duration, extent of exposure to Covid confirmed cases. Consider rapid antibody testing. Neuropsychiatric history- Part 1 symptoms at onset- in particular disruptions of consciousness and altered mental state. Acute memory impairment, anterograde/retrograde and with/ without a temporal gradient. neurocognitive function. ITU admission and oxygen requirements. Part 2 Current cognitive and mental state- in addition to standard history seek evidence of internal inconsistency of memory symptoms and attentional dysregulation. Has social cognition and meta-cognition been affected. Note attribution bias i.e. no Im not depressed, I cant enjoy anything because of my symptoms Background history- subtle suggestion of neurodegeneration and depression, anxiety and functional symptoms should be explored. MRI findings- signal changes in the medial temporal lobe, nonconfluent multifocal white matter hyperintense lesions, and isolated white matter microhemorrhages. Novel biomarkers IL-6, MCP-1, and IP-10. Conclusion Cognitive symptoms are common after confirmed and assumed COVID exposure. We propose a framework for neuropsychiatric assessment and the use of adjuvant imaging and potential biomarkers.

Clinical and paraclinical manifestation COVID-19 in different age children

Purpose - to establish the clinical and paraclinical manifestations of the course of COVID-19 in children, depending on age to predict the severity of the disease's manifestation. Materials and methods. The 60 children aged from 3 months to 17 years old with laboratory-confirmed SARS-CoV-2 were examined. All patients underwent general clinical, laboratory, and instrumental examinations and received therapy according to Ukrainian National protocol. SARS-CoV-2 infection was confirmed by real-time PCR. Results. Thus, in young children COVID-19 begins acutely (90.0%) with intoxication (75.0%), fever (65.0%), nasal congestion (25.0%), rhinorrhea (20.0%), dry cough (60.0%), increased ESR and C-reactive protein (55.0%). The course of COVID-19 in children 4-6 years is accompanied by acute onset (85.71%), fever (85.71%), pharyngitis (85.71%), lymphopenia (28.56%), and no CT signs of lesions (71.43%). In children 7-12 years old, COVID-19 causes intoxication (88.89%), fever (83.33%), pharyngitis (55.56%), dry cough (77.78%), lymphocytosis (16.67%) with accelerated ESR (38.89%) and pneumonia (38.89%). The course of COVID-19 in children was older than 13 years old characterized by fever (73.33%), pharyngitis (66.67%), dry cough (73.33%), olfactory loss (20.0%), leukopenia (20.0%), ESR acceleration (20.0%), and a decrease in prothrombin (13.33%) without pulmonary lesions (73.33%). Conclusions. These data suggest that the severity and duration of clinical and laboratory manifestations of COVID-19 depend on the child's age. The course of COVID-19 in children of all age groups is mostly of moderate severity with a favorable prognosis ((56.67%) hospitalized children did not have any complications). Only children from 7 to 12 years old need additional attention due to the severe manifestations of intoxication (88.89%) and the risk of complications with pneumonia (38.89%). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.Copyright © 2022 Modern Pediatrics. Ukraine. All rights reserved.

Oro-Facial manifestations of COVID-19 infection in a sample of Iraqi people

Public health officials are gravely concerned about the harm that viral illnesses continue to pose to humanity, various viral outbreaks, including the Middle East Respiratory Syndrome Corona-Virus (MERS-CoV), H1N1 influenza, the severe acute respiratory syndrome coronavirus (SARS-CoV-2) and SARS CoV-2 or COVID-19 that struck the globe in December 2019. A wide range of COVID-19 oral symptoms, such as ulceration, blisters, enanthems, hemorrhagic sores and cheilitis. Aim(s): to investigate the prevalence of oral symptoms amongst COVID-19 patients due to the disease's aggressive nature and diverse symptomatology and to assess the impact of oral health conditions on COVID-19 disease severity in a sample of Iraqi people. Material(s) and Method(s): a cross-sectional study was conducted on (200) patients in total, (81) male and (119) female, who were identified as SARS-COV2 patients. Result(s): COVID confirmed patients were involved in the present study with mean age (36.69+/-17.22) years & age range of (16-78) years. at least one of the oral manifestations was present in 72.5% of the patients, while about 27.5% did not experience any oro-facial symptoms. The oral symptom with the highest prevalence was dry mouth 50% followed by gustatory dysfunction 37% then burning mouth sensation 22.5% after that the oral pain 17%;myofacial pain 15.5 %;stomatitis\mucositis 14.5%;the prevalence of aphthous lesions, fissural cheilitis and tongue depapillation were at the same percentage which was 9.5%;then candidiasis 7.5%;the least prevalent oral symptoms was gingival bleeding at percentage of 2.5%. Conclusion(s): COVID-19 has a noticeable effect on oral cavity, there was a correlations between some general and orofacial manifestations of COVID-19.Copyright © 2023, Codon Publications. All rights reserved.

