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1.
Laryngo- Rhino- Otologie ; 101:S242, 2022.
Article in English | EMBASE | ID: covidwho-1967662

ABSTRACT

Background This study aims to investigate the prevalence and long-term development of gustatory dysfunction (GD) after COVID-19. Methods In the population-based cross-sectional COVIDOM-study, 667 patients above the age of 18 years (mean 48.2) who tested positive for SARSCoV- 2 via PCR-testing on average 9.09 months ago were examined between November 2020 and June 2021. Extensive medical history taking was conducted via questionnaires. Participants were asked to rate their ability to taste before, during and after COVID-19 on a Visual Analogue Scale (VAS) ranging from 0 to 10. Whole mouth gustatory testing with Taste Strips for the qualities sweet, sour, salty, and bitter was performed. Results 60.9 % (406 of 667) participants reported gustatory impairment during their infection. Out of those, 56.9 % perceived this symptom as severe and 13.3 % noticed it as the earliest symptom. At the time of our examination, 36.2 % had a persistent subjective GD, defined as a lower score on the VAS than before COVID-19 (mean difference -0.9 points). This difference was significant (p < 0.001). In the testing, 7.3 % (47 of 667) participants had a GD, defined as the correct identification of less than three out of four Taste Strips. No signifi- cant correlation was found between subjectively persistent and tested GD (p = 0.250). Conclusions SARS-CoV-2 seems to frequently affect the gustatory function in the long term as well, what might have an influence on patients' everyday-life. However, Patients' own perception does not always correspond with psychophysiological testing which might be caused by the common difficulty to differentiate between the chemosensory senses of taste and smell.

2.
Journal of Clinical Periodontology ; 49:296, 2022.
Article in English | EMBASE | ID: covidwho-1956769

ABSTRACT

Background: Nifedipine is a calcium channel-blocking drug, common antihypertensive medication. Gingival tissue enlargement is a frequent periodontal side effect, associated to the presence of dental plaque. Description of the procedure: In January 2018, a male 62-year-old patient was evaluated at the Dentistry Department of Coimbra University Hospital. His main complaint was gingival “swelling” and masticatory difficulty. Anamnesis revealed hypertension medicated with Nifedipine for 8 years. Besides partial edentulism and tooth migration, oral observation highlighted severe bimaxillary gingival enlargement, not restricted to the papillae, pronounced inflammation and periodontal attachment loss. Periodontal screening revealed 10 mm probing depth (PD) at several interdental sites, maximum clinical attachment loss (CAL) of 5 mm, bleeding on probing (BOP) of 61% and plaque index (PI) of 100%. The patient was diagnosed Nifedipine Gingival Enlargement with a Generalized Stage IV, Grade B Periodontitis. Non-surgical periodontal treatment was initiated with oral hygiene instructions, supra and subgingival instrumentation. Simultaneously, his assistant physician replaced nifedipine with enalapril. The patient attended regular periodontal appointments for 12 months. A decrease in gingival enlargement was noted in the subsequent months. Due to COVID-19 restrictions, patient was only reevaluated in May 2021. Outcomes: Three years after replacement of nifedipine and nonsurgical periodontal treatment, gingival enlargement was resolved. Periodontitis was stabilized, as periodontogram revealed a mean reduction PD of 6 mm at the deepest sites, grade II furcation involvements, BOP of 10% and PI of 34%. Step 3 periodontal therapy could be initiated. Due to economic restrictions, oral rehabilitation could not be fulfilled. Conclusions: Severe gingival tissue enlargement related to nifedipine in a periodontitis IVB patient was resolved by non-surgical periodontal treatment. Meticulous plaque control is mandatory. Communication with the Physician is important to alter the medication and restore patient's quality of life.

3.
Journal of Clinical Periodontology ; 49:347-348, 2022.
Article in English | EMBASE | ID: covidwho-1956768

ABSTRACT

Background: New Classification of Periodontal and Peri-implant Diseases and Conditions having worked into 2017 has defined candida-associated periodontal lesions as “Non-plaque-induced gingival diseases” associated with specific infection (list point 2.3). Patients with diagnosis Periodontal candidosis have been observed at the Division of Periodontology SPBGMU and City Periodontal Center “PAKS” more than for 25 years with an average quantity of 3-5 new cases a year. There had been formed a typical pattern for setting diagnosis and treatment. As a risk group was recognized, patients who predominantly had such general conditions as diabetes, immunosuppressive therapy, and heavy smokers. Since 2020 the pattern has been completely changed due to changing general conditions of the patients who consisted of the group and increasing quantity of periodontal candidosis about threefold. The core of the group has consisted of predominantly patients who recently had COVID-19 and/or underwent immunosuppressive therapy. Description of the procedure: Diagnostic procedure: Level 1. Anamnesis, clinical record, standard periodontal charting, estimation of periodontal and hygienical indices, absence or present mucosa lesions. CBCT Level 2. Clinical fluorescence diagnostic-wave length 400 ± 10 nm estimation gingival and mucosa condition. The cultural test for Candida detecting. Level 3. Cytology Treatment: in addition to SRP procedure there prescribed local and systemic antifungal therapy. 1. Photodynamic therapy (toluidine blue photosensitizer) 2. Local antifungal therapy - rinsing by Clotrimazole solution 3. Systemic antifungal therapy - Fluconazole 150 mg once in day 4. Modification of host response - Imudon 6 six in day 5. Toothpaste with the alkalic antifungal agent -sodium bicarbonate. Outcomes: Outcome control: Clinical investigation, the cultural test for Candida. Case: Female age 47 had a severe COVID-19 case, 3 months later she had rising level of activity periodontitis without response on usual periodontal therapy. Conclusions: Candida-associated periodontitis is difficult for diagnostic and treatment disease which use to occur quietly rare but nowadays have vastly increased.

