A document by Ines Lahouel. Click on the document to view its contents.

Children with sickle cell disease (SCD) are at increased risk for severe illness due to severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). We describe the successful native lung recovery of a child with SCD referred for lung transplant (LTx) evaluation who was on prolonged veno-venous extracorporeal membrane oxygenation (VV-ECMO). He initially presented with acute chest syndrome complicated by SARS-CoV-2 infection that ultimately required dual-lumen, single bicaval VV-ECMO cannulation for respiratory support. Despite increased risk of hemolysis and thrombosis from SCD and SARS-CoV-2 infection, he was successfully supported on VV-ECMO for 71 days without complications leading to native lung recovery with meticulous management of his SCD therapy. This report provides new insight on our approach to VV-ECMO support in a child with SCD and SARS-CoV-2 infection. With a successful outcome, the patient has returned home but still on mechanical ventilation with LTx still an option if he is not eventually liberated from invasive respiratory support.

Abstract Rationale, Aims and Objectives: To examine the relationship between nurse employment setting and nurse job change as related to work stress. Method: A retrospective quantitative analysis. The secondary data was from the 2008 National Sample Survey of Registered Nurses (NSSRN). The outcome measure was job change related to nursing work stress (yes vs. no). The independent variable was nurse work settings, including covariates. Results: Nurses working in medical/physician practice, an insurance company or other private claims/benefits/utilization, and other settings, including nurses who were neither satisfied nor dissatisfied, moderately dissatisfied, and extremely dissatisfied, had higher odds for job change due to stress when compared to inpatient unit community hospital /medical center, non-federal and moderately satisfied the reference category, respectively. Nurses who were unsure and had no plans to remain in the profession had higher odds for job change due to stress than a nurse who said yes to staying in the profession, the reference category. However, nurses in the 65 to 69 age cohort had substantially lower ([OR] = .482, p = .003) odds for not changing jobs due to stress compared to the age group between 50 to 54, the reference category. Conclusion: Among nurses, workplace job dissatisfaction translates to job change related to nursing work stress, while nurses aged 65 to 69 stayed at the job despite work stress. Given the current coronavirus (COVID-19) high-stress pandemic environment, healthcare organizations must do more to mitigate work-related job stress to prevent attrition and job change. KEYWORDS nurses, job change, work stress, and workplace

Background Conventional tracheostomy and percutaneous dilatational tracheostomy (PDT) present risks of exposing health care workers to coronavirus disease (COVID‐19). We report a hybrid modified percutaneous dilatational tracheostomy (hybrid MPDT) to reduce this risk of COVID-19 aerosol transmission. Methods We performed tracheostomy using a hybrid MPDT involving a combination of conventional tracheostomy and PDT. Hybrid MPDT requires a small incision and minimal dissection like conventional tracheostomy, followed by PDT without bronchoscope guidance and the use of an endotracheal tube cuffed at cricoid. Results Hybrid MPDT was successfully performed in 20 patients with COVID‐19. The infection rate to medical staff was 0% and the average operation time was 6.45±1.02 min. Conclusion Hybrid MPDT may ensure rapid and safe airway management in critically ill COVID-19 patients.

Most children and adolescents with SARS-CoV-2 infection shows asymptomatically or with mild symptoms. There are few reported cases of extracorporeal membrane oxygenation (ECMO) in pediatric patients with coronavirus disease 2019 (COVID-19). We present a previously healthy 13-year-old male, diagnosed with metastatic Ewing’s sarcoma at the same time as catastrophic acute respiratory distress syndrome due to COVID-19, which was successfully supported by veno-venous ECMO, while he received the corresponding chemotherapy protocol. ECMO can be used as salvage therapy in oncology pediatric patients with respiratory failure secondary to COVID-19. In addition, successful chemotherapy can be administered while patients are supported on ECMO.

