Showing papers in "Irish Journal of Medical Science in 2021"

Exploring the adoption of telemedicine and virtual software for care of outpatients during and after COVID-19 pandemic.

Abstract: As the novel coronavirus disease 2019 (COVID-19) continues to spread across countries, the need for innovative measures to provide high-quality patient care and manage its spread has become more imperative. Software-based systems such as medical software applications could provide valuable suggestion on health-related information to physicians towards improving quality of life, especially for outpatients (e.g., elderly, immunosuppressed, pregnant women). The use of telemedicine and virtual software offers promising potential in the fight against COVID-19. Accordingly, by means of expedited literature and document review, this paper provides implication on the opportunities, application, and challenges of telemedicine and existing virtual software currently adopted as suitable initiatives for reducing the spread of COVID-19. More importantly, findings present factors that impact adoption of telemedicine. The findings suggest that telemedicine and virtual software are capable of decreasing emergency room visits, safeguarding healthcare resources, and lessening the spread of COVID-19 by remotely treating patients during and after the COVID-19 pandemic.

A national survey of attitudes to COVID-19 digital contact tracing in the Republic of Ireland.

Abstract: Contact tracing remains a critical part of controlling COVID-19 spread. Many countries have developed novel software applications (Apps) in an effort to augment traditional contact tracing methods. Conduct a national survey of the Irish population to examine barriers and levers to the use of a contact tracing App. Adult participants were invited to respond via an online survey weblink sent via e-mail and messaging Apps and posted on our university website and on popular social media platforms, prior to launch of the national App solution. A total of 8088 responses were received, with all 26 counties of the Republic of Ireland represented. Fifty-four percent of respondents said they would definitely download a contact-tracing App, while 30% said they would probably download a contact tracing App. Ninety-five percent of respondents identified at least one reason for them to download such an App, with the most common reasons being the potential for the App to help family members and friends and a sense of responsibility to the wider community. Fifty-nine percent identified at least one reason not to download the App, with the most common reasons being fear that technology companies or the government might use the App technology for greater surveillance after the pandemic. The Irish citizens surveyed expressed high levels of willingness to download a public health–backed App to augment contact tracing. Concerns raised regarding privacy and data security will be critical if the App is to achieve the large-scale adoption and ongoing use required for its effective operation.

Sports activities during any pandemic lockdown.

Abstract: The coronavirus disease 2019 (COVID-19) pandemic forced the world’s population to alter daily routines, including exercise habits. This unusual situation has physical, psychological, and behavioral consequences to all individuals, including elite and recreational athletes. Life in lockdown has been difficult because everyone has to stay safe and healthy, while at the same time abiding by new norms. Currently, mitigation strategies have been widely implemented to contain the spread of COVID-19. These measures include lockdown, social distancing, personal protective measures, and environmental and surface cleaning [1]. Furthermore, the practice of physically active lifestyles is recommended to counteract health and mental consequences of the COVID-19 pandemic [2]. While sedentary behavior certainly has no effect on the immunity, exercising in moderation is associated with improved immune competency and a reduced risk of illness. Overtraining and high-intensity exercise induce transient immune dysfunction and are associated with a greater risk of illness, including upper respiratory tract infections, but this may not apply to elite sportsmen [3, 4]. Post-exercise immune depression, especially after a strenuous training, may be explained by an impaired cell-mediated immunity [5]. Various modalities, such as soccer, football, and triathlons, are considered high-intensity sports. Consequently, these activities lead to an open window of susceptibility to infection [6]. The introduction of the new routines in the context of COVID-19 will allow certain outdoor exercises, which facilitate SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) transmission due to increased ventilation rates during exercise and possible mass gathering at sporting venues, stadiums, jogging tracks, parks, or any recreational areas. Currently, there are no solid guidelines regarding the use of face masks for outdoor exercises during the COVID-19 pandemic. We advise people to wear face masks during low to moderate-intensity exercises outside such as brisk walking and jogging, while maintaining a safe physical distance (2 m away) and personal hygiene in public. However, the use of face masks may compromise breathing and oxygen uptake in high-intensity, which are not recommended during these times. With the resumption of normal life during COVID-19 taking effect immediately, guidelines for outdoor exercise, recreational activities, and returning to competitive sports must be enacted with caution. To help delay and mitigate COVID-19 spread, staying at home is still encouraged and the Centers for Disease Control and Prevention (CDC) recommends daily physical activity for both children (60 min/day) and adults (30 min/day). Each sport and activity is categorized by risk, but the general classification is (1) low risk: exercise at home, alone or with shared household members, with owned and sanitized equipment; (2) medium risk: exercise at public, alone or with shared household members no more than 5 people, with own and sanitized equipment; and (3) group exercise with non-household members in private or public, not physically distant, with shared equipment [7]. The risk of opportunistic infection is more likely to be influenced by the pre-exercise physical, nutritional, and psychological well-being. It is known that regular and frequent exercise enhances rather than suppresses the immune response in individuals of all ages, and thus protects them from infections [8]. In addition to exercise, appropriate immunenutritional support as well as proper management of psychological stress and sleep hygiene can reduce infection risk [5, 9]. Adoption of a proper diet and physical activity will event u a l l y b o o s t i mmun i t y ( immun e a c t i v a t i o n , immunosenescence, and vaccination efficacy) and metabolic systems (obesity, diabetes, and metabolic syndrome) [10]. During the self-isolation period, the majority of people grew accustomed to a sedentary lifestyle with less physical activity, fewer daily step counts, and rarely exercise, while athletes and certain people train individually to keep themselves fit and healthy [11]. Returning to normal exercise and * Michael Anthonius Lim lim.michael.a@gmail.com

Atypical presentation of COVID-19 in hospitalised older adults.

