The pandemic and the war in Ukraine - psychological and social dimensions of collective trauma in children with cancer and their parents

The focus of the present study is on the psychological and social dimensions of collective trauma resulting from the intense impact of strong emotional and stress factors connected with the COVID-19 pandemic and the crisis in Ukraine in parents of children with oncological diseases. The process of overcoming collective trauma in its diversity is a long one and requires specific care. The challenge of recovery is to regain the sense of control over the mental, economic and social parameters of the individuals affected. For the group of parents studied this includes discovery of a way for the caregivers to be calm and focused on the accompanying care for the child with an oncological disease, even in a pandemic situation and war. The effective overcoming collective trauma of the sense of imminent danger in society is based on public support and personal responsibility. Fear, anger, depression, isolation and lack of resources that are a direct psychological and economic result of pandemic and war, aggravates the quality of life of patients. As socially determined parameters, they carry a high risk of the recurrence and mortality of children with malignant diseases.

CT findings and dynamic changes of COVID-19 in the patients younger than 18 years old infected with SARS-CoV-2 omicron variant

Objective: To investigate the chest computed tomography (CT) manifestations and dynamic changes of coronavirus disease 2019 (COVID-19) in the patients younger than 18 years old infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant, and to provide a basis for determining the chest CT changes and efficacy of COVID-19 caused by Omicron virus variant in patients younger than 18 years old. Methods The clinical and imaging data of 30 cases of patients younger than 18 years old infected with COVID-19 Omicron variant, who admitted to the Third People's Hospital of Shenzhen from February 11 to March 26, 2022 were collected and retrospectively analyzed. The clinical manifestations, imaging features and dynamic changes of lesions were summarized. Results A total of 41 intrapulmonary lesions in 30 patients with COVID-19 caused by SARS-CoV-2 Omicron variant. The main manifestations were patchy or nodular ground-glass opacities and/or consolidation, with focal subpleural distribution, lesions mainly occur in the right lung (70.73%, 29/41). There were 42 lesion morphologies, with 22 (52.38%) striped shadows and 16 (38.10%) nodular shadows, with small lamellar and patchy shadows predominating. There were 36 lesion density variations, with ground glass shadows being the most common, with a total of 24 ground glass shadows (66.66%) in each lobe of the lung, and also 6 consolidation lesions (16.67%) and 6 mixed ground glass opacity and consolidation lesions (16.67%). With the progression of the disease, lesions gradually enlarged, appeared on the 2nd day (312.93 mm3), peaked on the 9th day (1 837.18 mm3). The average absorption time of the lesions was (16+or-3) days, and there was no significant difference between the absorption time of patchy and nodular lesions (ground glass and/or consolidation) (t=0.853, P > 0.05). The lesions showed focal ground-glass opacity in the early stage, 77.78% lesions were absorbed after treatment in the late stage. Inflammatory nodules were absorbed slowly (9-19 days), without residual fibrotic changes. Conclusions The imaging manifestations of COVID-19 in patients younger than 18 years old infected with SARS-CoV-2 Omicron variant have certain characteristics, showed patchy or nodular ground glass opacities and/or consolidation, mainly distributed in the subpleural area, with small and few lesions and slow change, didn't remain fibrosis. Being familiar with its clinical and imaging manifestations can assist in early diagnosis, but confirming the diagnosis requires a combination of epidemiological history, clinical symptoms, SARS-CoV-2 nucleic acid and radiological manifestations.

