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Background: Polymorphisms in the C-X-C motif chemokine receptor 3 (CXCR3) gene may impact the immune system’s reaction to infections such as coronavirus disease-19 (COVID-19). Nevertheless, a detailed analysis of the precise influence of CXCR3 gene polymorphisms on COVID-19 has not yet been conducted. This study aims to determine the genotype distribution of three specific CXCR3 gene polymorphisms (rs770806154, rs776323716, and rs778526136) and their potential association with the severity of COVID-19. Methods: One hundred COVID-19 patients were enrolled after the study protocol was approved by institutional ethical clearance. Selection of single-nucleotide polymorphisms was based on the bioinformatics analysis; CXCR-3 receptor (rs770806154, rs776323716, and rs778526136) polymorphism was analyzed by sequencing. D-dimer, ferritin, and erythrocyte sedimentation rate were estimated by Cobas C-311. Chi-square analysis was used to find the association of gene polymorphisms with the severity of infection and clinical parameters. P

Objective: The coronavirus-2019 pandemic has led to the deaths of many people in the world. Due to the changing physiology in pregnant patients, there is no consensus on the management of the disease. The effects of the disease have decreased over time with the changing virus variants and the spread of the vaccine during the pandemic. Material and Methods: 231 pregnant patients hospitalized and treated in our clinic due to severe acute respiratory syndrome coronavirus 2 infection between April 2020 and April 2022 were retrospectively analyzed. Results: Patients were divided into three groups according to the time of occurrence of possible variants. Group 11 (n=99) includes patients with pre-delta, group 2 (n=79) delta, and group 3 (n=53) omicron variants. Considering the vaccine distribution, there is no vaccinated individual in group 1. Individuals in group 2 who are vaccinated in 2 doses have the highest percentage as 42% and group 3 has the highest percentage as 66% (p<0.01). Steroid administration to improve respiratory parameters was mostly preferred in patients in groups 1 and 2 (78–57%) (p=0.022). O2 support was found to be statistically significantly higher in groups 1 and 2 compared to group 3. The number of patients who needed O2 support was found to be lower in group 3 than in the other groups. There was no significant difference between the groups in terms of maternal mortality and morbidity, delivery type, or caesarean section indications. When the length of hospital stay was compared, it was found to be the lowest in group 3 (p<0.001). Fetuses in group 3 had the least need for a neonatal intensive care unit. Conclusion: We think that the management of infectious respiratory diseases during pregnancy should be with a multidisciplinary and holistic perspective. More scientific studies should be conducted on the management of pregnant patients against the potential danger of a new pandemic. [ABSTRACT FROM AUTHOR]

The disproportionate impact of coronavirus-2019 (COVID-19) on communities of color is gaining global attention. Current research demonstrates that historically marginalized populations are experiencing disproportionate levels of SARS-Cov-2 infection and adverse clinical outcomes. However, research examining whether COVID-19 outcomes vary by race and ethnicity within the rheumatic disease population is limited. This paper will review data showing how SARS-CoV-2 infection has differentially affected racial and ethnic minorities in the general population and those with rheumatic disease. We will also highlight disparities in rheumatic disease risk and severity that existed prior to the pandemic, and discuss recent work examining severe outcomes of COVID-19 in rheumatic disease patients by race and ethnicity. Finally, we propose several actionable steps for the rheumatology community to address COVID-19 health disparities, which may have long-term effects on patients with rheumatic disease.

Abstract Background Utero-vaginal brachytherapy (BT) is an irreplaceable care component for the curative treatment of locally advanced cervix cancer (LACC). Magnetic Resonance Imaging (MRI)-image guided adaptive BT (IGABT) using the GYN-GEC-ESTRO EMBRACE guidelines is the international care standard. Usually following chemo–radiation therapy (CRT), IGABT has high proven utility in LACC but requires significant health system resources. Timely access was disrupted by the COVID-19 pandemic which challenged us to re-design our established IGABT care pathway. Methods From April 2020 consecutive patients with LACC were enrolled after CRT in a single arm exploratory non-inferiority study of a modified IGABT (mIGABT) protocol. This delivered an iso-effective IGABT dose (39.3 Gy: EQD2: α/β10Gy concept) over a 24-h period during a single overnight hospitalisation. Results Fourteen LACC patients received mIGABT from April 2020 to March 2022. Median age was 62.5 years (37–82 years). LACC histology was primary squamous (9/14) or adeno-carcinoma (5/14). International Federation of Gynaecology and Obstetrics (FIGO) 2018 stages ranged from IB1/2 (N = 3), IIA1/IIB (5), IIIB (2), IIIC1/2 (4) with mean ± standard deviation (SD) gross tumour volume-at-diagnosis (GTV_D) of 37.7 cc ± 71.6 cc. All patients achieved complete metabolic, clinical, and cytologic cancer response with CRT and IGABT. High-risk HPV was cleared by 6-months. Complete MRI-defined cancer response before mIGABT (GTV_Fx1) was seen in 77% of cases (10/13). Only two women developed metastatic disease and one died at 12-months; 13 patients were alive without cancer at mean 20.3 ± 7.2 months follow-up. Actuarial 2-year overall survival was 93%. Compared with our pre-COVID IGABT program, overall mIGABT cost-saving in this cohort was USD 22,866. Prescribed dose covered at least 90% (D90) of the entire cervix and any residual cancer at time of BT (HRCTV_D90: high-risk clinical target volume) with 3-fractions of 8.5 Gy delivered over 24-h (22.8 ± 1.7 h). Total treatment time including CRT was 38 days. The mIGABT schedule was well tolerated and the entire cohort met EMBRACE recommended (EQD2: α/β10Gy) combined HRCTV_D90 coverage of 87.5 ± 3.7 Gy. Similarly, organ-at-risk (OAR) median: interquartile range D2cc constraints (EQD2: α/β3Gy) were EMBRACE compliant: bladder (65.9 Gy: 58.4–72.5 Gy), rectum (59.1 Gy: 55.7–61.8 Gy), and sigmoid colon (54.6 Gy: 50.3–58.9 Gy). ICRU recto-vaginal point dose was significantly higher (75.7 Gy) in our only case of severe (G4) pelvic toxicity. Conclusions This study demonstrated the utility of mIGABT and VMAT CRT in a small cohort with LACC. Loco-regional control was achieved in all cases with minimal emergent toxicity. Single insertion mIGABT was logistically efficient, cost-saving, and patient-centric during the COVID-19 pandemic.

