diff --git "a/train.tsv" "b/train.tsv" new file mode 100644--- /dev/null +++ "b/train.tsv" @@ -0,0 +1,415 @@ + text label +610 Harnessing the immune system to overcome cytokine storm and reduce viral load in COVID 19 a review of the phases of illness and therapeutic agents Coronavirus disease 2019 COVID 19 is caused by Severe Acute Respiratory Syndrome Coronavirus 2 SARS CoV 2 previously named 2019 nCov a novel coronavirus that emerged in China in December 2019 and was declared a global pandemic by World Health Organization by March 11th 2020 Severe manifestations of COVID 19 are caused by a combination of direct tissue injury by viral replication and associated cytokine storm resulting in progressive organ damage We reviewed published literature between January 1st 2000 and June 30th 2020 excluding articles focusing on pediatric or obstetric population with a focus on virus host interactions and immunological mechanisms responsible for virus associated cytokine release syndrome CRS COVID 19 illness encompasses three main phases In phase 1 SARS CoV 2 binds with angiotensin converting enzyme ACE 2 receptor on alveolar macrophages and epithelial cells triggering toll like receptor TLR mediated nuclear factor kappa light chain enhancer of activated B cells NF ƙB signaling It effectively blunts an early IFN response allowing unchecked viral replication Phase 2 is characterized by hypoxia and innate immunity mediated pneumocyte damage as well as capillary leak Some patients further progress to phase 3 characterized by cytokine storm with worsening respiratory symptoms persistent fever and hemodynamic instability Important cytokines involved in this phase are interleukin IL 6 IL 1β and tumor necrosis factor TNF α This is typically followed by a recovery phase with production of antibodies against the virus We summarize published data regarding virus host interactions key immunological mechanisms responsible for virus associated CRS and potential opportunities for therapeutic interventions Evidence regarding SARS CoV 2 epidemiology and pathogenesis is rapidly evolving A better understanding of the pathophysiology and immune system dysregulation associated with CRS and acute respiratory distress syndrome in severe COVID 19 is imperative to identify novel drug targets and other therapeutic interventions 0 +556 New Strategies to Improve Patient Adherence to Medications for Noncommunicable Diseases During and After the COVID 19 Era Identified via a Literature Review Noncommunicable diseases NCDs place a huge burden on healthcare systems and society as a whole Relatively early in the coronavirus disease 2019 COVID 19 pandemic clinicians became aware that in individuals infected with COVID 19 those with preexisting NCDs such as diabetes mellitus and cardiovascular disease CVD were at a greater risk of poor outcomes and mortality than those without The importance of adherence to medications and lifestyle changes to control and prevent NCDs has been a major focus for many years but with limited success the proportion of patients adherent and persistent to their medications remains very low There are many facets to adherence and persistence Recent evidence suggests that a patient centric approach is important and ensuring that a patient is both motivated and empowered is critical to improving adherence persistence The COVID 19 pandemic has brought many changes to the way in which patients with NCDs are managed with telemedicine and ehealth becoming more common Changes have also occurred in the way in which patients can gain access to medications during the pandemic The potential for these changes forms the basis of improving the management of patients with NCDs both during and after the pandemic Over the coming months a huge amount of work will be put into initiatives to promote adherence to COVID 19 vaccination programs Those at highest risk of severe COVID 19 such as people aged 80 years and older are likely to receive the vaccine first in some parts of world Finally social determinants of health are critical elements that can impact not just the likelihood of having an NCD or becoming infected with COVID 19 but also access to healthcare and a patients adherence and persistence with their treatments 0 +97 Acute and Post Acute Neurological Complications of COVID 19 Coronavirus disease 2019 COVID 19 is an emerging global health emergency caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 SARS CoV 2 The global outbreak of SARS CoV 2 infection has been declared a global pandemic by the World Health Organization WHO The clinical presentation of SARS CoV 2 infection depends on the severity of the disease and may range from an asymptomatic infection to a severe and lethal illness Fever cough and shortness of breath are among the most common symptoms associated with SARS CoV 2 infection Accumulating evidence indicates that COVID 19 patients commonly develop neurological symptoms such as headache altered mental status anosmia and myalgia In this comprehensive literature review we have summarized the most common neurological complications and reported neurological case studies associated with COVID 19 and neurological side effects associated with COVID 19 treatments Additionally the post acute COVID 19 syndrome and long term neurological complications were discussed We also explained the proposed mechanisms that are involved in the pathogenesis of these neurological complications 1 +148 Long COVID a comprehensive systematic scoping review To find out what is known from literature about Long COVID until January 30 2021 We undertook a four step search with no language restriction A preliminary search was made to identify the keywords A search strategy of all electronic databases resulted in 66 eligible studies A forward and backward search of the references and citations resulted in additional 54 publications Non English language articles were translated using Google Translate We conducted our scoping review based on the PRISMA ScR Checklist Of 120 papers we found only one randomized clinical trial Of the 67 original studies 22 were cohort and 28 were cross sectional studies Of the total 120 publications 49 1 focused on signs and symptoms 23 3 on management and 10 8 on pathophysiology Ten publications focused on imaging studies The results are also presented extensively in a narrative synthesis in separated sections nomenclature diagnosis pathophysiology risk factors signs symptoms management The controversies in its definition have impaired proper recognition and management The predominant symptoms were fatigue breathlessness arthralgia sleep difficulties and chest pain Recent reports also point to the risk of long term sequela with cutaneous respiratory cardiovascular musculoskeletal mental