Abstract: It is increasingly recognised that older patients may not present with typical symptoms of COVID-19. This study aims to evaluate the incidence, characteristics and clinical outcome of older adults with atypical presentations of COVID-19. A retrospective analysis of adults ≥ 65 years with confirmed COVID-19 admitted to our institution between 1 March and 24 April 2020 was performed. Patients were categorised into typical or atypical groups based on primary presenting complaint in the community. One hundred twenty-two patients (mean age 81 ± 8 years; 62 male) were included. Seventy-three (60%) were categorised into the typical group and 49 (40%) into the atypical group. In the atypical group, common presenting complaints were fall in 18 (36%), reduced mobility or generalised weakness in 18 (36%) and delirium in 11 (22%). Further assessment by paramedics and on admission found 32 (65%) to have typical features of COVID-19, fever being the most common, and 22 (44%) were hypoxic. This subset had worse outcomes than those in the typical group with a mortality rate of 50% versus 38%, respectively, although this was not statistically significant (P = 0.27). No significant difference in mortality or length of hospital stay between the groups was demonstrated. Older patients with atypical presentation of COVID-19 in the community are equally susceptible to poor outcomes. Early detection may improve outcomes and limit community transmission. Primary care practitioners should be vigilant and consider prompt onward referral.

An integrated multidisciplinary model of COVID-19 recovery care.

Abstract: In January 2020, the WHO declared the SARS-CoV-2 outbreak a public health emergency; by March 11, a pandemic was declared. To date in Ireland, over 3300 patients have been admitted to acute hospitals as a result of infection with COVID-19. This article aims to describe the establishment of a COVID Recovery Service, a multidisciplinary service for comprehensive follow-up of patients with a hospital diagnosis of COVID-19 pneumonia. A hybrid model of virtual and in-person clinics was established, supported by a multidisciplinary team consisting of respiratory, critical care, infectious diseases, psychiatry, and psychology services. This model identifies patients who need enhanced follow-up following COVID-19 pneumonia and aims to support patients with complications of COVID-19 and those who require integrated community care. We describe a post-COVID-19 service structure together with detailed protocols for multidisciplinary follow-up. One hundred seventy-four patients were discharged from Beaumont Hospital after COVID-19 pneumonia. Sixty-seven percent were male with a median age (IQR) of 66.5 (51–97). Twenty-two percent were admitted to the ICU for mechanical ventilation, 11% had non-invasive ventilation or high flow oxygen, and 67% did not have specialist respiratory support. Early data suggests that 48% of these patients will require medium to long-term specialist follow-up. We demonstrate the implementation of an integrated multidisciplinary approach to patients with COVID-19, identifying those with increased physical and mental healthcare needs. Our initial experience suggests that significant physical, psychological, and cognitive impairments may persist despite clinical resolution of the infection.

Psychological factors affecting COVID-19 vaccine hesitancy.

Abstract: Vaccine hesitancy is an important public health problem. Identifying and understanding COVID-19 vaccine hesitancy may aid future public health messaging. This study, in which we planned to study the determinants of COVID-19 vaccine hesitancy, aims to reveal the relationship between “intolerance of uncertainty,” “belief in conspiracy theories,” and “COVID-19 phobia” with vaccine hesitancy. This is a cross-sectional study conducted during a COVID-19 outbreak. Participants were reached via various social media platforms and e-mailing lists for convenience. Data were collected with an online survey using SurveyMonkey application. “Intolerance of Uncertainty Scale (IUS-12),” “Conspiracy Mentality Scale (CMS),” and “COVID-19 Phobia Scale” were applied to 488 participants. Statistical significance level was considered p < 0.05. Four hundred eighty-eight people between the ages of 18 and 65 participated. Twenty-one participants were excluded from the analysis due to random marking and unreasonable filling times (< 10 min). In this way, analyzes were made with 467 people. We found a positive correlation between the belief in conspiracy theories and vaccine hesitancy (p < 0.05). And also found that individuals with low fear of COVID-19 would hesitate about vaccination (p < 0.05). Vaccine hesitancy is an important public health problem, and it puts public health at risk, especially during the epidemic period we live in. Therefore, it is important to understand the psychological factors involved in vaccine hesitancy. It would be useful to look for ways to spread accurate information about the vaccine in a healthier way in this case.

Cellular immunotherapies for cancer

Abstract: Cancer is a major burden on the healthcare system, and new therapies are needed. Recently, the development of immunotherapies, which aim to boost or use the immune system, or its constituents, as a tool to fight malignant cells, has provided a major new tool in the arsenal of clinicians and has revolutionized the treatment of many cancers.Cellular immunotherapies are based on the administration of living cells to patients and have developed hugely, especially since 2010 when Sipuleucel-T (Provenge), a DC vaccine, was the first cellular immunotherapy to be approved by the FDA. The ensuing years have seen two further cellular immunotherapies gain FDA approval: tisagenlecleucel (Kymriah) and axicabtagene ciloleucel (Yescarta).This review will give an overview of the principles of immunotherapies before focusing on the major forms of cellular immunotherapies individually, T cell-based, natural killer (NK) cell-based and dendritic cell (DC)-based, as well as detailing some of the clinical trials relevant to each therapy.