Abstract Background Gastrointestinal (GI) bleeding is one of the most impactful complications in patients hospitalized from COVID-19 infection. Limited study has focused on patients with upper GI bleeding (UGIB). This study aimed to identify the risk factors of patients who were hospitalized from COVID-19 infection and developed UGIB as well as the effectiveness of proton pump inhibitor (PPI) prophylaxis in those patients. Methods This study was comprised of two phases. The first phase was the retrospective enrollment of patients who were admitted due to COVID-19 infection and developed UGIB between April and August 2021 to evaluate the associated factors of active UGIB. The second phase was a retrospective analysis after PPI prophylaxis protocol from September – October 2021 to assess the benefit of PPI use in those patients. Results Of 6,373 patients hospitalized, 43 patients (0.7%) had evidence of UGIB. The majority were male 28 (65.1%) with a mean age of 69.1 ± 11.8 years. Twenty-four of 43 patients (55.8%) needed mechanical ventilation, 35 patients (81.4%) received systemic corticosteroids, and 10 patients (23.3%) were taking anticoagulants for venous thromboembolic prophylaxis. Seven of 43 patients (16%) had active UGIB. There was no significant difference in the number of patients taking antiplatelets, anticoagulants, or steroids and the severity of COVID-19 infection between the two groups. An emergency endoscopy or endoscopic hemostasis were performed in 6/7 (85.7%) patients. The multivariate logistic regression analysis revealed two significant factors associated with active UGIB including higher of Glasgow-Blatchford score (GBS) per point (OR = 7.89; 95%CI 1.03–72.87; p = 0.04) and an absence of PPI use (OR 4.29; 95%CI 1.04–19.51; p = 0.04). After prescribing PPI as a prophylaxis, there was a slightly lower incidence of UGIB (0.6% vs 0.7%) in addition to an absence of active UGIB (0% vs 16%). Conclusion Our study demonstrated that the absence of PPI and higher GBS were significant risk factors for active UGIB which required therapeutic endoscopy in patients with COVID-19 infection. We suggest that short-term PPI prophylaxis should be prescribed in those patients once they need hospitalization regardless of the severity of COVID-19 infection to minimize the severity of UGIB.

Fear is an adaptive response that alerts individuals to the presence of a danger or threat. However, in the context of the current novel coronavirus disease 2019 (COVID-19) pandemic, the fear experienced could be intense because the number of victims of the virus is continuously increasing globally and is inducing severe mental health concerns. The seven-item Fear of COVID-19 Scale (FCV-19S) assesses the severity of fear related to COVID-19 and has already been validated in many languages. The present study evaluated the psychometric properties of the Amharic (Ethiopian) version of the FCV-19S. An online survey including the Amharic versions of the FCV-19S and the six-item UCLA Loneliness Scale (ULS-6) was administered to 307 Amharic-speaking participants using convenience sampling. The participants' age ranged between 18 and 70 years. In the evaluation process, confirmatory factor analysis, Item Response Theory, concurrent validity, and reliabilities (Cronbach's alpha, McDonald's omega, Guttman's lambda, and composite reliability) of the Amharic version of the FCV-19S were performed. The uni-dimensional structure of the FCV-19S was confirmed and the Amharic version of the FCV-19S had strong psychometric properties. All reliability coefficients of the Amharic FCV-19S were satisfactory, with sound concurrent validity shown by significant and positive correlations with loneliness. The results indicate that the FCV-19S can be used in research to assess the fear of COVID-19 among Amharic-speaking populations. [ABSTRACT FROM AUTHOR]

Background: Utero-vaginal brachytherapy (BT) is an irreplaceable care component for the curative treatment of locally advanced cervix cancer (LACC). Magnetic Resonance Imaging (MRI)-image guided adaptive BT (IGABT) using the GYN-GEC-ESTRO EMBRACE guidelines is the international care standard. Usually following chemo–radiation therapy (CRT), IGABT has high proven utility in LACC but requires significant health system resources. Timely access was disrupted by the COVID-19 pandemic which challenged us to re-design our established IGABT care pathway. Methods: From April 2020 consecutive patients with LACC were enrolled after CRT in a single arm exploratory non-inferiority study of a modified IGABT (mIGABT) protocol. This delivered an iso-effective IGABT dose (39.3 Gy: EQD2: α/β10Gy concept) over a 24-h period during a single overnight hospitalisation. Results: Fourteen LACC patients received mIGABT from April 2020 to March 2022. Median age was 62.5 years (37–82 years). LACC histology was primary squamous (9/14) or adeno-carcinoma (5/14). International Federation of Gynaecology and Obstetrics (FIGO) 2018 stages ranged from IB1/2 (N = 3), IIA1/IIB (5), IIIB (2), IIIC1/2 (4) with mean ± standard deviation (SD) gross tumour volume-at-diagnosis (GTV_D) of 37.7 cc ± 71.6 cc. All patients achieved complete metabolic, clinical, and cytologic cancer response with CRT and IGABT. High-risk HPV was cleared by 6-months. Complete MRI-defined cancer response before mIGABT (GTV_Fx1) was seen in 77% of cases (10/13). Only two women developed metastatic disease and one died at 12-months; 13 patients were alive without cancer at mean 20.3 ± 7.2 months follow-up. Actuarial 2-year overall survival was 93%. Compared with our pre-COVID IGABT program, overall mIGABT cost-saving in this cohort was USD 22,866. Prescribed dose covered at least 90% (D90) of the entire cervix and any residual cancer at time of BT (HRCTV_D90: high-risk clinical target volume) with 3-fractions of 8.5 Gy delivered over 24-h (22.8 ± 1.7 h). Total treatment time including CRT was 38 days. The mIGABT schedule was well tolerated and the entire cohort met EMBRACE recommended (EQD2: α/β10Gy) combined HRCTV_D90 coverage of 87.5 ± 3.7 Gy. Similarly, organ-at-risk (OAR) median: interquartile range D2cc constraints (EQD2: α/β3Gy) were EMBRACE compliant: bladder (65.9 Gy: 58.4–72.5 Gy), rectum (59.1 Gy: 55.7–61.8 Gy), and sigmoid colon (54.6 Gy: 50.3–58.9 Gy). ICRU recto-vaginal point dose was significantly higher (75.7 Gy) in our only case of severe (G4) pelvic toxicity. Conclusions: This study demonstrated the utility of mIGABT and VMAT CRT in a small cohort with LACC. Loco-regional control was achieved in all cases with minimal emergent toxicity. Single insertion mIGABT was logistically efficient, cost-saving, and patient-centric during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Since the dawn of the democratic dispensation in the early 1990s, the South African government has continued to face difficulties in the provision of basic but essential services to its constituencies. Despite the successful restructuring of local government as a non-racial and democratic sphere of government closer to local people, the provision of services remains one of the ongoing challenges faced by the post-apartheid government. The lack of basic services was further exposed when the South African government, in line with the World Health Organisation (WHO), announced that some of the preventative measures for the outbreak of Coronavirus 2019 (COVID-19) were wearing masks, social distancing, hygiene, and regular washing of hands. Even though the outlined preventative measures were substantially significant in curbing the skyrocketing numbers of COVID-19 infections, some South Africans, especially residents of informal settlements, found it challenging to adhere to them because of a lack or the absence of basic services. Therefore, it is from this background that this paper sought to explore the lack of service delivery (water and sanitation) in South Africa as a challenge during the COVID-19 national lockdown, especially among the residents of informal settlements. The paper adopts a qualitative research design and utilises secondary data where resources such as newspapers, book chapters, articles, government documents, and a thesis will be reviewed. Furthermore, it employs efficiency services theory as a lens for the interpretation of the findings. The paper concludes by affirming that the COVID-19 national lockdown exposed the service delivery deficiencies in some South African local municipalities. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal (GI) bleeding is one of the most impactful complications in patients hospitalized from COVID-19 infection. Limited study has focused on patients with upper GI bleeding (UGIB). This study aimed to identify the risk factors of patients who were hospitalized from COVID-19 infection and developed UGIB as well as the effectiveness of proton pump inhibitor (PPI) prophylaxis in those patients.Methods: This study was comprised of two phases. The first phase was the retrospective enrollment of patients who were admitted due to COVID-19 infection and developed UGIB between April and August 2021 to evaluate the associated factors of active UGIB. The second phase was a retrospective analysis after PPI prophylaxis protocol from September - October 2021 to assess the benefit of PPI use in those patients.Results: Of 6,373 patients hospitalized, 43 patients (0.7%) had evidence of UGIB. The majority were male 28 (65.1%) with a mean age of 69.1 ± 11.8 years. Twenty-four of 43 patients (55.8%) needed mechanical ventilation, 35 patients (81.4%) received systemic corticosteroids, and 10 patients (23.3%) were taking anticoagulants for venous thromboembolic prophylaxis. Seven of 43 patients (16%) had active UGIB. There was no significant difference in the number of patients taking antiplatelets, anticoagulants, or steroids and the severity of COVID-19 infection between the two groups. An emergency endoscopy or endoscopic hemostasis were performed in 6/7 (85.7%) patients. The multivariate logistic regression analysis revealed two significant factors associated with active UGIB including higher of Glasgow-Blatchford score (GBS) per point (OR = 7.89; 95%CI 1.03-72.87; p = 0.04) and an absence of PPI use (OR 4.29; 95%CI 1.04-19.51; p = 0.04). After prescribing PPI as a prophylaxis, there was a slightly lower incidence of UGIB (0.6% vs 0.7%) in addition to an absence of active UGIB (0% vs 16%).Conclusion: Our study demonstrated that the absence of PPI and higher GBS were significant risk factors for active UGIB which required therapeutic endoscopy in patients with COVID-19 infection. We suggest that short-term PPI prophylaxis should be prescribed in those patients once they need hospitalization regardless of the severity of COVID-19 infection to minimize the severity of UGIB. [ABSTRACT FROM AUTHOR]

