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Research Framework: The COVID-19 pandemic and the restrictive measures issued, such as physical distancing and lockdown, have affected social and family ties. These constraints have forced people to reexamine their family and conjugal relationship, the management of family and professional time, their intergenerational connections, and life transitions. Either exacerbating the tensions on conjugal and family life or strengthening these links, this pandemic has also provided an opportunity to explore on new strategies for living together. Objectives: This article offers an overview of the effects and consequences of the COVID-19 pandemic on families and their members. Methodology: This article is based on a literature review from various social science disciplines. Results: Partial insights were provided on the following questions: What effects did the pandemic have on families and family members? How did families manage the pandemic's economic consequences? What were the repercussions of health measures that were put in place to counter the spread of COVID-19 on couples, children, intergenerational relationships, and mental health? How were mortuary rites and mourning processes affected? Conclusion: This article contributes, beyond the individual and social hardships resulting from COVID-19, to show familial – generational and community – solidarity and resiliency that have emerged, as well as the ways in which families and their members have coped and organized themselves during the pandemic. Contribution: Throughout history, societies have been confronted with epidemics that have affected all spheres of life. The COVID-19 pandemic has once again highlighted the importance, fragility and strength of the social and family ties, along with the challenges of living together. © 2022 Centre - Urbanisation Culture Societe de l'INRS. All rights reserved.
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Research framework: Using the theoretical frameworks of quality of life and the sociology of technology uses, this qualitative article explores the consequences of lockdown following the COVID-19 pandemic among Spanish students enrolled at the University of Salamanca. Objectives: This article analyzes the impact of lockdown on the quality of life of university students in different spheres, such as residential, mental health, diet, alcohol and drug consumption, physical exercise, use of information and communication technologies (ICTs), academic work, financial repercussions and coping strategies. Methodology: Exploratory interviews were conducted with 12 respondents (6 male and 6 female students) enrolled at the University of Salamanca on the impact of lockdown in the different spheres of life. The transcripts were coded and thematically analyzed to identify the salient dimensions, convergences and differences in the students' experience. Results: This study allowed us to identify the positive and negative repercussions of lockdown following the COVID-19 pandemic on the quality of life, to identify the repertoire of reactions to this extreme event in the different spheres of life, and in particular in the use of information and communication technologies at the social and academic level. Conclusions: Our analysis allows us to conclude that the lockdown was not always a problematic period, but that it allowed the exploration of existential issues and new behaviours likely to contribute to personal development. Contribution: This article contributes to the research on COVID-19 and university students from a qualitative perspective that is still not widely used in the growing literature on the pandemic. © 2022 Centre - Urbanisation Culture Societe de l'INRS. All rights reserved.
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OBJECTIVE: To present an established practice protocol for safe and effective hospital-setting ophthalmic practice during the coronavirus disease 2019 (COVID-19) pandemic. METHODS AND ANALYSIS: Literature was reviewed to identify articles relevant to COVID-19 pandemic and ophthalmology. The following keywords were used: COVID-19, SARS-CoV-2 and telemedicine, combined with eye, ophthalmology, conjunctivitis and tears. Data were extracted from the identified manuscripts and discussed among subspecialists to obtain consensus evidence-based practice. RESULT(S): A protocol for ophthalmic practice in the era of COVID-19 pandemic was established. The protocol covered patient screening, clinic flow, required personal protective equipment and modifications of ophthalmic equipment for improved safety. CONCLUSION(S): Important literature emerged with respect to the practice of ophthalmology in the era of COVID-19. An evidence-based ophthalmic practice protocol was established and should be modified in the future to accommodate new insights on the COVID-19 pandemic.Copyright © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Background/Case Studies: Decreased blood collection during the COVID-19 pandemic resulted in long-term red blood cell (RBC) shortages in the United States. To conserve RBCs, an existing passive alert system for auditing transfusions was modified to activate at a lower hemoglobin (HGB) threshold (6.5g/dL for stable nonbleeding inpatients) during a 9-month shortage at a 400-bed academic medical center. Study Design/Methods: This retrospective study compared the number of single unit RBC transfusions and pre-transfusion HGB levels among inpatients during 9 months of the intervention (Period 2, 06/01/2021- 2/28/2022) to the same period of the previous year (Period 1, 06/01/2020-2/28/2021) to determine whether RBC utilization changed during the intervention. Results/Findings: Overall full unit RBC transfusions to inpatients decreased by 15%. The incidence rate difference and incidence rate ratio of units transfused per 1000 patient-days significantly decreased (p = 0.029). The average pre-transfusion HGB level significantly decreased (p = 0.0002), largely due to significant decreases in HGB transfusion triggers for adult inpatient ward transfusions. Conclusion(s): Modification of the passive alert system was associated with significantly decreased RBC utilization during a long-term RBC shortage at a single center. Modification of transfusion criteria recommended by passive alerts may be a feasible option to decrease RBC utilization during long-term RBC shortages.
