Five Key points COVID 19 treatment generate nose bleeding Covid 19 treatment necessitate prone position Nasal packing is useful but sometimes insufficient CAVI-T is a new treatment of epistaxis CAVI-T is especially adapted to COVID patient in prone position due to its specific form

Introduction: Although most children experience minor symptoms from SARS-CoV-2 infection, some develop complications including MIS-C. Neuroblastoma patients may be at higher-risk of infection. We hypothesized that ACE2, CD147, PPIA and PPIB are poor-prognosis and SARS-CoV-2 infection biomarkers in neuroblastoma. Results: In-depth gene-expression-dataset statistical analysis showed ACE2, CD147, PPIA and PPIB high-expression significantly associated with poor-prognosis neuroblastomas with amplified MYCN, unfavourable-tumors and patients older than 18 months of age. Low-expression was associated with the NTRK1-PTPN6-TP53 module, a good-prognostic marker. Conclusion: ACE2, CD147, PPIA and PPIB high expression is associated with poor-prognosis neuroblastomas. These patients may be at higher-risk of SARS-CoV-2 infection.

A corona virus infectious disease (COVID – 19) is spreading quickly throughout the globe. An exhaustive data available for this infectious disease on confirmed cases, active cases, recovered cases and fatal cases and relation between them will give us some information for future statistical analysis and modelling. In this research paper, the focus is on Modelling and forecasting the COVID – 19 cases for India and Karnataka. With this view an auto regressive model has been developed for the confirmed and fatal cases which are validated for the period of data which has not been used for modelling. While comparing to the other existing models this gives preferable results.

Objective: To evaluate the association of COVID-19 status in pregnant women and hypertensive disorders of pregnancy. Design: Retrospective Cohort Study Setting: Multicenter study from a large metropolitan hospital system Population: Pregnant patients who tested positive for COVID-19 Methods: Patients who tested positive for COVID-19 during their pregnancy and delivered (index cases) were compared to the three subsequent deliveries of patients who tested negative (controls) at the same institution. We evaluated the impact of COVID-19 on the development of hypertensive disorders of pregnancy. We also evaluated the association of these disorders with maternal characteristics; demographics; prior pregnancy complications; current pregnancy complications; COVID-19 severity; laboratory values and inflammatory markers; and maternal and fetal outcomes. Univariable analysis was conducted with Student’s t-test, the chi-squared test and analysis of variance. Multivariable analyses were done using linear and logistic regression models. Main Outcome Measures: The incidence of hypertensive disorders of pregnancy in SARs-CoV-2 positive patients compared to SARs-CoV-2 negative patients. Results: Compared with pregnancies negative for SARs-CoV-2 infection, maternal SARs-CoV-2 infection was associated with an increased risk for hypertensive disorders of pregnancy (OR 3.68, 95% CI 1.67 -8.10). Overall rates of preeclampsia with severe features were significantly higher in patients with a COVID-19 diagnosis (18.6% vs 7.1%, p=0.006). An early SARS-CoV-2 infection (prior to 32 week’s gestation) conferred a higher risk of hypertensive disorders in pregnancy compared to SARs-CoV-2 infections diagnosed after 32 weeks’ gestation(OR=6.29, CI 1.64-24.07; p=0.007). Conclusion: COVID-19 is a risk factor for hypertensive disorders of pregnancy. Funding: None Conflicts of Interest: None

A document by Silvana Annamaria Urru. Click on the document to view its contents.