Background: While the coronavirus disease 2019 (COVID-19) is most commonly associated with the respiratory system, disorders in other organ systems, such as the cardiovascular, neurologic, or renal, can also contribute to disease fatality. This study aimed to evaluate the relation of comorbidities to COVID-19 short-term mortality. Method: This was a single-center observational study with a historical cohort method at Bethesda Hospital Yogyakarta, Indonesia. COVID-19 diagnosis was made by utilizing reverse transcriptase-polymerase chain reaction (RT-PCR) on nasopharyngeal swabs. Patient data were retrieved from electronic medical records and used for Charlson Comorbidity Index assessments. In-hospital mortality was monitored throughout their hospital stay. Results: This study enrolled 333 patients. According to the total number of comorbidities in Charlson, 11.7% (n=39) of patients had no comorbidities; 30.9% (n=103) of patients had one comorbidity; 20.1% (n=67) of patients had two comorbidities; and 37.2% (n=124) of patients had more than three comorbidities. In multivariate analysis, these variables were significantly related to short-term mortality in COVID-19 patients: older age (odds ratio [OR] per year 1.64; 95% confidence interval [CI] 1.23-2.19; p 0.001), myocardial infarction (OR 3.57 ; 95% CI 1.49-8.56; p: 0.004), diabetes mellitus (OR 2.41; 95 CI 1.17-4.97; p: 0.017), renal disease (OR 5.18 ; 95% CI 2.07-12.97; p <0.001), and longer duration of stay (OR 1.20; 95% CI 1.08-1.32; p <0.001). Conclusion: Our study revealed multiple risk factors for mortality in patients with COVID-19. The coexistence of cardiovascular disease, diabetes, and renal problem are significant predictors of short-term mortality in COVID-19 patients.

Study Objective: The purpose of this study was to determine the effects of self-prone positioning on oxygenation in COVID-19 positive patients utilizing supplemental oxygen and incidence of intubation. Method: A one-year observational cohort pilot study at a major inner-city hospital to evaluate self-proning on independent COVID-19 positive patients. Qualified patients 18 years of age or older were recruited based on inclusion and exclusion criteria. Data collection included vital signs and timing for body position changes, and results were analyzed using descriptive and inferential statistics. Results: Between April 2020 and May 2021, 93 COVID-19 enrolled patients engaged in stomach or lateral self-prone positioning. Eighty-four percent (n=78) of the population did not require intubation, whereas 16% (n=15) were intubated during their hospital stay. SpO2 means were determined for each population and prone position: Non-intubated (stomach) - before proning 93% (IQR 4) and during proning 95% (IQR 3); (lateral) before proning 92% (IQR 4) and during proning 93% (IQR 4). Intubated (stomach) - before proning 90% (IQR 7) and during proning 95% (IQR 4); (lateral) before proning 92% (IQR 5) and during proning 95% (IQR 5). Stomach proning significantly increased oxygenation in the non-intubated (p <0.001) and intubated (p 0.017) populations. Lateral proning significantly improved oxygenation in the intubated population (p 0.002). Conclusion: Self-proning in the independent COVID-19 positive patient on supplemental oxygen was effective in improving SpO2 levels short-term. Further controlled trial studies will elucidate the duration of proning effects and reinforce its use as a noninvasive rescue intervention to prevent intubation.

Viruses that emerge pose challenges for treatment options as their uniqueness would not know completely. In spite of large diversity, viruses share common characteristics for infection. There are at least 12 different respiratory borne viruses that belong to different virus taxonomic families. Many of these viruses multiply and cause damage to the upper and lower respiratory tracts. The description about these viruses in comparison to each other with reference to their epidemiology, molecular characteristics, disease manifestations, diagnosis and treatment is lacking. Such information helps to diagnose, differentiate and for formulating the control measures at faster pace. The leading cause of acute illness worldwide are the acute respiratory infections (ARIs) and are being responsible for nearly 4 million deaths every year which are mostly in young children and infants. Among the above ARIs, influenza, respiratory syncytial virus (RSV), parainfluenza virus type 3 (PIV-3), Streptococcus pneumoniae, Haemophilus influenzae and corona viruses are the main infectious agents. WHO recognized respiratory syncytial virus, parainfluenza viruses, coronavirus, rhinovirus, and human metapneumovirus [non-influenza RNA respiratory viruses (NIRVs)], as considerable global health burden. Lower respiratory tract infections are the fourth most common cause of death globally, after the non-infectious chronic conditions. This review aimed at presenting the characteristics of different viruses causing the respiratory infections highlighting the uniqueness of Covid-19. We expect that this review would help in understanding the similarities and differences among the closely related viruses causing respiratory infections and hence to formulate the specific preventive or control measures.

Background: There is an urgent need to review the status of COVID-19 vaccine immunization in pregnant women globally so that the adverse outcomes may be prevented. Objective: To evaluate the probable outcome of COVID-19 vaccination in pregnant women. Search strategy: An electronic search was conducted over the period of 3 months (June 15-August 15, 2021). Selection criteria: The original studies evaluating safety concerns in pregnant women for COVID-19 vaccination were included. Data collection and analysis: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines were used for the collection of the data and reporting of the findings. The inclusion and exclusion criteria for the studies were determined based on ‘PICO principle’ (Population, Intervention, Comparator, and Outcome, Study design. Risk of bias assessment was done using National Institute of Health (NIH) tool for systematic reviews. Main results: COVID-19 vaccination in pregnant women was not associated with increased adverse effects or complications to the mother as well as developing fetus or newborn compared to non-vaccinated pregnant women. Vaccinated pregnant women showed a robust immune response against COVID-19 infection. Conclusions: COVID-19 vaccination during pregnancy causes no significant health risks for the mother or developing fetus or newborn.