4.
Journal of Pediatric Infectious Diseases ; 2022.
Article in English | EMBASE | ID: covidwho-1956442

ABSTRACT

Objective Vitamin D has many immune benefits and because its deficiency impacts most age groups, it became a nutrient of interest in the coronavirus disease 2019 (COVID-19) era. The objective of this study was to highlight the contribution of vitamin D status to the disease severity of hospitalized pediatric patients suffering from COVID-19 infection. Methods This was a cross-sectional study that was conducted on 42 children with documented positive polymerase chain reaction for COVID-19 infection. Detailed history taking and thorough clinical examination were done for each recruited patient. Besides the laboratory and radiological assessment done for COVID-19 patients, 25 hydroxy vitamin D levels [25(OH) D] in the serum were estimated using enzyme linked immunosorbent assay. Results Using the cutoff level of 10 ng/mL, only 40% of the patients were below this level and 60% had their vitamin D level more than or equal to 10 ng/mL. Significantly more patients of the first group needed oxygen support (denoting more severe COVID-19 infection and lung involvement). The older the patients, the more evident was vitamin D deficiency among them, and 25(OH) D values were not correlated to weight for length nor weight categories in the studied series of patients suffering from COVID-19. Conclusion Vitamin D deficiency affects the severity of pediatric COVID-19 infection in hospitalized patients. It is prudent to advise vitamin D level assessment in such cases and promptly manage the patients accordingly. We recommend further studies to assess the effect of vitamin D supplementation on the clinical outcome of COVID-19 in the pediatric population and other vulnerable groups.

5.
Sleep Science ; 15:77-78, 2022.
Article in English | EMBASE | ID: covidwho-1935203

ABSTRACT

Introduction: In addition to the challenges commonly observed in adolescence, it is noteworthy that the COVID-19 pandemic may have caused even more changes in the routine of young people. It is known that lack of physical activity, inadequate nutrition and excessive use of screens can impair sleep quality, which can cause poor school performance and even compromise physical and mental health. Objective: To evaluate whether there was any change in the diet and sleep of adolescent schoolchildren during the COVID-19 pandemic. Methods: This is an observational, prospective field study, in which students were subjectively evaluated with an online anamnesis. We evaluated 75 students (63% girls), with an average of 15.9 (±1.0) years old, which were studying at the first (36%), second (23%) or third year (41%) of high school (HS) from a private school in Americana-SP. Results: When asked about changes during the COVID-19 pandemic, 52 (69%) students said that they had noticed changes in diet. Of these, 15 (29%) indicated increased consumption of ultra-processed foods with higher caloric density, 13 (25%) indicated feeling less hungry and consequently eating less, 12 (23%) improved the quality of food and 9 (17%) increased food consumption compared to before the pandemic. As for sleep, 42 students (56%) observed changes during the pandemic, with 8 (19%) students noticing that they are sleeping less, 7 (17%) are sleeping more, 7 (17%) observed that sleep is unregulated and 7 (17%) that sleep is affected by anxiety and insomnia. The 2nd year HS students were the ones who most observed changes in sleep (71%) and diet (82%) during pandemic, followed by 3rd year students (55% changes in sleep and 71% in diet). When asked about the quality of sleep, 14 (33%) students said they do not sleep well because they sleep for a short time and have “unregulated” sleep, seven (17%) said they sleep well only sometimes, four (10%) said they did not sleep well because of anxiety, two (5%) because of insomnia and one student (2%) said that he didn't sleep well because he woke up several times during the night. When we evaluated the usual time for going to bed and waking up before and after the pandemic, it was noted that most students went to sleep and woke up later in the pandemic. Conclusion: It is concluded that there were changes in sleep and diet habits during the pandemic, with changes in sleep reflecting a lower sleep quality, while positive and negative changes were reported in diet.