Comparative impact of COVID-19 and common diseases on poverty in Cameroon and sustainable response strategies

In the context of a developing country like Cameroon characterized by the scarcity of financial resources and the appearance of Covid-19, this article shows that this pandemic was not more important than the pre-existing health problems to the point of giving it more importance in funding compared to strengthening the health system. The theoretical elasticity model of the poverty rate to growth is used to estimate the impact of Covid-19 and the incidence of impoverishing health expenditure is used for the impact of common diseases. It is estimated through direct health payments that common diseases push about 340,865 people into extreme poverty annually. The Covid-19, through the loss of growth generated between 4.8 and 6.6 points according to the optimistic or pessimistic scenarios, would impoverish between 224,193 and 398,565 people: impact on the number of poor ranging from 0.7 to 1.2 times that of all common diseases, i.e., equivalent on average, but sensitive to the speed of spread of the virus and the duration of the crisis while the impact of common diseases is structural and linked to the poorly performing health system. The solutions proposed are endogenous and linked to the impact mechanisms.

The clinical trial of patients improved from COVID-19: the effectiveness of mindfulness-based cognitive therapy on mental health and life expectancy (single-subject study)

Background & Aims: In early January 2020, a new corona virus called corona was identified as an infectious agent by the World Health Organization and caused a viral pneumonia outbreak, the first of which was reported in Wuhan, China in December 2019. The virus has so far infected most countries in the world and has become a global problem. By this time in December 2021, about 265 million people in the world have been infected with this virus and 5 million 270 thousand people have died from this disease. According to the World Health Organization, the incidence of this disease is still increasing and will become the third leading cause of death in the world by 2030. This disease has a special complexity and has multiple dimensions and consequences that have caused many problems in the field of health, social and economic as well as psychological for people. The emergence of this disease is now a public health crisis. According to this research, exposure to news and restrictions caused by this disease can lead to many mental health problems. In fact, one of the situations that puts a lot of stress on people during the outbreak of covid 19 disease is the inability to predict and uncertainty about the control and end of the disease. Mental health is defined as a harmonious and harmonious behavior with society, recognizing and accepting social realities, the power to adapt to them and meeting one's balanced needs and is an important factor for the health of society. The prevalence of the disease can also increase feelings of loneliness, decrease social support, feelings of fear and anxiety to clinical stress and anxiety, obsessive-compulsive disorder associated with the disease, and decreased life expectancy. One of the hopeful factors is health and the disease can cause despair, fear and even despair of the patient. The outbreak of a disease has a much deeper and wider impact and affects not only the affected community and relatives, but the entire community. Because everyone finds themselves at risk, and therefore people's feel of safe and healthy changes, and this situation causes people to despair. Hope is the capacity to imagine the ability to create paths to desirable goals and to imagine the motivation to move in those paths. Hope predicts physical and mental health such as positive response to medical interventions, mental health, effective getting along, and health-promoting behaviors. Covid 19 disease can also lead to psychological problems due to its infectious nature and unpredictable nature. In this regard, various researchers consider the implementation of public health policies, including areas related to individual and collective mental health in accordance with the different stages of the epidemic of this disease is very necessary. Mindfulness can be an effective tool for achieving peace of mind and body that helps people become aware of their current feelings. Mindfulness-based interventions are considered as one of the third generation or third wave cognitive-behavioral therapies. Mindfulness is a form of meditation rooted in Eastern religious teachings and rituals, especially Buddhism. Segal has defined mindfulness as paying attention to specific and purposeful ways, in the present time, without judgment or prejudice. Linhan stressed for the first time the need to pay attention to mindfulness as one of the essential components of psychological therapy. Mindfulness requires the development of three components: judgment avoidance, purposeful awareness, and focus on the present moment. Focusing on the present and processing all aspects of the above experience makes one aware of the daily activities and automatic functioning of the mind in the past and future world and he controls emotions, thoughts, and physical states through moment-to-moment awareness of thoughts. As a result, it is released from the everyday and automatic mind focused on the past and the future. Although general vaccination has reduced the virus in some countries, including Iran, and reduced the number of infected people, a large num

Favipiravir pharmacokinetics in immunocompromised infants and children with chronic RNA viral infections