Remdesivir versus ritonavir/lopinavir in COVID-19 patients.

Abstract: To the Editor: The new coronavirus SARS-CoV-2 is responsible for the current global pandemic COVID-19. To date, data indicate 1.11 million deaths. [1] Several vaccines and monoclonal antibodies to SARS-CoV-2 are in clinical trials. In themeantime, several studies have been conducted to test the risk factors COVID-19 and drugs with antiviral efficacy against SARSCoV-2. [2] The trials have attributed some efficacy to the antivirals Remdesivir and Ritonavir/lopinavir. However, recent literature evidence shows some differences between the two antiviral treatments. Remdesivir is a drug of the nucleotide analogues family, with antiviral activity against several RNA viruses, and is considered a potential antiviral agent against SARS-CoV-2. Lopinavir is an inhibitor of HIV-1 protease, which is in combination with ritonavir to increase its plasma half-life time. Lopinavir is associated with an in vitro inhibitory activity against SARS-CoV and SARS-CoV-2. [3] In these months, several epidemiological studies have been carried out to evaluate the antiviral efficacy of the above mentioned drugs. Recent evidence associates Remdesivir’s significant clinical improvements in COVID-19 positive patients hospitalized, leading to a reduction in mortality and a decrease in recovery time. [4] Recent evidence suggests that Ritonavir/ lopinavir is not an effective treatment for severe and hospitalized COVID-19 patients, excluding any benefit on the probability of mortality fromCOVID-19 and length of hospital stay, highlighting discrepancies between reported in vitro and in vivo results. Probably further studies are necessary to understand the most effective dose, also considering the safety profile of the drug, in the treatment of COVID-19 viral infection. However, the existing EBM shows that today the drug with the most effective antiviral SARS-CoV-2 and improving clinical parameters is Remdesivir. However, we believe that further epidemiological studies are needed to clarify the optimal dose to be used in severe COVID-19 patients, and possible dose modifications to be made to avoid drug-drug interaction, and drug-pathology, considering that the COVID-19 patient is a complex patient. [5] Epidemiological studies associate Remdesivir with the gold standard of SARS-CoV-2 antiviral therapy, demonstrating some efficacy, and with Ritonavir/lopinavir association, there are no results of SARS-CoV-2 antiviral efficacy. However, further studies are needed to provide further data on these COVID-19 treatments.

Clinical presentations of pain in patients with COVID-19 infection

Abstract: Pain can be considered an early sign of COVID-19 infection. There are no studies that specifically investigate the frequency, characteristics, and presentation patterns of pain in COVID-19 infection. Our aim is to evaluate the frequency, localization, and severity of pain among the presenting signs and symptoms in patients with COVID-19. Patients with the diagnosis of COVID-19 who were admitted to our hospital between March and June 2020 were retrospectively analyzed. Patients’ general symptoms at the first admission to the hospital, presence of pain at admission, localization, severity, and persistence of pain were queried by phone call. A total of 210 inpatients diagnosed with COVID-19 were recruited from the hospitals database. Complaints of the patients were 76.6% fatigue, 69.3% pain, 62% fever, 45.3% cough, 43.5% loss of taste and/or smell, 25% diarrhea, and 0.5% skin lesions respectively. Pain was the chief complaint in of 46.61% of the patients. Pain complaints had started on average 2.2 (± 2.8) days before admission. Among 133 patients reporting pain, the distribution of site was 92 (69.2%) myalgia/arthralgia; 67 (50.4%) headache; 58 (43.6%) back pain; 44 (33.1%) low back pain; 33 (25.0%) chest pain; 28 (21.1%) sore throat; and 18 (13.6%) abdominal pain. The most common pain symptoms were myalgia/arthralgia and headache (69.17% and 50.37%) and found to be much higher than previously reported. Pain is one of the most common complaints of admission to the hospital in patients with COVID-19. Patients who apply to health institutions with pain complaints should be evaluated and questioned in suspicion of COVID-19 infection.

Early use of high-dose vitamin C is beneficial in treatment of sepsis

Abstract: Vitamin C has shown benefits in patients with sepsis in addition to standard therapy recently. However, further evidence is required to verify the efficacy of vitamin C in clinical practice. This study aimed to investigate the effect of adjunctive intravenous high-dose vitamin C treatment on hospital mortality in patients with sepsis. One hundred seventeen patients with sepsis in our department from June 2017 to May 2019 were randomly divided into two groups: the control group (56 cases) and the vitamin C group (61 cases). The control group was treated by the routine and basic therapy with intravenous drip of 5% dextrose and placebo (100 ml/time, 2 times/day), while the vitamin C group was administered intravenously by 3.0 g vitamin C dissolved into 5% dextrose (100 ml/time, 2 times/day) based on the control group. The mortality and efficacy were statistically analyzed and compared between the two groups. The 28-day mortality differed significantly between the control group and the vitamin C group (42.97% vs. 27.93%) (p < 0.05). The changes in the sepsis-related organ failure assessment (ΔSOFA) scores at 72 h after ICU admission (4.2 vs. 2.1), the application time of vasoactive drugs (25.6 vs. 43.8), and the procalcitonin clearance (79.6% vs. 61.3%) differed significantly between groups (p < 0.05). The early treatment of sepsis with intravenous high-dose vitamin C in combination with standard therapy showed a beneficial effect on sepsis, in terms of the reduced 28-day mortality, the decreased SOFA score, and the increased clearance rate of procalcitonin.