ObjectiveThree aims: to elucidate determinants associated with COVID-19 vaccine uptake in children and the association with parental vaccination; to compare rates of PCR-positive SARS-CoV-2 results between vaccinated and unvaccinated children; to estimate the rate of parental COVID-19 vaccination and its association with the vaccination rate of their children.MethodsWe performed a retrospective chart review of all children aged 5–11 years registered at a central district in Israel from November 21st, 2021 to April 30th, 2022, and characterized COVID-19 vaccinated vs. unvaccinated individuals. Data retrieved from the electronic medical files included: demographics [age, gender, sector, socioeconomic status (SES)]; COVID-19 vaccination (first and second doses) and influenza vaccination status; co-morbidities; and parental vaccinations for COVID-19. We divided the population into three distinct demographic groups: non-ultra-orthodox Jews (43,889 children), ultra-orthodox Jews (13,858 children), and Arabs (4,029 children).ResultsOf the 61,776 children included in the study, 20,355 (32.9%) received at least one dose of the COVID-19 vaccine. Vaccination rates were similar amongst males and females and were higher in children aged 9–11 years compared to children aged 5–6 years. Multivariate analysis identified five independent determinants that were significantly (p

COVID-19 has a significant impact on the hematopoietic system and hemostasis. Leukocytosis, lymphopenia, and thrombocytopenia are associated with increased severity and even death in COVID-19 cases. Objective: The aim is to examine the laboratory results of COVID-19 patients from a hospital in the Peruvian Amazon and their clinical prognosis. Material and Methods: An analytical cross-sectional study was carried out whose purpose was to identify the laboratory tests of patients with COVID-19 and mortality in a hospital in Ucayali, Peru during the period from March 13 to May 9, 2020, selecting a total of 127 with Covid-19. Mean and the standard deviation was described for age, leukocytes, neutrophils, platelets, RDW-SD; median and interquartile range for the variables lymphocyte, RN / L, fibrinogen, CRP, D-dimer, DHL, hematocrit, monocytes, eosinophils. Results: No differences were observed in this population regarding death and sex (OR: 1.31; 95% CI 0.92 to 1.87), however, it was observed that, for each one-year increase, the probability of death increased by 4% (PR: 1.04, 95% CI 1.03 to 1.05). The IRR (Incidence Risk Ratio) analysis for the numerical variables showed results strongly associated with hematological values such as Leukocytes (scaled by 2500 units) (IRR: 1.08, 95% CI 1.03 to 1.13), neutrophils (scaled by 2500 units) (IRR: 1.08; 95% CI 1.03 to 1.13), on the contrary, it is observed that the increase of 1000 units in lymphocytes, the probability of dying decreased by 48% (IRR: 0.52; 95% CI 0.38 to 071). Conclusions: Parameters such as leukocytes, neutrophils and D-dimer were statistically much higher in patients who died. [ABSTRACT FROM AUTHOR]

Recognizing hepatic manifestations of COVID-19 and their impact on the severity and outcome is crucial in managing this emerging pandemic. However, we lack such reported data in Saudi Arabia regarding this clinical entity. This is a retrospective observational study conducted on 387 patients with COVID-19 disease who were hospitalized at King Fahad Hospital of the University from March-September 2020. The total cohort was divided into two groups: liver and non-liver involvement. Then, the frequency of hepatic manifestations was determined, followed by comparing severity and outcome among the two study groups. A total of 387 patients were included, of which 72.87% had hepatic manifestations. The most prevalent abnormalities were high LDH in 308 (79.58%) followed by AST 205 (52.97%), GGTP 124 (31.26%), ALT 74 (19.12%), PT/INR 66 (17.05%), direct bilirubin 51 (12.40%), total bilirubin 46 (11.88%), and low albumin 48 (12.4%). Univariate analyses showed that liver involvement was significantly associated with severe (31.91%) and critical (34.75%) presentation (P<0.001). Multivariate regression analysis showed that the presence of liver involvement was an independent risk factor for severe or critical COVID-19 disease (OR 2.44; P<0.001), longer hospitalization (OR 2.27; P=0.001), and ICU admission (OR 2.27; P=0.006). The current study showed that liver involvement is common in the setting of COVID-19 disease. Such patients had a higher disease severity and a worse clinical outcome. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved.Objective: This narrative review provides emergency clinicians with a focused update of the resuscitation and airway management of COVID-19.Discussion: Patients with COVID-19 and septic shock should be resuscitated with buffered/balanced crystalloids. If hypotension is present despite intravenous fluids, vasopressors including norepinephrine should be initiated. Stress dose steroids are recommended for patients with severe or refractory septic shock. Airway management is the mainstay of initial resuscitation in patients with COVID-19. Patients with COVID-19 and ARDS should be managed similarly to those ARDS patients without COVID-19. Clinicians should not delay intubation if indicated. In patients who are more clinically stable, physicians can consider a step-wise approach as patients' oxygenation needs escalate. High-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) are recommended over elective intubation. Prone positioning, even in awake patients, has been shown to lower intubation rates and improve oxygenation. Strategies consistent with ARDSnet can be implemented in this patient population, with a goal tidal volume of 4-8 mL/kg of predicted body weight and targeted plateau pressures <30 cm H2O. Limited data support the use of neuromuscular blocking agents (NBMA), recruitment maneuvers, inhaled pulmonary vasodilators, and extracorporeal membrane oxygenation (ECMO).Conclusion: This review presents a concise update of the resuscitation strategies and airway management techniques in patients with COVID-19 for emergency medicine clinicians. [ABSTRACT FROM AUTHOR]