IntroductionFavipiravir selectively inhibits RNA polymerase responsible for single-stranded viral replication. It is licensed for treating influenza and repurposed to treat other diseases such as Ebola and COVID-19. It is metabolised by hepatic aldehyde oxidase (AO) and is an AO inhibitor with complex pharmacokinetics. We have used favipiravir, in combination with other antivirals, in severely immunocompromised children with life-threatening RNA virus infections. As an unlicensed indication, favipiravir pharmacokinetics were routinely monitored at our institution. Population pharmacokinetic model is used to describe the favipiravir pharmacokinetic properties, drug exposure and sources of variability in these children.MethodsRoutine favipiravir plasma levels of 9 patients (0.8–11yrs, mean age=5.3yrs;median weight=15kg) were analysed retrospectively (62 samples). All patients received favipiravir 200mg or 400mg tds and had at least one plasma level 45min (peak), 3h and 8h (trough) post-dose. Parameter estimation and model simulation properties (visual predictive check) were assessed using R language (v 4.1.2) and RStudio (2022.02.0+443).ResultsA one-compartment model with weight as covariate best describes the data, with (1) elimination clearance=1L/h and volume of distribution=7.54L, both allometric scaled centring at median weight, and (2) estimated t1/2=5.17h with Cmax = 24µg/mL at 200mg and 41µg/mL at 400mg.ConclusionsTo our knowledge this is the first report of favipiravir pharmacokinetic parameters in infants and young children. Weight significantly improves the model fit as a covariate. Reported EC50 for norovirus in vitro was 19–39µg/mL and enterovirus 71 was 23µg/mL, indicating higher favipiravir doses or combination with other antivirals are required.

Characteristics of viral shedding in people infected with SARS-CoV-2 during difference stages

Viral shedding of SARS-CoV-2 is a continuous dynamic process, which can be divided into latent stage, initial stage, peak stage and decreasing stage according to the characteristics of viral shedding. After being infected with SARS-CoV-2, the infected person generally stays in the latent period for 1-3 days, which is characterized by continuous negative nucleic acid test results and no infectiousness, and the risk of infection for close contacts is very low. At the initial stage of viral shedding is characterized by a rapid decline in the Ct value of nucleic acid tests in a short time, and clinical symptoms gradually appear. The infectiousness of the infected person gradually increases during this period, and the risk of infection for close contacts also gradually increases, but it is still in the early stage of infection, the possibility of viral shedding is low, and the risk of infection of secondary close contacts is low. The peak of viral shedding is characterized by low Ct value in nucleic acid test and obvious clinical symptoms;during this period, the infected person is the most infectious, and the risk of infection of the contact is the highest, so the scope of close contacts should be expanded appropriately. The decreasing period is characterized by the gradual increase of Ct value of nucleic acid test and the gradual disappearance of clinical symptoms;during this period, the infectiousness of the infected person gradually decreases to disappear. In an outbreak, an infected person in the decreasing phase is more likely to be an early infected person in the transmission chain. If infected individuals in the decreasing phase are found in an area without a SARS-CoV-2 epidemic, it suggests that the local outbreak epidemic has been spreading for some time and may be larger in scale. According to the characteristics of viral shedding, risk personnel can be determined more scientifically and accurately, so as to minimize the risk and reduce the waste of epidemic prevention resources.

Best practices for pediatricians in diagnosing and treating asthma

Additionally, they can treat atopic comorbidities such as atopic dermatitis, chronic urticaria, nasal polyps, eosinophilic esophagitis, and hypereosinophilic syndrome, resulting in improved quality of life for our patients. Parents should be made aware of its updated black box warning for possible effects on mental health and behavior changes,3 including but not limited to suicidal ideation. FDA requires boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair);advises restricting use for allergic rhinitis.