An analysis of YouTube videos as educational resources for dental practitioners to prevent the spread of COVID-19.

Abstract: Coronavirus disease (COVID-19) was first reported on 31 December 2019 and has rapidly been spreading day by day. Dental patients and professionals have a high risk of the coronavirus infection and also have a huge responsibility to prevent its spread during emergency dental treatment over the period of the COVID-19 outbreak. Informing patients and dental practitioners about the novel coronavirus in an accurate and effective way is very important. Therefore, this study aimed to evaluate the quality of dentistry-related medical information about COVID-19 on YouTube as educational resources for dental practitioners. YouTube was queried for the search phrases ‘COVID-19 and dental practice’, ‘SARS-Cov-2 and dental practice’ and ‘2019-COV-2 and dental practice’. The first 100 videos for each term were viewed and analysed by 3 independent investigators. The scope was limited to videos in English. The search phrases yielded 1102 videos, among which 802 videos were excluded and 300 videos screened. Fifty-five videos were included in the final analysis. Of the 55 videos, only 2 videos (3.6%) were found to be of good quality, while 24 videos (43.6%) were found to be of poor quality. YouTube is a popular video broadcast site and can provide both relevant educational information and the spreading of misinformation. Health professionals should play a more active role with regard to educative information given on social media, especially YouTube, during global disease outbreaks.

Remdesivir and COVID-19.

Abstract: To the editor: The coronavirus SARS-CoV-2, first identified in November 2019 in China, is responsible for severe acute respiratory syndrome, the cause of the global pandemic COVID-19. To date, the global pandemic COVID-19 has caused about 1.04 million deaths and is currently ongoing [1, 2]. Several vaccines have entered phase 3 clinical trials. While waiting for effective vaccines, several antiviral drug treatments have been evaluated to treat the COVID-19 patient. To date, the data from epidemiological studies are not yet completely clear. Recent evidence associates some antiviral efficacy against SARS-CoV-2 with remdesivir [3]. Remdesivir is an antiviral drug of the nucleotide analogues family, which has been shown to have antiviral activity directed against several RNA viruses, such as Ebola virus, and coronaviruses responsible for MERS and SARS. It is currently considered a potential antiviral agent against SARS-CoV2; in fact, in vitro studies have shown some activity to inhibit SARS-CoV-2. Several epidemiological studies are underway to evaluate the clinical antiviral SARS-CoV-2 efficacy of remdesivir. Recent evidence associates remdesivir with continuous and clinically significant improvements in COVID-19positive patients, leading to a reduction in mortality and a decrease in recovery time [4]. While demonstrating some efficacy against SARS-CoV-2, the therapeutic treatment with remdesivir in COVID-19 patients requires additional data. Specifically, in the COVID-19 patient, remdesivir can be administered in combination with other drugs, increasing the risk of potential drug interactions. In fact, remdesivir is a substrate of enzymes such as CYP 3A4, CYP 2D6, and CYP 2C8 involved in the metabolism of several drugs used in the COVID-19 patient, and the potential co-administration of inhibitors may lead to a potential increase in its levels [5]. However, we believe that further aspects need to be considered and clarified, in particular the development of resistance to remdesivir by SARS-CoV-2. In addition, the severe COVID-19 patient may have extra pulmonary lesions, including liver, kidney, or cardiac lesions with development of arrhythmias [6–8]. A liver or kidney damaged by multisystem inflammation [9] caused by COVID-19 may require a modified and appropriate dose of remdesivir. Furthermore, the postmarketing data of remdesivir on the possible risk of longQT is unclear, and in a severe COVID-19 patient with cardiac lesions arrhythmias may be present, increasing the risk of cardiotoxicity. Epidemiological studies associate remdesivir with an efficacy against SARS-CoV-2, probably higher than other antivirals on the market, but further studies are needed to provide further data on this drug and on the treatment of COVID-19.

Herpes simplex and herpes zoster viruses in COVID-19 patients.

Abstract: Reactivation of herpes family viruses in immunocompromised patients may result in detrimental outcomes for the hosts; therefore, herpes simplex virus-1 and varicella zoster virus infections in the context of COVID-19 may have clinical and prognostic implications. Several reports associated this human herpes virus with COVID-19 infection and have claimed that it can be an indicator for latent COVID-19 infection. However, since most of these were case reports, it is impossible to assess the prevalence of these associations. The University of Florida patient registry i2b2 with ICD-10 diagnosis codes was used for retrieval of patients with diagnosis of COVID-19 and each of the other viruses over the period of October 2015–June 2020. The prevalence of the herpes simplex-1 occurrence in the COVID-19 group was 2.81% compared to 0.77% in the hospital population odds ratio of 5.27. When adjusted for gender, race, and age, the odds were 5.18, 4.48, and 4.61, respectively. After adjustment for respiratory disease, endocrine disease, obesity, diabetes, circulatory disease, and smoking, the odds were 1.94, 3.18, 1.37, 3.54, 3.7, and 5.1, respectively. The prevalence of the varicella zoster virus in COVID-19 patients was 1.8% compared to 0.43% in the hospital population, odds ratio of 5.26 before adjustment, and 5.2, 5.47, and 4.76 after adjusting for gender, age, and race, respectively. When adjusted for respiratory disease, endocrine disease, obesity, diabetes, and circulatory and neurological diseases, the odds were 1.3, 2.2, 1.48, 2.33, 2.85, and 2.6, respectively. Herpes simplex-1 and varicella zoster viruses are strongly associated with COVID-19 infection.