6.
Sleep Science ; 15:72, 2022.
Article in English | EMBASE | ID: covidwho-1935154

ABSTRACT

Introduction: In high-performance athletes, sleep is an important tool in physical and mental recovery due to routine training and competitions. However, given the COVID-19 pandemic, the lives of the entire population were changed. The routine of high-performance athletes, especially team sports, was directly impacted by the measures of social isolation, and understanding the extent of damage to athletes' sleep in this scenario is desirable. Objective: To evaluate the sleep pattern of young athletes in team sports during the Covid-19 pandemic. Methods: Young athletes of both sexes and federated in their respective team sports in the State of São Paulo and Paraná were evaluated. They were evaluated under two conditions: during social isolation (2020) and during the return to presential activities (2021). An anamnesis was carried out and questionnaires that assess sleep (Mini-Sleep, Epworth Sleepiness Scale and Morningness-Eveningness Questionnaire) were applied online through Google Forms. Paired t-test was used to compare the both moments. The study was approved by the UNIFESP Research Ethics Committee via Plataforma Brazil. Results: The sample consisted of 34 young people (24 boys and 10 girls), 15.79 ± 1.38 years, 62.17 ± 8.68 kg, 1.67 ± 0.08 m and BMI 22.12 ± 2.16 kg/m2. Among the sports played, 50% practice futsal, 23.5% handball, 17.6% soccer and 8.9% softball. They maintained a routine of 4.02 ± 1.29 days of training/week before the pandemic began, 4.02 ± 1.64 days/week during isolation, and 3.42 ± 1.09 days/week after return. Regarding the sleep of young athletes, they had good sleep quality and normal sleepiness. The sleep quality (26.20 ± 8.16 vs 25.27 ± 6.79) and daytime sleepiness (8.47 ± 4.88 vs 7.81 ± 3.53) showed no differences between the isolation period and the return, respectively. They had higher Social Jet lag during isolation (2.51 ± 1.31 hours) when compared to the return period (2.05 ± 1.13 hours, p = 0.04), in addition to shorter sleep duration during the week in the isolation period when compared to the return period (7.95 ± 1.55 vs 8.56 ± 1.63, p = 0.01). Conclusion: The young athletes kept their training routines at home during social isolation, and with the return to the presential training and collective activities, they decreased the Social Jet lag and increased the hours of sleep during the week, suggesting that the pandemic negatively influenced their sleep.

7.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927776

ABSTRACT

Introduction: Conium maculatum, poison hemlock, is native to Europe, North Africa and Western Asia. Over the last 50 years, it has become more prevalent as an invasive species in the United States. Notorious for its role in Socrates' suicide in 399 BC and frequently referenced by Shakespeare, the plant has a rich history of toxicity in man. We present a case of an accidental hemlock exposure leading to acute interstitial pneumonia and acute respiratory distress syndrome. Case Presentation: A 58 year old male presented with acute dyspnea and cough with hemoptysis the morning after clearing wooded brush in his backyard. Other symptoms included tachycardia, diaphoresis, nausea, and diarrhea. His condition rapidly progressed to acute respiratory failure with imaging suggestive of ARDS. Thorough investigation for infectious and inflammatory etiology was unremarkable. Open lung biopsy was consistent with diffuse alveolar damage. Further history from the wife revealed the presence of significant amounts of poison hemlock identified in photos from the yard. Initial treatment included prednisone with prolonged taper with eventual transition to mycophenolate mofetil. After a prolonged hospital course, he was discharged with tracheostomy and continued ventilatory support. Discussion: Hemlock produces piperidine alkaloids akin to nicotine including coniine and γ-coniceine. These inhibit the nicotinic acetylcholine receptors of the central nervous system causing an array of symptoms that without intervention lead to respiratory depression and death. Diagnosis is based on history. Treatment is supportive, in many instances requiring mechanical ventilation. Conclusions: Even in the Covid era, ARDS differential diagnosis is dependent on thorough history taking, including obscure environmental exposures.

8.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925455

ABSTRACT

Objective: This case report describes a longitudinally-extensive transverse myelitis after Moderna SARS-CoV-2 vaccination. Background: Transverse myelitis (TM) is an inflammatory spinal cord syndrome presenting with acute-to-subacute neurological deficits. A lesion spanning three or more vertebral segments on imaging is considered “longitudinally-extensive.” The TM differential is broad-- among these etiologies, vaccination is a rare but recognized entity. Design/Methods: 60-year-old, right-handed man with chronic right hemisphere stroke with residual left hemiparesis admitted for four days of bilateral lower extremity numbness progressing to weakness and urinary and bowel incontinence 10 days after receiving his second Moderna SARS-CoV-2 vaccination. Examination showed hypotonic lower extremities, proximal greater than distal weakness, a T9 dermatome sensory level, perineal numbness, mildly-reduced rectal tone, and preserved reflexes. MRI spine revealed a longitudinallyextensive, non-enhancing T2-hyperintense lesion spanning T8-T12. CSF analysis demonstrated 5 white blood cells, 1271 red blood cells, 124 glucose, and 55 protein. Aside from mildly elevated ESR and CRP, extensive serum and CSF work-up for other causes of myelopathy, including nutritional/toxic (copper, zinc, heavy metals), infectious (RPR/VDRL, HIV, HTLV, HSV, VZV, West Nile), and rheumatologic (anti-Jo, anti-Mi-2, anti-Ro/La, anti-smith, anti-Scleroderma, anti-dsDNA, anti-ribosomal P, anti-RNP), were unremarkable. Anti-NMO and anti-MOG antibodies were negative. He improved with methylprednisolone 1000 mg daily for five days suggesting an autoimmune etiology. Results: NA Conclusions: Transverse myelitis has a broad presentation and differential, requiring detailed history-taking to determine the cause as management differs between etiologies. SARS-CoV-2 and post-vaccination are known etiologies for TM. Given the timing of our patient's symptom onset after vaccination and thorough exclusion of other causes, we postulate a potentially novel case of TM associated with the Moderna SARS-CoV-2 vaccine. Though post-vaccination myelopathy is potentially debilitating if untreated, it is rare, and the benefits of vaccination appear to outweigh the risks.