Objective: This study gathered adolescent and caregiver perspectives on sleep hygiene practices and beliefs for Black families living in low-resourced urban communities., Methods: Semistructured interviews were conducted with adolescents (n = 9) and caregivers (n = 9) from January-March 2021, during the COVID-19 pandemic. Interview questions included adolescent's current sleep habits, barriers, and home and neighborhood influences. Trained researchers coded data using inductive analysis and a constant comparative method to derive themes., Results: Two themes focused on sleep hygiene practices, including items used to facilitate sleep (e.g., melatonin, electronics) and COVID-19 consequences on sleep schedules. Two themes focused on sleep hygiene beliefs, including a common value on the importance of sleep and influences on caregiver's bedtime rules., Conclusions: Findings provide important insights on sleep hygiene practices and beliefs in a historically marginalized population of Black adolescents and caregivers in urban communities to inform targeted sleep interventions, policies, and programs for optimal sleep and well-being., Competing Interests: Declaration of conflicts of interest None., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Guillain-Barre Syndrome (GBS) is an autoimmune acute inflammatory demyelinating polyneuropathy usually elicited by an upper respiratory tract infection. Several studies reported GBS associated with Coronavirus Disease 2019 (COVID-19) infection. In this study, we described nine GBS patients following the COVID-19 vaccine. Methods: In this study, nine patients were introduced from six referral centers for neuromuscular disorders in Iran between April 8 and June 20, 2021. Four patients received the Sputnik V, three patients received the Sinopharm, and two cases received the AstraZeneca vaccine. All patients were diagnosed with GBS evidenced by nerve conduction studies and/or cerebrospinal fluid analysis. Results: The median age of the patients was 54.22 years (ranged 26-87 years), and seven patients were male. The patients were treated with Intravenous Immunoglobulin (IVIg) or Plasma Exchange (PLEX). All patients were discharged with some improvements. Conclusion: The link between the COVID-19 vaccine and GBS is not well understood. Given the prevalence of GBS over the population, this association may be coincidental; therefore, more studies are needed to investigate a causal relationship.

Objective: Coronavirus-2019 (COVID-19) is a global health crisis. Although pregnant women are a vulnerable population during the infectious pandemics, extremely rare cases of pregnant women infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are described in Taiwan. We share our experience to manage a pregnant women with COVID-19 in the third trimester and subsequent delivery at term. Case report: A 43-year-old woman presented with sore throat, cough and rhinorrhea was diagnosed as laboratory-confirmed SARS-CoV-2 infection at the 35 gestational weeks (GW). During the hospitalization, the disease progressed with a need of oxygen supplement and prednisolone therapy. She was discharged uneventfully at 37 GW. Finally, she delivered a female baby with Apgar score of 8–9 points at 38 GW by cesarean section due to the deformity of pelvic cavity resulted from previous surgery for pelvic bone tumor. Both mother and her offspring (without SARS-CoV-2 infection) were discharged uneventfully. Conclusion: Our report adds the growing body of experience toward management of pregnant women with SARS-CoV-2 infection. Decision making of timing and method of delivery is regarding to individualized condition and hospital setting.

Introduction: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. Its impact on the health and welfare of the human population is significant; its impact on the delivery of healthcare is also considerable.Objective: This article is another paper in a series addressing COVID-19-related updates to emergency clinicians on the management of COVID-19 patients with cardiac arrest.Discussion: COVID-19 has resulted in significant morbidity and mortality worldwide. From a global perspective, as of February 23, 2022, 435 million infections have been noted with 5.9 million deaths (1.4%). Current data suggest an increase in the occurrence of cardiac arrest, both in the outpatient and inpatient settings, with corresponding reductions in most survival metrics. The frequency of out-of-hospital lay provider initial care has decreased while non-shockable initial cardiac arrest rhythms have increased. While many interventions, including chest compressions, are aerosol-generating procedures, the risk of contagion to healthcare personnel is low, assuming appropriate personal protective equipment is used; vaccination with boosting provides further protection against contagion for the healthcare personnel involved in cardiac arrest resuscitation. The burden of the COVID-19 pandemic on the delivery of cardiac arrest care is considerable and, despite multiple efforts, has adversely impacted the chain of survival.Conclusion: This review provides a focused update of cardiac arrest in the setting of COVID-19 for emergency clinicians. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved.Objective: This is the second part in a series on COVID-19 updates providing a focused overview of the medical management of COVID-19 for emergency and critical care clinicians.Discussion: COVID-19, caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality worldwide. A variety of medical therapies have been introduced for use, including steroids, antivirals, interleukin-6 antagonists, monoclonal antibodies, and kinase inhibitors. These agents have each demonstrated utility in certain patient subsets. Prophylactic anticoagulation in admitted patients demonstrates improved outcomes. Further randomized data concerning aspirin in outpatients with COVID-19 are needed. Any beneficial impact of other therapies, such as colchicine, convalescent plasma, famotidine, ivermectin, and vitamins and minerals is not present in reliable medical literature. In addition, chloroquine and hydroxychloroquine are not recommended.Conclusion: This review provides a focused update of the medical management of COVID-19 for emergency and critical care clinicians to help improve care for these patients. [ABSTRACT FROM AUTHOR]

Objective: To postulate that ADHD is a potential risk factor for COVID-19 infection; to evaluate the COVID-19 risk factor on drug-treated ADHD subjects. Methods: A retrospective chart review was performed on ADHD subjects aged 6 to 18 years in Israel, who had undergone at least one COVID-19 test during the study period. Results: Of the 64,409 subjects included in the study, 6,207 (9.64%) had at least one positive COVID-19 test result, 13,300 (20.65%) were diagnosed with ADHD, and of whom 1,751 (13%) had purchased at least two ADHD medications 3 months prior to COVID-19 testing and were defined as being medically treated. Medically-treated ADHD subjects had a significantly lower likelihood to be infected with COVID-19 than untreated subjects. Conclusion: Untreated ADHD patients seem to constitute a risk group for COVID-19 infection. Drug treatment ameliorates risk of spreading COVID-19 infection within the pediatric population and secondary spread in the general population. [ABSTRACT FROM AUTHOR]