5G in healthcare: how fast will be the transformation?

Abstract: The 5G technology, with its low latency, high speed, enhanced high-resolution bandwidth, superior reliability, and less energy consumption, is bound to transform telemedicine and the healthcare industry as a whole. This next-generation wireless networking technology has many far-reaching implications in both preventive and therapeutic care of the patients. Remote monitoring of patients is possible with wearables facilitated by robust sensors coupled to 5G network. Virtual patient consultation; augmented reality (AR) and virtual reality (VR)-based simulated surgeries; artificial intelligence (AI)-powered robotic surgeries; real-time maintenance of ambulances and other medical devices; and dynamic huge data repository are some of the other applications of 5G technology in the health sector.

The mental health and well-being benefits of exercise during the COVID-19 pandemic: a cross-sectional study of medical students and newly qualified doctors in the UK.

Abstract: University students have been uniquely affected by the COVID-19 pandemic. However, there is currently little data upon the measures that medical students and newly qualified doctors have taken to help their mental well-being and mood during the COVID-19 pandemic. We aimed to identify the activities respondents found beneficial for their well-being and mental health and recorded a mood score from survey respondents. A nationwide study was completed to investigate the mental health impact of the COVID-19 pandemic upon medical students and newly qualified doctors (interim foundation year one). We received 2075 respondents from across the UK. Physical activity was found to be the most common activity used by the survey respondents to help with their mental well-being (80.1%) (medical students, 83.7%; interim foundation doctors, 72.3%). Participants who stated that exercise helped their well-being had a mean score (SD) of 52.3 (20.7) which was significantly higher (P = 0.048) than those who reported that they did not exercise (49.8 (21.1)). Respondents who stated they had used exercise to help with their mental well-being had (on average) a higher mood score than those who did not. This was seen in both the medical student and interim foundation doctor subgroups. Exercise can help to benefit the well-being of medical students and interim foundation doctors. It is hoped that higher education providers and employers recognise the importance of promoting physical activity for the well-being of their students and staff, respectively.

The impact of COVID-19 on trauma referrals to a National Neurosurgical Centre.

Abstract: To investigate the impact of COVID-19 on trauma referrals to a National Neurosurgical Centre during the first wave of COVID-19 in Ireland. Retrospective analysis of a prospectively maintained database of all trauma referrals to the National Neurosurgical Centre at Beaumont Hospital, Dublin, during the period March 1–May 31, 2019 and 2020. Patient characteristics including age, sex, alcohol use, anticoagulant/antiplatelet use and initial Glasgow Coma Scale (GCS) were recorded. Patients were grouped based on trauma aetiology and diagnosis. There were 527 and 437 trauma referrals in 2019 and 2020 respectively. Overall, there was a 17.1% reduction in trauma referrals between 2019 and 2020. Traumatic brain injury, spinal injury and cranial fractures referrals reduced 25% (375 vs 283), 59% (32 vs 13) and 18% (39 vs 32) respectively from 2019 to 2020. Low-energy falls below 2 m was the most common mechanism of injury and accounted for 60 and 61% of referrals in 2019 and 2020. No reduction in road traffic collision (33 vs 34) and assault (40 vs 40) referrals were observed between years. COVID-19 has had a significant impact on both the volume and mechanism of trauma referrals to the National Neurosurgical Centre in Ireland, with falls below 2 m the most common mechanism of trauma referral across both years. The workload remains substantial and a fully resourced neurosurgical department is essential in any future COVID-19 waves.

Evaluation of the effects of the COVID-19 pandemic on children with cerebral palsy, caregivers' quality of life, and caregivers' fear of COVID-19 with telemedicine.

Abstract: The sudden and unexpected pandemic changed the daily routine of the children with cerebral palsy (CP) and their caregivers. This study aimed to investigate the impact of the novel coronavirus (COVID-19) pandemic on the utilization of health and rehabilitation services and the general health and physical status of children with CP. In addition, the second aim of the study was to examine the effects of the COVID-19 pandemic on caregivers’ quality of life (QOL) and their fear of COVID-19. The utilization of children health and rehabilitation services during the pandemic, the general health and physical status of the children during the pandemic, and the children and caregivers’ history of COVID-19 infections were questioned. Furthermore, the caregivers’ level of fear of COVID-19 and their QOL were examined. One hundred twenty caregivers were contacted by phone, and 94 (78.33%) caregivers agreed to participate in the study. Sixty-three of 94 children (67.1%) did not attend their routine control check-up during the pandemic. Twelve children (12.8%) discontinued their physical therapy sessions during the pandemic. Caregivers physical and mental QOL significantly decreased during the pandemic (p < 0.05). The median of caregivers’ Fear of COVID-19 scale (FCV-19S) was 17.5 (7–35). We think that more attention should be given to telerehabilitation and telemedicine services of the clinicians who deal with the children with CP, and their caregivers in order to prevent the negative effects of future pandemic periods.