Demographic and clinical profile of patients with COVID-19 infection during first and second wave in a tertiary care hospital of South Assam

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was first detected in Wuhan, China in 2019 and since then has engulfed the entire globe at an unprecedented pace. The virus has infected all age groups, both males and females with or without symptoms and with significant variations. In this study, we wanted to analyse the data related to demographic features of COVID-19-infected patients mainly focusing on their age, gender and symptoms. METHODS: This was a hospital-based retrospective study that included all laboratory-confirmed COVID-19 cases which were declared SARS-COV-2 real-time RT-PCR positive by VRDL, SMCH, Silchar from March 2020 to August 2021. Data related to the demographic characteristics of patients with COVID-19 infection was retrieved from the ICMR-COVID-19 portal of the laboratory and analysed. RESULTS: The study included 8065 laboratory-confirmed COVID-19 cases which involved 5605 cases during the first wave and 2460 cases during the second wave of COVID-19, diagnosed from different districts of South Assam. The majority of infected patients were of the younger age group of 20-30 years. The mean age of the patients was almost similar in both waves i.e. 35.9 and 38.4 years. Of the total enrolled patients, 91.7% were reported asymptomatic while 8.3% were symptomatic with fever and cough being the commonest ones. CONCLUSIONS: The COVID-19 pandemic is a huge burden on healthcare facilities. The majority of the infected patients presenting to our hospital were young and asymptomatic, thus posing risk to the community. Hence, it is crucial to practice proper hygiene, wearing of masks and complete the vaccination schedule to achieve better vigilance to combat the COVID-19 pandemic more efficiently and effectively.

Changing patterns in the distribution of skin lesions of scabies during the COVID-19 pandemic - a cross-sectional observational study

BACKGROUND: An ectoparasitic disease, scabies, caused by the mite Sarcoptes scabiei var hominis. Some of the predisposing factors are overcrowding, unhygienic surroundings, immunocompromised status, dementia, homelessness, and sexual contact. In this study, we wanted to evaluate the changed distribution of lesions of scabies during pandemic. METHODS: A cross sectional study was performed on 600 patients attending the skin department of our tertiary care hospital over a period of 6 months. The sites of the scabies lesions were noted along with types of lesions. Demographic data and history of regular hand washing and sanitization were also documented. RESULTS: Our study revealed an important correlation between change in pattern of distribution of scabies lesions from being less frequent on finger webs (19%) to being more frequent on abdomen (periumbilical area) (73%) and groins (67%) due to regular hand washing and frequent sanitization, in this pandemic era. CONCLUSIONS: A significant change in distribution of skin lesions in scabies can be noticed during this COVID-19 pandemic.

Relationship of clinical symptoms, comorbidities and treatment options along with disease outcomes in individuals tested for COVID-19 in Pakistan: a national survey

Background: This web-based survey is done to collect and assess data from people tested for COVID-19 with PCR in Pakistan. Methods: This 3-month study is a cross-sectional online survey, conducted by Pakistan Islamic Medical Association (PIMA), Health Research Advisory Board (HealthRAB) and National Institute of Health (NIH). Data collection was done using Google Forms. People who were tested for COVID-19 using Polymerase Chain Reaction (PCR) were included in the study. The sample size of the study was 1,537. SPSS version 22 was used for data analysis. Results: Majority of the respondents belonged to the age group 20 - 39 years. The most common symptoms found were fever 633 (41%), cough 534 (34%), generalized body aches 432 (28%) and sore throat 392 (25%). The mean COVID-19 mental health score was 3.59 (SD: 5.808, range: 0-18). Treatment with antibiotics and painkillers had a strong correlation (p-value < 0.05) with the disease outcomes. The disease outcomes had moderate correlation (p-value < 0.05) with anti-allergy, steroids, plasma and oxygen therapy, and weak correlation (p-value < 0.05) with Antiviral and Antimalarial therapy. Out of the total respondents, 561 (36.1%) were cured from COVID-19, 14 (0.9%) were expired during/after hospitalization, 15 (1%) were still infected and 962 (62%) were not infected. Conclusion: Pakistani population has a better cure rate than some of its neighboring countries. However, further research in this area is required to draw a definite conclusion.

