Correlation between C-reactive protein (Crp) level and clinicoradiological profile in COVID-19 patients admitted in a tertiary care hospital in eastern India

Background: Coronavirus disease 2019, first reported in December 2019 mainly presented with the symptoms of Cough, Fever, Shortness of breath, Myalgia, Weakness and anosmia. C-reactive Protein (CRP) is an acute-phase reactant protein which is synthesized by the liver in response to raised levels of interleukin-6 (IL-6) which is a biomarker of inflammation. Methods: This was a prospective observational study, done on 110 COVID-19 patients after applying inclusion and exclusion criteria. Detailed history, vaccination status, presence of comorbidities and thorough clinical examination was performed. Serum CRP levels was assessed and Computed Tomographic scan (CT scan) of Thorax was done. CORADS scoring and CT severity grading as per CT scan was done. All the above parameters were recorded in the preformed proforma and data was entered in excel spreadsheet and was analysed using SPSS v26 software. Results: Majority were males (56.3%) and majority were from 61-80 years of age. Majority (57.3%) patients were non-smokers. Hypertension was the most common associated comorbidity (86.4%) (r=0.743, p=0.000). There is a strong positive correlation between CRP levels and CTSS in COVID 19 patients and a strong negative correlation between the CRP levels and outcome of COVID-19 patients (r=-0.449, p=0.000). Conclusion: Elevated serum CRP value is associated with disease progression and poorer outcome.

Comprehensive medication management services provided via telehealth or hybrid models: A scoping review

Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.

Spontaneous pneumomediastinum secondary to COVID-19 in Iran: a case series study: SPM secondary to COVID-19

BACKGROUND: Pneumomediastinum is defined as open-air in the mediastinum. Spontaneous pneumomediastinum (SPM) occurs when air leaks into the surrounding vascular sheath through small alveolar ruptures. CASE REPORT: We want to introduce 4 different cases with different outcomes. The first case was a 60-year-old man with a history of psychological disorders, the second case was a 41-year-old man with a history of hypertension (HTN) and asthma, the third case was a 50-year-old heavy smoker with no history of an underlying disease, and the fourth case was a 60-year-old man with a history of schizophrenia. They suddenly developed an exacerbation of cough, dyspnea, chest pain, and a severe decrease in oxygen saturation during hospitalization. Antibiotic therapy, corticosteroids, and high-dose oxygen therapy were administered to the patients. One of these patients died. CONCLUSION: All patients can potentially be at risk for this complication and have a good prognosis if diagnosed early and treated properly overall.

Relationship between cognitive dysfunction and the promoter methylation of PER1 and CRY1 in patients with cerebral small vessel disease

Background: The prevalence of cerebral small vessel disease (CSVD) is increasing due to the accelerating global aging process, resulting in a substantial burden on all countries, as cognitive dysfunction associated with CSVD is also on the rise. Clock genes have a significant impact on cognitive decline and dementia. Furthermore, the pattern of DNA methylation in clock genes is strongly associated with cognitive impairment. Methods: We recruited patients with CSVD admitted to the Geriatrics Department of the Lianyungang Second People's Hospital between March 2021 and June 2022. Based on their Mini-Mental State Examination score, patients were categorized into two groups: 65 cases with cognitive dysfunction and 36 cases with normal cognitive function. Clinical data, 24-hour ambulatory blood pressure monitoring parameters, and CSVD total load scores were collected. Moreover, we employed methylation-specific PCR to analyze the peripheral blood promoter methylation levels of clock genes PER1 and CRY1 in all CSVD patients who were enrolled. Finally, we used binary logistic regression models to assess the association between the promoter methylation of clock genes (PER1 and CRY1) and cognitive dysfunction in patients with CSVD. Results: A total of 101 individuals with CSVD were included in this study. There were no statistical differences between the two groups in baseline clinical data except MMSE and AD8 scores. After B/H correction, the promoter methylation rate of PER1 was higher in the cognitive dysfunction group than that in the normal group, and the difference was statistically significant (adjusted P0.05). Binary logistic regression models showed that the influence of promoter methylation of PER1 and CRY1 on cognitive dysfunction were statistically significant in Model 1 (P<0.001;P=0.025), and it still existed after adjusting for confounding factors in Model 2. Conclusions: The promoter methylation rate of PER1 gene was higher in the cognitive dysfunction group among CSVD patients. And the hypermethylation of the promoters of clock genes PER1 and CRY1 may be involved in affecting cognitive dysfunction in patients with CSVD.

