Predictive approach for post-covid 19 evolution study of the pavement surface deterioration based on visual inspection results.

This study proposes a statistical approach to examine pavement surface deterioration tendencies resulting from the COVID-19 pandemic. The road inspection results, the historical road databases, and the condition analysis make pavement management a major challenge for managers in Morocco as well as around the world. The decrease in traffic, the maintenance stoppages, the difficulties in obtaining field information, all these imperative ingredients are a consequence of the covid-19 pandemic. In this respect, historical analysis, remote monitoring and damage prediction have become increasingly important. In collaboration with the Moroccan National Center for Road Research, this study examines the impact of pandemic-induced lockup on the variation of three important pathologies: pullouts, cracks and potholes, based on the results of a visual inspection and the results of deflection and evenness performed in 2020 on a 50 km long section connecting Meknes and Khemisset cities. First, the reduction of data based on deterioration represented in four levels (A, B, C and D), second, the comparison of the different pathologies before and after the pandemic, the impact of the pandemic on the pavement quality, and finally, a prediction of the progression of the pathology using the linear regression method. This study will help decision makers to take into account pandemics and health failures in their pavement management approaches, and especially to prevent future damage for budget allocation.

Increase of nutritional security in Sub-Saharan Africa through the production of dried products from underutilized crops

Currently, an estimated 20% of the population in Sub-Saharan Africa is food insecure with the incidence of hunger and malnutrition still rising. This trend is amplified by the socio-economic consequences of the COVID-19 pandemic. In contrast, more than a third of the harvestable perishable produce is lost due to a lack of preservation or failure to utilize preservation as is the case for underutilized crops (UCs). Moreover, some of the preservation techniques utilized are poor, leading to the deterioration of food quality, especially the micronutrients. In this study, we thus exemplarily investigated the impact of different drying settings on the quality of two highly nutritious UCs, namely cocoyam and orange-flesh sweet potato (OFSP) (40, 60, and 80 °C for cocoyam and 40, 50, 60, and 70 °C for OFSP) to deduce the optimum quality retention and further develop a theoretical design of processing units and processing guidelines for decentralized food processing. Drying cocoyam at 80 °C and OFSP at 60 °C, respectively resulted in a relatively shorter drying time (135 and 210 min), a lower total color difference (2.29 and 11.49-13.92), greater retentions for total phenolics (0.43 mg GAE/100 gDM and 155.0-186.5 mg GAE/100 gDM), total flavonoid (128 mg catechin/100 gDM and 79.5-81.7 mg catechin/100 gDM) and total antioxidant activity (80.85% RSA and 322.58-334.67 mg AAE/100 gDM), respectively for cocoyam and OFSP. The β-carotene, ascorbic acid and vitamin A activity per 100 gDM of the OFSP flours ranged between 6.91- 9.53 mg, 25.90 − 35.72 mg, and 0.53 − 0.73 mg RAE, respectively. © 2022 The Author(s). Published with license by Taylor and Francis Group, LLC.

CAN MELATONIN REDUCE THE SEVERITY OF POST-COVID-19 SYNDROME?

This short review aimed at (i) providing an update on the health benefits associated with melatonin supplementation, while (ii) considering future potential research directions concerning melatonin supplementation use relative to Coronavirus disease of 2019 (COVID-19). A narrative review of the literature was undertaken to ascertain the effect of exogenous melatonin administration on humans. Night-time melatonin administration has a positive impact on human physiology and mental health. Indeed, melatonin (i) modulates the circadian components of the sleep-wake cycle;(ii) improves sleep efficiency and mood status;(iii) improves insulin sensitivity;and (iv) reduces inflammatory markers and oxidative stress. Melatonin has also remarkable neuroprotective and cardioprotective effects and may therefore prevent deterioration caused by COVID-19. We suggest that melatonin could be used as a potential therapy in the post-COVID-19 syndrome, and therefore call for action the research community to investigate on the potential use of exogenous melatonin to enhance the quality of life in patients with post-COVID-19 syndrome.