COVID-19 vaccine — can it affect fertility?

Abstract: Headlines have appeared across multiple social media platforms questioning the effects of newly authorised COVID-19 vaccines on fertility. Although the effects on future fertility were not studied in the initial trials, at present, there is no evidence that the COVID-19 vaccine has any effect of future fertility. It is well known that pregnant women are at a higher risk of complications associated with COVID-19 such as ICU admission and death, and there is a rare but tragic increase in placentitis and stillbirth, highlighting the importance for those planning a pregnancy any time in the future to be vaccinated. Here we summarise international consensus from multiple organisations advising on fertility and the COVID-19 vaccine. Preliminary studies all suggest that there is neither link, nor indeed any theoretical reason why any of the COVID-19 vaccines might affect fertility. Dissemination of misinformation regarding the impact of the vaccine on future fertility needs to be controlled in order to avoid any hesitancy amongst young women attending for vaccination. It is also vital that the medical profession counteract this information, and, in order to do that, healthcare providers must be well informed on the latest recommendations and research.

Resveratrol and cardiovascular system-the unfulfilled hopes

Abstract: Resveratrol is a natural polyphenolic compound with a stilbene structure endowed with multiple health-promoting effects. Among phenolic compounds, resveratrol is assigned a leading role in the health-promoting effects of red wine. The aim of the study was to assess the effect of resveratrol on the cardiovascular system in the experimental and clinical studies conducted so far. Moreover, the paper discusses the results of the most recent meta-analyses assessing resveratrol’s therapeutic effect on the cardiovascular system in humans. In animal and preclinical studies, resveratrol has demonstrated a wide physiological and biochemical spectrum of activity, including antioxidant, anti-inflammatory, antiplatelet, and anticoagulant activities, which translated into its health-promoting effects on the cardiovascular system. The performed meta-analyses allow to confirm such an impact, however, after the assessment with the use of the SYRCLE’s tool, these studies are burdened with a high risk of bias, and the results are not clearly presented. Despite numerous articles and clinical studies, the convincing beneficial mechanisms of resveratrol as well as its health-promoting effects in cardiovascular diseases have not been clearly confirmed in humans. Therefore, there is a need for further clinical studies, especially randomized, double-blind, placebo-controlled trials to objectively confirm the possible health-promoting effects of this substance and to determine both the efficacy and safety, and possible therapeutic potential.

COVID-19 infection is a major cause of acute telogen effluvium.

Abstract: Acute telogen effluvium is a non-scaring hair loss, usually occurs 3 months after the stressful event that causes hair shedding, and lasts up to 6 months. It can be associated with post COVID-19 infection. To study the possible effects of COVID-19 on the hair growth cycle and the relationship between COVID-19 and acute telogen effluvium. This is an observational cross-sectional study that had been conducted during the period from September 2020 to March 2021 years. Thirty-nine patients with post COVID-19 hair loss are confirmed by polymerase chain reaction (PCR) or antibody testing. Hair pull test was carried out to confirm the diagnosis and severity of telogen effluvium. Thirty-nine patients were evaluated; their ages ranged from 22 to 67 years with a mean and SD of 41.3 ± 11.6 years with 36 (92.3%) females and 3 (7.69%) males. All patients with a diagnosis of ATE were enrolled in this study and had a laboratory-confirmed diagnosis of prior SARS-CoV-2 infection; 15 (38.46%) patients reported mild symptoms, 24 (61.53%) patients presented with moderate disease, and no patient required hospitalization. They all experienced excessive hair loss within 2–3 months after infection. Pull tests were strongly positive (> 10–50% with a mean of 35% of pulled hair away from scalp). COVID-19 infection is now a frequent and a common cause of acute telogen effluvium. Hence, clinicians should be aware about the relation between this infection and this pattern of hair loss. Drugs that have been used for the treatment of COVID-19 were excluded as a cause of acute telogen effluvium.

Impact on mental health of the COVID-19 outbreak among general practitioners during the sanitary lockdown period.

Abstract: COVID-19 outbreak can impact mental health including health care workers. The aim of this study was to assess the mental health impact of COVID-19 in French General Practitioners (GPs). We carried out a postal-based survey during the first lockdown. Four psychological validated self-report questionnaires were used to assess stress,post-traumatic stress symptoms, burnout and self-efficacy (Perceived Stress scale, Impact of Event Scale-revised, Maslach Burnout Inventory and General Self-Efficacy scale). The sample consists of 332 general practitioners (43.50% women, mean age = 50.74 ± 11.91). General practitioners working in high epidemic location represented 27.71% of the sample (n = 92). Thirty four GPs reported significant post-traumatic stress symptoms (10.59%). High burnout symptoms were found in 79 (24.46%), 137 (42.41%) and 17 (5.26%) participants. Only General Self-Efficacy scores were significantly different according to epidemic location status with lower scores in GPs working in high epidemic location (33.37 ± 4.64 vs. 32.06 ± 5.43; P = 0.04). Women reported more stress and burnout symptoms than men (P = 0.01). This study showed the psychological impact of COVID-19 in GPs during the sanitary lockdown period including burnout and post-traumatic stress symptoms. Up to 42% of GPs reported psychological disturbances. Interventions to promote mental health well-being of healthcare workers need to be developing.