Coronavirus Disease 2019 (COVID-19) is a respiratory and systemic illness that may progress to severe Acute Respiratory Distress Syndrome (ARDS). There is a pressing need to identify clinical predictors of severe COVID-19 which can help in risk stratification and prognostication. The COVID-19 pandemic tends to have more severe clinical presentation in older age group and in chronic diseases; Chronic Obstructive Pulmonary Disease (COPD) is one of them. COPD is the common cause of high mortality and morbidity worldwide. It is obvious to fear for patients with underlying COPD. Acute episode of exacerbation and COVID-19 pneumonia are the two pivotal differential diagnoses in contemporary era, in patients of COPD presenting with worsening dyspnoea. Mortality rate have been higher among COPD group of patients with the development of hypoxemia. Literature shows that pre-existing COPD worsens the risk of COVID-19 progression and leads to poorer prognosis. Even after recovery from the acute event, proper adherence to maintenance therapy for COPD (inhalational agents) continues to be of paramount importance and remains the standard of care. Because COPD remains a subset that is highly vulnerable for adverse outcomes with COVID-19 infection, preventive therapy should be directed towards–attenuation of contact with droplets, proper hand hygiene and maintenance of adequate nutritional status. The aim of this brief review is to know the burden and impact of COPD on COVID-19 pandemic and challenges in diagnosis and management of COPD patients.

Introduction Anxiety has become a topical issue since the arrival of the coronavirus pandemic, especially for frontline healthcare professionals as they deal with patients affected by the Covid-19. Objectives Objectify anxiety in frontline medical and paramedical staff and study its associated factors. Methods We conducted a national descriptive and analytical cross-sectional study via a survey over a 2-month period from September to October 2020. We used “Beck Anxiety Inventory” to screen anxiety as well as “Brief Cope Scale” to detect probable correlations between anxiety and coping mechanisms. Results We collected 78 persons. The mean age was 29.86 years. 35.9% moved out of home. 39.7% worked in Covid units. 7.7% had personal psychiatric history. 76.9% provided direct care to patients with Coronavirus. The frontline staff reported that only 29.5% of patients were stables. Only 48.4% received adequate training of protection against Covid-19. 64.1% of professionals did PCR test and only 16.7% of them tested positive. We objectified an increase of 6.4% in the anxiolytics use. Stigma affected 57.7% of professionals. We highlighted a link between anxiety and social support strategy (p=0.048). 92.3 % of the staff suffered from anxiety according to Beck Anxiety Inventory. Conclusions Screening anxiety among frontline medical and paramedical staff might enhance their productivty and thus provide patients with the best care. Disclosure No significant relationships.

Introduction The current coronavirus pandemic is a unique and unusual situation. It is putting the general population under severe strain. However, frontline medical and paramedical staff remain particularly vulnerable to depression because of its close contact with patients. Objectives The aim of this work was to screen and evaluate depression in the frontline professionals during the pandemic and to study their associated factors . Methods In this study , we conducted a national descriptive and analytical cross-sectional study over a 2-month period from September to October 2020. We used “Beck Depression Inventory” to assess depression and “Brief Cope Scale” to detect a possible correlation between depression and coping mechanisms. Results We collected 78 professionals. The mean age was 29.86 years. 2/3 of workers were women. 67.9% of the staff were residents. 39.7% worked in Covid units. 7.7% had personal psychiatric history. 56.4% of the staff worked daily and 76.9% of them provided direct care to patients with Coronavirus. 52.6% of workers did not receive adequate training of protection against Covid-19.The staff reported 66.7% of death among their patients. 42.3% suffered from minor depression and only 2.3% suffered from severe depression. During this period we objectified an increase of 14.1% in the psychoactive substances use. Stigma affected 57.7% of professionals. We didn’t objectify a significant correlation between Depression and coping mechanisms . Conclusions Screening depression among healthcare professionals should be considered in order to prevent it, ensure continuity of care and avoid sick leaves. Disclosure No significant relationships.

Introduction Coronavirus disease 2019 (COVID-19) is the current world issue, with huge impact on mental health. More specifically,we expect that it will have a naocif effect on the pregnant women’s mental health and their well being, since they are more likely to be hospitalized and require more intensive care units admission than non- pregnant women. Objectives The aim of this work was to evaluate the evolution of depression symptoms in the time of pandemic and their associated factors. Methods In the current work, we conducted a comparative in field cross-sectional study. We compared depressive scores and prevalences before and after the COVID-19 outbreak in Tunisia in pregnant women.The sampling period was outside the lockdown period to avoid quarantine bias. The sampling period was from September to October 2020. Results showed a significantly higher prevalence of depressive symptoms in expecting mothers during the pandemic. Multivariate analysis showed that the pandemic multiplied by 3 the risk of severe depression symptoms. The impact of the COVID-19 period on depression was independent of sociodemographic and obstetric changes related to the pandemic. Conclusions These results highlighted the emergency of preparing strategies to avoid post-partum psychiatric disorders and to enable a healthy development of born. Screening the post-partum depression and assessing the mother-children early interactions should be considered in the up-coming births. Disclosure No significant relationships.

Abstract Background There are limited data on the outcomes of adults with coronavirus disease 2019 (COVID‐19) and atrial fibrillation (AF). The objectives were to (i) examine associations between AF, 30‐day thromboembolic events and mortality in adults with COVID‐19 and (ii) examine associations between COVID‐19, 30‐day thromboembolic events and mortality in adults with AF. Methods A study was conducted using a global federated health research network. Adults aged ≥50 years who presented to 41 participating healthcare organizations between 20 January 2020 and 1 September 2020 with COVID‐19 were included. Results For the first objective, 6589 adults with COVID‐19 and AF were propensity score matched for age, gender, race, and comorbidities to 6589 adults with COVID‐19 without AF. The survival probability was significantly lower in adults with COVID‐19 and AF compared to matched adults without AF (82.7% compared to 88.3%, Log‐Rank test P