Management of Adults with Systemic Lupus Erythematosus (Sle) in 2021: A Multi-Centre Audit within Wales as Part of an Ongoing Quality Improvement Exercise

Background/Aims Significant changes to working practices within rheumatology have occurred since the beginning of the COVID-19 pandemic: virtual consultations have now become commonplace. This audit was undertaken as part of ongoing quality improvement work to assess the standards of care provided to patients with SLE attending rheumatology departments across Wales. Care was audited against the standards outlined in the 2018 British Society of Rheumatology guideline for the management of adults with SLE. Results were compared with the previous multi-centre audits of SLE care in Wales and the UK. We were interested to see whether changes to working practices had significantly affected the care of patients with SLE across Wales. Methods Rheumatology services in Wales were invited via email to participate. Data collection occurred between June and August 2021. Data was collected via online questionnaire, held securely by the Dudley Group NHSFT. Unit questionnaires were submitted by a lead clinician in each centre. Five centres across Wales submitted data from 62 clinical encounters with patients with SLE. Result(s): Conclusion Results of this multi-centre audit do not demonstrate any widespread significant changes in care for patients with SLE in Wales between 2019 and 2021, despite 48% of consultations audited being undertaken virtually. Blood pressure and urinalysis were not consistently measured in 2021, likely secondary to the increased prevalence of virtual consultations. Group education has been undertaken as to the importance of facilitating observations in the virtual environment and centres have shared their experiences of how they tackle this challenge locally. (Table Presented).

Adherence to treatment and quality of life of patients with hypertension during the COVID-19 pandemic

Introduction: Reduced accessibility to routine follow-up visits in GP surgeries during the COVID-19 pandemic as well as the failure to report to health care facilities for fear of infection may have disrupted doctor-patient cooperation and worsened adherence to therapeutic recommendations. Aim of the research: To examine the quality of life of patients with arterial hypertension and their assessment adherence to therapeutic recommendations during the COVID-19 pandemic. Material(s) and Method(s): A total of 103 hypertensive patients of the Independent Public Healthcare Centre of the Ministry of Interior and Administration in Wroclaw were examined. The World Health Organization Quality of Life Instrument Short Form (WHOQOL-BREF) and the Adherence in Chronic Diseases Scale (ACDS) were used. Result(s): The mean score for perception of quality of life was 3.64 +/-0.73. Quality of life was rated best in the psychological domain (M = 15.05, SD = 2.42) and worst in the physical domain (M = 13.25, SD = 2.67). 57.28% (59/103) of the respondents had medium adherence, 23.30% (24/103) had low adherence, and 19.42% (20/103) had high adherence. The level of adherence was significantly better among patients keeping a self-monitoring diary compared to those who did not keep such a diary (24.19 +/-2.86 vs. 21.86 +/-4.56, p = 0.007). Patient age (r = 0.323, p = 0.001) and systolic blood pressure value (r = -0.193, p = 0.05) significantly correlated with adherence level. The higher the level of adherence, the better the quality of life in the psychological (r = 0.197, p = 0.046) and social (r = 0.198, p = 0.045) domains. Conclusion(s): Adherence to the therapeutic plan and good patient-doctor cooperation are extremely important for the level of quality of life of hypertensive patients.Copyright © 2023 Termedia Publishing House Ltd.. All rights reserved.