Background: HAE patients have been postulated to be at increased risk for COVID-19 infection due to inherent dysregulation of the plasma kallikrein-kinin system. Only limited data has been available to explore this hypothesis. The aim of this study was to assess the interrelationship(s) between COVID-19 and HAE. Methods: Self-reported COVID-19 infection, complications, morbidity and mortality were surveyed using an online questionnaire. Subjects included HAE with C1 inhibitor deficiency (HAE-C1INH), normal C1 inhibitor (HAE-nl-C1INH and household controls. The impact of HAE medications was examined. Results: 1445 participants completed the survey, including: 695 HAE-C1INH, 175 HAE-nl-C1INH, and 292 controls. The incidence of reported COVID-19 was not significantly different between controls (9%) and HAE-C1INH (11%) but was greater in HAE-nl-C1INH (19%, p=0.006). Obesity was positively correlated with COVID-19 across the overall population (16% vs 10%, p=0.012), with a similar but non-significant trend in HAE-C1INH (14% vs 9%). Co-morbid autoimmune disease was a risk factor for COVID-19 in HAE-C1INH (p = 0.047). COVID-19 severity and complications were similar in all groups. Reported COVID-19 was reduced in HAE-C1INH subjects receiving prophylactic subcutaneous C1INH (5.6%, p=0.0371) or on-demand icatibant (7.8%, p=0.0016). HAE-C1INH subjects not on any HAE medications had an increased risk of COVID-19 compared to normal controls (24.5%, p=0.006). Conclusions: HAE-C1INH subjects not taking HAE medications had an enhanced risk for COVID-19 infection. Subcutaneous C1INH and icatibant significantly reduced this risk. The results implicate roles for the complement cascade as well as non-contact system related kinin generating pathways in the pathogenesis of COVID-19 in HAE-C1INH.

Inhaled corticosteroids in early COVID-19 – a tale of many facetsLudger Klimek1, Cezmi A. Akdis2, Marek Jutel3, Torsten Zuberbier4, Jean Bousquet5-71. Center for Rhinology and Allergology, Wiesbaden, Germany.2. Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich - Christine Kühne - Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.3. Department of Clinical Immunology, Medical University of Wroclaw, ALL-MED Medical Research Institute, Wrocław, Poland.4. Clinic for Dermatology, Venereology and Allergology, Charité - University Medicine Berlin, Berlin, Germany.5. Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany6. Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin Institute of Health, Berlin, Germany7. Centre Hospitalier Universitaire, Montpellier, France

Introduction. Since the introduction of first measures designed to tame the COVID-19 pandemic, several speculations have been made about their simultaneous effect on seasonal influenza. Although social distancing policies could be effective in mitigating influenza spread, the ultimate consequences remain unknown. Aim of this study is to evaluate the effect of COVID-19 pandemic on influenza related-pneumonia in hospitalized patients. Methods. We conducted a cross-sectional retrospective analysis to evaluate the rate of influenza-related pneumonia in current pandemic year (April 2020 to March 2021), compared to previous five years (April 2015 to March 2020). Analysis was based on the clinical records and ICD-9 diagnosis code of all adult patients admitted for pneumonia at Fondazione Policlinico Universitario A. Gemelli, IRCCS of Rome. The diagnosis of pneumonia caused by influenza and by other common respiratory tract viral infections were assessed. Results. Overall 15,029 (15.2%) hospitalized for pneumonia were considered. Patients’ median age was 76 years [interquartile range 64 – 84); males were 8652 (57.6%). Influenza-related pneumonia almost disappeared in the 2020-2021 (0.0002%) compared previous five years (1.5%). Conversely, other virus related pneumonia had a similar incidence in both the evaluated periods. Discussion The present analysis suggests that during COVID-19 pandemic the cases influenza-related pneumonia was basically absent among our hospitalized patients. Interestingly, other virus-related pneumonia showed a countertrend, and the actual incidence rate was slightly higher than previous five years. Further investigations are needed to assess the ultimate effect of COVID-19 pandemic on the total trend of influenza and other respiratory tract infections.

To assess and compare the activity of pharmaceutical analysis on drug management in a geriatric acute care unit prior to and during the COVID-19 pandemic. This was a single-centre, observational, retrospective, and comparative cohort study. All Pharmacist Interventions (PIs) carried out in the unit between 27 January 2020 and 30 April 2020 were distinguished according to whether they were conducted prior to or during the first wave of COVID-19. The main outcome measure was the rate of PIs per patient and per line of treatment analysed. Other data collected were the drug class managed by the PI, the Drug Related Problems (DRP) identified, the nature of the advice given, and the acceptance rate by geriatricians A total of 355 stays were analysed, with PIs generated for 21.7% of the stays prior to COVID-19, and for 53.4% of the stays during the first wave (p=1.029 E-9). Among the 4,402 lines of treatments analysed, 54 PIs were carried out for prescriptions prior to COVID-19, and 177 during the first wave (p=0.002). DRPs were mostly related to anti-infectious drugs during the pandemic (20.3%, p=0.038), and laxatives prior to the pandemic (13.0%, p=0.023). The clinical impact of the PIs was mainly moderate (43.7%). The acceptance rate was 59.3%. A greater amount of DRPs were detected and more therapeutic advice was proposed during the first wave of COVID-19, with a focus on drugs used for the management of COVID-19 rather than geriatric routine treatments. The needs for clinical pharmacists were strengthened during the pandemic.