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Background: In response to the coronavirus disease-2019 (COVID-19) pandemic, routine clinical visits to the ophthalmic emergency department (OED) were deferred, while emergency cases continued to be seen. Objectives: To assess the consequences of the COVID-19 pandemic for ophthalmic emergencies. Methods: A retrospective chart analysis of patients who presented to the OED during the peak of the COVID-19 pandemic was conducted. The proportions of traumatic, non-traumatic-urgent, and non-traumatic-non-urgent presentations in 2020 were compared to those of the same time period in 2019. Duration of chief complains and best-corrected visual acuity were also assessed. Results: There were 144 OED visits in 2020 compared to 327 OED visits during the same 3-week-period in 2019. Lower mean age of OED patients was present in 2020. Logarithmic expression (LogMAR) best corrected visual acuity (BVCA) was similar in both years. In 2020 there was a reduction in traumatic, non-traumatic-urgent, and non-traumatic-non-urgent cases compared to 2019 (15.4% reduction, P= 0.038;57.6% reduction, P= 0.002;74.6% reduction, P= 0.005, respectively). There was a higher proportion of same-day presentations at commencement of symptoms in 2020 compared with 2019 (52.8% vs. 38.8%, respectively P= 0.006). Conclusions: During the COVID-19 pandemic, the number of OED visits at a tertiary hospital dropped by more than half. Although the drop in visits was mostly due to decrease in non-traumatic-non-urgent cases, there was also decrease in non-traumatic-urgent presentations with possible important visual consequences. Additional studies should elucidate what happened to these patients.
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Background. The temporal dynamics of SARS-CoV-2 infectivity in immunocompromised children (IC) are unknown but may have important infection control implications. We evaluated SARS-CoV-2 viral persistence and assessed factors associated with viral persistence and cycle threshold (CT) values as a surrogate of viral load for IC. Methods. We conducted a retrospective cohort study of SARS-CoV-2-positive IC at a large quaternary pediatric hospital from March 2020-2021. Immunocompromised status was defined as primary or secondary/acquired immunodeficiencies due to comorbidities or immunosuppressive treatment. The primary outcome was time to first-of-two consecutively negative SARS-CoV-2 PCR tests ≥ 24 hours apart. Polymerase chain reaction (PCR) testing of sequential patient samples was conducted using the Centers for Disease Control 2019-nCoV Real-Time RT-PCR Diagnostic Panel (CDC assay). Chi-square, Fisher exact, and Wilcoxon tests were used to compare demographic and clinical characteristics. Kaplan-Meier curve median event times and log-rank tests were used to compare outcomes. Subjects without 2 consecutive negative tests censored at the last test. Analyses were conducted using SAS v 9.4. Results. Ninety-one children met inclusion criteria, and 67 children had more than 1 test (Figure 1). Median age was 15.5 years (IQR 8-18 yrs), 64% were male, 58% of children were white, and 43% were Latinx. Most (67%) were tested in outpatient settings, and 58% of children were asymptomatic. The median time to two negative tests was 42 days (IQR 25.0,55.0), with no difference in duration of positivity with specific diagnoses, degree of lymphopenia, or symptomatic vs asymptomatic illness. Five of 7 (71%) children with samples available for repeat testing had initial CT