Subjective mental deterioration of healthcare workers during the first wave of the COVID-19 pandemic in Poland

Aim. The presented study is aimed at determining the subjective psychological reaction to the outbreak of pandemic in healthcare workers and is part of a wider research project covering successive waves of increasing number of SARS-CoV-2 infections during the COVID-19 pandemic in Poland. Method. 664 respondents completed the anonymous online questionnaire in the period from March 12, 2020 to May 3, 2020. This is the period of the first lockdown in Poland. Data were collected using the snowball method (employees passed the questionnaire over the Internet to subsequent groups of employees in subsequent healthcare units). Results. The outbreak of pandemic had varying impact on the well-being of 96.7% of respondents. Subjectively perceived stress of varying intensity was reported by 97.3% of them, low mood was reported in 19.0%, and anxiety in 14.1% of the respondents. These results and other features of the psychological reaction (including sleep problems) to overload in healthcare workers may indicate mental deterioration in the first weeks of pandemic. Conclusions. The results obtained in the study group may encourage further analyzes of healthcare workers' mental state and contribute to discussion on the COVID-19 pandemic.

Rapid disease progression after enzyme replacement therapy interruption in a patient with cholesteryl ester storage disorder

Lysosomal acid lipase deficiency (LALD) has two clinical phenotypes: an infantile-onset form - Wolman disease (WD) presented by severe malabsorption, cholestasis, malnutrition, hepatosplenomegaly and early death, and a later-onset form - cholesteryl ester storage disorder (CESD) with hepatosplenomegaly, dyslipidemia, malabsorption and variable disease severity manifestation. Enzyme replacement therapy (ERT) with sebelipase alfa was approved by the Brazilian Health Regulatory Agency (ANVISA) in 2017. We report the deleterious effect of ERT interruption in a CESD patient. Male, 16y, diagnosed at 7y, positive familiar history with mother, grandfather and three siblings affected. He was enrolled in the phase 3 clinical trial from age 9-12y under the 3 mg/Kg dose regimen. Then he enrolled in the post-study donation program under the same dose. Due to personal, importation and supply issues, and the COVID-19 pandemic restrictions, he had a progressive decrease in treatment adherence rate: 68% at 12y, 27% at 13y, 30% at 14y and after that he had an interruption of 1 entire year. At 15y he presented with generalized edema, severe fatigue, tachycardia, was hospitalized, diagnosed low serum iron, albumin and protein, acute anemia (hemoglobin: 6.2 g/dL - normal range of 12,5-13,5), and received blood transfusion. In the next year, still without ERT, he was hospitalized again due to generalized edema, acute anemia (Hemoglobin = 6.9 g/dL) and worsening of hypoalbuminemia and iron deficiency, and received blood transfusion. Although our patient has the CESD phenotype, the ERT interruptions did not worsen the liver involvement nor the dyslipidemia, but caused a severe malabsorption which is classically described in WD phenotype. In conclusion, this case serves as an alert that when ERT is interrupted, there is a rapid clinical deterioration. Acknowledgements: to IGEIM, and Drs Felippe Raphael e Oliveira Previdi and Ana Eduarda Saraiva Pereira Campos for clinical assistance of the patient.

Ambroxol therapy for patients with Gaucher disease type 1, either poor responders to enzyme replacement therapy/substrate reduction therapy (ERT/SRT) or untreated