Background. Neutrophil extracellular traps (NETs) are observed in both COVID-19 pathology and autoimmune disorders, and molecular mimicry is a mechanism that can lead to autoimmune response. Methods. Accordingly, homologous sequences between SARS-CoV-2 proteins and 5 proteins (plasminogen receptor KT: PLRKT, myeloperoxidase: MPO, proteinase 3: PR-3, neutrophil elastase: NE, matrix metalloproteinase 9: MMP-9) that are present in NETs, are searched. Human and SARS-CoV-2 sequence pairs are identified. Those among the identified sequence pairs, which are strong-binding peptides or epitopes of the same HLA alleles, are predicted. Results. PLRKT and SARS-CoV-2 similar peptides with high affinities to HLA-A*24:02, HLA-B*08:01, and HLA-B*15:01; MPO and SARS-CoV-2 similar peptides with strong affinities to HLA-A*01:01, HLA-A*26:01 and HLA-B*15:01; and MMP-9 and SARS-CoV-2 similar peptides with elevated affinity to HLA-B*39:01, are detected. Conclusions. This is a proof of the concept study, which revealed potential involvement of molecular mimicry in NETs-pathology within susceptible individuals, in case of being infected with SARS-CoV-2.

This case report documents a reactivation of a pulmonary pathology, beginning some hours after the administration of a first dose of BNT162b2 mRNA vaccine, in a patient having presented a symptomatic pulmonary form of covid-19 one month before. The lessons to be learned and the possible involved mechanisms are discussed.

Background: Little is known about the characteristics of those who transmit SARS-CoV-2 infection vs those who do not, but this information could inform disease control policies. This study described the features of clusters in the first wave of COVID-19 in Shanghai and compared contagiousness by clinical and health care risk factors. Methods: In this retrospective cohort study of cases in Shanghai in January and February 2020, cases with successive generations were considered to be “contagious.” Characteristics of contagious and non-contagious cases were compared in log-binomial models that also adjusted for age and sex. Results: Between January 21 and February 17, 2020, 333 cases of COVID-19 were reported in Shanghai across 28 known infection chains. Contagiousness was higher among cases with a sore throat (risk ratio [RR]: 3.41, 95% CI: 1.59, 7.35, P=0.0051), and those with heart disease (RR: 2.06, 95% CI: 0.72, 5.90). Delays in diagnosis were also associated with higher risk of contagiousness. Having ≥2 medical visits before diagnosis was associated with 4.46 times higher risk of contagiousness (95% CI: 2.03, 9.83, P=0.0002), and there was a non-significant increase in risk with increasing numbers of days between disease onset and isolation (for each day, RR: 1.08, 95% CI: 1.01, 1.16, P=0.1734). Conclusions: Individuals with mild COVID-19 symptoms in the upper respiratory tract may still be contagious, and such individuals should be prioritized for early diagnosis and isolation to limit further chains of transmission.