9.
Medical Immunology (Russia) ; 24(2):337-350, 2022.
Article in Russian | EMBASE | ID: covidwho-1918188

ABSTRACT

At the present time, studying humoral immunity to the new coronavirus infection is among the most important tasks. The COVID-19 infection induces a protective pool of specific antibodies determining severity and duration of such immune protection after convalescence. The antibody testing is also necessary for assessing efficiency of anti-COVID vaccines in order to defeat the SARS-CoV-2 pandemic. Despite enormous interest of scientific community in this problem seen in the literature, there is still a lack for longitudinal observations of immunological status (more than 6 months) in the patients who have undergone COVID-19. The aim of this study is a long-term monitoring (9-14 months) of development and extinction of immune response to SARS-CoV-2 infection using quantitative assessment of IgA and IgG levels in peripheral blood of the patients who had COVID-19 in anamnesis. Monitoring of anti-SARS-CoV-2 levels over time has demonstrated significant individual variability, and made it possible to divide the study participants into three groups, according to characteristic features of humoral immunity after documented COVID-19. The study describes characteristic features of humoral immune response for each of these groups. The first group (30% of the study group) exhibited classical pattern of antibody response to viral infection. The second group (40% of study participants) presented with high plasma IgA levels, and their significant excess (about 2 times) over IgG levels throughout the observation period. The third group (30% of study participants), apparently comprised the subjects with increased humoral immunity to SARS-CoV-2 infection. Their plasma antibodies remain at high levels for at least 9-10 months after the onset of infection. The data obtained confirm the pattern of plasma IgA which is not quite typical to viral infections in dynamics after a sufficiently long time period after the disease in most study participants (2nd and 3rd groups;70% of all volunteers who have recovered from COVID-19) and suggests an important role of this immunoglobulin against SARS-CoV-2 infection. The specific responses of anti-SARS-CoV-2 IgG are very similar to behavior of such antibodies in other viral infections including contacts with coronaviruses from earlier generations. Humoral immunity against SARS-CoV-2 may persist for more than 6 months, thus supporting an assumption that the naturally infected patients are able to resist re-infection for a long time.

10.
Journal of Neurology, Neurosurgery and Psychiatry ; 93(6):114, 2022.
Article in English | EMBASE | ID: covidwho-1916433

ABSTRACT

Croydon University Hospital Remote consultations were rapidly introduced in the spring of 2020 in the neurology outpatient setting across the UK and worldwide due to the Covid-19 pandemic. Consulting remotely provides new chal-lenges to previously familiar practices. Here we present four different but commonly seen cases in a south London outpatient neurology service. With each case we address a key domain: history taking, examina-tion, the digital divide and changing the consulting environment. History taking is largely unchanged and indeed may improve the patient experience when performed in a familiar environment. The examina-tion is different and a greater understanding of which aspects of the neurological exam are and are not possible remotely continues to be discussed. The adoption of remote consultations requires patients to have a confident ability to activate and interact with technologies. The future development of technolo-gies and guidelines should proactively engage with patients of all ages and abilities to avoid biases in their development. Remote consultations are likely to continue to play a part in the future of outpatient neurology;understanding their most effective allocation and proactively developing technologies with patients will be essential for their success.

