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1.
Int J Environ Res Public Health ; 18(9)2021 May 02.
Article in English | MEDLINE | ID: covidwho-1231479

ABSTRACT

INTRODUCTION: We reported previously that when teams of students reflect on readings about communication, unconscious bias, and service-learning, their critical reflection, implicit bias mitigation, empathy, and compassionate behavior all increase. However, would these gains occur when intimate classroom settings, in-person team meetings, and direct interactions with people served were lost owing to the COVID-19 pandemic and remote learning? METHODS: Before an online Medical Humanities course began in August 2020 and following the course in December 2020, 61 prospective medical students (54.1% female) completed reliable surveys of their reflective capacity (RC) and cognitive empathy (compassion). Students also completed surveys about their implicit biases and team community service in December 2020. RESULTS: Both RC and empathy scores increased in students after they reflected on difficulties in communication, unconscious biases, and team service-learning experiences in the course. In written reflections, they reported how their compassionate behavior also grew owing to bias mitigation. Most students concurred that "unconscious bias might affect some of (their) clinical decisions or behaviors as a healthcare professional" and vowed to remain aware of these biases in clinical settings. CONCLUSIONS: Compared to previous years, the pandemic and remote learning had minimal effects on the benefits of our Medical Humanities course.


Subject(s)
COVID-19 , Students, Medical , Empathy , Female , Humanities , Humans , Male , Pandemics , Prospective Studies , SARS-CoV-2
2.
J Mov Disord ; 14(2): 119-125, 2021 May.
Article in English | MEDLINE | ID: covidwho-1136663

ABSTRACT

OBJECTIVE: Telemedicine has rapidly gained momentum in movement disorder neurology during the coronavirus disease (COVID-19) pandemic to preserve clinical care while mitigating the risks of in-person visits. We present data from the rapid implementation of virtual visits in a large, academic, movement disorder practice during the COVID-19 pandemic. METHODS: We describe the strategic shift to virtual visits and retrospectively examine elements that impacted the ability to switch to telemedicine visits using historical prepandemic in-person data as a comparator, including demographics, distance driven, and diagnosis distribution, with an additional focus on patients with deep brain stimulators. RESULTS: A total of 686 telemedicine visits were performed over a five-week period (60% of those previously scheduled for in-office visits). The average age of participants was 65 years, 45% were female, and 73% were Caucasian. Men were more likely to make the transition (p = 0.02). Telemedicine patients lived farther from the clinic than those seen in person (66.47 km vs. 42.16 km, p < 0.001), age was not associated with making the switch, and patient satisfaction did not change. There was a significant shift in the distribution of movement disorder diagnoses seen by telemedicine compared to prepandemic in-person visits (p < 0.001). Patients with deep brain stimulators were more likely to use telemedicine (11.5% vs. 7%, p < 0.001). CONCLUSION: Telemedicine is feasible, viable and relevant in the care of movement disorder patients, although health care disparities appear evident for women and minorities. Patients with deep brain stimulators preferred telemedicine in our study. Further study is warranted to explore these findings.

3.
Indian J Clin Biochem ; 36(4): 416-426, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1092844

ABSTRACT

Nutritional deficiency is associated with impaired immunity and increased susceptibility to infections. The complex interactions of trace elements with the macromolecules trigger the effective immune response against the viral diseases. The outcome of various viral infections along with susceptibility is affected by trace elements such as zinc, selenium, iron, copper, etc. due to their immuno-modulatory effects. Available electronic databases have been comprehensively searched for articles published with full text available and with the key words "Trace elements", "COVID-19", "Viral Infections" and "Immune Response" (i.e. separately Zn, Se, Fe, Cu, Mn, Mo, Cr, Li, Ni, Co) appearing in the title and abstract. On the basis of available articles we have explored the role of trace elements in viral infections with special reference to COVID-19 and their interactions with the immune system. Zinc, selenium and other trace elements are vital to triggerTH1 cells and cytokine-mediated immune response for substantial production of proinflammatory cytokines. The antiviral activity of some trace elements is attributed to their inhibitory effect on viral entry, replication and other downstream processes. Trace elements having antioxidants activity not only regulate host immune responses, but also modify the viral genome. Adequate dietary intake of trace elements is essential for activation, development, differentiation and numerous functions.

