RESUMEN
Aim: To study the various presentations and manifestations of complicated rhinosinusitis in COVID era- ranging from bacterial rhino sinusitis to invasive fungal rhino sinusitis. Methods: Design-A retrospective observational study was carried out from March 2020 to May 2021. Setting-Tertiary care hospital subjects—all COVID-positive patients who had paranasal sinus involvement. Methods-Patients were evaluated based on their symptomatology profile. Fungal stains and culture were carried out for all. They underwent Magnetic resonance Imaging and Computed Tomography scan on case-to-case basis, apart from routine nasal endoscopy. All were managed both medically and surgically depending upon their diagnosis. The natural course including outcomes, was studied, documented and analyzed. Results: Out of 496 patients presenting with sinonasal disease, 126 were COVID-positive, 16 patients had complicated rhino sinusitis, of which 4 patients had complicated rhinosinusitis with intraorbital, intracranial or combined complications. All patients were managed successfully with combined medical and surgical approach. Twelve patients had invasive mucormycosis with overall mortality rate of 37%. Conclusion: Complicated sinusitis was encountered in COVID-positive patients either when they were being actively treated for COVID-19 or as part of post-COVID sequalae. Though rhino-orbito-cerebral mucormycosis constituted the major disease burden in such patients but the possibility of bacterial rhino sinusitis with or without complications must also be kept in mind while evaluating such patients. We must remember every complicated rhinosinusitis in COVID-positive patient may not be mucor and manage appropriately. © 2023, The Author(s).
RESUMEN
Introduction: Research on Coronavirus Disease-2019 (COVID-19) seroprevalence in children and adolescent population across the globe is quite limited. In India, there is a dearth of data on COVID-19 seropositivity, especially in unvaccinated paediatric population, particularly in the Himalayan region. Aim: To estimate the seroprevalence of COVID-19 in children presenting in a tertiary care health institution. Materials and Methods: A hospital-based cross-sectional serosurvey was conducted on 500 children, from October 2021 to March 2022 in paediatric age group, attending Indira Gandhi Medical College Shimla, Himachal Pradesh, India, for various health related concerns such as fever, cough, loose stools, vomiting and fast breathing using convenience sampling. Socio-demographic profile was recorded and blood sample was drawn for COVID-19 antibody titre estimation. Chi-squared and Fisher's-exact tests for proportions was used for testing statistical significance. Results: A total of 500 children, age ranged from 12 hours to 17 years 7 months were enrolled with maximum children belonging to 01-05 years age group and there was slight male preponderance. Seropositivity in males (27.3%) was significantly higher than females (8.3%). Highest (42.3%) seropositivity was seen in age group of 06 months to 01 year. About 10.8% of cases were positive for Immunoglobulin (Ig) G antibody, 4.4% were positive for IgM antibody, while about 6.6% cases were positive for both antibodies. Conclusion: The seroprevalence status of children and adolescents is quite low in this region, revealing the high susceptibility of children to SARS-CoV-2 in the study region. It further emphasises benefits of serological testing in children for SARS-CoV-2 as well as the need of safe and effective vaccination for the unimmunised, unprotected and vulnerable paediatric age group.
RESUMEN
'Critical' career milestones for faculty (e.g., tenure, securing grant funding) relate to career advancement, job satisfaction, service/leadership, scholarship/research, clinical or teaching activities, professionalism, compensation, and work-life balance. However, barriers and challenges to these milestones encountered by junior faculty have been inadequately studied, particularly those affecting underrepresented minorities in science (URM-S). Additionally, little is known about how barriers and challenges to career milestones have changed during the COVID-19 pandemic for URM-S and non-URM faculty mentees in science. In this study, we conducted semi-structured interviews with 31 faculty mentees from four academic institutions (located in New Mexico, Arizona, Idaho, and Hawaii), including 22 URM-S (women or racial/ethnic). Respondents were given examples of 'critical' career milestones and were asked to identify and discuss barriers and challenges that they have encountered or expect to encounter while working toward achieving these milestones. We performed thematic descriptive analysis using NVivo software in an iterative, team-based process. Our preliminary analysis identified five key themes that illustrate barriers and challenges encountered: Job and career development, Discrimination and a lack of workplace diversity; Lack of interpersonal relationships and inadequate social support at the workplace; Personal and family matters; and Unique COVID-19-related issues. COVID-19 barriers and challenges were related to online curriculum creation and administration, interpersonal relationship development, inadequate training/service/conference opportunities, and disruptions in childcare and schooling. Although COVID-19 helped create new barriers and challenges for junior faculty mentees, traditional barriers and challenges for 'critical' career milestones continue to be reported among our respondents. URM-S respondents also identified discrimination and diversity-related barriers and challenges. Subsequent interviews will focus on 12-month and 24-month follow-ups and provide additional insight into the unique challenges and barriers to 'critical' career milestones that URM and non-URM faculty in science have encountered during the unique historical context of the COVID-19 pandemic.