Two major challenges for pregnancy: labor emergencies and SARS-CoV-2 infection - our experience in Saint John hospital, Bucharest, Romania

Introduction: Obstetric emergencies that occur during labor, often present as a major indication for prompt completion of labor by instrumental methods or emergency cesarean section. The purpose of this study was to present the clinical features of emergencies, the evolution of labor, maternal and fetal or neonatal complications at patients with SARS-COV-2 infection. Materials and methods: We performed a retrospective study that included 150 pregnant women who gave birth in Bucur Maternity, St John Hospital, Bucharest, between 2018-2020 that fulfilled the features of obstetrical emergency during labor and SARS-CoV-2 infection. The study group was divided in patients positive for SARS-CoV-2 and negative for SARS-CoV-2. Results: Following PCR testing for SARS-CoV-2 were 26.67% of patients positive and 73.33% had a negative result. Analyzing the data obtained from this group of patients, it resulted that the average hospitalization is higher in the positive group (7.05 days) versus the negative group (5.47 days). The average gestational age at birth of SARS-CoV-2 positive patients was 37.26 weeks, lower than the gestational age of neonates from uninfected mothers (38.41 weeks). The average of the APGAR scores in the COVID group is 8.41, and for the negative group is 8.90. Conclusions: The associated SARS-CoV-2 infection played a significant role in terms of the APGAR score and the early peripartum outcomes of new-borns, negatively influencing the value of the APGAR index. Gestational age was considerably lower in patients diagnosed with the infection. The SARS-CoV-2 virus infection has a significant influence in unsatisfactory neonatal outcomes compared to new-borns of healthy mothers.

Kinesiophobia, physical activity, depression, anxiety and stress levels in post COVID-19 individuals: a cross-sectional study

Objective: Kinesiophobia, inactivity and mood disturbances in post-COVID-19 individuals are poorly investigated. Therefore, the aim of this study was to compare measures of kinesiophobia, physical activity, depression, anxiety and stress in post-COVID-19 individuals and healthy individuals. Methods: This cross-sectional study was conducted between 25 November 2021 and 30 December 2021. The individuals were recruited from the general community. Kinesiophobia was assessed with the Tampa Scale of Kinesiophobia, physical activity levels with the International Physical Activity Questionnaire Short-Form, and mood (depression, anxiety, and stress) with the Depression Anxiety Stress-21 Scale in all individuals. Results: There were 29 volunteer individuals who had COVID-19 with a mean age of 33.41+or-7.95 years. Healthy controls consisted of 20 volunteers with a mean age of 31.3+or-7.81 years. Anxiety (55.2% versus 20%) and stress (34.5% versus 5%) were observed more frequently in the post-COVID-19 group. The scores for kinesiophobia and anxiety were significantly higher in post-COVID-19 individuals than healthy individuals (p< 0.05). The scores for physical activity, depression and stress were similar between groups (p >0.05). Significant correlations were found among post-COVID-19 individuals for (i) the scores for kinesiophobia and stress, and (ii) the scores for physical activity, stress, and depression (p< 0.05). There was no relationship between kinesiophobia and other outcomes in healthy individuals (p >0.05). Conclusion: Although a high degree of kinesiophobia is observed in both post-COVID-19 and healthy individuals, kinesiophobia, anxiety and stress measures were higher in people exposed to COVID-19 than others. In post-COVID-19 individuals, kinesiophobia increased as stress increased, and physical activities decreased while stress and depression increased. Hence, exercises, physical activities and psychological counseling should be recommended to individuals exposed to COVID-19.