4.
Int J Clin Pract ; 75(6): e14078, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1069395

ABSTRACT

AIM: The contribution of micronutrients to the immune system has been known for a long time. This study aimed to investigate the association between the micronutrient levels and hemogram values and prognostic factors of the disease in COVID-19 patients in Ankara City Hospital. MATERIALS AND METHODS: Our study is a descriptive observational study based on a retrospective review of patient files. COVID-19 patients over 18 years of age who were admitted to our hospital between 14 March and 1 June 2020, and with a complete micronutrient profile were included in the study. Age, gender, chronic diseases, micronutrient concentrations in the last 6 months, hemogram data on the day of hospitalization, total length of stay in hospital, and hospitalization to Intensive Care Unit (ICU)-intubation-death status of the patients were obtained from the patient files. RESULTS: A total of 310 patients whose parameters were thoroughly examined were included in our study; 51.9% of them were men and the mean age of all patients was 57.02 ± 18.28 years, and the most common comorbid disease was hypertension. The percentage of patients who were followed in the ICU, were intubated, and died was 34.5%, 13.9%, and 9.4%, respectively. The mean length of hospital stay was 15.87 ± 12.79 days. Low folate, iron, vitamin D, and hemoglobin levels of the patients and high vitamin B12 concentration were more related to poor prognostic factors. The number of white blood cells was significantly higher in patients with a worse prognosis, and the number of lymphocytes was lower in patients with ICU admission but higher in intubated and dead patients. CONCLUSION: Micronutrient and hemogram values, advanced age, being male, and having comorbid diseases were correlated with the poor prognosis of COVID-19 infection. Deficiency of Iron, Folate, and vitamin D should be well-considered in COVID-19. Excessive vitamin B12 and multivitamin supplementation should be avoided by choosing supplement wisely. In addition, attention should be paid to leukocytosis, lymphocyte counts, and anemia during COVID-19 patient follow-up. What's known Some micronutrients have an immunomodulatory and anti-inflammatory effect with antioxidant effects and thus play a protective role in respiratory tract infections as COVID-19. Vitamin D deficiency is found to be associated with poor prognostic factors in COVID-19. Lymphopenia is found to be associated with poor prognostic factors in COVID-19. What's new According to the results obtained from our study, low iron and folate levels should be controlled first in patients diagnosed with COVID-19, low vitamin D levels should also be well-considered, and supplementation should be provided in the case of deficiencies. On the other hand excessive use of vitamin B12 should be avoided. The fact that all micronutrients should be evaluated and managed by choosing wisely rather than a complete multivitamin supplement approach was demonstrated by the differences in the poor prognosis levels of vitamin B12 versus the other micronutrients. In addition, it was found in our study that leukocytosis, lymphocyte counts, and anemia should be taken into consideration together when evaluating hemogram parameters in the follow-up of COVID-19 patients.


Subject(s)
COVID-19 , Micronutrients , Adolescent , Adult , Aged , Female , Humans , Infant , Male , Middle Aged , Prognosis , Retrospective Studies , SARS-CoV-2 , Turkey/epidemiology
5.
ESMO Open ; 6(1): 100007, 2021 02.
Article in English | MEDLINE | ID: covidwho-1023563