Effect of WeChat group management on blood pressure control rate and drug compliance of hypertension patients during the epidemic of coronavirus disease 2019

Objective To explore the effect of WeChat group management on blood pressure control rate and drug compliance of hypertension patients during the epidemic of coronavirus disease 2019 (COVID-19) . Methods A total of 428 consecutive patients with essential hypertension in our outpatient department from Jan. 2020 to Dec. 2020 were enrolled and randomly divided into experimental group and control group with a ratio of 1 : 1. There were 214 patients in the experimental group, 110 males and 104 females, with an average age of (55.48+/-6.11) years. There were 214 cases in the control group, 108 males and 106 females, with an average age of (56.52+/-5.19) years. WeChat groups were established for the 2 groups separately. Information on education, supervised medication and lifestyle of hypertension was provided to the patients in the experimental group through WeChat, while no active intervention was given to the control group. The blood pressure control rate and medication possession ratio (MPR) were calculated at 1, 3, 6 and 12 months of intervention, and the differences between the 2 groups were compared. Results There were no significant differences in the blood pressure control rate (91.12%[195/214] vs 90.65% [194/214], 86.67%[182/210]vs 89.62%[190/212])or MPR (0.90+/-0.03 vs 0.90+/-0.05, 0.85+/-0.04 vs 0.88+/-0.03) between the 2 groups at 1 or 3 months of intervention (all P>0.05). At 6 and 12 months, the blood pressure control rate (81.73%[170/208]vs 88.57%[186/210],75.12%[154/205]vs 85.99%[178/207]) and MPR (0.74+/-0.04 vs 0.87+/-0.05, 0.58+/-0.05 vs 0.85+/-0.03) of patients in the experimental group were significantly higher than those in the control group (all P<0.05). Conclusion During the COVID-19 epidemic, WeChat group management of hypertension patients by doctors could improve patients' blood pressure control rate and drug compliance and strengthen patients' self-management ability.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Outcomes, risk factors, and incidence of acute kidney injury in hospitalized COVID-19 patients

Background: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) is the virus causing Coronavirus Disease 2019 (COVID-19). Apart from respiratory disease, this virus can affect different organs. Objectives: Therefore, multiple mechanisms have been hypothesized for Acute Kidney Injury (AKI) in COVID-19. In this study, we evaluate the incidence and prognosis of AKI in COVID-19 patients. Methods: This retrospective cohort study assessed 397 COVID-19 patients hospitalized between April 1, 2020, and September 30, 2021. Patients with a sudden rise of serum creatinine level, more than 0.3 mg/dl in two days or more than 50% of the initial level in one week, were diagnosed with AKI. Demographic, laboratory, and clinical features were compared in AKI patients with patients without AKI. Results: A total of 397 patients with a mean age +or- standard deviation of 55.42 +or- 15.26 years were included in the study. According to diagnostic criteria, 48 (12.1%) patients developed AKI. Old age, a history of hypertension, and chronic renal failure were suggested as risk factors for AKI. High levels of C-Reactive Protein, Erythrocyte Sedimentation Rate, Lactate Dehydrogenase, D-dimer, and serum phosphorus upon arrival were also associated with an increased risk of AKI. In addition, the incidence of hypernatremia and hyperkalemia increased mortality in patients with AKI. Conclusion: The incidence of AKI in admitted COVID-19 patients affects the duration of hospitalization, the chance of ICU admission, and mortality. It is important to limit the use of nephrotoxic drugs and to maintain water-electrolyte balance to prevent the incidence of AKI and improve the outcome.