Antiviral foods in the battle against viral infections: Understanding the molecular mechanism

Viruses produce a variety of illnesses, which may also cause acute respiratory syndrome. All viral infections, including COVID‐19, are associated with the strength of the immune system. Till now, traditional medicine or vaccines for most viral diseases have not been effective. Antiviral and immune‐boosting diets may provide defense against viral diseases by lowering the risk of infection and assisting rapid recovery. The purpose of this review was to gather, analyze, and present data based on scientific evidence in order to provide an overview of the mechanistic insights of antiviral bioactive metabolites. We have covered a wide range of food with antiviral properties in this review, along with their potential mechanism of action against viral infections. Additionally, the opportunities and challenges of using antiviral food have been critically reviewed. Bioactive plant compounds, not only help in maintaining the body's normal physiological mechanism and good health but are also essential for improving the body's immunity and therefore can be effective against viral diseases. These agents fight viral diseases either by incorporating the body's defense mechanism or by enhancing the cell's immune system. Regular intake of antiviral foods may prevent future pandemic and consumption of these antiviral agents with traditional medicine may reduce the severity of viral diseases. Therefore, the synergistic effect of antiviral foods and medication needs to be investigated. [ FROM AUTHOR] Copyright of Food Science & Nutrition is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COVID-19 vaccine hesitancy and its associated factors among Health Care Workers of Islamabad

Background: Covid-19 has been declared a global pandemic by WHO. Health Care Workers (HCWs) being the front-line warriors have been most exposed to the SARS-CoV-2 virus. Vaccine hesitancy against Covid-19 has been seen among HCWs. The main aim of the research was to find the hesitancy rates of vaccine among HCWs and the pulling and pushing factors to get vaccinated. Methods: A descriptive cross-sectional study was conducted on HCWs. Questionnaires on Google forms were sent to all participants through their WhatsApp number and data was analysed through SPSS version 23.0. Results: Out of 81 HCWs selected, 51.9% (n=42) were initially hesitant when the vaccine was first introduced. The main pulling factor initially to get vaccinated was to shield loved ones, 38.75% (n=31) and 46.2% (n=37) of them received a booster dose of vaccine mainly due to employment requirements. Out of the total, 19.75% (n=16) are still hesitant even after vaccination and the most common pushing factors were fear of the side effects and inadequately tested vaccines. Conclusion: Though the majority of the HCWs got vaccinated, vaccine hesitancy is still present among the HCWs and the major reason is uncertainty about the side effects it could cause in the long term.

An insight into gender specific comparison of COVID-19 patients in Lahore, Pakistan

Background: The deadly disease, named SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2), which emerged in 2019, immediately spread across the world and killed millions of people. The aim of the current work was to find gender-based disparities in the people of Lahore, Pakistan in terms of COVID-19 severity. Methods: We examined the individuals (n = 1000) that visited two private diagnostic centers in Lahore, Pakistan, for COVID-19 testing between May 1, 2020, and December 31, 2020. Nasopharyngeal swabs were collected from the individuals to confirm the COVID-19 disease by RT-PCR assay using "Sansure Biotech Inc. Nucleic Acid Detection Kit". Clinical and demographic information of the respective individuals was also obtained. The data was analyzed using Microsoft Excel. Results: We did not find any major difference of COVID-19 positivity rate between men and women. Men's average age was 44.4 years, whereas women's average age was 40.9 years. The severity of the symptoms was remained equal in men and women however, majority of the women as compared to men were showing a greater number of symptoms (2 or 3) simultaneously. We found that some of the symptoms were associated with the specific gender, for example chills, loss of taste or smell, and muscle pain were only found among men. While headache was restricted to women only. We also observed that some of the symptoms were co-occurred frequently in only men, these included shortness of breath with flu and fever with flu, while in women the frequently co-occurred symptoms were sore throat with fever. Conclusion: COVID-19 infection is equally common in men and women of Lahore, Pakistan. Whereas the number and the type of symptoms of COVID-19 could vary across the gender. Understanding these gender disparities in terms of symptomatology may help to guide the local health authorities in allocating the available resources more efficiently.

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.