PD13-08 Phase 1 TROPION-PanTumor01 Study Evaluating Datopotamab Deruxtecan (Dato-DXd) in Unresectable or Metastatic Hormone Receptor-Positive/HER2-Negative Breast Cancer (BC)

Background: Datopotamab deruxtecan (Dato-DXd) is an antibody-drug conjugate (ADC) consisting of a humanized anti-TROP2 IgG1 monoclonal antibody covalently linked to a highly potent topoisomerase I (Topo I) inhibitor payload via a stable, tumor-selective, tetrapeptide-based cleavable linker. Dato-DXd demonstrated compelling single-agent antitumor activity in heavily pretreated patients (pts) with metastatic triple-negative BC (Krop, SABCS 2021). This is the first report of results from the TROPION-PanTumor01 study in pts with unresectable or metastatic hormone receptor- positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-;including HER2-low and HER2-zero) BC. Method(s): TROPION-PanTumor01 (NCT03401385) is a phase 1, multicenter, open-label, 2-part doseescalation/expansion study evaluating Dato-DXd in previously treated pts with solid tumors. Based on previous clinical findings and exposure-response results from pts with NSCLC, Dato-DXd 6 mg/kg IV Q3W is being evaluated in pts with unresectable or metastatic HR+/HER2- BC that progressed on standard therapies. The primary objectives were safety and tolerability. Tumor responses, including ORR (complete response [CR] + partial response [PR]) and DCR (CR + PR + stable disease [SD]), were assessed per RECIST version 1.1 by blinded independent central review. Result(s): As of the April 29, 2022, data cutoff, 41 pts had received Dato-DXd (median follow-up, 10.9 mo [range, 7-13]);9 pts were ongoing. The primary cause of treatment discontinuation was disease progression (63% progressive disease [PD] or clinical progression). Median age was 57 y (range, 33- 75);54% had de novo metastatic disease. Pts were heavily pretreated (Table) with a median of 5 (range, 3-10) prior regimens in the advanced setting;95% had prior CDK4/6i (adjuvant/metastatic). Median time from initial treatment for metastatic disease to the first dose of Dato-DXd was 42.7 mo (range, 10.2-131.1). Treatment-emergent adverse events (TEAEs;all cause) were observed in 98% (any grade) and 41% (grade >=3) of pts. Most common TEAEs (any grade, grade >=3) were stomatitis (80%, 10%), nausea (56%, 0%), fatigue (46%, 2%), and alopecia (37%, 0%). Serious TEAEs were observed in 6 pts (15%);1 pt died due to dyspnea, which was not considered to be treatment related. Dose reductions occurred in 5 pts due to stomatitis (n=3), fatigue (n=2), keratitis (n=1), and decreased appetite (n=1) (>1 AE per pt);14 pts had treatment delayed due to stomatitis (n=8), retinopathy (n=1), dysphagia (n=1), fatigue (n=1), malaise (n=1), COVID-19 (n=1), cellulitis (n=1), urinary tract infection (n=1), decreased lymphocyte count (n=1), and nasal congestion (n=1;>1 AE per pt). Three pts discontinued treatment due to keratitis (n=1) and pneumonitis (n=2);1 case of pneumonitis was adjudicated as grade 2 drug-related interstitial lung disease. The ORR was 29% (11 confirmed PRs;1 pending confirmation), the DCR was 85% (35/41), and the clinical benefit rate (CR + PR + SD >=6 mo) was 41% (17/41). Conclusion(s): Dato-DXd demonstrated a manageable safety profile and encouraging antitumor activity, with high disease control in heavily pretreated pts, the majority having received prior CDK4/6i. Based on these findings, the TROPION-Breast01 (NCT05104866) randomized phase 3 study comparing 2L+ Dato-DXd vs investigator's choice chemotherapy is currently enrolling pts with HR+/HER2- BC.