Corticosteroids are the most important factor to reduce the mortality in patients with moderate-severe COVID-19. The aim of the study was to analyze the impact of methylprednisolone pulse (MPP) on in-hospital mortality of patients with acute respiratory distress syndrome (ARDS) due to COVID-19. We conducted a retrospective, single-center observational study We selected adult patients admitted to the hospital with the diagnosis of COVID-19 between March and June 2020. A total of 306 patients were analyzed. In-hospital crude mortality rate was 17%. Diabetes mellitus (HR 5.5, 95% CI 1.40–4.55), dementia (HR 7.7, 95% CI 4.25-13.87) and ARDS (HR 4.2, 95% CI 2.34-7.46) were associated with in -hospital mortality. In patients diagnosed of ARDS, the only in-hospital mortality risk factor was dementia (HR 5.2, 95% CI 2.44–11.07), whereas MPP was a protective factor (HR 0.2, 95% CI 0.09–0.63)

Continual innovation to address emerging population needs necessitates health service ongoing redesign and transformation worldwide. Recent examples include service transformations in response to covid-19. Ensuring effective change management processes occur is central to delivering these transformative changes yet notoriously challenging. Recent evidence indicates that affective commitment to change amongst healthcare staff may be an important contributor to gaining support for change implementation but understudied in healthcare. Our analysis sought to examine the association between affective commitment to change and change readiness in projects across the New South Wales health system in Australia. Our findings indicate that affective commitment to change; healthcare worker’s emotional and personal perception of the value of the proposed change, is independently associated with individual and collective change readiness. Given that achieving change readiness is a central goal of change management strategies, this pilot work provides valuable insight to inform change management practices in healthcare contexts.

A document by Jennifer Talbott. Click on the document to view its contents.

- We hypothesized that the surgical mask could filter some odorant particles, leading to a transient hyposmia. - A crossover prospective comparative study between 2 groups of 10 healthy volunteers was conducted to evaluate the impact of wearing a surgical mask on sense of smell by comparing the results of sniffin’ sticks test (SST) with and without a surgical mask. - All the subjects, except one, had a significantly better total score (TDI) without a mask. - 4/20 (20%) were normosmic without a mask, while being recategorized as hyposmic with a mask. - Wearing a surgical mask may reduce the sense of smell, in a cohort of young normosmic patients.

The outbreak of novel SARS-CoV-2 virion has wreaked havoc with a high prevalence of respiratory illness and high transmission due to a vague understanding of the viral antigenicity augmenting dire challenge to public health globally. This viral member requisite the expansion of diagnostic and therapeutic tools to track its transmission and confront through vaccine development. Therefore, prophylactic strategies are mandatory. Virulence-related spike proteins can be the desirable candidate befitting computational design of vaccines targeting SARS-CoV-2 followed by meteoric development of immune epitopes. This study aims to characterize Spike protein using the existing knowledge related to the immunological profile of SARS-CoV-2 to predict immunogenic epitopes based on antigenicity, allergenicity, toxicity, immunogenicity, and population coverage. Applying in-silico approaches, a set of twenty-four B lymphocyte-based epitopes and forty-six T lymphocyte-based epitopes (MHC-I and MHC-II) were selected. The predicted epitopes were evaluated for their intrinsic properties. Physico-chemical characterization of epitopes qualify them for further in vitro and in vivo analysis pre-requisite vaccine development. This study presents a set of screened epitopes that binds to the HLA- specific allelic proteins that can be employed for designing a multi-epitopic peptide vaccine construct (MEPVC) against SARS-CoV-2 that will confer vaccine-induced protective immunity due to its structural stability.