ABSTRACT

Treatment of patients with cancer in hospitals or clinics is resource-intensive and imposes a burden on patients. 'Flexible care' is a term that can be used to describe treatment administered outside the oncology ward, oncological outpatient clinic or office-based oncologist setting. Programmes that reduce travel burden by bringing cancer treatment to the patient's home, workplace or closer to the patient's home, in the form of satellite clinics or mobile cancer units, expand treatment capacity and are well received. Clinical trial data show that, compared with intravenous administration, subcutaneous (s.c.) administration of trastuzumab is preferred by patients with breast cancer (BC), saves healthcare professionals' (HCPs) time, reduces drug preparation and administration time and reduces direct and indirect costs. As such, s.c. trastuzumab is well suited to flexible care. The results of a Belgian study (BELIS) show that home administration of s.c. trastuzumab is feasible and preferred by patients with BC. Numerous programmes and pilot studies in Europe show that s.c. trastuzumab can be administered effectively in the patient's home, in primary care settings or local hospitals. Such programmes require planning, training, careful patient selection and technology to link patients, caregivers and specialists in oncology clinics. Once these elements are in place, flexible care offers patients with BC a choice of how treatment may be delivered and lead to improved quality of life, while reducing pressure on HCPs and hospitals. The concept of flexible care is particularly relevant amid the COVID-19 pandemic where guidelines have been developed encouraging remote care.


Subject(s)
Breast Neoplasms/drug therapy , COVID-19/prevention & control , Home Care Services, Hospital-Based , Trastuzumab/administration & dosage , Antineoplastic Agents, Immunological/administration & dosage , COVID-19/epidemiology , COVID-19/virology , Female , Humans , Injections, Subcutaneous , Medical Oncology/economics , Medical Oncology/methods , Medical Oncology/trends , Pandemics , Quality of Life , SARS-CoV-2/isolation & purification , SARS-CoV-2/physiology
6.
Environ Res ; 194: 110670, 2021 03.
Article in English | MEDLINE | ID: covidwho-1002512

ABSTRACT

BACKGROUND: The dynamics of urinary trace elements in patients with COVID-19 still remains to be investigated. METHODS: A retrospective study was performed on a cohort of 138 confirmed COVID-19 patients for their urinary levels of essential and/or toxic metals including chromium, manganese, copper, arsenic, selenium, cadmium, mercury, thallium and lead according to the different disease severity (severe or non-severe) and outcome (recovered or deceased). RESULTS: Urinary concentrations of chromium, manganese, copper, selenium, cadmium, mercury and lead after creatinine adjustment were found to be higher in severe patients than the non-severe cases with COVID-19. And among the severe cases, these elements were also higher in the deceased group than the recovered group. When the weeks of the post-symptom onset were taken in account, the changes of these urinary elements were existed across the clinical course since the disease onset. These urinary elements were found to be mostly positively inter-correlated, and further positively correlated with other laboratory inflammatory parameters including serum cytokines (IL-1B, IL2R, IL6, IL8, IL10, TNFα), ferritin, and neutrophil count and white blood cell count. As a independently predictive factor, urinary creatinine-adjusted copper of ≥25.57 µg/g and ≥99.32 µg/g were associated with significantly increased risk of severe illness and fatal outcome in COVID-19, respectively. CONCLUSIONS: These results suggest abnormities in urinary levels of the trace metals were tightly associated with the severe illness and fatal outcome of COVID-19.


Subject(s)
COVID-19 , Selenium , Trace Elements , Cadmium , Copper , Humans , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index
7.
Development (Rome) ; 63(2-4): 291-297, 2020.
Article in English | MEDLINE | ID: covidwho-962990

ABSTRACT

What is the impact of COVID-19 on Portugal's Serviço Nacional de Saúde (SNS), the country's national health service? The story, still unfolding, has all the elements of a recipe for disaster: one of the most elderly populations in the world; a weakened SNS, the result of a litany of policies and interventions by the 'Troika' (the European Commission, the European Central Bank and the International Monetary Fund); a health care delivery system focused on non-communicable diseases and long-term care; the growing public distrust in public services, compared to private, hotel-like health care facilities. We are aware that these are still the early days of the epidemic, yet it is safe to say that algorithmic scenarios of doom and gloom have so far been averted. In the past six months of the pandemic, the level of trust of the Portuguese population in the SNS and its health personnel has significantly improved, while the government has started to provide additional funding and to work for the expansion of the public system. At the very inception of the pandemic, private hospitals practically closed their doors to COVID-19 patients. Unexpectedly a new disease, COVID-19, by definition the foe of any health system, has granted the opportunity for a rare consensus amongst different key political and/or corporate actors in a long-called-for reform of the SNS. Social science and humanities, with their analytical tools and theoretical-conceptual frameworks, are mandatory in providing well-funded answers to such riddles and better grasping the reasons for the twist and turns.