Introduction: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved.Objective: This first in a two-part series on COVID-19 updates provides a focused overview of the presentation and evaluation of COVID-19 for emergency clinicians.Discussion: COVID-19, caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality worldwide. Several variants exist, including a variant of concern known as Delta (B.1.617.2 lineage) and the Omicron variant (B.1.1.529 lineage). The Delta variant is associated with higher infectivity and poor patient outcomes, and the Omicron variant has resulted in a significant increase in infections. While over 80% of patients experience mild symptoms, a significant proportion can be critically ill, including those who are older and those with comorbidities. Upper respiratory symptoms, fever, and changes in taste/smell remain the most common presenting symptoms. Extrapulmonary complications are numerous and may be severe, including the cardiovascular, neurologic, gastrointestinal, and dermatologic systems. Emergency department evaluation includes focused testing for COVID-19 and assessment of end-organ injury. Imaging may include chest radiography, computed tomography, or ultrasound. Several risk scores may assist in prognostication, including the 4C (Coronavirus Clinical Characterisation Consortium) score, quick COVID Severity Index (qCSI), NEWS2, and the PRIEST score, but these should only supplement and not replace clinical judgment.Conclusion: This review provides a focused update of the presentation and evaluation of COVID-19 for emergency clinicians. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of the coronavirus-2019 (COVID-19) pandemic on pediatric critical care medicine (PCCM) fellowship training through a cross-sectional survey of both program directors (PDs) and fellows. Design: Cross-sectional internet-based survey. Setting: Accreditation Council for Graduate Medical Education (ACGME)-accredited PCCM fellowship programs in the United States. Subjects: PCCM PDs and fellows. Results: A total of 34 PDs and 92 fellows responded to the national survey (rate of 47% and 17%, respectively). The majority (69%) of respondents agreed that medical education has been negatively impacted by the COVID-19 pandemic. When PDs were surveyed, 91% noted a significant decrease in the patient census since March 2020, with 59% citing a >15% decrease. Further, 65% reported trainees had less procedural experience. All respondents reported that education was at least in part provided through virtual learning platforms, with nearly half having exclusive remote learning without in-person sessions. Fifty percent of PDs and 62% of fellows reported decreased learner engagement during virtual didactics when compared to in-person education. The majority of PDs reported specific decreases in simulation, procedural skills training, and ultrasound training. Few PDs (15%) and fellows (13-16%) reported redeployment to adult patient care, with northeastern programs having the highest rates. In univariate analyses, decreased PDs confidence in trainee procedural skills was associated with reported decreases in number of procedures performed (P=.0006) and number of procedural skills didactic sessions (P =.0245). Change in the unit census was associated with less PDs confidence in fellows' medical knowledge (P =.0004), fellows' management skills (P =.0232), and fellows' procedural skills (P =.0003), with larger decreases in patient census correlating with larger decreases in confidence. Conclusions: The COVID-19 pandemic has significantly impacted the education and clinical training of PCCM fellows. More knowledge on this topic can assist PDs in curriculum changes for the future to address any gaps in learning that have occurred. [ABSTRACT FROM AUTHOR]

Introduction: Mental health and well-being is as important as physical health during pregnancy. But the Coronavirus Disease-2019 (COVID-19) pandemic has caused more anxiety and stress among pregnant women. The augmented levels of anxiety and stress may have detrimental effects on antenatal women. Anxiety and depression in pregnancy can lead to adverse pregnancy outcomes like increased risk of abortions, preterm labour and even foetal deaths. Aim: To assess the anxiety and stress levels among pregnant women attending a tertiary care hospital in Thiruvananthapuram, Kerala during the COVID-19 pandemic and to determine the associated factors. Materials and Methods: A cross-sectional study was conducted among 348 pregnant women attending a tertiary care teaching hospital in Thiruvananthapuram District in Kerala during the period between October 2020 to November 2020 using a validated tool, Pandemic Anxiety Stress Scale for pregnant women (PASSP). Higher scores indicating higher perceived anxiety stress with a maximum score of 60, categorised as normal, mild, moderate and severe with score between 0-14, 15-29, 30-44, and 45-60, respectively. Qualitative variables were expressed in frequency and percentage. Multivariate logistic regression was done to determine the factors associated with anxiety and stress. The p-value

The benefits of percutaneous dilational tracheostomy (PDT) placement have been well documented in patients requiring prolonged mechanical ventilation. However, the data regarding the benefit of PDT in coronavirus-2019 (COVID-19) patients are scarce. The objective of this study is to evaluate the outcomes of a cohort of 37 patients who underwent tracheostomy as part of their COVID-19 care. Retrospective data from a series for 37 patients undergoing tracheostomy was collected using chart review. Primary outcomes included 30 and 60 day mortality, weaning rate, and decannulation rate. Secondary outcomes collected included admission demographics, comorbidities, and procedural information. Thirty-seven (37) patients requiring prolonged mechanical ventilation due to COVID-19. Of these 37 patients, 35 were alive 60 days post-PDT placement, 33 have been weaned from mechanical ventilation and 18 have been decannulated. The low mortality and high decannulation rates in this cohort in is a promising development in the care of critically ill COVID-19 patients. Of note, all participating physicians underwent routine polymerase chain reaction (PCR) testing for infection with the severe acute respiratory syndrome coronavirus-2 virus and no physician contracted COVID-19 as a result of their involvement. Overall, this case series describes the modified PDT technique used by our team and discusses the feasibility and potential benefit to PDT placement in COVID-19 patients requiring long-term mechanical ventilation. [ABSTRACT FROM AUTHOR]

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Introduction: Guillain-Barre Syndrome (GBS) is an autoimmune acute inflammatory demyelinating polyneuropathy usually elicited by an upper respiratory tract infection. Several studies reported GBS associated with Coronavirus Disease 2019 (COVID-19) infection. In this study, we described nine GBS patients following the COVID-19 vaccine. Methods: In this study, nine patients were introduced from six referral centers for neuromuscular disorders in Iran between April 8 and June 20, 2021. Four patients received the Sputnik V, three patients received the Sinopharm, and two cases received the AstraZeneca vaccine. All patients were diagnosed with GBS evidenced by nerve conduction studies and/or cerebrospinal fluid analysis. Results: The median age of the patients was 54.22 years (ranged 26-87 years), and seven patients were male. The patients were treated with Intravenous Immunoglobulin (IVIg) or Plasma Exchange (PLEX). All patients were discharged with some improvements. Conclusion: The link between the COVID-19 vaccine and GBS is not well understood. Given the prevalence of GBS over the population, this association may be coincidental; therefore, more studies are needed to investigate a causal relationship. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 is an emerging respiratory disease that is caused by a novel coronavirus and was first detected in December 2019 in Wuhan, China. The world was affected by the Coronavirus Disease in 2019. In sub-Saharan Africa, including Ethiopia, there is no study conducted on the level of Knowledge, Attitude, and Associated Factors towards Coronavirus disease 2019 among Health care workers, specifically Nurses. This study aims to assess the level of Knowledge, Attitude, and Associated Factors towards Coronavirus disease 2019 among Nurses who work in South Gondar Zone, Hospitals, Northwest Ethiopia, 2020. An Institution based cross-sectional study was conducted among 166 Nurses in South Gondar Zone, Ethiopia, From 1 June to 30 June 2020. For selecting the study participants after proportional allocation of study subjects to each hospital, simple random sampling techniques were to be used. Data were entered into Epi info version 7.2.0.1, and exported to Statistical Package for Social Sciences window version 24 for analysis. Binary and multivariable logistic regression was used to see the association between dependent and independent variables. Adjusted odds ratio with 95% confidence interval was computed. P-value < 0.05 was used to declare association. Finally, the result is presented in the form of texts, tables, and graphs. Of 166 Nurses, 166 (100% response rate) responded to the online interview questionnaire. Of the participating 166 nurses, 57.2% were females and 42.8% were males; 41.6 % of the respondents were between the ages of 20 and 29 years. About 84.9 % had good knowledge and 63.3% favourable attitude of COVID-19. Wearing general medical masks can prevent one from acquiring infection by the COVID-19 virus. AOR = 0.44, 95% CI = 0.005–0.362 were factors of knowledge about COVID-19, whereas, ‘I strongly agree’ Medical staff were ready to participate in anti-epidemic in the community, AOR = 0.08, 95% CI = 0.003–1.76 were factors of attitude about COVID-19. Where factors of attitude about COVID-19. In this study, most of the nurses had good knowledge and a favourable attitude regarding of COVID-19. Wearing general medical masks that can prevent one from acquiring infection by the COVID-19 virus were factors in association with the knowledge of nurses on COVID-19. Similarly, Medical staff were ready to participate in anti-epidemic community factors associated with the attitudes of nurses on COVID-19.