Cardiometabolic and psychocognitive features of the post-COVID period in patients with atrial fibrillation

The number of people with long-term consequences of COVID-19 is increasing worldwide. The long-term prognosis for patients remains poorly understood. Objective. To study cardiometabolic and psychocognitive features in comorbid elderly patients with atrial fibrillation (AF), de-pending on the presence of post-COVID syndrome (PCS). Material and methods. The observational analytical cohort study included 223 patients with AF and comorbidity (coronary artery disease, hypertension, obesity, type 2 diabetes mellitus) aged 60-74, who were divided into two groups: group 1 included 123 patients without COVID-19 and group 2 included 110 patients with a history of COVID-19 and the presence of PCS. The study evaluated laboratory and instrumental tests, and a general clinical study assessing psychocognitive disorders using the SPMSQ and HADS questionnaires was conducted. Results and discussion. In COVID-19 survivors, compared with patients of group 1, there were more pronounced atherogenic changes in total cholesterol (TC) (p=0.003), low-density lipoprotein cholesterol (p<0.001), and triglycerides (p=0.011). Lower dia-stolic blood pressure was found in COVID-19 survivors (p<0.001). In addition, patients in group 2 had higher median pulse pressure (p<0.001) and heart rate (p<0.001). In group 2 patients, a larger ascending aorta diameter was observed (p<0.001). The anx-iety-depressive syndrome was more common in COVID-19 survivors with comorbidities, and a statistically significant difference was found in clinical anxiety (24%, p=0.041) and subclinical depression (21%, p=0.015). When assessing cognitive function, mod-erate cognitive impairment was detected in 22% (p=0.005) of patients with PCS and severe cognitive impairment in 2% (p=0.007). Conclusion. In comorbid elderly patients with the post-COVID syndrome, a high prevalence of psychocognitive disorders and adverse cardiometabolic changes were observed, supporting the need for long-term monitoring of the general clinical condition and psychocognitive status of COVID-19 survivors.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Assessment and treatment of eating disorders in adolescents

Pediatric health care providers understand that eating disorders are not lifestyle choices but lifethreatening mental health conditions Among patients of all ages, anorexia nervosa (AN) has the second-highest mortality rate of all mental health conditions, after substance abuse.1 Both suicide and the physical effects of nutritional deficit are implicated. Prevalence Analyses of prevalence vary widely in their findings.2 One meta-analysis found lifetime prevalence of AN from 1.7% to 3.6% for female patients and 0.1% for male patients;lifetime prevalence of BN for female patients was about 2.1%.3 BED, with reported prevalence rates of approximately 2% to 4%, is almost as common among male as female patients.2 4 Among adolescents aged 13 to 18 years, one study found prevalence rates of 0.3% for AN, 0.9% for BN, and 1.6% for BED.5 Long characterized as affecting primarily affluent White adolescent girls, eating disorders now affect people from lower socioeconomic groups, members of non-White ethnic groups, preteen children, and boys.2 LGBTQIA+ young people may be at particular risk.6 During the early months of the COVID-19 pandemic, hospitalizations for eating disorders doubled,7 and patients reported significant increases in unhealthy behaviors.8 Screening Caregiver reports about a child's weight or eating habits or clinical observation of unexpected weight changes are likely to alert the pediatrician to the possibility of an eating disorder. Presence of any one of the following symptoms indicates the need for immediate medical hospitalization for refeeding2'14: O Heart rate less than 50 beats per minute (bpm) while awake;less than 45 bpm while asleep O Systolic pressure less than 90/45 mm Hg O Orthostatic changes: decrease in blood pressure of more than 20 mm Hg systolic or 10 mm Hg diastolic;heart rate increase of more than 20 bpm O ECG abnormalities: Prolonged corrected QT interval or other arrhythmia O Syncope O Temperature less than 96 °F (35.6 °C) O Electrolyte abnormalities O Uncontrollable binge eating and purging Dehydration Suicide risk O Less than 75% of expected body weight O Failed outpatient management O Acute weight loss and food refusal Communication Today's young people typically know what anorexia and bulimia are.