11.
European Heart Journal, Supplement ; 24(SUPPL C):C96-C97, 2022.
Article in English | EMBASE | ID: covidwho-1915557

ABSTRACT

Already from the first data in China it emerged that patients with cardiovascular comorbidities had an increased risk of contracting SARS-CoV-2 infection and a more unfavourable clinical course. From March to May 2020, 85 patients affected by COVID-19 were enrolled, hospitalized at the Hospital of Reggio Calabria. All patients underwent anamnesis, clinical evaluation, chest CT, ECG and measurement of markers of cardiovascular damage (Troponin I, CK-MB, LDH, D-dimer, BNP) and of inflammation (PCR, IL-6, and PCT). Thirty-one patients underwent echocardiography. In particular, we evaluated parietal dimensions and thicknesses, biventricular function and transvalvular tricuspid and pulmonary flows and correlated the data obtained with ECG, radiological, clinical, and biohumoral parameters. The aim of our study was to evaluate the prognostic impact of cardiovascular involvement in COVID- 19, investigating the effect of cardiovascular risk factors, levels of cardiovascular damage markers and newly emerging ECG and echocardiographic changes on a composite primary endpoint, consisting of the combination of death and the need for intensive care (ICU). The enrolled patients were divided into two subpopulations: those with better prognosis and those with poorer prognosis (ICU/exitus). We analysed the reciprocal correlation of each of the parameters and searched for the presence of echocardiographic signs of repercussion on the right sections of the pulmonary pathology. All markers of cardiovascular damage had significantly higher values in the most critically ill patients and similar behaviour had indices of inflammation. Patients with poorer prognosis had significantly lower lung AcT values, which correlated with higher D-dimer levels and more complicated hospital stays. There were no statistically significant differences between PAPs, right ventricular size, TAPSE and pulmonary trunk diameter in the two subpopulations. Larger right ventricular diameters were associated with more dilated lung trunks and higher IL-6 levels. The most interesting data of our study is the behaviour of pulmonary AcT: lower values of AcT were associated with higher levels of D-dimer, expression of a greater pulmonary microthrombotic burden, and a poorer prognosis, in the presence of PAPs normal. The dynamic analysis of this parameter, which is easy to calculate in the patient's bed, can play a crucial role in the instrumental follow-up of patients hospitalized for SARS-CoV-2 infection.

12.
Tokai Journal of Experimental and Clinical Medicine ; 47(2):90-93, 2022.
Article in English | EMBASE | ID: covidwho-1913260

ABSTRACT

Introduction: Clinical clerkships could not be conducted as usual in 2021, due to the COVID-19 pandemic. We conducted a questionnaire survey of medical students and patients to determine whether remote medical interviews conducted in such a scenario could build a trusting relationship between the two. Materials and Methods: Fifth-year students at Tokai University School of Medicine conducted tablet-based medical interviews (remote medical interviews) with patients as part of their clinical clerkship of breast endocrine surgery. Later, both the patients and students had to rate the trustworthiness of their relationship and their preference for remote/face-to-face medical interviews in a questionnaire survey. Forty-three students and 42 patients took part in the survey. Results and Discussion: All the patients and students agreed that a trusting relationship had been established. The results showed that most of the students preferred remote medical interviews, but patients were very divided in their preferences between face-to-face and remote medical interviews. Overall, we may conclude that remote medical interviews could be a safe tool for clinical practice in the future.

13.
European Journal of Molecular and Clinical Medicine ; 9(3):10378-10386, 2022.
Article in English | EMBASE | ID: covidwho-1913069

ABSTRACT

Background:Mucormycosis has been increasingly described in patients with covid 19 2nd wave (delta variant) which is a highly contagious disease caused by SARS-COV-2 is the leading cause of global pandemic. AIM AND OBJECTIVES: To evaluate etiology, indications, management options and complications in patients managed with endoscopic and external maxillectomy after mucormycosis, to evaluate the incidence and distribution of cases who had extensive mucormycosis and to evaluate the outcome of the management options. Materials and Methods: This is a prospective study done in 30 cases at a tertiary care centre.All the patients were subjected to detailed history taking, clinical examination, endoscopic, radiological, pathological, microbiological investigations after taking informed consent. Patients with age group(30yrs -70yrs) who presented with ROM with extensive maxillary sinus involvement and destruction of different walls of the maxillary sinus were managed with different types of maxillectomies. Results: In this study, 30 cases of post covid rhinoorbital mucormycosis who presented to our hospital were studied, among male 24(80%) & females6 (20%).12 patients (40%) were in 5th to 6th decade and 9 patients (30%) in 4th to 5th decade.Main presenting features were unilateral cheek pain, cheek swelling, nasal obstruction, loosening of teeth, tooth ache, cheek numbness, headache, periorbital edema, visual disturbances being present in 95% of the patients.5% presented with epistaxis, ptosis, diplopia alone.90% patients were known case of diabetes milletus,10% are denovo diabetes.All the patients were subjected to routine blood investigations, microbiological, radiologicalinvestigations.(CT, MRI contrast- PNS, Orbit & Brain).Most commonly seen in males 80%. 1 patient had to undergo orbital exenteration,3 patients underwent palatal resection. Conclusion: Debridement of sinuses is necessary in all cases of mucormycosis so that the fungal reservoir could be removed and the antifungal therapy can reach the viable areas. Therefore the management of mucormycosis is individualised to each patient based on the extension of the disease and overall general conditon of the patient.