8.
Biol Trace Elem Res ; 199(10): 3608-3617, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-942612

ABSTRACT

SARS CoV-2 is a novel coronavirus which has caused many deaths in the recent pandemic. This study aimed to determine zinc, copper and magnesium status on pregnant women with COVID-19. 100 healthy (33/32/35) and 100 SARS-CoV-2 positive (34/33/33) pregnant women were included in the study according to their trimesters. Blood samples were obtained from the patients along with the initial laboratory tests for clinical outcomes upon their first admission to hospital. In the first and third trimesters serum zinc level was lower (p:0,004 and p:0,02), serum copper level was higher (p:0,006 and p:0,008), the Zn / Cu ratio decreased(p < 0.0001 and p < 0.0001) and the serum magnesium level was higher(p < 0.0001 and p < 0.0001) in the COVID-19 group.In the second trimester COVID-19 patients had lower serum zinc (p:0,05) and copper levels (p:0,0003) compared to controls. Disease severity correlated with zinc/copper ratio in COVID19 patients (p:0.018, r:-0.243). Serum zinc and Zn/Cu ratio levels had a negative relationship with acute phase markers such as IL-6, Erythrocyte Sedimentation Rate, procalcitonin and C-reactive Protein. Also, increased serum magnesium level may play a role in decreased white blood cell, neutrophil, lymphocyte cell count and increased CRP levels in the third trimester. This study indicated that trace element status changed in pregnant women with COVID-19. The effect of trace elements on pregnant women diagnosed with COVID-19 infection was investigated in comparison with healthy pregnant women for the first time. This effect will be revealed better in more comprehensive studies to be planned in the future.


Subject(s)
COVID-19 , Trace Elements , Case-Control Studies , Copper , Female , Humans , Magnesium , Pregnancy , SARS-CoV-2 , Zinc
9.
MMWR Morb Mortal Wkly Rep ; 69(44): 1625-1630, 2020 Nov 06.
Article in English | MEDLINE | ID: covidwho-914857

ABSTRACT

Correctional and detention facilities have been disproportionately affected by coronavirus disease 2019 (COVID-19) because of shared space and movement of staff members and detained persons within facilities (1,2). During March 1-April 30, 2020, at Cook County Jail in Chicago, Illinois, >900 COVID-19 cases were diagnosed across all 10 housing divisions, representing 13 unique buildings.† Movement within the jail was examined through network analyses and visualization, a field that examines elements within a network and the connections between them. This methodology has been used to supplement contact tracing investigations for tuberculosis and to understand how social networks contribute to transmission of sexually transmitted infections (3-5). Movements and connections of 5,884 persons (3,843 [65%] detained persons and 2,041 [35%] staff members) at the jail during March 1-April 30 were analyzed. A total of 472 (12.3%) COVID-19 cases were identified among detained persons and 198 (9.7%) among staff members. Among 103,701 shared-shift connections among staff members, 1.4% occurred between persons with COVID-19, a percentage that is significantly higher than the expected 0.9% by random occurrence alone (p<0.001), suggesting that additional transmission occurred within this group. The observed connections among detained persons with COVID-19 were significantly lower than expected (1.0% versus 1.1%, p<0.001) when considering only the housing units in which initial transmission occurred, suggesting that the systematic isolation of persons with COVID-19 is effective at limiting transmission. A network-informed approach can identify likely points of high transmission, allowing for interventions to reduce transmission targeted at these groups or locations, such as by reducing convening of staff members, closing breakrooms, and cessation of contact sports.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Disease Outbreaks , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Prisons , COVID-19 , Contact Tracing , Data Visualization , Humans , Illinois/epidemiology , Pandemics , Social Networking
10.
Heliyon ; 6(9): e04943, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-756823