Prognostic role of inflammatory indices in risk classification of patients with COVID-19

Objective: The Covid-19 pandemic has revealed the importance of an evidence-based efficient triage system in the early identification of high risk patients and the rational use of limited medical resources for reducing mortality. The aim of this study was to evaluate the role of various inflammatory indices that can be easily calculated using readily accessible, inexpensive routine test parameters in risk stratification and prediction of prognosis in patients with Covid-19. Material and Methods: The study was carried out retrospectively with the data of 8036 patients with Covid-19, who were grouped according to their prognosis in outpatient and inpatient follow-ups, and inpatients as survivors and death. Using the complete blood count and C-reactive protein baseline results of the patients at admission, neutrophillymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocytelymphocyte ratio (MLR), MVP-platelet ratio (MPR), platelet mass index (PMI), systemic immune-inflammatory index (SII), systemic inflammatory response index (SIRI), and multi-inflammatory indices (MII) were calculated. Results: Our results demonstrate that almost all of the inflammatory indices were significantly different in severe patients and in patients with high mortality risk, but not all of them had a predictive value. It has been seen that the most effective factors in determining the disease severity at the onset of Covid-19 are SIRI and age, and SII, MII-1 and MII-3 may also contribute to this prediction. Our results have also revealed that NLR is the most effective independent factor to predict mortality both at disease onset and for inpatients. Conclusion: Inflammatory indices, especially SIRI, NLR, SII, MII-1 and MII-3 can substantially contribute to clinical decisions in the early identification of high-risk patients and predicting mortality beginning from the onset of Covid-19.

Factors affecting admission to intensive care unit of COVID-19 patients in the Kingdom of Bahrain

Objective: Coronavirus disease-2019 (COVID-19) is a newly emerging infectious disease that has become a global pandemic. This study aimed to identify the risk factors at presentation to predict intensive care unit (ICU) admissions. Materials & Methods: This retrospective observational study recruited 188 confirmed laboratory COVID-19 patients who were hospitalized in Jidhafs Maternity Hospital (JMH) from 1st June to 5th July 2020. Univariate and multivariate analyses were used to Explore risk factors associated with the increased risk of ICU admission. Results: The study revealed that older age (>60 years old) (16[38.1%], P=0.044), male gender (30 [40.0%], P=0.000) were significantly associated with the increased risk of ICU admissions. The most prevalent symptoms in admission were myalgia (13[40.6%], P=0.035), fever (39[34.2%], P=0.002) and cough (37[31.4%], P=0.032). In addition, raised serum level of alanine amino-transferase (ALAT) (34.7% vs. 20.7%, P=0.033), D-dimers (30.7% vs 12.2%, P=0.012), lactate dehydrogenase (LDH) (31.6% vs 0.0%, P=0.025) and ferritin (37.7% vs 16.7%, P=0.011) found to be important predictor of ICU admission. Conclusion: The finding indicates that older age, male gender, with increased alanine transferase (ALT), increased lactate dehydrogenase (LDH), high D-dimer and high ferritin was associated with an increased risk of ICU admissions. Identification of such factors will help to detect people who are more likely to develop severe COVID-19 disease and will help physicians to determine if patients need regular health care or ICU admission.

The experience of countries in implementing the principles of "one health". Comparative review

Relevance: The global consequences of the COVID-19 pandemic emphasize today the importance of the concept of "One Health" for the health system, which provides for the use of a coordinated, joint, interdisciplinary and intersectoral approach to eliminate potential or existing risks arising at the interface of the "environment-animal-human-ecosystem". The aim of the work is to study the experience of countries in implementing the concept of "One Health". Search strategy: comparative analysis of publications on the research topic, sources indexed in the databases of the electronic library e-Library, Google Academy, Pubmed, Web of Science, Scopus. 26 countries from the European Union, South America and Africa were subject to analysis. The criteria defined are: institutional framework;mechanisms of intersectoral interaction and programs/tools for the implementation of the concept of "One Health". Results: The literature review provides a comparative analysis of the experience of implementing the concept of "One Health" in 26 countries. Realizing the importance of "One Health" in the general concept of public safety, countries have launched an active policy to promote it in the last decade. Characteristic features of country policies are the intersectoral approach with appropriate support from the government of the country, the activity of all participants in promoting the initiative and their investment.

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.