Introduction: Project-based learning has both constructionist as well as constructivist principles that engage the students in autonomous deep learning. Aim: To obtain the perceptions of participants on project-based learning in the subject of Pharmacology during COVID-19 lockdown. Materials and Methods: This was an online questionnairebased descriptive study done on the Google platform. A series of integrated lectures were conducted in the Department of Pharmacology and Internal Medicine on diabetes, lipid dysfunction and thyroid disorder for second year MBBS students. The study was conducted from August 2020 to November 2020 in a medical college in Kerala, India. Google-based project submission was done after identifying a patient at home or neighbourhood with the disease covered after each integrated lecture. A validated questionnaire was used to obtain feedback about the projectbased learning on a Likert scale. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) Version 16 software for Windows. Results: The response rate was 76.9% (100 out of 130). The majority of the participants agreed/totally agreed to statements on professional attributes attained during project-based learning session like the ability to think creatively (60%), make observations (81%), compile information (80%), assess and make a decision (59%), analyse situations of professional practice (65%), develop oral communication skills (57%), develop Self-Directed Learning (SDL) (70%), develop skills needed for professional practice (54%), develop empathy towards patients with disease (79%) and develop self-confidence in learning the subject (63%) with a median score of 4. The majority of participants agreed/totally agreed to the effectiveness of the project-based learning in helping acquire various clinical and theoretical competencies during COVID-19 lockdown. The majority of the participants and the patient identified at home were happy to be part of the project-based learning. Conclusion: The majority of the participants were in agreement with the questions posed to them with a median score of 4, however, a neutral opinion was obtained on the acquisition of written communication skills as well as their family members having better compliance after getting involved in project-based learning.

Introduction: Project-based learning has both constructionist as well as constructivist principles that engage the students in autonomous deep learning. Aim: To obtain the perceptions of participants on project-based learning in the subject of Pharmacology during COVID-19 lockdown. Materials and Methods: This was an online questionnairebased descriptive study done on the Google platform. A series of integrated lectures were conducted in the Department of Pharmacology and Internal Medicine on diabetes, lipid dysfunction and thyroid disorder for second year MBBS students. The study was conducted from August to November 2020 in a medical college in Kerala, India. Google-based project submission was done after identifying a patient at home or neighbourhood with the disease covered after each integrated lecture. A validated questionnaire was used to obtain feedback about the projectbased learning on a Likert scale. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) Version 16 software for Windows. Results: The response rate was 76.9% (100 out of 130). The majority of the participants agreed/totally agreed to statements on professional attributes attained during project-based learning session like the ability to think creatively (60%), make observations (71%), compile information (80%), assess and make a decision (59%), analyse situations of professional practice (65%), develop oral communication skills (57%), develop Self-Directed Learning (SDL) (70%), develop skills needed for professional practice (54%), develop empathy towards patients with disease (79%) and develop self-confidence in learning the subject (63%) with a median score of 4. The majority of participants agreed/totally agreed to the effectiveness of the project-based learning in helping acquire various clinical and theoretical competencies during COVID-19 lockdown. The majority of the participants and the patient identified at home were happy to be part of the project-based learning. Conclusion: The majority of the participants were in agreement with the questions posed to them with a median score of 4, however, a neutral opinion was obtained on the acquisition of written communication skills as well as their family members having better compliance after getting involved in project-based learning. [ABSTRACT FROM AUTHOR]

Background: There are limited data on the outcomes of adults with coronavirus disease 2019 (COVID‐19) and atrial fibrillation (AF). The objectives were to (i) examine associations between AF, 30‐day thromboembolic events and mortality in adults with COVID‐19 and (ii) examine associations between COVID‐19, 30‐day thromboembolic events and mortality in adults with AF. Methods: A study was conducted using a global federated health research network. Adults aged ≥50 years who presented to 41 participating healthcare organizations between 20 January 2020 and 1 September 2020 with COVID‐19 were included. Results: For the first objective, 6589 adults with COVID‐19 and AF were propensity score matched for age, gender, race, and comorbidities to 6589 adults with COVID‐19 without AF. The survival probability was significantly lower in adults with COVID‐19 and AF compared to matched adults without AF (82.7% compared to 88.3%, Log‐Rank test P <.0001; Risk Ratio (95% confidence interval) 1.61 (1.46, 1.78)) and risk of thromboembolic events was higher in patients with AF (9.9% vs 7.0%, Log‐Rank test P <.0001; Risk Ratio (95% confidence interval) 1.41 (1.26, 1.59)). For the second objective, 2454 adults with AF and COVID‐19 were propensity score matched to 2454 adults with AF without COVID‐19. The survival probability was significantly lower for adults with AF and COVID‐19 compared to adults with AF without COVID‐19, but there was no significant difference in risk of thromboembolic events. Conclusions: AF could be an important risk factor for short‐term mortality with COVID‐19, and COVID‐19 may increase risk of short‐term mortality amongst adults with AF. [ABSTRACT FROM AUTHOR]

The reviews of this paper are available via the supplemental material section. [ABSTRACT FROM AUTHOR]