ABSTRACT

The current situation with the SARS-CoV-2 pandemic indicates the importance of new approaches in vaccine design. In order to design new attenuated vaccines, to decrease virulence of virus wild types, it is important to understand what allows a virus to hijack its host cell's metabolism, a property of all viruses. RNA and protein sequences obtained from databases were used to count the number of atoms of each element in the virions of SARS, MERS and SARS-CoV-2. The number of protein copies and carbohydrate composition were taken from the literature. The number of lipid molecules was estimated from the envelope surface area. Based on elemental composition, growth equations were balanced, and thermodynamic properties of the viruses were determined using Patel-Erickson and Battley equations. Elemental and molecular compositions of SARS, MERS and SARS-CoV-2 were found, as well as their standard thermodynamic properties of formation and growth. Standard Gibbs energy of growth of virus nucleocapsids was found to be significantly more negative than that of their host tissue. The ratio of Gibbs energies of growth of virus nucleocapsids and host cell is greater than unity. The more negative Gibbs energy of growth of viruses implies that virus multiplication has a greater driving force than synthesis of host cell components, giving a physical explanation of why viruses are able to hijack their host cell's metabolism. Knowing the mechanism of viral metabolism hijacking can open new paths for vaccine design. By manipulating chemical composition of viruses, virulence can be decreased by making the Gibbs energy of their growth less negative, resulting in decreased multiplication rate, while preserving antigenic properties.

11.
J Biol Chem ; 295(31): 10741-10748, 2020 07 31.
Article in English | MEDLINE | ID: covidwho-611982

ABSTRACT

Approximately 17 years after the severe acute respiratory syndrome coronavirus (SARS-CoV) epidemic, the world is currently facing the COVID-19 pandemic caused by SARS corona virus 2 (SARS-CoV-2). According to the most optimistic projections, it will take more than a year to develop a vaccine, so the best short-term strategy may lie in identifying virus-specific targets for small molecule-based interventions. All coronaviruses utilize a molecular mechanism called programmed -1 ribosomal frameshift (-1 PRF) to control the relative expression of their proteins. Previous analyses of SARS-CoV have revealed that it employs a structurally unique three-stemmed mRNA pseudoknot that stimulates high -1 PRF rates and that it also harbors a -1 PRF attenuation element. Altering -1 PRF activity impairs virus replication, suggesting that this activity may be therapeutically targeted. Here, we comparatively analyzed the SARS-CoV and SARS-CoV-2 frameshift signals. Structural and functional analyses revealed that both elements promote similar -1 PRF rates and that silent coding mutations in the slippery sites and in all three stems of the pseudoknot strongly ablate -1 PRF activity. We noted that the upstream attenuator hairpin activity is also functionally retained in both viruses, despite differences in the primary sequence in this region. Small-angle X-ray scattering analyses indicated that the pseudoknots in SARS-CoV and SARS-CoV-2 have the same conformation. Finally, a small molecule previously shown to bind the SARS-CoV pseudoknot and inhibit -1 PRF was similarly effective against -1 PRF in SARS-CoV-2, suggesting that such frameshift inhibitors may be promising lead compounds to combat the current COVID-19 pandemic.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/drug therapy , Drug Design , Frameshifting, Ribosomal/drug effects , Pneumonia, Viral/drug therapy , RNA, Viral/genetics , Betacoronavirus/chemistry , COVID-19 , Gene Expression Regulation, Viral , Humans , Pandemics , RNA, Viral/chemistry , SARS-CoV-2 , Virus Replication/drug effects
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