Ambroxol hydrochloride is an oral mucolytic drug, available over-the-counter for many years as cough medicine, which was found to also act as a pharmacological chaperone for mutant glucocerebrosidase, albeit in a several-fold higher dose. Proof-of-concept reports have been published over the past decade in all three forms of Gaucher disease (GD). The current study aimed to assess the safety and efficacy of 12-months ambroxol 600 mg/day in 3 groups of type 1 GD patients with sub-optimal response, after a minimum of 3 years, to enzyme replacement therapy (ERT)/substrate reduction therapy (SRT) defined as lumbar spine bone density <−2.0 t-score, or platelet count<100 × 10−3/L, or LysoGb1 > 200 ng/ml, and for a group of naïve patients, i.e., never treated or stopped therapy >12 months prior to enrollment, who had abnormal values in 2 of the 3 above-mentioned parameters. Forty patients were enrolled: 28 ERT/SRT treated and 12 naïve;21 (52%) males, mean age 52 years (range 24–84). Safety aspects included several adverse effects (mainly gastrointestinal, excessive saliva, and vertigo) all mild and transient in nature, but led to drug discontinuation in 14 patients, additional dropouts were 7 patients due to COVID19 pandemic and 3 due to personal reasons. Of the remaining 16 patients, 14 have completed 12 months, and 2 are ongoing. Of the 14 completers, 5 (~36%) achieved significant improvement in at least one of the three parameters, and nine did not demonstrate any improvement nor deterioration. The interpretation of the results must take into account the fact that most of the enrolled patients have had poor response to ERT/SRT (including 10 of the 12 naïve patients) and therefore may not represent the majority of the patients. Further studies are needed in never-treated patients as well as an oral, less expensive, alternative to unselected stable patients currently treated with ERT/SRT with a favorable response.

Free floating aorto-iliac thrombosis: A rare complication of COVID-19 pneumonia

Arterial thrombosis encountered during sars-cov2 infections is a rare complication with a poor prognosis compared to venous ones. They generally occur in severe and critical clinical forms of covid19 [1,2]. The physiopathology of arterial thrombosis, even if not completely understood highlights hypercoagulability and excessive inflammation as risk factors with a major role of the endothelial lesions in their occurrence. The presence of cardiovascular risk factors in patients infected with covid19 is also discussed as a predisposing factor for arterial thrombosis [2,3]. We report the case of a North African male patient hospitalized for acute respiratory distress syndrome (ARDS) secondary to covid19 pneumonia, complicated by the occurrence of multiple arterial thrombosis of the aorto-iliac axis with the rare finding of two free floating thrombus in the aorta and the right common iliac artery. Clinically, the patient had developed acute bilateral lower limb ischemia and multi-organ failure and the evolution was dramatic with rapid worsening of the patient…s health and eventually his death. Thromboembolic complications are frequent during covid19 infection but the aortic localization is very rare. Its diagnosis is difficult and it has a poor prognosis. Our objective through this case report is to increase knowledge about arterial thromboembolic events while discussing their link to the sars-cov2 viral infection. © 2022

Does The Suffering End After Cure From Covid?

Background Multisystem involvement of Covid-19 has been known since beginning of the pandemic. Multisystem after-effects or sequelae of covid-19 have been noted and the term 'long Covid' encompasses these signs and symptoms. This leads to prolonged morbidity which have not been adequately addressed by Covid guidelines.The primary aim of our study was to know the spectrum of different sequelae patients have endured after recovery from acute Covid-19 and study their impact on their quality of life. Methods It was a longitudinal observational study of a cohort of 146 patients who recovered from Covid-19 illness. Patients were enrolled within a week of their onset of Covid symptoms and were followed up monthly for a duration of 6 months with a detailed clinical and investigational pulmonary, cardiac, neurological and psychiatric assessment anda final follow-up after a year. Impact on quality of life was assessed using EQ-5D-3L questionnaire. Those lost to follow up were excluded from the analysis. Results 120/146 patients qualified for final analysis. Pulmonary sequelae (40%) were the majority among the patients, followed by psychiatric (25%), neurological (21.7%) and opportunistic infections (5.8%). 4/120 died within a year. 62/120 patients documented worsening in quality of life. Sequelae like pulmonary fibrosis, PTSD had the worst impact on the quality of life.95% severe, 54.5% moderate and 25% mild Covid patients reported deterioration in QoL score respectively. Conclusion Study indicates health related consequences from Covid-19 extend far beyond acute infection andmake significant impact on their quality of life, regardless of the severity of the disease. Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

Is Lockdown Good for Constipation?