values < 30, indicating a moderate to high viral load, and of these, 4 (57%) had repeat testing 21 to 30 days later with CT values < 30 (Figure 2), suggesting persistence of moderate to high viral loads. Figure 1. Plot of immunocompromised children in cohort with positive SARS CoV2 PCR and subsequent testing (n = 67). Timelines of immunocompromised children in cohort with positive SARS CoV2 PCR and subsequent testing, grouped by immunocompromising condition. Each line represents an individual patient. Positive results are shown in light grey, negative results are shown in black. Figure 2. Plot of CT values from SARS-CoV-2 PCR testing over time among children with sequential samples available for retesting (n = 7) Plot of CT values (y axis) from SARS-CoV-2 PCR testing on the CDC assay over time (x axis) in days from initial positive test. Repeated testing which yielded a negative result on the CDC assay or intermittent negative results on clinical testing represented as CT value of 40. Each line represents a unique patient. Conclusion. The median duration of viral persistence among IC with SARS-CoV-2 infection was 6 weeks, with no significant difference in immunocompromised diagnoses or clinical presentation, with over half of children with testing on the same platform having moderate to high viral loads after 3 weeks, suggesting potential transmission risk.
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Introduction 'Take-home exposures' occur when workers accidentally bring home contaminants from work. In construction, job responsibilities may expose workers to lead and other metals, which extend to their household members via the take-home pathway. It is crucial that construction workers are aware of the take-home pathway and learn about exposure prevention strategies. Objectives This work is part of the RECLEAN Pilot Study, which aims to reduce lead in the homes of construction workers through educational and environmental interventions. Methods We developed and evaluated a suite of educational materials to train construction workers and their families on strategies to prevent take-home lead exposure. Each of the two sessions targets a specific audience, with one tailored to construction workers and the other to workers' family or household members. The sessions were originally developed to take place in person but given the COVID-19 pandemic we adapted them for online delivery as well. Results Like traditional occupational health and safety trainings, the construction worker sessions present workers with best practices to prevent take-home lead and open discussion for how such practices may fit into their own routine after work. Alternatively, the family session is designed to engage household members in discussion through a process derived from motivational interviewing. The materials for both sessions include an introduction, behavior scoring sheet, behavior wheel, and action plan. Facilitators and participants discuss strategies to prevent take-home lead, identify barriers participants (and their coworkers or families) experience when trying to change their behaviors, and ultimately prioritize a prevention goal. Conclusion The materials for both educational sessions were developed based on current literature on take-home lead and behavioral theories and in partnership with lead and construction experts from multiple organizations. Using feedback from participants, project stakeholders, and session facilitators, we evaluate the feasibility and efficacy of these educational interventions.