Aim of the study: The inception of the COVID-19 has put healthcare workers (HCWs) in a precarious situation across the world. Despite the challenges in Jordan, the high awareness and preparedness of HCWs made it feasible for the country to control the contagious virus. COVID-19 has created a critical situation in the health sector for many countries in the world. Healthcare workers (HCWs) include physicians, dentists, nurses, pharmacists, laboratory technicians etc.; have provided the front-line healthcare services facing challenges. The study aimed to provide a useful insight into availability of Personal Protective Equipment (PPE) among HCWs in Jordan, which could help the policy/decision makers of public health to design better programs based on the information reported. Method: This cross-sectional online survey was conducted during July 2020 for the evaluation of the availability of Personal Protective Equipment (PPE) among HCWs in Jordan. Result: A total of 751 HCWs responded from different parts of the country, who were actively working at different hospitals in Jordan. Most of the participants (94%) had sufficient knowledge about COVID-19, and more than two-thirds of participants (68%) reported that Personal Protective Equipment (PPE) were provided by Jordan ministry of health. The majority (91%) of participants reported availability of medical face masks, while only 26% reported having facial protective shields. Conclusion: The study highlighted sufficient availability of personal protective equipment (PPE) which could prevent exposure of the front-line health workers from the high dose of virus as well as the best management of Jordanian HCWs during COVID-19 pandemic. It is obvious that availability and proper donning and doffing of the PPE is important for the safety of the HCWs specifically in the pandemic settings. Keywords: Jordan, COVID-19, healthcare workers, personal protective equipment

While people around the world are terrified of the global pandemic coronavirus disease 2019 (COVID-19) and are dying for a permanent solution, undertaking preventive safety measures are said to be the most effective way to stay away from it. People’s adherence to these measures is broadly dependent on their knowledge, attitude, and practices (KAP). People working in the food industry must be extra cautious during this time because they are in close proximity to consumable items. The present study was designed to evaluate food handlers’ knowledge, attitude, and practices regarding COVID-19 in a food industry in Dhaka, Bangladesh. A number of 155 food handlers took part in this online-based study. The information was collected from the participants through a questionnaire prepared in Google form. With a correct response rate of about 90% on average (knowledge 89.7%, attitude 93%, practices 88.2%), the participants showed a good level of KAP regarding COVID-19. However, education and working experiences had a significant association with the total KAP scores (p < 0.05). Further KAP studies in different generic food industries in Bangladesh should be carried out to bring a more precise picture for ensuring the level of workplace and worker’s safety.

SARS-CoV-2 RNA was not detected in 219 nasal/oro-pharyngeal swabs, analyzed for respiratory disease diagnosis at the National Institute for Infectious Diseases “Lazzaro Spallanzani”, from November 2019 to January 2020; these results suggest lack of unrecognized SARS-CoV-2 circulation before the identification of the first two cases in Italy.

Introduction: Respiratory infection in particular community acquired pneumonia (CAP) in children is a major disease that ranks high in outpatient and inpatient cases. The causes of CAP vary depending on the individual susceptibility, epidemiological characteristics of the community, and season. We performed this study to establish nationwide survillance network system and identify the causative agents for CAP and antibiotics resistance in Korean children with CAP.. Methods: The monitoring network was composed of the 28 secondary and tertiary medical institutions. Upper and lower respiratory samples were assayed using culture or Polymerase chaini reaction (PCR) from Aug 2018 to May 2020. Results: A total of 1023 cases were registered in patients with CAP, and 264 cases (25.8%) were isolated by culture, S. aureus 131 cases (12.8%), S. pneumoniae 92 cases (9%), H. influenzae 20 cases (2%). PCR of atypical pneumonia pathogen revealed 422 cases of M. pneumoniae (41.3%). Respiratory virus showed positive rates in 65.7% by multiplex PCR test and of them, human rhinovirus was most highest with 312 cases (30.5%). The proportion of mixed infection was 49.2%. The rate of antibiotics resistance showed similar results as previous reports. Conclusion: It will identify the pathogens that cause respiratory infections, and analyze the current status of antibiotic resistance to provide scientific evidence for management policies of domestic respiratory infection. Also, in preparation for the new epidemic, including COVID19, monitoring of respiratory infections in children and adolescents, has become more important, and research should be continuously conducted in the future.