Background Children's routines have been disturbed during the last 2 years due to national lockdowns with school closures. It is acknowledged that daily routine is important for a healthy bowel habit and we therefore had concerns that this may have a detrimental effect on children with constipation. Aim of Study To examine the effects of lockdown due to COVID19 on children's symptoms of constipation. Method Prospective data was obtained by questionnaires, which were handed to 50 children and parents attending a childhood constipation clinic in the normal way following the easing of lockdown. The questionnaires asked about symptoms that would normally be asked in the clinic appointments. Parents were asked if the child's symptoms had become worse, improved or stayed the same and asked respondents to give reasons for their answers. The questionnaires were then collated and common themes noted. Ethics approval was not required. Results 38% of parents reported improvement in symptoms 34% of parents reported deterioration in symptoms 28% of reported no change in symptoms. The reasons given for improvements in symptoms included an increase in the ability of parents to monitor children's fluid intake and toileting routines at home, easier access to toilets and less with holding behaviour, usually adopted to avoid using school toilets. These children were also reported as being generally more relaxed and happier to be at home. Of note in this group were reports that symptoms often deteriorated on returning to school. The reasons given for a deterioration in symptoms included a lack of physical activity, lack of routine in toileting and taking medication, and changes in diet. This group also commonly included reports of children and parents experiencing anxiety, isolation, anger and lack of motivation. The most common symptom to be reported as problematic was children either beginning to soil or their soiling becoming more frequent. Most who gave reasons in the group reporting no change did recognise some of the above observations and in some cases positive aspects such as easier access to toilets were counterbalanced by lack of exercise. Summary Many reasons for changes in symptoms of childhood constipation during the national lockdowns were reported. There was a balance, with almost equal numbers, reporting improvements and a worsening of symptoms. Others did not notice any change in their child's condition. Physical, behavioural and emotional reasons were cited as being responsible for changes in children's experience of constipation. Conclusion Lockdown due to COVID19 has had a varied effect on symptoms of constipation in children. The assumption that children's constipation would become worse has been challenged in that slightly more children improved during this time with some then deteriorating again when lockdown was eased. These results re-iterate the need to tailor approaches to treatments and care of children with constipation on an individual basis. It is also important to equally understand the anxieties of being in school for some but the effects of social isolation and uncertainty for others.

Effect of Learning and Forgetting on Inventory Model under Carbon Emission and Agile Manufacturing

The aim of this study is to examine the learning and forgetting effect on a manufacturer's production process with volume agility and carbon emission costs. During COVID-19, the learning rate becomes very low, and the forgetting rate becomes very high. That is why, the analysis of the learning and forgetting effects on the production process is very important. This research finds an effect of learning and forgetting on the manufacturer and on reducing the unit manufacturing cost. Here, the production rate is a function of the number of units produced, and it is taken as a decision variable through agile manufacturing. Here, the Weibull deterioration rate is used, and the production process is subject to the learn–forget–learn policy. Here, a carbon emission cost is introduced into the setup/ordering cost, holding cost, and item cost for the manufacturer. The effect of learning and forgetting is analyzed through numerical examples. © 2023 by the authors.

Telemedicine for follow-up of lupus nephritis in the Covid-19 outbreak: A randomised controlled trial

