Strategies for the Emergency Treatment of Pregnant Women with Neurological Symptoms during the COVID-19 Pandemic.

Coronavirus disease-19 (COVID-19) has been spreading all over the world for more than two years. Though several kinds of vaccines are currently available, emergence of new variants, spike mutations and immune escape have raised new challenges. Pregnant women are vulnerable to respiratory infections due to their altered immune defence and surveillance functions. Besides, whether pregnant persons should receive a COVID-19 vaccine is still under debate because limited data are available on the efficacy and safety of receiving a vaccine during pregnancy. Physiological features and lack of effective protection making pregnant women at high risk of getting infected. Another concern is that pregnancy may trigger the onset of underlying existing neurological disease, which is highly similar to those neurological symptoms of pregnant women caused by COVID-19. These similarities interfere with diagnosis and delay timely and effective management. Therefore, providing efficient emergency support for pregnant women suffering from neurological symptoms caused by COVID-19 remains a challenge among neurologists and obstetricians. To improve the diagnosis and treatment efficiency of pregnant women with neurological symptoms, we propose an emergency management framework based on the clinicians' experience and available resources. This emergency care system aimed at addressing the conundrums faced by the emergency guarantee system under COVID-19 pandemic and could serve as a potential multisystem project for clinical practice and medical education.

Constructing a diversified online neurology teaching model under the COVID-19.

Purpose: To construct a diversified and comprehensive network teaching model to provide highly qualified medical teaching in neurology under COVID-19 pandemic. Materials and methods: Published studies on medical education were systematically reviewed and summarized. Based on previous studies and our experience, we constructed a novel online neurology teaching model and applied it to real scene. Students taking traditional in class lessons and online lessons were asked to finish the test, respectively, to compare the efficiency of learning. Questionnaires were designed and assigned to get the feedback from students. Results: The average test score of students who take online class (84.27 ± 4.64) was significantly higher than those who take in class lessons (82.08 ± 6.17) (P < 0.01). According to the feedbacks from students, online classes were more attractive to students than the conventional one. Conclusion: Traditional single-mode teaching can no longer meet the needs of current medical education, especially under the rampant epidemic. This novel teaching mode, which orchestrates high-tech tools, diverse teaching methods and traditional teaching concepts, provides the solution to the challenge faced by traditional medical education. We believe that this novel online teaching mode will boost neurology education and inspire educators in other fields during this tough period.

Constructing a diversified online neurology teaching model under the COVID-19

Purpose To construct a diversified and comprehensive network teaching model to provide highly qualified medical teaching in neurology under COVID-19 pandemic. Materials and methods Published studies on medical education were systematically reviewed and summarized. Based on previous studies and our experience, we constructed a novel online neurology teaching model and applied it to real scene. Students taking traditional in class lessons and online lessons were asked to finish the test, respectively, to compare the efficiency of learning. Questionnaires were designed and assigned to get the feedback from students. Results The average test score of students who take online class (84.27 ± 4.64) was significantly higher than those who take in class lessons (82.08 ± 6.17) (P < 0.01). According to the feedbacks from students, online classes were more attractive to students than the conventional one. Conclusion Traditional single-mode teaching can no longer meet the needs of current medical education, especially under the rampant epidemic. This novel teaching mode, which orchestrates high-tech tools, diverse teaching methods and traditional teaching concepts, provides the solution to the challenge faced by traditional medical education. We believe that this novel online teaching mode will boost neurology education and inspire educators in other fields during this tough period.

Knowledge, Anxiety, Depression, and Sleep Quality Among Medical Staff in Central South Areas of China During the Break of COVID-19: Does the Level of Hospitals Make a Difference?