14.
Indian Journal of Psychiatry ; 64(SUPPL 3):S695-S696, 2022.
Article in English | EMBASE | ID: covidwho-1912844

ABSTRACT

Background: Social anxiety disorder (SAD) is characterized by excessive fear of embarrassment, humiliation, or rejection when exposed to possible negative evaluation by others when engaged in a public performance or social interactions. Often, the diagnosis of SAD is missed due to lack of awareness and sometimes misclassified into other psychopathological domains. Case report: A 30-year-old male presented with c/c of fearfulness and suspiciousness in the form that whenever he sees any two individuals talking, he thinks that they are talking about him which were followed by panic like episodes and social avoidance. He consulted a psychiatrist and was prescribed Tab. Amisulpride 400mg/day, Tab. Aripiprazole 20mg/day, Tab. Olanzapine 10mg/day, Tab. Clozapine 100mg/day, Tab. Trifluoperazine 10mg/day+ Tab. Trihexyphenidyl 4mg/day, Tab. Alprazolam 1.5mg/day, Tab. Lorazepam 2mg/day, Tab. Clonazepam 0.5 mg/day and Tab. Propranolol 40mg/day. He didn't improve on these medications but took them for 5-6 years because he was able to sleep throughout the day and avoid social interactions. He visited us and detailed evaluation was done. During history taking, it was noted that his symptoms were actually fear of going in public as he used to think that people are talking that he is inferior to them and that people might misjudge or underestimate him. On detailed Mental Status Examination, it was noted that he suffered from social anxiety with avoidant behavior. Conclusion: It is important to categorize the symptoms into clinically relevant domain by detail history taking and MSE. © IBM Results 152 participants 49.3% Males and 50.7% Females Mean age-29.6 years (SD 4.5) 35.5% reported significant stress Average Stress score on DASS-12.9 (SD 11.1) Mean Professional fulfilment (PF) score-2.0 (SD 1.0) Mean Burnout score-1.3 (SD 0.9) 20.4% residents felt professionally fulfilled 41.4% residents had burnout Stress negatively correlated with Agreeableness Stress positively correlated with Neuroticism Stress positively correlated with Burnout (ñ 0.67;p 0.00) Stress negatively correlated with Professional fulfillment (ñ-0.41;p 0.00) Only Conscientiousness moderated the effect of stress on Burnout and Professional fulfillment Conclusion COVID pandemic generated significant stress among resident doctors Stress is associated with Burnout and Professional fulfilment Higher Conscientiousness reduced burnout due to stress Residents with higher Conscientiousness would experience more negative effect of stress on their professional fulfillment.

15.
Medical Immunology (Russia) ; 24(2):367-378, 2022.
Article in Russian | EMBASE | ID: covidwho-1897222

ABSTRACT

The dominance of reliably immunized population is a fundamental factor in prevention of COVID-19 pandemia, with immune prophylaxis taking a dominant position. Due to lack of clear data on the intensity of specific immunity after a new coronavirus infection, consolidation of immunological memory by vaccination becomes the urgent task, in order to exclude the risk of re-involvement of previously ill patients into the epidemic process. Meanwhile, many questions related to vaccination of COVID-19 survivors do not get distinct answers. To study the features of immune response, using a vaccine based on SARS-CoV-2 peptide antigens (EpiVacCorona), we monitored 81 participants. The inclusion criteria were data confirming COVID-19 in the anamnesis (medical documentation), low levels or absence of antibodies to the SARS-CoV-2 nucleocapsid protein, and negative PCR tests for SARS-CoV-2. When assessing the data of post-vaccinal immunity checked 21 days after 1st dose of the vaccine, the patients were divided into 2 groups: those who did not respond, and those who developed the immune response. In order to identify possible reasons for different phenotypic patterns of humoral response to vaccination, a comparative analysis of B lymphocyte indexes was carried out in these groups. Absolute counts, subpopulation composition and activation potential of peripheral blood B lymphocytes were determined by flow cytofluorometry using appropriate labeled monoclonal antibodies purchased from Beсkman Coulter. Comparative analysis of B lymphocyte indexes on the day of first vaccination showed that the persons who did not respond to the vaccine had smaller counts of circulating B cells, i.e., both percentage and absolute cell numbers, than in comparison group, as well as changed ratio of B1-to-B2 subpopulations. After administration of the first vaccine dose (by day +21), in alternative variant of the antibody response to V1, the differences in the parameters of B cells were presented as a smaller percentage and absolute numbers of regulatory B lymphocytes in non-responding participants. Moreover, the contents of minor B cell subpopulations were decreased in the non-responding group than in the comparison group, thus affecting the values of the B1:B2 ratio. In general, the presented data demonstrate that the absence of secondary immune response to antigens of the SARS-CoV-2 peptide vaccine could be is associated with altered differentiation of B1 and B2 subpopulations, B regulatory lymphocytes, B memory cells.