Background: Blockade of JAK, preferably JAK1, by upadacitinib is a feasible approach to achieve erosion repair as it (1) is approved for the treatment of rheumatoid arthritis (RA), (2) effectively controls the inflammation and (3) targets pathogenic pathways that influence local bone homeostasis in the joint. To address the question whether inhibition of JAK1 could lead to erosion repair in patients with active RA, we performed a pilot non-randomized study comparing the changes in bone erosions on high-resolution peripheral quantitative computer tomography (HR-pQCT) before and after upadacitinib. Method(s): This is a 24-week, single-centered, prospective, non-randomized pilot study. We enrolled 20 adult patients with active RA (Disease activity score 28-C- reactive protein [DAS28-CRP] > 3.2) and >=1 bone erosion on HR-pQCT. They were given upadacitinib 15mg once daily for 6 months. HR-pQCT of the 2-4 metacarpophalangeal (MCP) head was done at baseline and 6 months. The primary outcome was the change of erosion volume on HR-pQCT. Secondary outcomes included change in RA disease activity and predictors of response to treatment. Erosion regression was defined as decrease in volume exceeding the smallest detectable change. Result(s): The baseline clinical characteristics of the recruited patients were shown in Table 1. Of the 20 patients, 11 (55%) patients failed to respond to 3 or more csDMARDs. At 24-week, there was significant improvement in mean DAS28 (-1.75, P < 0.001). Erosion regression was seen in 8 (40%) patients on HR-pQCT (Figure 1). Although no significant change in overall median erosion volume before and after upadacintinib (0.07 [-0.90 to 0.76 mm3] mm3, P = 0.904) was noted, the deterioration was less obvious compared to a historic cohort of 20 patients with similar age and disease activity on csDMARDs (median erosion volume change in 6 months: 0.67 mm3). When patients were stratified according to whether or not they had failed multiple csDMARDs, significantly high proportion of patients in the non-multiple- DMARDs failure group had volume regression in at least one erosion compared to those in the failure group (75% vs 25%, P = 0.04). There was improvement in mean total erosion volume in the non-failure group (-0.33 +/- 1.33 mm3), whereas mean erosion volume in the failure group worsened (2.09 +/- 7.62 mm3). One patient developed chest infection requiring hospitalization and withdrew from the study. No other serious adverse event was noted. Conclusion(s): The results of the study suggest upadacitinib is clinically efficacious in refractory RA disease and can retard erosion progression. Regression of erosion is possible, particularly in those with limited csDMARDs exposure. Whether early JAK1 inhibition could lead to better structural outcome warrants further investigations. (Figure Presented).

The association between reduced calf and mid-arm circumferences and ICU mortality in critically ill COVID-19 patients

Background & aims: Patients with COVID-19 are at a high risk of malnutrition caused by inflammatory syndrome and persistent hypermetabolism, which may affect clinical outcomes. This study aimed to evaluate the changes in nutritional status indicators between two time points of nutritional assessments of COVID-19 patients during their stay in the intensive care unit (ICU). Moreover, the study also assessed the association of nutritional status with ICU mortality. Method(s): This cohort study included retrospective data of adult patients admitted to a public hospital ICU in southern Brazil, between March and September 2020. These participants with confirmed COVID-19 diagnosis received nutritional assessment within the first 72 h after ICU admission. The anthropometric measurements collected included mid-arm circumference (MAC) and calf circumference (CC). The percentage (%) of MAC adequacy was calculated, and values < 50th percentile for sex and age were considered low. CC values of <=33 cm for women and <=34 cm for men were indicative of reduced muscle mass. Data on the date of discharge from the ICU and mortality outcome were collected. Result(s): A total of 249 patients were included (53.4% men, 62.2 +/- 13.9 years of age, SOFA severity score 9.6 +/- 3.5). Of these, 22.7 and 39.1% had reduced MAC and CC at ICU admission, respectively. In these participants, weight, MAC, CC, and % MAC decreased significantly from the first to second nutritional assessment (p < 0.05), but there was no significant difference between survivors and non-survivors. Patients with reduced CC (HR = 2.63;95% CI 1.65-4.18) or reduced MAC (HR = 2.11;95% CI 1.37-3.23) at the first nutritional assessment had approximately twice the risk of death in the ICU than those with normal CC and normal MAC, regardless of the severity assessed by the SOFA score and age. Conclusion(s): Reduced MAC and CC values were identified in approximately 20 and 40% of COVID-19 patients admitted to the ICU, respectively. Additionally, these indicators of nutritional depletion were associated with an approximately 2-fold increase in the risk of ICU mortality. A significant reduction in anthropometric indicators during the first weeks of ICU stay confirmed the deterioration of nutritional status in these patients, although this was not associated with mortality. Copyright © 2023 European Society for Clinical Nutrition and Metabolism

Rapid systematic review of respiratory rate as a vital sign of clinical deterioration in COVID-19.