This paper deals the mathematical modeling of second wave COVID19 pandemic in India, also we discussed such as uniformly bounded of the system, Equilibrium analysis and basic reproduction number R0. We calculated the analytic solutions by HPM (Homotopy Perturbation Method) and used Mathematica 12 software for numerical analysis up to 8th order approximation. It checked the error values of the approximation while the system has residual error, absolute error and h curve initial derivation of square error at up to 8th order approximation. The basic reproduction number ranges between 0.8454 and 2.0317 form numerical simulation, it helps to identify the whole system fluctuations. Finally, our proposed model validated from real life data for highly affected 5 states

Objective: To evaluate the intensity of climacteric symptoms and possible associations with sociodemographic variables, anxiety, depression, and quality of life in women between 40 and 65 years old who sought attendance in a primary health care setting in the city of Rio de Janeiro, Brazil during the COVID-19 pandemic. Design: An observational cross-sectional study. Setting: a municipal health care facility (MHF) in Rio de Janeiro, Brazil. Sample: 138 women (age = 51.4 ± 7.1 years old) seeking health services from June to August 2020. Methods: A cross-sectional approach was developed using self-reported questionnaires. Main outcome measures: Sociodemographic and economic aspects, the Blatt and Kupperman Menopausal Index (BKMI), the WHOQOL-BREF for quality of life, and the Hospital Anxiety and Depression Scale (HADS). Results: Ninety-six percent of the women had moderate to accentuated climacteric symptoms. Women with severe menopausal symptoms tended to have higher HADS scores (p < 0.05). There was a significant association between BKMI scores and education levels (p = 0.04). All illiterate women had moderate or severe climacteric symptoms. Proportionately, women who have completed high school had less marked intensity than those with moderate schooling. Moreover, most women with severe or moderate climacteric intensity levels presented “highly likely” incidence of anxiety. Conclusions: This is the first report to highlight climacteric and menopausal effects on women’s health status during the COVID-19 pandemic, which is an aggravating factor for the emergence of emotional changes resulting from sanitation, social isolation, and socioeconomic uncertainties.

A case of COVID-19 in a pregnancy complicated by fetal pleural effusionŁukasz Witek1, Natalia Filochowska1, Tomasz Janikowski2, Helena Sławska3, Anita Olejek11Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia, Bytom, Poland2Silesian College of Medicine, Katowice, Poland3Department of Neonatology in Bytom, Medical University of Silesia, Katowice, Poland.

Survivors of SARS-CoV-2 (Covid-19) infections have a unique immune response that allows them to either delay reinfection or outsmarts the virus’s whims. The emergence of new SARS-CoV-2 variants and immunization have furthered this immune response by producing high-affinity anti-SARS-CoV-2 antibodies. There is limited data on the extent to which this immune response confers protective immunity against recurrent infections, as well as the duration of this protection. Here we present the first-ever quantum mechanical model to provide an answer to this question. The model is well applicable because of the 20 nm -500 nm size range of coronavirus. We call this model the ‘Quantum Perturbation Model’. The model relates the strength of the COVID-19 attack to a wave function containing information about the system (person infected by the SARS-CoV-2) and quantized energy states, which shows the chances of reoccurrence of the disease. By applying the energy corrections provided by the Quantum Perturbation Theory to the SARS-CoV-2 attack under reinfections and various pre-existing conditions we have provided possible interpretations. When pre-existing problems exist at the time of SARS-COV-2 infection, the model illustrates how the influence of COVID-19 accumulates up. The model also formulates the deficit in the intensity of the COVID-19 effect in recurrence or in the presence of other variables strengthening the body’s antibody affinity and immunity to resist the virus variants.

Objective The study has been conducted to identify the factors affecting the breastfeeding self-efficacy of pregnant women in the COVID-19 pandemic. Design A descriptive and correlational design has been used in this study. Setting The population of the study comprised all the pregnant women applying to the obstetrics polyclinic of a university hospital. Sample The study sample consisted of 320 pregnant women’s. Methods The data of the study were collected by using an Information Form and the Prenatal Breastfeeding Self-Efficacy Scale. Main Outcome Measures Breastfeeding self-efficacy. Results The seven variables having a significant effect on the pregnant women’s Prenatal Breastfeeding Self-Efficacy Scale scores, in the order of descending importance, have been determined as follows; being knowledgeable on COVID-19, thinking breastfeeding to be beneficial for the baby, going to prenatal care checkups on time, pregnancy duration, educational status , age, and receiving breastfeeding training in the COVID-19 pandemic. Conclusion Although the study findings show similarities to those of the studies conducted before the pandemic analyzing breastfeeding self-efficacy and the factors affecting it, it is an important aspect that this study has been carried out during the COVID-19 pandemic. This study is believed to contribute to the literature and guide interventional studies to be conducted in the COVİD-19 pandemic by evaluating the breastfeeding self-efficacy levels of mothers and the factors affecting them.