ABSTRAK Penyakit Coronavirus-2019 atau Covid-19 telah menjadi pandemi global dan menjadi masalah utama yang harus segera dikendalikan. Salah satu cara yang dapat dilakukan adalah memutus rantai penyebaran virus tersebut dengan melakukan deteksi dan melalukan karantina. Pencitraan X-Ray dapat dijadikan alternatif dalam mempelajari Covid-19. X-Ray dianggap mampu menggambarkan kondisi paru-paru pada pasien Covid-19 dan dapat menjadi alat bantu diagnosa klinis. Pada penelitian ini, kami mengusulkan pendekatan deep learning berbasis residual deep network untuk deteksi Covid-19 melalui citra chest X-Ray. Evaluasi yang dilakukan untuk mengetahui performa metode yang diusulkan berupa precision, recall, F1, dan accuracy. Hasil eksperimen menunjukkan bahwa usulan metode ini memberikan precision, recall, F1 dan accuracy masing-masing 0,98, 0,95, 0,97 dan 99%. Pada masa mendatang, studi ini diharapkan dapat divalidasi dan kemudian digunakan untuk melengkapi diagnosa klinis oleh dokter. Kata kunci: Coronavirus-2019, Covid-19, chest X-Ray, deep learning, residual network ABSTRACT Coronavirus-2019 or Covid-19 disease has become a global pandemic and is a major problem that must be stopped immediately. One of the ways that can be done to stop its spreading is to break the spreading chain of the virus by detecting and doing quarantine. X-Ray imaging can be used as an alternative in detecting Covid-19. X-Ray is considered able to describe the condition of the lungs for Covid-19 suspected patients and can be a supporting tool for clinical diagnosis. In this study, we propose a residual based deep learning approach for Covid-19 detection using chest X-Ray images. Evaluation is carried out to determine the performance of the proposed method in the form of precision, recall, F1 and accuracy. Experiments results show that our proposed method provides precision, recall, F1 and accuracy respectively 0.98, 0.95, 0.97 and 99%. In the future, this study is expected to be validated and then used to support clinical diagnoses by doctors. Keywords: Coronavirus-2019, Covid-19, chest X-Ray, deep learning, residual network

In the year 2019, the potent zoonotic virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began to rage globally, which resulted in the World Health Organization (WHO) declaring it as a pandemic on March 11th, 2020. Although extensive research is currently ongoing worldwide to understand the molecular mechanism and disease pathogenicity of SARS-CoV-2, there are still many nuances to elucidate. Therefore, developing an appropriate vaccine or therapeutic drug to combat coronavirus 2019 (COVID-19) is exceedingly challenging. Such scenarios require multifaceted approaches to identify suitable contenders for drugs against COVID-19. In this context, investigating natural compounds found in food, spices, and beverages can lead to the discovery of lead molecules that could be repurposed to treat COVID-19. Sixteen cucurbitacin analogues were investigated for activity against the SARS-CoV-2 main protease protein (Mpro), angiotensin-converting enzyme 2 (ACE2) binding receptor, nonstructural protein 12 (NSP12) RNA-dependent RNA polymerase (RdRp), NSP13 helicase, and Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) pathway using several relevant tools and simulated screening methods. All key proteins were found to bind efficiently only with cucurbitacin G 2-glucoside and cucurbitacin H with the lowest global energy. Further, the absorption, distribution, metabolism, and excretion (ADME) of all the cucurbitacins were analysed to explore their drug profiles. Cucurbitacin G 2-glucoside and H showed the best hits and all the analogues showed no adverse properties that would diminish their drug-likeness abilities. The encouraging results of the current study may lay the foundation for future research and development of effective measures and preventive medications against SARS-CoV-2.

Alzheimer’s disease (AD) is characterized by the deposition of amyloid-beta (Aβ) plaques from improper amyloid-beta precursor protein (APP) cleavage. Following studies of inflammation caused by coronavirus-2019 (COVID-19) infection, this study investigated the impact of COVID-19 on APP expression. A meta-analysis was conducted utilizing QIAGEN Ingenuity Pathway Analysis (IPA) to examine the link between severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and the modulation of APP expression upon virus binding the Angiotensin-converting enzyme-2 (ACE2) receptor. A Core Analysis was run on the infection by severe acute respiratory syndrome (SARS) coronavirus node, which included molecules affected by SARS-CoV-2, revealing its upstream regulators. Intermediary molecules were found between the upstream regulators and ACE2 and between ACE2 and APP. Activation of the upstream regulators downregulated the expression of ACE2 with a Z-score of −1.719 (p-value = 0.086) and upregulated APP with a Z-score of 1.898 (p-value = 0.058), showing a less than 10% chance of the results occurring by chance and pointing to an inverse relationship between ACE2 and APP expression. The neuroinflammation signaling pathway was the fifth top canonical pathway involved in APP upregulation. The study results suggest that ACE2 could be downregulated by SARS-CoV-2, resulting in APP upregulation, and potentially exacerbating the onset and progression of AD.

Coronavirus Disease 2019 (COVID-19) is a respiratory and systemic illness that may progress to severe Acute Respiratory Distress Syndrome (ARDS). There is a pressing need to identify clinical predictors of severe COVID-19 which can help in risk stratification and prognostication. The COVID-19 pandemic tends to have more severe clinical presentation in older age group and in chronic diseases; Chronic Obstructive Pulmonary Disease (COPD) is one of them. COPD is the common cause of high mortality and morbidity worldwide. It is obvious to fear for patients with underlying COPD. Acute episode of exacerbation and COVID-19 pneumonia are the two pivotal differential diagnoses in contemporary era, in patients of COPD presenting with worsening dyspnoea. Mortality rate have been higher among COPD group of patients with the development of hypoxemia. Literature shows that pre-existing COPD worsens the risk of COVID-19 progression and leads to poorer prognosis. Even after recovery from the acute event, proper adherence to maintenance therapy for COPD (inhalational agents) continues to be of paramount importance and remains the standard of care. Because COPD remains a subset that is highly vulnerable for adverse outcomes with COVID-19 infection, preventive therapy should be directed towards-attenuation of contact with droplets, proper hand hygiene and maintenance of adequate nutritional status. The aim of this brief review is to know the burden and impact of COPD on COVID-19 pandemic and challenges in diagnosis and management of COPD patients. [ABSTRACT FROM AUTHOR]

Background With emergence of coronavirus-2019 or COVID-19 a diverse number of people have been infected worldwide in a short time, with no specific treatment or vaccine. Infected patients are in danger of creating respiratory failure that necessitating admission to intensive care units (ICU). Thus intensivists (ICU providers) and anesthesiologists must be ready for the newcomers to ICU and to sustain care for them. Method We performed a narrative review via searching in three databases PubMed, Google Scholar and Embase for all studies that mentioned all intensive care admission rates for who infected with coronavirus 2019, manual searching also completed. All the selected reviews were limited to the English language and date also. Result Five researches referred to the rate of ICU admission, about 9.3% of all cases. Male patients were more comparing to female (59% to 41 %), median age range were (40-56) years, cases with co-existing diseases range from 23.7%-51%, with ICU admission rate being 5%-32%. An immense number of patients received oxygen therapy (41.3%-76.81%), while 6.7% of cases were under non- invasive ventilation with range from 4.9%-24% and just 3.6% of patients who received invasive ventilation with range from 3.3%-12.32%. Finally the mortality rate was 2.6%. Conclusion The novel virus, COVID-19 has shown to more likely affect older male with underlying conditions such as hypertension, diabetes and others, a point that could expose them to fatal respiratory symptoms, including respiratory failure. So a quite enough of patients might need oxygen support and ICU admission. [ABSTRACT FROM AUTHOR]