Assessment of risk factors for thrombosis in ICU patients with COVID-19

Introduction: According to scientific studies, a high incidence of thrombotic events is known in hospitalized patients with COVID-19. Less than 50% of pulmonary embolisms (PE) are associated with signs of deep vein thrombosis (DVT) of the lower extremities. Background: To identify significant risk factors for thrombosis thrombosis (DVT) in intensive care patients with COVID-19. Materials and methods: We conducted a prospective cross-sectional study that included 465 adult patients with laboratory-confirmed COVID-19 admitted to the intensive care unit. All patients underwent computer tomography of the chest organs, ultrasound angioscanning of lower extremities, body mass index was calculated, the presence of comorbotity diseases and indicators of volumetric blood saturation were considered. The level of D-dimer in blood plasma, coagulation parameters (fibrinogen, factor VIII) were taken from laboratory parameters in calculations. For subgroups with 5 or fewer people, the chi-square test and Fisher's exact test were used. For quantitative variables, analysis of variance (ANOVA) and the Pearson and Spearman correlation coefficient were used. For multiple variables, ordered logistic regression models were built, with likelihood ratio tests performed to compare the models. Results: A total of 465 patients were included in the study. Comorbidities were present in 435 of 465 patients (93.55%) had at least one comorbidity. The most common was arterial hypertension - 370 (79.57%), followed by chronic heart failure - 196 (42.15%), obesity - 161 (34.62%), diabetes mellitus - 144 (30.97%), chronic renal failure (CRF) -58 (12.47%) and oncological diseases -25 (5.38%). The average body mass index was 29.7 kg/m2. In patients with DVT and venostasis, the body mass index (BMI) was more than 30 kg/m2 than without DVT (32.57+or-10.92 kg/m2, and 30.24+or-6.85 kg/m2, versus 29.22+or-6.46 kg/m2, respectively). Ultrasound angioscanning (USAS) confirmed deep vein thrombosis in 60 patients (13.8%) and was associated with older age (71.12+or-13.98 versus 67.20+or-11.16, p < 0.006), venous stasis was detected in 56 patients (12%) no DVT was detected in the rest of the studied patients. In the majority of cases, DVT was detected in the tibial segment -26 (43.33%), in 18 (30%) patients it was diagnosed in the popliteal veins and in 14 (23.33%) cases in the femoral segment. Diabetes mellitus (p=0.041), obesity (p=0.01) and CRF (p=0.028) were also significant risk factors for DVT. Conclusions: Significant risk factors for deep vein thrombosis in intensive care patients with COVID-19 are high levels of D-dimer (>=2.33 g/ml) and comorbidities such as obesity, chronic kidney failure, and diabetes mellitus.

THE STUDY OF THE DYNAMICS OF CLINICAL AND LABORATORY-INSTRUMENTAL PARAMETERS IN HYPERTENSIVE PATIENTS WITH OBESITY WHO UNDERWENT COVID-19-ASSOCIATED PNEUMONIA

BACKGROUND: According to the results of the ESSE-RF study, the frequency of obesity in the population reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem. AIM: The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital. MATERIALS AND METHODS: Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 - 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers - concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol;echocardiography using an expert class ultrasound diagnostic system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822. RESULT(S): Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-alpha and NRL parameters in group 2 of patients with 2-3 degrees of obesity, may indicate the highest probability of developing delayed adverse cardiovascular complications in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium. CONCLUSION(S): Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium.Copyright © Endocrinology Research Centre, 2022.

Higher Blood Pressure and Weight Observed Among Early Adolescents During the COVID-19 Pandemic