RESUMEN
Lacking a federal policy to control the spread of COVID-19, state governors ordered lockdowns and mask mandates, at different times, generating a massive natural experiment. The authors exploit this natural experiment to address four issues: (1) Were lockdowns effective in reducing infections? (2) What were the costs to consumers? (3) Did lockdowns increase (signaling effect) or reduce (substitution effect) consumers' mask adoption? (4) Did governors' decisions depend on medical science or nonmedical drivers? Analyses via difference-in-differences and generalized synthetic control methods indicate that lockdowns causally reduced infections. Although lockdowns reduced infections by 480 per million consumers per day (equivalent to a reduction of 56%), they reduced customer satisfaction by 2.2%, consumer spending by 7.5%, and gross domestic product by 5.4% and significantly increased unemployment by 2% per average state by the end of the observation period. A counterfactual analysis shows that a nationwide lockdown on March 15, 2020, would have reduced total cases by 60%, whereas the absence of any state lockdowns would have resulted in five times more cases by April 30. The average cost of reducing the number of cases by one new infection was about $28,000 in lower gross domestic product.
RESUMEN
Objectives: Immune checkpoint blockade (ICB) has demonstrated efficacy in a small fraction of patients with platinum-resistant ovarian cancer (PROC), some with durable responses. The receptor tyrosine kinase AXL and its sole ligand, GAS6, are possible mediators of T cell exclusion and an attractive target due to the expected synergy between AXL inhibition and immune targeting agents. The recommended phase II dose (RP2D), safety, and efficacy of the combination of AXL inhibition via AVB-S6-500 with durvalumab (MEDI4736) were evaluated in patients with PROC. Methods: In this open-label Phase Ib open-label study, patients with PROC received AVB-S6-500 and durvalumab therapy in escalating dosing regimens guided by a Bayesian optimal interval (BOIN) design: durvalumab (1500 mg Q4W) and AVB-S6-500 (10mg/kg Q2W, 15mg/kg Q2W, 20mg/kg Q2W) with durvalumab infused prior to AVB-S6-500. The response was evaluated using modified RECIST v1.1. Pharmacokinetic/pharmacodynamic (PK/PD) studies were collected, and PD-L1 status and tumor/tumor microenvironment AXL and GAS6 staining pre and on-treatment were assessed. Results: Eleven patients with epithelial ovarian cancer (six clear cells [55%], four high-grade serous [36%], one endometrioid histology [1%]) received treatment per protocol. The median number of prior lines of therapy was 3 (range: 1-5);73% (8/11) of patients had received prior bevacizumab. There were no DLTs noted over the 6-week period and no grade ≥3 adverse events attributed to study drugs. Five patients experienced an immune-related AE, most commonly liver enzyme elevations (36%). Infusion reaction with AVB-S6- 500 was noted in the first two subjects, prompting the institution of a premedication regimen, after which only one of the nine additional patients experienced an infusion reaction. Dose delays greater than one week occurred in six (55%) patients;three patients experienced delays for cancer-related complications (small bowel obstruction, pneumonia, severe fatigue), while three patients experienced delays for non-medical causes (COVID/travel, weather). Patients received therapy for a median of two cycles (range: 1-6), and there were no responses noted across all dosing levels. One patient had stable disease, with a duration of response of three months. Only two patients had strong (2+) AXLstaining on pretreatment biopsy, both with high-grade serous histology. The majority of serum AXL levels were within previously demonstrated ranges (range: 5.6-112ng/mL), though two patients had comparatively high levels (102, 112ng/mL). PK/PD analysis revealed expected AVB-S6-500 levels at initial postdose (C1D1), but low levels at trough (C2D1 predose) when compared to prior AVB-S6-500 data [1]. Conclusions: The combination of AVB-S6-500 and durvalumab was tolerable in this PROC patient population at all dosing levels tested. Exploratory studies to correlate lack of response to AXL-GAS6 pathway alterations, tumor microenvironment, and clinical characteristics, such as prior treatment, dosing delays, burden of disease, and ascites, are ongoing.