ABSTRACT Background: Hemoglobin D – Los Angeles (HbD) is a variant hemoglobin that can polymerize in the deoxygenated state. When co-inherited with Hemoglobin S (HbSD disease) a severe sickling syndrome can result. Infection with SARS-CoV-2 has been associated with acute chest syndrome (ACS) in individuals with sickle cell disease (SCD), but this complication has not previously been reported in patients with HbSD. Dexamethasone has been shown to improve outcomes in non-sickle cell patients with SARS-CoV-2 pneumonia or adult respiratory distress syndrome (ARDS); however, its use in SCD patients with ACS is controversial due to a reported increased risk of complications including vaso-occlusive painful episodes (VOE). Procedure: Case Report and literature review focusing on the management of pediatric SCD patients with SARS-CoV-2 associated ACS. Results: A 7-year-old female with HbSD presented with fever, cough, shortness of breath, hypoxia and pulmonary infiltrates consistent with ACS. She tested positive for SARS-CoV-2. She began treatment with dexamethasone (6 mg/ kg/ day divided BID). She had a rapid recovery without sequalae from steroid use. Literature review identified 39 pediatric patients with SCD and COVID-19, of whom 21 (54%) had ACS. Simple transfusion (9 pts) and exchange transfusion (3 pts) were the most frequently reported treatment, with hydroxychloroquine (5 pts), remdesivir (1pt), and tocilizumab (1 pt) also being reported. Three patients were treated with dexamethasone. All 3 recovered and no adverse outcomes from steroid use were reported. Conclusions: Further study is needed to determine the optimal treatment of SARS-CoV-2 associated ACS; however, dexamethasone should be considered.

Background: Standard precautions (SPs) practices are of crucial management skills among Health Care Workers (HCWs) including nurses against the highly infectious novel virus SARS-CoV-2. Aim of the study: The study aimed to assess level of nurse’s compliance with SPs, and identify the main challenges that experienced by nurses during their work with infected SARS-CoV-2 patient’s. Methods: A cross-sectional survey design was used. The study was conducted in different sectors that represent the health care sector in Jordan. 386 nurses recruited from the different sectors. Results: Data were collected from 386 participants. 66.8% of the participants were female. Most of them revealed that they were dealt previously SARS-CoV-2 patients (73.6%). Generally, nurses demonstrated good level of compliance with SPs practices (71%). The staff reported that they mostly adhere with performing hand hygiene after all procedures (65.8%). On the other hand, they were least adherence with maintaining a physical distance of patient and staff of at least 6ft apart (28.5%). conclusion: It was concluded that nurses have a good level of SPs practices. Many challenges were experienced by nurses while caring of SARS-CoV-2 patients.

Objective: To explore impact of COVID-19 outbreak on resilience and emotions of frontline healthcare workers (HCW) during the pandemic Design: Cross-sectional retrospective descriptive study Setting: KK Women and Children’s Hospital, Singapore, Department of Obstetrics and Gynaecology, between 7 February to 30 April 2020 Population: One hundred and one (101) HCW who worked in COVID-19 screening facilities and wards Methods: The participants were given a survey designed to understand their emotions when caring for patients with suspected or confirmed COVID-19, and how their various aspects of health were affected. The Brief Resilience Scale (BRS) was used to evaluate their resilience. Results: Normal resilience scores were found in 72.6% of HCW, 11.3% had high resilience scores while 16.1% had low resilience scores. Doctors had higher resilience scores than nurses (3.8 vs 3.3, p-value 0.017). HCWs perceived their mental health was most affected, followed by social and physical health as a result of COVID-19 related work. The main stressors faced were related to their personal safety and that of their family. A positive attitude at work with good teamwork, time away from routine clinical work and appreciation received helped to relieve the emotional and psychological stress faced. Conclusion: It is essential to explore appropriate interventions for HCW with low resilience to better assist the coping mechanism during this pandemic. Stressors identified and feedback received through this study are useful for implementing supportive workforce resources during an infectious disease outbreak.

Background: Coronavirus disease 2019 (COVID-19) and Influenza A are common disease caused by viral infection. The clinical symptoms and transmission routes of the two diseases are similar. This study established a model of laboratory findings to distinguish COVID-19 from influenza A perfectly. Methods: In this study, 56 COVID-19 patients and 54 influenza A patients were included. Laboratory findings, epidemiological characteristics and demographic data were obtained from electronic medical record databases. Elastic network models, followed by a stepwise logistic regression model were implemented to identify indicators capable of discriminating COVID-19 and influenza A. Results: A monogram is diagramed to show the resulting discriminative model. The majority of hematological and biochemical parameters in COVID-19 patients were significantly different from those in influenza A patients. In the final model, albumin/globulin, total bilirubin and erythrocyte specific volume were selected as predictors. This model has been demonstrated to have a satisfactory predictive performance to discriminate between COVID-19 and influenza A (AUC=0.844) using an external validation set. Conclusion: The establishment of a diagnostic model on laboratory findings is of great significance for the identification of COVID-19 and influenza A.