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Background: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is marked by coagulopathy that may relate to disease severity. Aims: We sought to understand the link between coagulopathy and acute respiratory distress syndrome (ARDS) in critically ill patients with Coronavirus Disease 2019 (COVID-19). Methods: We prospectively evaluated coagulation factor-specific biomarkers by ELISA and activity assays, viscoelastic testing by rotational thromboelastometry (ROTEM), and clinical data in 56 critically ill patients with COVID-19. One and two-way analyses of variance were performed to uncover association of factor levels with mortality, ECMO-requirement, major thrombotic events, and ARDS severity by PaO2/FiO2 ratio. Results: Patients averaged 57.2 years in age. Twenty-five percent had a major thromboembolic event, 16% had a major hemorrhage, and 23% died. All patients displayed hypercoagulability on viscoelastic testing, although those requiring veno-venous extracorporeal membrane oxygenation (ECMO) also had signs of consumptive coagulopathy and more frequent hemorrhagic complications than ECMO-naïve patients. In all patients, plasminogen activator inhibitor-1 (PAI-1) levels were increased, and ROTEM-determined clot lysis limited despite increased D-dimer levels, consistent with fibrinolytic suppression. In patients with thromboembolic events, regardless of ECMO status, PAI-1, von Willebrand Factor (vWF), and factor VIII levels were elevated. Increased PAI-1 and vWF and decreased ADAMTS13 levels correlated with ARDS severity and mortality. Conclusions: Our study defines the relationship between COVID-19 associated coagulopathy and the severity of acute lung injury by describing elevation in markers of endotheliopathy in association with low PaO2/FiO2 ratios. We identified increased PAI-1 with ARDS severity and thrombotic events, implicating fibrinolytic suppression in the microcirculatory injury and subsequent micro-and macrovascular thrombosis of severe COVID-19. Further investigation into therapeutic approaches to limit endothelial injury is needed. Other items for consideration: The study was approved by the Duke Institutional Review Board (Pro00101196 and Pro00105315).
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Purpose : To analyze the consequences of delaying intravitreal (IVI) anti-vascular endothelial growth factor (VEGF) therapy in patients under treat-and-extend (TAE) protocol. Methods : A retrospective review of medical records of a consecutive group of patients receiving IVI using TAE protocol before and during the COVID-19 pandemic. Data collected included diagnosis, demographics, treatment schedule, compound used and anatomical outcome according to spectral-domain optical coherence tomography (SD-OCT). Results : A total of 923 eyes (691 patients) were included;58.8% (543 eyes) were treated for neovascular age-related macular degeneration (nvAMD), 25% (231 eyes) had diabetic macular edema (DME), and 16.2% (149 eyes) with retinal vein occlusion (RVO). The average patient age (±SD) was 74.5 ± 11.7 years. The Female/male ratio was 1.08:1. Delayed therapy during the pandemic (?7 days) occurred in 56.3% of the eyes. This included 56.2%, 61.5%, 49.0% of nvAMD, DME and RVO patients respectively. The overall average delay (±SD) was 15.3±23.4 days. RVO patients were on average less late (9.3±16.1 days) compared to nvAMD (15.8±23.8) and DME (18.2±25.6) eyes (P=0.002). Multivariate analysis showed that in nvAMD duration of the disease and type of anti-VEGF were predictors of the number of days late (P=0.011 and 0.019). In eyes ? 7days late, 45.7%, 58.5%, and 58.9% of nvAMD, DME, and RVO eyes respectively showed an increase in central subfield thickness (CST). Worsening was related to absolute numbers of days late, and not to the percentage of delay of the recommended interval. A positive correlation was found between delay to treatment and an increase in CST. Conclusions : Delaying IVI in eyes under TAE regimen was common during the COVID-19 pandemic. These delays were associated with macular thickening having potential visual consequences.