RESUMEN
Personal Protective Equipment are protective gear designed to safeguard the health care workers by minimizing exposure to a biological agent. Personal protective equipment includes mask, gloves, face and eye protection (face shield, goggles), gowns and full body suits. Different types of masks are available for specific purposes. Masks are intended for protecting others from respiratory emissions of the wearer while respirator protects wearer from small particles like aerosols besides large droplets. Face shields provide a barrier for suddenly expelled aerosol of body fluids and are commonly used as an alternative to goggles. Isolation gowns may be adequate for medium risk while coveralls provide full protection. It is important to know and appropriately choose the gowns based on the fabric and reliability of manufacturer. All health care workers need to be taught the correct sequence of donning and doffing-PPE in order to avoid contamination. Though not ideal, the most effective methods of sterilizing and reusing N95 masks during scarcity may have to be adopted. Essential protective measures depend heavily on the location of patient contact, the role of the particular health care facility and the hazard vulnerability analysis. Hazards for the health care worker can be through air, surface, equipment and body secretions. Personal Protective Equipment reduces the risk of acquiring infection through any of these routes. This article deals with the selection of appropriate personal protective equipment for the health care workers managing suspected or proven COVID-19 infected persons.
RESUMEN
Rationale: Identification and control of environmental triggers is one of the cornerstones of asthma management. Access to homes, underscored during the COVID-19 pandemic, frequently limits mitigation efforts. We sought to determine the feasibility of telemedicine for identification of home asthma triggers. Methods: Patients age 5-18 years with persistent asthma, recent exacerbation, home Internet access, and stable residency were eligible. Families were randomized to standard of care (SOC) or telemedicine (TELE);virtual assessments were performed at 2, 4, and 6 months. Data included demographics and standardized assessment of the home environment. Results: Eighteen participants were enrolled (9 TELE, 9 SOC). There were no significant differences in baseline demographics between groups. Sensitization to pollens and dust mites was most common in both groups. Housing conditions were similar. In both groups, 89% lived in detached homes with forced air (standard filter) being the most common heating source (33%). Visible signs of pests/mold were seen in <12%. 89% use scented air fresheners/candles/potpourri. The SOC group had more pets (67% versus 33%) and smoking in the home (22% versus 11%). There was less evidence of mold in the TELE group (0 versus 22%). All SOC participants use bleach/ammonia cleaning products (78% in TELE). Thirteen participants (72%) completed at least one virtual home visit. No significant barriers were identified to telemedicine encounters. All participants reported “completely” or “very” satisfied with telemedicine visits. Conclusions: Virtual home assessments for identification of asthma triggers is a feasible alternative to in-person home visits, and it is well accepted by patients.
RESUMEN
INTRODUCTION AND OBJECTIVE: Continued vigilance of operative outcomes of COVID-19 patients is important given the relative novelty of the SARS-CoV-2 infection. We here sought to evaluate the 30-day mortality and cardiopulmonary adverse event rates in patients undergoing emergency surgery with perioperative COVID-19 infection, in comparison to a control group of medically managed COVID-19 patients that did not require surgical intervention. METHODS: A retrospective review of electronic medical data from a single tertiary-care center in Michigan was undertaken. Patients who had tested positive for SARS-CoV-2 infection either 7 days before or within 30 days after surgery during March-May 2020 were included in the study (n=52). Propensity score matched (1:6) patients who had been positive for SARS-CoV-2 infection during this time-period but did not undergo surgery were used as controls (n=314, Figure 1). The primary endpoint was 30-day mortality. Secondary endpoints included cardiac and pulmonary complications. Multivariable logistic regression analyses were utilized to account for baseline differences. A pvalue <0.05 was considered significant. RESULTS: The 30-day mortality (17.3% vs 13.1%, p=0.408) and cardiac (28.9% vs 19.1%, p=0.107) and pulmonary complication (55.8% vs 49.4%, p=0.392) rates were similar in patients in the surgical versus non-surgical group, respectively. Multivariable analyses confirmed that an emergency surgical intervention was not associated with increased odds for any of the studied adverse events (p >0.10 for all 3 endpoints). CONCLUSIONS: Patients undergoing emergency surgery with a co-diagnosis of SARS-CoV-2 infection in the perioperative period do not have an increased risk for short-term mortality or cardiopulmonary complications compared to the medically treated COVID-19 patients.