Predictive factors for hospitalization in a cohort of primary healthcare patients with suspected COVID-19

Background: The objective of the study was to identify clinical and demographic factors predictive of hospitalization in primary healthcare patients diagnosed with suspected COVID-19 at the beginning of the pandemic. Method(s): A retrospective cohort study design was used. Patients attended in Casanova primary healthcare centre (CAP) (Barcelona, Spain) for symptoms compatible with possible or confirmed SARS-CoV-2 infection between February 24 and May 30, 2020, were included. Data was collected through the electronic medical record and by telephone interview. Result(s): 518 patients were included, of whom 283 (54.6%) were female. The median age was 50.2 years and 19.3% were aged >= 65 years: 79% were followed on an outpatient basis while the rest were hospitalized. Predictive factors for hospital admission were male sex, older age, a history of ischemic heart disease and the presence of dyspnoea, haemoptysis, nausea and vomiting, with a sensitivity of 48% and a specificity of 95.4%. Odynophagia and nasal congestion were predictors of a good prognosis. Mortality was 2.3% and 25% of deaths did not occur in hospital. Conclusion(s): Nearly 80% of primary healthcare patients received only outpatient care. Male sex, older age, a history of ischemic heart disease and symptoms like dyspnoea, haemoptysis, nausea and vomiting could lead to a greater risk of an unfavorable evolution during COVID-19. Patients with at least one of the above factors, which correlate with a higher hospital admission rate, should receive a closer follow-up to early detect when they can benefit from a hospital evaluation based on their clinical evolution.Copyright © 2023 The Authors

COVID-19 in patients diagnosed with persistent tachypnea of infancy

Objective: Novel coronavirus has raised substantial concern for patients with chronic lung diseases. The aim of this study was to evaluate the clinical characteristics and outcome of COVID-19 in children with persistent tachypnea of infancy (PTI). Method(s): Children who were previously diagnosed with PTI and admitted for regular follow-up visits were assessed. Data on the history of having SARS-CoV-2 infection was collected. Result(s): Between January 1, 2021, and February 28, 2022, 62 patients with PTI (median age 3.7 years) were evaluated. Thirty-eight patients (61.3%) were diagnosed with COVID-19. Fourteen (36.8%) of them had a positive SARS-CoV-2 PCR test, and 24 (63.2%) were diagnosed by a positive serology test for specific antibodies connected with a history of close contact. Sixteen patients (42.1%) were asymptomatic, and 22 (57.9%) symptomatic. The most common symptoms were rhinorrhea or nasal congestion (77.3%), cough (72.7%), and sore throat (45.5%). According to NIH guidelines, 16 (42.1%) patients were classified as having mild disease, and in 3 (7.9%) children who had dyspnea, the moderate disease was recognized. Three children (7.9%) with increased dyspnea and oxygen demand required admission to the hospital. Follow-up performed in a median time of 6 months revealed that nearly all PTI patients after COVID-19 returned to their baseline status (78.9%);4 children (10.5%) suffered from exacerbating symptoms of the chILD for one month. Surprisingly two (5.3%) children became completely asymptomatic after COVID-19. Conclusion(s): SARS-CoV-2 infection in children with PTI is usually associated with a mild illness with a low risk of hospitalization.

Analysis of the current Covid-19 infection and vaccination status in patients with neurofibromatosis type 1

Background: To investigate the common symptoms after Covid-19 infection, characteristics of adverse events after vaccination, changes in clinical manifestations related to Neurofibromatosis type 1 (NF1), as well as the current vaccination status and factors related to vaccine hesitation among NF1 patients, in order to provide a basis for scientific protection and vaccine acceptance in NF1 individuals in the new phase of pandemic management. Method(s): From December 29, 2022, to January 10, 2023, we conducted a self-assessment questionnaire survey among diagnosed NF1 patients. General data were provided including sex, age, main clinical presentations, and current treatment. This study mainly focused on the infection and vaccination status of Covid-19 among these patients with NF1. The data were statistically analyzed using SPSS26.0 software. Result(s): Of the 250 questionnaires distributed, 226 were valid. Among the 164 patients (72.6%) with Covid-19 infection, the most common infection symptoms and incidence of patients were not significantly different from those in the normal population (P>0.05), but the incidence of symptoms such as nasal congestion, headache, myalgia, sore throat, abdominal pain, diarrhea, and eye discomfort was higher than that in the normal population (P<0.05), and no severe infection was observed;186 patients (82.3%) had completed the Covid-19 vaccination, and more than half of those who were not vaccinated had no plans for vaccination. Among the vaccinated patients, there was no significant difference in the incidence of adverse events, such as fever, pain, redness, and swelling at the injection site after vaccination, compared to the normal population (P>0.05), but the incidence of fatigue and headache was higher in NF1 patients (P<0.001). Most patients with NF1 believe that there is no significant progressive change in NF1-related clinical manifestations after Covid-19 infection and vaccination. Conclusion(s): Currently, some NF1 patients appear to be worried about the evolution of their disease after Covid-19 infection in the face of large fluctuations in the pandemic situation, and some patients hesitate to receive the vaccine due to their special disease condition. Thus, clinical trials should be conducted to develop a refined pandemic response and vaccination program for this special group.Copyright © 2023 China Medical Cosmetology Press Co. Ltd.