The COVID-19 pandemic led to significant disruptions in the lifestyle behaviors of adolescents;however, there is a paucity of data on objective changes in health indicators of adolescents such as blood pressure, hypertension, and weight. The aim of this study is to quantify differences in blood pressure and weight before and during the COVID-19 pandemic among a demographically diverse national sample of early adolescents. We analyzed cross-sectional data from 2018-2020, corresponding to the second follow-up year (Year 2) of the Adolescent Brain Cognitive Development (ABCD) Study. Among 4,065 early adolescents (mean age 12.00, 49.4% female, 55.5% white), 4.7% vs 7.4% of adolescents had hypertension pre-pandemic vs during the pandemic (p=0.002). The pandemic was associated with a 1.64 percentile (95% CI 0.01, 3.27) higher systolic blood pressure, a 4.65 percentile (95% CI 2.65, 6.66) higher diastolic blood pressure, and a 1.68 kg (95% CI 0.51, 2.85) higher weight when adjusting for covariates. The pandemic was associated with a 1.72 higher odds of hypertension (95% CI 1.21, 2.44) compared to pre-pandemic when adjusting for covariates. Future studies should explore mechanisms and longitudinal trends in blood pressure among adolescents as they return to pre-pandemic lifestyle behaviors.

Diabetes mellitus and depression amid the COVID-19 pandemic: Possible solutions for resource limited settings

Background and aims: The impact of the COVID-19 pandemic on mental health and well-being is a matter of significant concern. Besides the depression associated with diabetes mellitus (DM) diagnosis and management, the COVID-19 pandemic has also imposed significant distress among people with DM. Method(s): This is a narrative review of the interplay between DM management and depression amid the COVID-19 pandemic. Electronic databases, namely;PubMed, CINAHL, EMBASE and Google Scholar were searched for literature. Search terms were "diabetes", "depression", and ''corona virus", "COVID-19","diabetes self-care","diabetes self-care in low income countries and diabetes management in Zimbabwe". Result(s): This paper discusses the interaction between DM and depression, amid the COVID-19 pandemic. We further explain the implications on DM management, screening and elaborate on possible solutions to effective prevention and management of depression. Conclusion(s): We have made recommendations for prevention and management of depression such as collaborative practice, early and routine screening, meticulous self-care and use of non-pharmacological strategies.Copyright © 2020 FSG Communications Ltd. All rights reserved.

Remotely Controlled Real-Time Health Surveillance System of COVID-19 Patients

This work focuses on the development of a portable physiological monitoring framework that can continuously monitor the patient's heartbeat, oxygen levels, temperature, ECG measurement, blood pressure, and other fundamental patient's data. As a result of this, the workload and the chances of being infected by COVID-19 of the health workers will be reduced and an efficient patient monitoring system can be maintained. In this paper, an IoT based continuous monitoring system has been developed to monitor all COVID-19 patient conditions and store patient data in the cloud server using Wi-Fi Module-based remote communication. In this monitoring system, data stored on IoT platform can be accessed by an authorized individual and ailments can be examined by the doctors from a distance based on the values obtained. If a patient's physical condition deteriorates, the doctor will immediately receive the emergency alert notification. This model proposed in this research work would be extremely important in dealing with the Corona epidemic around the world. © 2022 IEEE.

Investigating factors affecting hospitalization of patients with mucormycosis after contracting COVID-19: a systematic review

Regarding the investigation of the factors related to the hospitalization of patients with Mucormycosis after being infected with Covid-19, several preliminary studies have been conducted in the hospital, but these studies were conducted in a small environment and have a smaller sample size. Therefore, the aim of the present systematic review study is to examine the factors affecting the hospitalization of patients with mucormycosis after being infected with covid-19. Methods: The current systematic review study was conducted according to PRISMA guidelines (preferred reporting items for systematic seviews and meta-analyses). For this study, the keywords "2019-nCoV", "COVID-19", "SARS-CoV-2", "Coronaviruses", "Hospitaliz", "Factor" and "Mucormycosis" in MagIran, SID, ISI, embase databases, ProQuest, PubMed, scopus were searched. Results: diabetes mellitus, old age, high body mass index, kidney disease, high blood pressure and smoking significantly increase the need for hospitalization in patients with mucormycosis after contracting covid-19. Conclusion: The results of the present study showed that the risk of hospitalization due to Mucormycosis after the covid-19 disease is significantly related to obesity, old age and underlying diseases..