16.
Egyptian Journal of Chest Diseases and Tuberculosis ; 71(2):156-161, 2022.
Article in English | EMBASE | ID: covidwho-1884547

ABSTRACT

Aim The aim was to assess the efficacy of ivermectin in the treatment of patients with coronavirus disease 2019 pneumonia with severe and critically ill status. Patients and methods This retrospective study was performed on 50 patients admitted in ICU and high-dependency unit of Ibrahim Bin Hamad Hospital, United Arab Emirate. All patients were subjected to the following on admission: careful history taking, general and local examinations, routine laboratory studies (complete blood count, liver function tests, and kidney function tests), other laboratory tests such as C-reactive protein and D-dimer, and chest radiography. All patients received ivermectin in doses of 0.2 mg/kg on first and third days. Results The age range of the studied group was from 35 and 107 years, with a mean age of 61.8±14.07 years. The sex distribution of the studied group was 29 (58%) males and 21 (42%) females. The clinical condition deteriorated in 18 (36%) patients, improved in eight (16%) patients, and remained the same in 24 (48%) patients. Three (6%) patients had bronchial asthma, eight (16%) patients had chronic kidney disease, 20 (40%) patients had diabetes mellitus, 20 (40%) patients had hypertension, two (2%) patients had hypothyroidism, seven (14%) patients had ischemic heart disease, and 14 (28%) patients did not have any comorbidities. Regarding the progress of patients' symptoms, shortness of breath deteriorated in 18 (36%) patients, improved in eight (16%) patients, and remained the same in 24 (48%) patients. The cough symptom deteriorated in 18 (36%) patients, improved in eight (16%) patients, and remained the same in 24 (48%) patients. Radiology (chest radiograph) showed deterioration in 18 (36%) patients, improvement in eight (16%) patients, and remained the same in 24 (48%) patients. There was no statistically significant difference before and after using ivermectin with respect to temperature (P=0.058), pulse (P=0.101), respiratory rate (P=0.054), white blood cell count (P=0.058), lymphocyte count (P=0.09), C-reactive protein (P=0.177), and D-dimer (P=0.087). Conclusion The use of ivermectin did not significantly improve resolution of symptoms, outcome, radiology, or laboratory markers. The findings do not support the use of ivermectin for treatment of severe coronavirus disease 2019.

17.
Egyptian Journal of Radiology and Nuclear Medicine ; 53(1), 2022.
Article in English | EMBASE | ID: covidwho-1869114

ABSTRACT

Background: Coronavirus disease COVID-19 is a viral illness, currently affecting millions of people worldwide. Pneumonia is the most common extreme presentation of COVID-19 infection, manifesting by fever, dry cough, difficulty of breathing or shortness of breath and mainly ground-glass infiltrates in radiological images. Chest computed tomography (CT) has a potential role in the diagnosis, detection of complications and prognostication of coronavirus disease COVID-19. In addition to severe respiratory manifestations, there are a wide range of neurological manifestations ranging from nonspecific symptoms to necrotizing encephalopathies and stroke. Our study aimed to review lung and neurological manifestations in recent and post-COVID-19 Egyptian patients and to be familiar with magnetic resonance imaging (MRI) findings of Neuro-COVID patients. Results: The present study included eighty COVID-19 patients with age ranged from 28 to 78 years (mean age 57.84 + 12.58 years) who were 54 males (mean age 56.64 + 12.50) and 26 females (mean age 48.65 + 14.24). All our patients were with recent or previous history of COVID-19 infection and subjected to careful history taking, thorough clinical examination, routine laboratory investigations and CT examination. The reported lung manifestations included normal lung shadows, ground-glass opacifications (GGOs), consolidations, reticulation, reticulation and GGOs (crazy paving) and fibrotic-like changes. Out of eighty COVID-19 patients, twenty showed neurological manifestations ranging from nonspecific symptoms to necrotizing encephalopathies and stroke. Patients with neurological manifestation were in addition to CT submitted to magnetic resonance imaging (MRI) as appropriate. MRI done to neuro-COVID patients showed that 8/20 (40%) had no abnormalities and 12/20 (60%) had abnormalities. The most common abnormalities are infarction, major or lacunar infarction, followed by acute disseminated encephalomyelitis (ADEM), posterior reversible encephalopathy syndrome (PRES) and meningoencephalitis. Conclusion: Old age patients, especially males, were more affected than females. Lung manifestations are common in COVID-19 patients than neurological manifestations. The presence of fibrotic changes in the lung could predict severe COVID-19 affection and bad prognosis. There might be an association between appearance of neurological manifestations and poor outcome in COVID-19 patients.