OBJECTIVES: This meta-analysis aimed to establish a clinical evidence base for respiratory rate (RR) as a single predictor of early-onset COVID-19. The review also looked to determine the practical implementation of mobile respiratory rate measuring devices where information was available. METHODS: We focused on domestic settings with older adults. Relevant studies were identified through MEDLINE, Embase, and CENTRAL databases. A snowballing method was also used. Articles published from the beginning of the COVID-19 pandemic (2019) until Feb 2022 were selected. Databases were searched for terms related to COVID-19 and respiratory rate measurements in domestic patients. RESULTS: A total of 2,889 articles were screened for relevant content, of which 60 full-text publications were included. We compared the Odds Ratios and statistically significant results of both vital signs. CONCLUSION: Multinational studies across dozens of countries have shown respiratory rate to have predictive accuracy in detecting COVID-19 deterioration. However, considerable variability is present in the data, making it harder to be sure about the effects. There is no meaningful difference in data quality in terms of variability (95% CI intervals) between vital signs as predictors of decline in COVID-19 patients. Contextual and economic factors will likely determine the choice of measurement used.

SARS-CoV-2 infection-related deregulation of blood lipids in a patient with -/-LDLR familial homozygous hypercholesterolemia: A case report.

BACKGROUND: The effect of SARS-CoV-2 infection in blood lipids of homozygous familial hypercholesterolemia (HoFH) has not been explored. CASE SUMMARY: We report a case of a 43-year-old male patient with -/-LDLR HoFH with previous history of premature coronary artery disease, coronary artery bypass graft (CABG) and surgical repair of aortic valve stenosis. He presented with an abrupt decrease of his blood lipid levels during acute infection with SARS-CoV2 and subsequently a rebound increase above pre-infection levels, refractory to treatment including LDL-apheresis, statin, ezetimibe and lomitapide up-titration to maximum tolerated doses. Markers of liver stiffness were closely monitored, increased at 9 months and decreased at 18 months after the infection. Potential interactions of hypolipidemic treatment with the viral replication process during the acute phase, as well as therapeutic dilemmas occurring in the post infection period are discussed.

Desktop Virtual Reality Versus Face-to-Face Simulation for Team-Training on Stress Levels and Performance in Clinical Deterioration: a Randomised Controlled Trial.

BACKGROUND: Simulation-based education can equip healthcare providers with the ability to respond to and manage stressors associated with rapidly deteriorating patient situations. However, little is known about the benefits of using virtual reality (VR) for this purpose. OBJECTIVE: To compare between desktop VR and face-to-face simulation in stress responses and performance outcomes of a team-based simulation training in managing clinical deterioration. DESIGN: A randomised controlled study METHOD: The study was conducted on 120 medical and nursing students working in interprofessional teams. The teams were randomly assigned to participate in a 2-h simulation using either the desktop VR or face-to-face simulation with simulated patient (SP). Biophysiological stress response, psychological stress, and confidence levels were measured before and after the simulation. Performance outcomes were evaluated after the simulation using a deteriorating patient scenario. RESULTS: The systolic blood pressure and psychological stress response were significantly increased among participants in VR and SP groups; however, no significant differences were found between the groups. There was also no significant difference in confidence and performance outcomes between participants in the VR and SP groups for both medical and  nursing students. Although the psychological stress response was negatively correlated (r = -0.43; p < 0.01) with confidence levels, there was no association between stress response and performance score. CONCLUSION: Despite being less immersive, the desktop VR was capable of inducing psychological and physiological stress responses by placing emotional, social, and cognitive demands on learners. Additionally, by ensuring close alignment between the simulation tasks and the clinical tasks (i.e. functional fidelity), the desktop VR may provide similar performance outcomes as conventional simulation training. This evidence is timely given the rise in the use of virtual learning platforms to facilitate training during the COVID-19 pandemic where face-to-face training may not be feasible. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov NCT04330924.