Epidemiological characteristics of infected patients aged 60 years and older during the outbreak of SARS-CoV-2 Omicron variant in Sanya, Hainan in 2022

Objective: To analyze the epidemic characteristics of coronavirus disease 2019 (COVID-19) cases aged 60 years or older during the outbreak epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant in Sanya City, Hainan Province, August-September 2022, and to provide scientific and effective basis for formulating strategies for the prevention and treatment of COVID-19 in the elderly in the future. Methods: The data of 1 785 COVID-19 cases aged 60 years reported from August 1 to September 8, 2022 in Sanya City, and 537 local COVID-19 inpatients aged 60 years treated in Sanya Central Hospital were collected and analyzed using WPS Office 2018 software for data cleaning, database assistance, and drawing, and SPSS 22.0 software was used to statistically describe and analyze the counting data. Results: A total of 1 785 local COVID-19 cases aged 60 years were reported in China's Disease Prevention and Control Information System, including 1 509 confirmed cases (84.54%) and 276 asymptomatic cases (15.46%). Of the confirmed cases, 1 448 were mild cases (95.96%), 40 were common cases (2.65%), 10 were severe cases (0.66%), and 11 were critical cases (0.73%), and no deaths were reported. The ratio of male to female was 0.88:1. The youngest was 60 years old, the oldest age was 107 years old, with a median age of 67 years old. Most of them (1 559 cases, 87.34%) were non-social employed personnel. Among them, 952 (53.33%) were from Tianya District and 733 (41.06%) from Jiyang District. Among the 537 COVID-19 elderly infected patients hospitalized in Sanya Central Hospital, infected patients with underlying diseases accounted for 287 (53.45%) cases of hypertension, diabetes and other types of basic diseases (chronic kidney disease, hyperlipidemia, chronic gastritis, gastric ulcer, etc.), and there were serious infections. Conclusions: Most of the elderly infected with Omicron variants were mild cases with few symptoms, but the elderly infected with Omicron variants were difficult to recover or even worsen the condition due to old age and underlying diseases. Therefore, by analyzing the various aspects of elderly infected cases, scientific and effective basis can be provided to prevent and control the epidemic situation in the future, and reduce the occurrence of severe, critical and death cases of COVID-19 in the elderly.

Autonomic Dysfunction after Covid-19 Immunization - Case Report

Background: The infection caused by the SARS-CoV-2 continues affecting millions of people worldwide and vaccines to prevent the coronavirus disease (COVID-19) are considered the most promising approach for curbing the pandemic. Otherwise, cardiovascular and neurological complications associated with the vaccines were speculated and some few case reports were published. Objective(s): We describe a case of postural orthostatic tachycardia syndrome (POTS) after viral vector COVID-19 vaccination and the possible autoimmune process of the syndrome. Method(s): A 35-year-old female, without previous symptoms or comorbidities, developed intermittent palpitation, intense fatigue and dyspnea, compromising her daily activities, triggered by upright position, seven days following the second dose of the Oxford vaccine. Physical examination was normal, except for a heart rate (HR) increase of 33 beats/min from supine to standing position, with no significant change in blood pressure and reproduction of symptoms. Result(s): A 24-hour Holter monitoring revealed episodes of spontaneous sinus tachycardia correlated with palpitation and fatigue. Extensive diagnostic investigations excluded primary cardiac, endocrine, infectious and rheumatologic etiologies. The patient underwent an autonomic function test which demonstrated normal baroreflex sensitivity, as well as normal cardiovagal and adrenergic scores. Head-up tilt test showed persistent orthostatic tachycardia (HR increase from a medium of 84 beats/min in supine position to 126 beats/min during upright tilt), without hypotension, consistent with the diagnostic criteria for POTS. According to the current guidelines, general behavior recommendations, pharmacotherapy with low dose of propranolol associated with the autonomic rehabilitation were oriented. Along three months of follow-up, the patient reported a gradually improvement in her symptoms. Conclusion(s): POTS is a heterogeneous disorder of the autonomic nervous system characterized by orthostatic tachycardia associated with symptoms of orthostatic intolerance. Although the physiopathology of COVID-19 vaccine and autonomic disorders remains speculative, autoimmune response is one of the possible mechanisms. Based on clinic presentation, the time frame of symptom onset is consistent with other well-known post-vaccination syndromes, which may be an indicator of an autoimmune process induced by immunization. Further studies are needed to assess causal relationship between immunization and autonomic dysfunction.Copyright © 2023