18.
New Armenian Medical Journal ; 16(1):43-48, 2022.
Article in English | EMBASE | ID: covidwho-1866096

ABSTRACT

Today, it has been proven that saliva is the main medium through which the new COVID-19 coronavirus infection spreads. Since the oral cavity is the gateway for the SARS-CoV-2 virus, the degree of change in the physicochemical parameters of the saliva of people who have had coronavirus infection compared to people who have not had COVID-19 is of interest. This study involved dental patients of the first and second health groups with a history of chronic generalized periodontitis of moderate degree in the stage of remission. We studied physicochemical parameters of saliva such as pH, surface tension and base buffering capacity. The results of this stage of the study showed saliva acidification, that is a decrease in pH in people who had had a new coronavirus infection compared to the indicators of people from the control group. The average values of the surface tension of saliva in patients of the control group are 30% less than in those who have had COVID-19. This indicates that the saliva of people who have not been sick with the new coronavirus contains more surface-active agents (surfactants). Surfactants provide rinsing and disinfecting functions of saliva, therefore, it can be concluded that these functions are less pronounced in patients who have recovered from COVID-19. The base buffering capacity of the saliva of patients who have had COVID-19 is, on average, 35% higher than that of people from the control group. Thus, the pH and the base buffering capacity are in correlation: the lower the pH value, the higher the acidity of the saliva and the higher the base buffering capacity is. At the second stage of the study, similar physicochemical parameters of patients’ saliva were measured after the application of an oral spray containing a synthetic peptide (ZP2) of the active center of granulo-cyte-macrophage colony-stimulating factor. This spray was used as an antibacterial therapy for the oral cavity after professional hygiene of patients. In 5 minutes after spray irrigation, an increase in saliva pH was observed in all test subjects within the physiological norm. In patients, regardless of their anamnesis, the surface tension of saliva changed in different ways. In a number of people, it increased, which indicates an increase in the concentration of surfactants in saliva, while in others it decreased, which can be explained by the high rate of penetration of surfactants from saliva through the gums into the blood. After the application of the ZP-2 peptide, the base buffering capacity of saliva decreases or remains unchanged. In patients of the control group, the indicators of the base buffering capacity of saliva change less than in patients who have undergone COVID-19. All the studied physicochemical parameters of saliva in patients who had had uncomplicated COVID-19, three months after receiving two negative results for the SARS-CoV-2 virus, remained within the physiological norm.

19.
B-ENT ; 16(1):81-85, 2020.
Article in English | EMBASE | ID: covidwho-1863150

ABSTRACT

The current COVID-19 or Sars-CoV-2 pandemic increased awareness of hyposmia or anosmia, as this can be an accompanying symptom. In mild cases, anosmia without rhinorrhea can be the only presenting symptom of this infection. Timely identification can lead to early detection of otherwise asymptomatic carriers. History taking and essential clinical assessment with appropriate protective measures can be performed in patients in whom COVID-19 is suspected. Patients with anosmia without nasal obstruction should be considered COVID-19 suspect and this should initiate testing or self-isolation. As for treatment of hyposmia or anosmia, the authors do not advise treatment with systemic corticosteroids in patients with COVID-19. Based on expert opinion, nasal corticosteroids can be considered, with a preference for spray formulation. Patients who were already using topical or inhalation corticosteroids for proven pre-existing disease (such as asthma and/or allergy) should be advised to continue their maintenance therapy. ENT (Ear Nose Throat) focus on hyposmia and anosmia should be continued, to gain additional knowledge of the disease mechanisms of COVID-19 and improve follow-up, not only on the pneumological aspects but also to evaluate the impact on quality of life of potentially long-term side effects caused by anosmia.

20.
Lung India ; 39(SUPPL 1):S20, 2022.
Article in English | EMBASE | ID: covidwho-1857332

ABSTRACT

Background: COVID-19 pandemic has been an unprecedented health crisis. Post COVID-19 lung sequelae comprise respiratory disease occurring after recovery from COVID-19. Objective: (1) To determine the baseline characteristics. (a) Inflammatory marker levels. (b) Spirometric values. (c) 6 minute walk distance. (d) Radiological parameters. (2) To assess the differences in above mentioned parameters, during follow up. Methods: All consecutive recovered patients of moderate to severe COVID-19 attending Post COVID-19 clinic were subjected to history taking of grade of dyspnea and preexisting co morbidities. At baseline visit, inflammatory markers (ESR, CRP, d-Dimer, Ferritin and LDH), Spirometry, 6MWD and HRCT thorax findings were determined. Spirometry and 6MWD were repeated in follow up visits (0, 3, 12, 24 weeks). Results: Of the 468 patients, 196 (41.9%) had moderate and 272 (58.1%) had severe disease. Ever smokers comprised 58 (16.2%) patients. 348 (74.3%) had comorbidities, most common being hypertension (192, 41%). The mean value of ESR, CRP, d-Dimer, LDH and Ferritin levels was higher in severe patient group, compared to moderate patient group (although statistically insignificant). Statistically significant decline was seen in ESR, CRP, ferritin and LDH levels in 1st follow up. Spirometric parameter, absolute FVC was higher in moderate group compared to severe group and statistically significant. Most common radiological finding was ground glass opacity (GGO), and treated with OCS. In OCS treatment arm, statistically significant increment in 6MWD was seen as compared to antifibrotic arm. Conclusion: Long recovery period should be expected in patients of moderate to severe COVID-19.

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