The impact of COVID-19 disease on health and economy has been global, and the magnitude of devastation is unparalleled in modern history. Any potential course of action to manage this complex disease requires the systematic and efficient analysis of data that can delineate the underlying pathogenesis. We have developed a mathematical model of disease progression to predict the clinical outcome, utilizing a set of causal factors known to contribute to COVID-19 pathology such as age, comorbidities, and certain viral and immunological parameters. Viral load and selected indicators of a dysfunctional immune response, such as cytokines IL-6 and IFN which contribute to the cytokine storm and fever, parameters of inflammation d-dimer and ferritin, aberrations in lymphocyte number, lymphopenia, and neutralizing antibodies were included for the analysis. The model provides a framework to unravel the multi-factorial complexities of the immune response manifested in SARS-CoV-2 infected individuals. Further, this model can be valuable to predict clinical outcome at an individual level, and to develop strategies for allocating appropriate resources to mitigate severe cases at a population level.

Objectives: To determine the nosocomial infection rate in women undergoing elective cesarean section Design: Non-randomized prospective cohort trial Setting: Two large-volume obstetrical units at academic institutions Population: Women undergoing elective cesarean section during the reopening phase of the Covid-19 pandemic in New York State Methods: Eligible patients with negative pre-operative Covid-19 reverse transcriptase-polymerase chain reaction test and IgG antibody test were re-tested 6-9 days after discharge. Main Outcome Measures: The primary objective was the Covid-19 test conversion rate defined as a positive PCR test after discharge with a negative pre-operative test. This was used as a proxy for the nosocomial infection rate. Results: No patients with a negative PCR test pre-operatively had a positive PCR test for the Covid-19 virus postoperatively. Conclusions: With a strict and methodical perioperative and postpartum protocol, we can limit nosocomial Covid-19 infections in women undergoing elective cesarean section. Funding: No external funding was obtained for this study Keywords: Covid-19, Cesarean Section, Nosocomial Infection

6-Mercaptopurine (6-MP) is a chemotherapeutic drug that exhibits hepatotoxic effects due to its toxic metabolites. This report describes a case of suspected drug induced liver injury exacerbated by a Sars-Cov-2 infection. A 16-year-old male with VHR B-ALL was admitted for hyperbilirubinemia two months after a 6-MP dosage increase and found to have an active Sars-Cov-2 infection. Liver function improved throughout hospitalization and the patient was discharged on allopurinol. Following liver function after a dosage increase of hepatoxic chemotherapy and in a pediatric oncology patient with an active Sars-Cov-2 infection undergoing treatment is vital due to potential liver impact.

Background: COVID-19 is an acute infectious respiratory disease caused by SARS-CoV-2. It has caused many deaths worldwide. Asymptomatic patients may be as infectious as symptomatic patients, but they are harder to identify. It is difficult for asymptomatic patients to realize that they have been infected and seek medical treatment in a timely manner, which poses challenges to virus prevention and control measures. Methods: This study reports 30 asymptomatic Chinese COVID-19 patients from the same road engineering company who worked in Sudan during the epidemic. Our team listed their symptoms after admission, various monitoring indicators and disease course to provide more information on asymptomatic COVID-19 patients. Results: 30 asymptomatic Chinese COVID-19 patients’ throat swab tests for SARS-CoV-2 were positive. Through further genetic testing, we found that these 30 Chinese individuals were infected with the European strain of SARS-CoV-2 circulating in Africa. In this study, the infection events occurred across three continents and suggested that the European strain could be brought to Asia via Africa by asymptomatic infected individuals and that the incubation and infection periods may be long; these points should be considered in epidemic prevention and epidemiological investigations. Fourteen days of quarantine may not be enough. After having negative results on at least 5 consecutive nucleic acid tests spanning 30 days, a patient may subsequently have a positive test result. Conclusions: We present our diagnosis and treatment process to provide useful reference information for colleagues during the COVID-19 pandemic.