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Background: COVID-19 poses a risk to the endoscopic skull base surgeon. Significant efforts to improving safety have beenemployed, including the use of personal protective equipment (PPE), preoperative COVID-19 testing, and recently the useof a modified surgical mask barrier. The objective of our cadaveric study is to reduce the risks of pathogen transmissionwith the use of readily available and innovative equipment as a means of creating a three-dimensional (3D) printed mask inaddition to a trocar system for use during endoscopic skull base surgery. Methods: Our study presents the ventilated upper airway endoscopic procedure mask (VPM), a 3D-printed mask with ananterior aperture fitted with a surgical glove with ports designed to allow for surgical instrumentation and side ports toaccommodate suction ventilation and an endotracheal tube. As an alternative, a modified laparoscopic surgery trocar servedas a port for instruments, and, on the contralateral side, rubber tubing was used over the endoscrub sheath to create anairtight seal. On cadaveric models, various surgical approaches were performed which each device to assess for surgicalmaneuverability including septoplasty, maxillary antrostomy, total ethmoidectomy, frontal sinusotomy, and sphenoidotomy.Surgical freedom (SF) and aerosolization were tested in both modalities. Results: The VPM allowed the unimpeded performance of the above-mentioned surgical approaches, using both two- andfour-handed techniques, with excellent surgical maneuverability and access, while maintaining a continuous facial seal.Debris and smoke were ventilated with a size 8-Frazier tip suction, and ambient gas was additionally suctioned by thenegative-pressure VPM. SF with the VPM was equivalent (1.0 cm2 ) to the SF with no mask. With the presence of a posterior septectomy, the endoscopic endonasal trocar (EET) system was effective for posteriorsurgical procedures, allowing access to critical paramedian structures (clivus, sella, and tuberculum), and afforded asuperior surgical seal, but was limited in terms of visualization and maneuverability during anterior approaches. For thisreason, aerosolization studies were only performed in the posterior nasal cavity with the EET. SF was found to be reducedby 55% (SF = 0.45 cm2 ), and surgery anterior to the sphenoid rostrum was limited when using the trocar system. Aerosolization was reduced using both the VPM and EET. During anterior surgery, the VPM reduced particle spillage by 86%.During posterior surgery, the VPM reduced overall particle spillage by 71%, while the EET reduced spillage by 97%.Conclusion: The VPM mask allows for a sealed surgical barrier during endoscopic skull base surgery and may play a criticalrole in advancing skull base surgery in the COVID-19 era. The EET may be a useful alternative for binarial procedures in theposterior nasal cavity and in instances where 3D printing is not available. Additionally, considering the ongoing pandemic,PPE shortage is a serious concern. The VPM may serve as a renewable alternative with various applications. In the future,our team will be performing studies to validate these preliminary findings.
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INTRODUCTION: Esophagogastric varices are a common complication of portal hypertension and can present with life-threatening bleeding. Definitive endoscopic therapy is via band ligation or sclerotherapy. The former is preferred for esophageal varices, but efficacy is lower in gastric varices (GV). Sclerotherapy with cyanoacrylate (CA) has shown better efficacy and is now recommended as first line therapy for bleeding GV. Studies on long-term efficacy and complications remain limited. CASE DESCRIPTION/METHODS: A 62-year-old woman with NASH cirrhosis (MELD 11) presented with hematemesis. She denied any history of SBP, varices, or encephalopathy. She endorsed a previous history of COVID-19 and had reactive IgG but PCR probe for SARS-CoV-2 was negative. She underwent EGD and was found to have oozing GV along the lesser curvature, which were treated with 4cc of CA achieving hemostasis. The following night she had altered mentation and the blood lactate was increased to 7.2 mmol/L. AST and ALT were also increased. She received broad spectrum antibiotics, and a CT angiogram showed evidence of embolization of CA into the left lobe of the liver. On day 3 her level of consciousness declined and she was intubated for airway compromise. An MRCP confirmed the presence of CA within the left hepatic lobe with associated ischemia. The lactate increased to 20 mmol/L and the blood ammonia level to 700 mcg/dL, with MELD 45. Continuous hemodialysis was started for anuric renal failure. She underwent evaluation for liver transplantation, but cerebral edema and multiorgan failure with refractory acidosis occurred and she died on day 7. DISCUSSION: We present a case of GV treated with CA and the subsequent embolization of CA into the left lobe of the liver. This precipitated acute on chronic liver failure with features of fulminant hepatic failure (FHF) complicated by severe hyperammonemia, cerebral edema, multiorgan failure, and death. Although she had a recent diagnosis of COVID-19, the time course, relatively normal initial inflammatory markers, and imaging suggest that CA embolization was likely the injury that led to fulminant hepatic failure. Given the lack of case reports of CA embolization to the liver causing infarction and few cases to the brain or distant vessels, further research on its long-term safety is warranted. Another novel aspect to this case is the development of FHF in a patient with known cirrhosis.