Background: Smoking depresses pulmonary immune function and is a risk factor contracting more serious outcomes among people who become infected. The association between smoking and persistent respiratory symptoms which are resistant to oseltamivir for suspected coronavirus disease 2019 (COVID-19) was evaluated. Methods: A total of 22 COVID-19 suspected medical personnel and their cohabitation families without hypoxia and lung diseases, who came to the adult fever clinic from March to September 2020 were studied. All patients received oseltamivir and antibacterial therapy together. And four patients suffering from constant cough were started on inhaled ciclesonide 400μg twice a day for a week. Results: Most of the infected patients were female [13 (59%)], 2 had diabetes (9%) and 4 hypertension (18%). The median age was 40 years (interquartile range [IQR] 25–47 years). The study patients were divided into 2 groups; individuals who currently smoke in 11 patients (current smokers) and never smoked in 11 (never smokers). Four (36%) of 11 current smokers experienced constant cough even after oseltamivir administration, compared with 0% of never smokers (χ 2=4.90; p<0.05). The cough score decreased from 1.5±0.5 at baseline to 0.3±0.5 during the one week after ciclesonide administration (p<0.001) and constant cough disappeared in three cases out of four current smokers. Conclusion: Because current smokers are at a higher risk to develop constant cough which is resistant to oseltamivir therapy for suspected COVID-19 as compared to never smokers, smoking cessation should be recommended at an early stage. Ciclesonide may improve the constant cough in suspected COVID-19.

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is challenging the health systems worldwide, and large population testing is a vital step to control this pandemic. Here, we developed a new method (named HCoV-MS), which combines multiplex PCR with matrix-assisted laser desorption/ionization-time of flight mass spectrometry to simultaneously detect and differentiate seven human coronaviruses (HCoVs). The HCoV-MS method had good specificity and sensitivity, with a detection limit of 1-5 copies/reaction. To validate the HCoV-MS method, we tested 151 clinical samples, and the results showed good concordance with real-time PCR. In addition, 41 D614G variants were identified, which were consistent with the sequencing results. This method was also used in EQAE-SARS-COV in 2020, and all the samples were accurately identified. Taken together, HCoV-MS could be used as an effective method for large-scale detection. It was also capable of detecting key single nucleotide polymorphism about variants.

Introduction: SARS-CoV2 serology testing is multipurpose provided to choose an efficient test. We evaluated and compared 4 different commercial serology tests, three of them had the Food and Drug Administration (FDA) approval. Our goal was to provide new data to help to guide the interpretation and the choice of the serological tests. Methods: Four commercial tests were evaluated: Cobas®Roche®(total anti-N antibodies), VIDAS®Biomerieux®(IgM and IgG anti-RBD antibodies), Mindray®(IgM and IgG anti-N and anti-RBD antibodies) and Access®Beckman Coulter®(IgG anti-RBD antibodies). Were tested: a positive panel (n=72 sera) obtained from COVID-19 confirmed patients and a negative panel (n=119) of pre-pandemic sera. Were determined the analytical performances and was drawn the ROC curve to assess the manufacturer’s threshold. Results: A large range of variability between the tests was found. Mindray®IgG and Cobas® tests showed the best overall sensitivity 79,2%CI95%[67,9-87,8]. Cobas® showed the best sensitivity after D14; 85,4%CI95%[72,2-93,9]. The best specificity was noted for Cobas®, VIDAS®IgG and Access® IgG(100%CI95%[96,9-100]). Access® had the lower sensitivity even after D14 (55,5% CI95%[43,4-67,3]). VIDAS®IgM and Mindray®IgM tests showed the lowest specificity and sensitivity rates. Overall, only 43 out of 72 sera gave concordant results (59,7%). Retained cut-offs for a significantly better sensitivity and accuracy, without altering significantly the specificity, were: 0,87 for Vidas®IgM(p=0,01), 0,55 for Vidas®IgG(p=0,05) and 0,14 for Access®(p<10-4). Conclusion: Although FDA approved, each laboratory should realize its own evaluation for commercial tests. Tests variability may raise some concerns that seroprevalence studies may vary significantly based on the used serology test.

Due to the Covid-19 pandemic, the intake of vitamin D (VD) has increased. Vitamin D has multiple regulatory effects in the human body, including immunological. Evidence accentuates the generation of a pro-tolerogenic T helper (Th) 2 cell state with VD, suppressing a Th1 inflammatory response. Th2 cell polarization is characteristic of atopy. However, VD promotes a balanced state through the action of regulatory T cells, controlling cytokines, both pro-inflammatory and anti-inflammatory, and by reducing B cell proliferation and differentiation, thus preventing the development of atopy.

COVID-19 vaccine side effects are still a hot area under study, Many side effects have been identified, and others are still under study. Herein, we are reporting a patient who developed Rapidly Progressive Glomerulonephritis due to anti-GBM disease two days after receiving the COVI-19 vaccine.