Extrapulmonary features of post-COVID-19 patients: muscle function, physical activity, mood, and sleep quality.

Abstract: Coronavirus disease 2019 (COVID-19) represents a wide range of clinical manifestations, even if mild disease severity. It has been known that pulmonary function is affected by COVID-19 during infection and mid-to-long term. However, there is inadequate evidence about extrapulmonary features in post-COVID-19 patients. This study aimed to investigate extrapulmonary features in post-COVID-19 patients who recovered from mild and moderate disease severity in the mid-term. This cross-sectional study was carried out after at least 12 weeks from the COVID-19 diagnosis. Disease severity was defined using criteria for clinical severity of confirmed COVID-19 pneumonia. The peripheral muscle strength was measured using the dynamometer. Physical performance was assessed with five times sit-to-stand and 4-m gait speed. Physical activity level (PAL), mood, and sleep quality were assessed with the International Physical Activity Questionnaire, Hospital Anxiety, and Depression Scale, and Pittsburgh Sleep Quality Index, respectively. A total of 48 participants with post-COVID-19 (39.2 ± 7.9 years, 54.2% women) were included in the study. Handgrip and quadriceps weakness was observed in 39.6% and 35.4% of the participants, respectively. PAL was low in 39.6%, moderate in 33.3%, and high in 27.1% of the participants. Anxiety, depression, and poor sleep quality were observed in 33.3%, 29.2%, and 50% of the participants, respectively. Extrapulmonary features are adversely affected in a substantial proportion of post-COVID-19 patients who recovered from mild and moderate disease severity in the mid-term. Comprehensive assessment and appropriate intervention strategies should also be considered for non-severe post-COVID-19 patients.

How reliable is BMI? Bioimpedance analysis of body composition in underweight, normal weight, overweight, and obese women

Abstract: The human body consists of water, proteins, lipids, carbohydrates, and minerals that build cells, tissues, and organs. In healthy people, the content of these molecules remains nearly constant. The body mass index (BMI) is commonly used to classify abnormal body composition among adults. According to the WHO, a high BMI is a major risk factor for many diseases. Bioelectrical impedance analysis is a commonly used method for assessing body composition in clinical practice and medical research. The aim of this study was to identify the advantages and disadvantages of using BMI in diagnosis of underweight, overweight, and obesity, by comparing the value of the index with the values of body composition analysis parameters. A total of 267 healthy women 18 to 35 years of age participated in this study. Bioelectrical impedance analysis was performed on all participants at the beginning of the experiment with an InBodyS10 device. In the BMI categories of overweight and obese, only women with excessive BFM were measured with BIA. The BMI category of normal body weight, apart from women with normal body composition, includes people with both deficient and excess body components, e.g., body fat or lean body mass. The BMI category of underweight includes women with different body compositions as well as people with excessive fat content. The BMI is useful to provide a warning of excessive fat content in overweight and obese women, whereas among normal weight and underweight women, it may mask various types of body composition defects.

Prophylactic negative pressure wound therapy for closed laparotomy wounds: a systematic review and meta-analysis of randomised controlled trials.

Abstract: Surgical site infections are a common source of post-operative morbidity and contribute significantly to healthcare costs Patients undergoing emergency laparotomy and/or bowel surgery are particularly at risk Prophylactic negative pressure wound therapy (NPWT) has been shown to reduce wound infection However, to date, there has been a lack of consensus around its use for closed laparotomy wounds We conducted a systematic review of randomised controlled trials comparing the use of prophylactic negative pressure wound therapy with standard dressings for closed laparotomy incisions The primary outcome was incidence of incisional surgical site infection (SSI) at 30 days post-operatively Secondary outcomes included superficial and deep SSI, skin dehiscence, fascial dehiscence and length of stay A total of 2182 publications were identified, of which, following review of titles, abstracts and full texts, five studies met the criteria for inclusion Across these studies, 467 patients were randomised to NPWT and 464 to standard dressings Overall SSI rate was 186% (n = 87/467) versus 239% (n = 111/464) in the NPWT and standard dressing groups, respectively (Odds ratio 071, 95% CI 052–099, p = 004*) Deep SSI incidence was the same in both groups (26%) Both skin dehiscence and fascial dehiscence were slightly higher in the standard dressing group ((42%, n = 11/263 versus 31% (n = 8/261) and (09% (n = 3/324) versus 06% (n = 2/323)), respectively This study observed that NPWT reduces the overall SSI for closed laparotomy wounds It supports data recommending the use of prophylactic NPWT dressings, especially in high-risk patients in both emergency and elective circumstances

Serum calprotectin as a novel biomarker for severity of COVID-19 disease.