Long-lasting brain fog is related with severity clusters of symptoms in COVID-19 patients. Background: COVID-19 patients may experience lon-lasting symptoms from weeks to even months. Aim: to evaluate long-term cognitive impairment based on the severity

Background: COVID-19 patients may experience lon-lasting symptoms from weeks to even months. Aim: To evaluate long-term cognitive impairment based on the severity of symptoms of COVID-19 infection in a primary health system setting. Material and methods: From a database of 363 patients, 83 cases aged 47 +or- 15 years, (58% females) were selected from June to August 2020. In patients who survived the virus, 24 infection-related symptoms were collected to create three severity clusters (mild, moderate, and severe). The follow-up time was at least seven months. Comparing the first two clusters with the severe cluster, the existence of brain fog and risk factors (obesity, hypertension, diabetes, chronic lung disease, and hypothyroidism) were analyzed. Results: Thirty-one patients (37%) had persistent symptoms lasting up to 240 days. Fifty-one patients (61%) experienced brain fog. Concentration was affected by symptom severity (odds ratio [OR] 3.63, 95% confidence interval [CI] 1.26-10.46, p = 0.02). Short- or long-term memory loss was not affected. Moreover, symptom severity was related to brain fog (OR 3.16, 95% CI 1.05-9.51, p = 0.04). Patients with persistent symptoms had a concentration impairment associated with severity patterns (OR 24.3, 95% CI 1.73-340.11, p = 0.03). Conclusions: Brain fog is associated with symptom severity in COVID-19 survivors and lasts for more than eight months.

Co-exposure to urban particulate matter and aircraft noise adversely impacts the cerebro-pulmonary-cardiovascular axis in mice

Worldwide, up to 8.8 million excess deaths/year have been attributed to air pollution, mainly due to the exposure to fine particulate matter (PM). Traffic-related noise is an additional contributor to global mortality and morbidity. Both health risk factors substantially contribute to cardiovascular, metabolic and neuropsychiatric sequelae. Studies on the combined exposure are rare and urgently needed because of frequent co-occurrence of both risk factors in urban and industrial settings. To study the synergistic effects of PM and noise, we used an exposure system equipped with aerosol generator and loud-speakers, where C57BL/6 mice were acutely exposed for 3d to either ambient PM (NIST particles) and/or noise (aircraft landing and take-off events). The combination of both stressors caused endothelial dysfunction, increased blood pressure, oxidative stress and inflammation. An additive impairment of endothelial function was observed in isolated aortic rings and even more pronounced in cerebral and retinal arterioles. The increase in oxidative stress and inflammation markers together with RNA sequencing data indicate that noise particularly affects the brain and PM particularly affects the lungs. Noise also increased levels of circulating stress hormones adrenaline and noradrenaline, while PM increased levels of circulating cytokines CD68 and MCP-1. The combination of both stressors has additive adverse effects on the cardiovascular system that are based on PM-induced systemic inflammation and noise-triggered stress hormone signaling. We demonstrate an additive upregulation of ACE-2 in the lung, suggesting that there may be an increased vulnerability to COVID-19 infection. The data warrant further mechanistic studies to characterize the propagation of primary target tissue damage (lung, brain) to remote organs such as aorta and heart by combined noise and PM exposure.Copyright © 2023