RESUMEN
Objectives: As appreciation for the role of adversity and trauma in the development of psychopathology has risen, so has the need to better understand resilience and how to enhance it. The goal of this session is to update attendees on new research in the area of resilience with an emphasis on the methods to increase it through interventions and education. Methods: New data from multiple study designs, settings, and ages will be presented. Samples used for this Symposium include: 1) high-risk newborns and toddlers, including a twin sample, many of whom were born into poverty and had histories of maltreatment and were followed prospectively;2) 39 classrooms of young children who received 0, 10, or 20 weeks of early childhood mental health consultation;3) a sample of 484 older adolescent college students who completed daily ratings of mental health and wellness prior to and during the COVID-19 pandemic using a smartphone app;and 4) another sample of 88 college students, some of whom were taught specific resilience skills in an undergraduate class. Results: Prospective data from the high-risk samples of newborns and toddlers reveal more favorable long-term outcomes for those at risk than are often assumed. Classroom mental health consultation was found to improve the classroom climate in young children, especially with longer intervention periods. For college students, those taught resilience skills showed improved coping skills, decreased stress, and a reduction in dysfunctional attitudes. In another college sample, specific personality traits, some of which had not been previously associated with resilience, were found to buffer against the negative impact of the COVID-19 pandemic. Conclusions: These presentations reveal a more hopeful picture for those who have experienced trauma and adversity than is sometimes assumed in discussions of toxic stress. Further, specific resilience-focused interventions can be successful at both the individual and group levels and across different ages. Data also suggest that some resilience factors should not be considered universal and may instead vary based upon the particular characteristics of the stressor itself. PRE, WL, SC
RESUMEN
Objectives: This presentation aims to detail how mental health practitioners are utilizing TikTok to provide psychoeducation and how their participation has grown during the COVID-19 pandemic. Methods: Ashvin Sood, MD, will present on data (age, daily use of SMP, interests, and gender) collected from January 1, 2018 to February 1, 2021 from App Ape and Hootsuite/We Are Social to examine adolescent TikTok use. He will examine trends among other social medial platforms compared to TikTok. Afterwards, he will present 4 therapist TikTok profiles to illustrate their growth in following narrative messages they portray during the COVID-19 pandemic to children and teens. Results: TikTok has over 1 billion users worldwide, with 69% of users between the ages of 10 and 19 years. Twenty-nine percent of US teens have marketed TikTok as their favorite social media platform. The 4 therapists that will be examined have between 134,700 and 932,000 followers, with increased subscription to a therapist’s TikTok occurring during the pandemic. Video content from therapists include coping techniques, understanding anxiety and depression, and how to seek mental health treatment. Conclusions: The presentation will highlight how prevalent TikTok has become among the child and adolescent populations around the world. Mental health providers can offer psychoeducation through social media platforms, which is an opportunity to reach child and adolescent populations on a global scale. MED, ADOL, COMP
RESUMEN
Background: Kawasaki disease (KD) is a common childhood vasculitis. Recent studies have shown an increase in proportions of children diagnosed with incomplete KD. Methods: Case records of 16 children with KD, registered from July 2019 to December 2020 in the department of pediatrics, Indira Gandhi Medical College, Shimla, India, were reviewed. Four children who had Kawasaki-like disease associated with Coronavirus disease 2019 were excluded from the study. Results: Sixteen children (11 boys, 5 girls;mean age 4.5 years) had KD. Eight (50%) children had incomplete KD. Fever (100%), oral changes (81.2%), rash (69%), desquamation (62.55), conjunctival injection (56.2%) and arthritis (31.2%) were common clinical features. Laboratory investigations showed neutrophilic leucocytosis (10/16), thrombocytosis (10/16), elevated erythrocyte sedimentation rate (12/16) and C-reactive protein (13/16). Six (37.5%) children had cardiac abnormalities. Three children had coronary artery aneurysms. Two children had pericardial effusion and 1 child had myocardial dysfunction. 14/16 children received intravenous immunoglobulin (IVIG). Two children received methylprednisolone pulse (30 mg/kg) followed by tapering dosages of prednisolone and 1 child was given injection infliximab (5 mg/kg), in addition to IVIG. Discussion: Fifty percent children in our cohort had incomplete KD and few children had atypical presentation. One child with KD had concomitant chicken pox. Another child had overlap of KD with HSP and 3 rd child developed insulin dependent diabetes mellitus (IDDM) 1 month after having KD. Five children in our cohort had arthritis. As compared to previous study from our centre, we found that KD is the most common childhood vasculitis at our centre with apparent increase in its occurrence and increase in the proportion of children with incomplete and atypical KD over the time. Conclusion: KD is the most common childhood vasculitis in our centre and apparent increase in its occurrence may be due to increased awareness and diagnosis of incomplete/atypical KD.
RESUMEN
Since the advent of Covid-19, the increase in working from home, online education and entertainment via online platforms has ramped up the number of Internet users worldwide. According to Forbes, Internet hits surged by 50-70%.1 This phase shift caught the eye of adversaries, causing increased numbers of targeted and broad-based attacks such as phishing, malware distribution and online fear-mongering in order to conduct scams and fraudulent operations. For example, more than 240 million Covid-19 related daily spam messages were mapped and Google blocked 18 million daily malware and phishing-related emails during April 2020.2 That shows how severely adversaries are exploiting the Covid-19 situation for online fraud. © 2021 Elsevier Ltd