Abstract: Some biomarkers have been reported to be related to the prognosis of the coronavirus disease 2019 (COVID-19). There are sparse data regarding the prognostic value of serum calprotectin in COVID-19 patients. This study aimed to investigate the relationship between serum calprotectin level and clinical severity of COVID-19 disease in hospitalized patients. This retrospective cross-sectional cohort study included 80 consecutive hospitalized patients with confirmed diagnosis of COVID-19. The study population was divided into two groups as patients hospitalized in the intensive care unit (ICU) and patients hospitalized but not in the ICU. The serum calprotectin levels, other laboratory, and clinical parameters were compared between groups. The mean age of the patients was 66.5 ± 15.7 years. Of the patients, 42 were in the ICU and 38 were not. Serum calprotectin level and acute-phase reactants such as C-reactive protein, procalcitonin, ferritin, fibrinogen, and white blood cell were significantly higher in ICU patients than in non-ICU patients. ROC curve analysis identified that serum calprotectin level was a predictor for ICU requirement with an area under the curve of 0.641 (p = 0.031). Logistic regression analysis revealed that serum calprotectin was a significant determinant for whether or not patient required the ICU. These findings demonstrate that serum calprotectin level seems to be a useful biomarker that can predict the severity of COVID-19 disease. Serum calprotectin is a significant predictor of ICU requirement in patients with COVID-19.

Vitamin D and SARS-CoV-2 infection-evolution of evidence supporting clinical practice and policy development : A position statement from the Covit-D Consortium

Abstract: Vitamin D is a vitamin pro-hormone which can be taken exogenously from the diet or supplements, or can be synthesised cutaneously through the action of summer sunlight on skin as shown in Fig. 1 [1].While oral intake is an important source of vitamin D, the major physiological source is UVB irradiation at a wavelength of 290–315 nm [2]. The ability of the skin to synthesise vitamin D is compromised at northerly latitudes, particularly amongst those who are older or who have dark skin pigmentation. While the kidneys are the major site of 1α-hydroxylation of 25(OH)D to its bio-active metabolite 1,25(OH)2D, it is now known that activation of vitamin D also occurs in many other cells and tissues. These include cellular components of both the innate and adaptive immune systems, highlighting the role of vitamin D as an important immunomodulator [3]. Susceptibility to viral infection and disease severity during viral infection are largely determined by host characteristics which influence immune response. For example, demographic characteristics, such as age and ethnicity, appear to greatly influence survival when patients are infected by the newly described SARS-CoV-2 agent. Children less than 10 years of age have an extraordinarily low mortality rate of 0.01%, while the very old (greater than 80 years) have greater disease severity and a mortality rate of close to 12.5% [4]. Patients with obesity have a 50% increased mortality rate [5], while black patients have approximately twice the mortality of white patients [6]. These differences are not entirely explained by the presence of comorbid illnesses such as diabetes mellitus and hypertension, conditions which are also commoner in those with obesity, and in older and black populations. We and others have hypothesized that nutritional state, and in particular vitamin D deficiency, which is also highly prevalent in those with obesity, and in older and black populations, might also affect infective risk and disease severity through its effects on immune function. In the absence of a cure, or an effective safe vaccine for SARS-CoV-2, it is timely to consider whether vitamin D deficiency is an easily reversible host factor which increases the risk of SARS-CoV-2 infection and worsens disease severity, and by extension, whether optimisation of vitamin D status through supplementation can ameliorate these risks. In the context of the accumulating evidence outlined in this position statement which strongly suggests a protective role for vitamin D against SARS-CoV-2 infection and Covid-19 Key Messages • Vitamin D deficiency is common across all age groups in the Irish population, but is particularly prevalent in those who are obese, have darker skin, or are older, especially if resident in nursing homes or other long-term care facilities. • We recommend daily supplementation with 20–25 μg/day (800–1000 IU/day) of vitamin D3 for most of the general adult population in Ireland for the duration of the current Covid-19 pandemic. • These doses are predicated on the achievement of a serum 25(OH)D level greater than 50 nmol/l and on the prioritised avoidance of deficiency below this threshold. Serum 25(OH)D greater than 50 nmol/l has been shown to be associated with reduced risk of SARS-CoV-2 infection, and with reduced Covid-19 disease severity. • For vulnerable groups in which vitamin D deficiency is prevalent (those who are obese, those with darker skin, older individuals, nursing home residents), daily supplementation at doses higher than 20–25 μg/day (800–1000 IU/day) will likely be required to achieve this > 50 nmol/l 25(OH)D threshold for protection. This should be prescribed and monitored under medical supervision. • An Expert Working Group should be convened by the Department of Health to comprehensively examine the evidence relating to vitamin D and risk of SARS-CoV-2 infection and risk of severe Covid-19 disease.

Vigilance regarding immune thrombocytopenic purpura after COVID-19 vaccine.

Abstract: Based on the severity of thrombocytopenia, patients with immune thrombocytopenic purpura (ITP) are at an increased risk of mucocutaneous or major bleeding. There has been an increased risk of ITP after administration of various vaccines like influenza, measles-mumps-rubella, hepatitis B, and diphtheria-tetanus-pertussis. The pathogenesis of vaccine-related thrombocytopenia is not completely clear and is probably caused by molecular mimicry. Till date, there have been few reported cases of thrombocytopenia in the pharmacovigilance databases after patients received the Pfizer and Moderna coronavirus disease-19 (COVID-19) vaccines. Emergency physicians should be aware of the occurrence of vaccine-induced ITP in patients who present with bleeding manifestations, especially after the current boost in COVID-19 vaccination drive worldwide.