Purpose: To evaluate the knowledge, anxiety, depression, and sleep quality toward COVID-19 among Chinese medical staff from tertiary and basic-level hospitals in central south areas of China. Method: A structured questionnaire was composed of Demographic and clinical characteristics of medical staff, Knowledge toward COVID-19 including epidemiology and clinical manifestations, The Self-rating anxiety scale (SAS), Center for Epidemiologic Studies Depression Scale (CES-D), and The Pittsburgh Sleep Quality Index (PSQI). It was administered to medical staff from tertiary hospitals (Group A) (n = 407) and basic-level hospitals (Group B) (n = 388) during February 2020 and May 2020. Results: Medical staff in group A had a stronger knowledge toward COVID-19 than group B (23.69 ± 5.83 & 18.15 ± 6.35, p < 0.001). Mild anxiety symptoms were found in both groups. The SAS scores (Mean ± SD) of group B were 58.87 ± 10.17, which was significantly higher than that of group A (52.59 ± 12.09, p < 0.001). There were no significant differences in CES-D scores between the two groups (p = 0.981). The mean score of total PSQI in group B (8.41 ± 3.03) was statistically higher than that of group A (7.31 ± 3.74, p < 0.001). Additionally, the scores of sub-components of group B, including subjective sleep quality, sleep latency, sleep disorder, sleeping medication use and daytime dysfunction, were significantly higher compared to Group A (p < 0.05). Conclusions: Our study showed greater anxiety, more severe depression and poorer sleep quality among medical staff in central south areas of China during the COVID-19 outbreak. Additionally, compared to the tertiary hospital group, medical staff from basic-level hospitals had poorer knowledge toward COVID-19 and worse mental health conditions. In addition, residence, specialty, title and education level may also be factors of knowledge of COVID-19 and psychiatry problems. In light of this information, more attention should be paid to early identification and intervention of symptoms of anxiety and depression in susceptible medical staff from the basic-level hospitals.

To Be or Not To Be Vaccinated: That Is a Question in Myasthenia Gravis.

Myasthenia gravis (MG) is an autoimmune disease characterized by muscle weakness and abnormal fatigability due to the antibodies against postsynaptic receptors. Despite the individual discrepancy, patients with MG share common muscle weakness, autoimmune dysfunction, and immunosuppressive treatment, which predispose them to infections that can trigger or exacerbate MG. Vaccination, as a mainstay of prophylaxis, is a major management strategy. However, the past years have seen growth in vaccine hesitancy, owing to safety and efficacy concerns. Ironically, vaccines, serving as an essential and effective means of defense, may induce similar immune cross-reactivity to what they are meant to prevent. Herein, we outline the progress in vaccination, review the current status, and postulate the clinical association among MG, vaccination, and immunosuppression. We also address safety and efficacy concerns of vaccination in MG, in relation to COVID-19. Since only a handful of studies have reported vaccination in individuals with MG, we further review the current clinical studies and guidelines in rheumatic diseases. Overall, our reviews offer a reference to guide future vaccine clinical decision-making and improve the management of MG patients.

Knowledge, Attitudes, and Social Responsiveness Toward Corona Virus Disease 2019 (COVID-19) Among Chinese Medical Students-Thoughts on Medical Education.

Purpose: To assess knowledge, attitudes, and social responsiveness toward COVID-19 among Chinese medical students. Methods: Self-administered questionnaires were used to collect data from 889 medical students in three well-known Chinese medical universities. The questionnaire was comprised of three domains which consisted of demographic characteristic collection, seven items for knowledge, and eight items for attitudes and social responsiveness toward COVID-19. Data from different universities were lumped together and were divided into different groups to compare the differences, including (1) students at the clinical learning stage (Group A) or those at the basic-medicine stage (Group B) and (2) students who have graduated and worked (Group C) or those newly enrolled (Group D). Results: Medical students at group B had a weaker knowledge toward COVID-19 than did students at group A, especially in the question of clinical manifestations (p < 0.001). The percentage of totally correct answers of COVID-19 knowledge in group C was higher than that in Group D (p < 0.001). There were significant differences between groups C and D in the attitudes and social responsiveness toward COVID-19. Surprisingly, we found that the idea of newly enrolled medical students could be easily affected by interventions. Conclusions: In light of this information, medical education should pay attention not only to the cultivation of professional knowledge and clinical skills but also to the positive interventions to better the comprehensive qualities including communicative abilities and empathy.

Knowledge, attitudes and anxiety toward COVID-19 among domestic and overseas Chinese college students.

BACKGROUND: To investigate the knowledge, attitudes and anxiety toward COVID-19 among Chinese college students studying in China and abroad. METHOD: A structured questionnaire, comprised of demographic characteristics, knowledge and attitudes toward COVID-19 and the State-Trait Anxiety Inventory (STAI), was used to collect data for 566 domestic students and 126 students studying abroad. RESULTS: Domestic students were better than students abroad in knowledge of epidemiology and manifestations. Domestic students showed a significant higher enthusiasm for voluntary services than students abroad, including medical science popularization, community services, traffic dispersion, logistics transportation and being volunteers for vaccine trials. The scores (Mean ± SD) of S-AI and T-AI among students abroad were 59.48 ± 8.63 and 54.10 ± 7.20, respectively, which were significantly higher than those of domestic students (39.46 ± 8.16 and 39.25 ± 7.72). CONCLUSIONS: Our study showed a better understanding of knowledge, more positive attitudes and less anxiety toward COVID-19 among domestic students, compared with students studying abroad. In light of this information, more attention and appropriate psychological and social intervention should be paid to college students with anxiety, especially those studying abroad.

Difficulties and Countermeasures in Hospital Emergency Management for Fast-Lane Treatment of Acute Stroke During the COVID-19 Epidemic Prevention and Control.

Background: Coronavirus disease 2019 (COVID-19) has a long incubation period and a high degree of infectivity. Patients may not show specific signs or symptoms of upper respiratory tract infection, and the age of onset is similar to that of stroke. Furthermore, an increase in neurological conditions, specifically acute cerebrovascular disease, has been detected. Providing emergency treatment for acute stroke in accordance with the strict epidemic control measures is currently one of the main challenges, as acute stroke is rapid onset and a major cause of death and disability globally. We aimed to evaluate the emergency treatment system for acute stroke during the epidemic control period to provide a reference and basis for informing government and medical institutions on improving patient treatment rates during this period. Methods: Difficulties faced in providing emergency treatment for stroke during an epidemic were investigated and combined with medical educational resources and clinical management experiences to construct an emergency treatment framework for acute stroke during the epidemic. Findings: Currently, emergency treatment measures for acute stroke during the epidemic control period are limited because the main focus is on identifying COVID-19 comorbidities during the critical period. Establishing standards for patients in the neurological outpatient consultation rooms and emergency observation and resuscitation zones; implementing a fast-lane system for the emergency treatment of patients with acute stroke, and strengthening ward management and medicine popularization, can improve the treatment efficiency for stroke patients during the epidemic and provide a reference for peers in clinical practice. Interpretation: Emergency treatment for acute stroke during COVID-19 epidemic control period requires a joint promotion of clinical, popularization, and teaching resources.

Differential Diagnosis and Hospital Emergency Management for Fastlane Treatment of Central Nervous System Infection Under the COVID-19 Epidemic in Changsha, China.

Importance: Corona virus disease 2019 (COVID-19) has long latent period, strong infectivity, and non-specific symptoms and signs in the upper respiratory tract. Some initial neurological symptoms appear, including dizziness, headache, seizures, slurred speech, disturbance of consciousness, and limb paralysis among a few COVID-19 patients, which share similar manifestations with central nervous system (CNS) infection. Improving the diagnostic efficiency of suspected CNS infection patients on the basis of preventing and controlling COVID-19 plays a key role in preventing nosocomial and cross infections. This study intends to formulate a hospital emergency management system of fastlane treatment of CNS infection for epidemic prevention and control, aiming at providing references and guidelines for the government and medical institutions to improve the efficiency of treating CNS infection patients in the clinical practice during COVID-19. Observations: This study formulated a framework of a fastlane treatment of CNS infection based on the cooperation of resources and experience, aiming at the key and difficult problems faced by the hospital emergency management system during the COVID-19 outbreak in Changsha, China. The main problem of formulating the hospital emergency management system is efficiently identifying whether CNS infection was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The framework improves the efficiency of diagnosing and treating CNS infections by standardizing the diagnosis and treatment process of patients in emergency observation and strengthening the management of inpatient wards, aiming at assisting medical staff during clinical practice. Conclusions and Relevance: The hospital emergency management system of a fastlane treatment of CNS infection for epidemic prevention and control of the COVID-19 outbreak is a professional and multisystem project, which needs the cooperation of various resources and the experience of clinical leadership.