health neurologic and renal involvement in those who survive the acute phase of the illness 1 +188 sup 18 sup F FDG brain PET hypometabolism in patients with long COVID In the context of the worldwide outbreak of severe acute respiratory syndrome coronavirus 2 SARS CoV 2 some patients report functional complaints after apparent recovery from COVID 19 This clinical presentation has been referred as long COVID We here present a retrospective analysis of sup 18 sup F FDG brain PET of long COVID patients from the same center with a biologically confirmed diagnosis of SARS CoV 2 infection and persistent functional complaints at least 3 weeks after the initial infection PET scans of 35 patients with long COVID were compared using whole brain voxel based analysis to a local database of 44 healthy subjects controlled for age and sex to characterize cerebral hypometabolism The individual relevance of this metabolic profile was evaluated to classify patients and healthy subjects Finally the PET abnormalities were exploratory compared with the patients characteristics and functional complaints In comparison to healthy subjects patients with long COVID exhibited bilateral hypometabolism in the bilateral rectal orbital gyrus including the olfactory gyrus the right temporal lobe including the amygdala and the hippocampus extending to the right thalamus the bilateral pons medulla brainstem the bilateral cerebellum p voxel 0 001 uncorrected p cluster 0 05 FWE corrected These metabolic clusters were highly discriminant to distinguish patients and healthy subjects 100 correct classification These clusters of hypometabolism were significantly associated with more numerous functional complaints brainstem and cerebellar clusters and all associated with the occurrence of certain symptoms hyposmia anosmia memory cognitive impairment pain and insomnia p 0 05 In a more preliminary analysis the metabolism of the frontal cluster which included the olfactory gyrus was worse in the 7 patients treated by ACE drugs for high blood pressure p 0 032 and better in the 3 patients that had used nasal decongestant spray at the infectious stage p 0 001 This study demonstrates a profile of brain PET hypometabolism in long COVID patients with biologically confirmed SARS CoV 2 and persistent functional complaints more than 3 weeks after the initial infection symptoms involving the olfactory gyrus and connected limbic paralimbic regions extended to the brainstem and the cerebellum These hypometabolisms are associated with patients symptoms with a biomarker value to identify and potentially follow these patients The hypometabolism of the frontal cluster which included the olfactory gyrus seems to be linked to ACE drugs in patients with high blood pressure with also a better metabolism of this olfactory region in patients using nasal decongestant spray suggesting a possible role of ACE receptors as an olfactory gateway for this neurotropism 1 +433 The psychopathological impact of the SARS CoV 2 epidemic on subjects suffering from different mental disorders An observational retrospective study SARS CoV 2 infection causes a pulmonary disease COVID 19 which spread worldwide generating fear anxiety depression in the general population as well as among subjects affected by mental disorders Little is known about which different psychopathological changes the pandemic caused among individuals affected by different psychiatric disorders which represents the aim of the present study Specific psychometric scales were administered at three time points T0 as outbreak of pandemic T1 as lockdown period T2 as reopening Descriptive analyses and linear regression models were performed A total of 166 outpatients were included Overall psychometric scores showed a significant worsening at T1 with a mild improvement at T2 Only psychopathology in schizophrenia SKZ patients and obsessive compulsive OC symptoms did not significantly improve at T2 Subjects affected by personality disorders PDs resulted to be more compromised in terms of general psychopathology than depressed and anxiety OC ones and showed more severe anxiety symptoms than SKZ patients In conclusion subjects affected by PDs require specific clinical attention during COVID 19 pandemic Moreover the worsening of SKZ and OC symptoms should be strictly monitored by clinicians as these aspects did not improve with the end of lockdown measures Further studies on larger samples are needed to confirm our results ClinicalTrials gov Identifier NCT04694482 0 +305 Cardiac MRI in Patients with Prolonged Cardiorespiratory Symptoms after Mild to Moderate COVID 19 Infection Background Myocardial injury and inflammation on cardiac MRI in patients suffering from coronavirus disease 19 COVID 19 have been described in recent publications Concurrently a chronic COVID 19 syndrome CCS after COVID 19 infection has been observed manifesting with symptoms like fatigue and exertional dyspnea Purpose To explore the relationship between CCS and myocardial injury and inflammation as an underlying cause of the persistent complaints in previously healthy individuals Materials and Methods In this prospective study from January 2021 to April 2021 study participants without known cardiac or pulmonary diseases prior to COVID 19 infection with persisting CCS symptoms like fatigue or exertional dyspnea after convalescence and healthy control participants underwent cardiac MRI Cardiac MRI protocol included T1 and T2 relaxation times extracellular volume ECV T2 signal intensity ratio and late gadolinium enhancement LGE Student i t i test Mann Whitney U test and χ sup 2 sup test were used for statistical analysis Results 41 participants with CCS 39 13 years 18 men and 42 control participants 39 16 years 26 men were evaluated Median time between initial mild to moderate COVID 19 disease without hospitalization and cardiac MRI was 103 days interquartile range 88 158 Troponin T levels were normal Parameters indicating myocardial inflammation and edema were comparable between participants with CCS and control participants T1 relaxation time 978 23 ms vs 971 25 ms P 17 T2 relaxation time 53 2 ms vs 52 2 ms P 47 T2 signal intensity ratio 1 6 0 2 vs 1 6 0 3 P 10 Visible myocardial edema was present in none of the participants Three of 41 7 participants with CCS demonstrated non ischemic LGE compared to none in the control group 0 of 42 0 P 07 None of the participants fulfilled the 2018 Lake Louise criteria for the diagnosis of myocarditis Conclusion Individuals without hospitalization for COVID 19 and with CCS did not demonstrate signs of active myocardial injury or inflammation on cardiac MRI See also the editorial by Lima and Bluemke 1 +644 Will Nothing Be the Same Again Changes in Lifestyle during COVID 19 Pandemic and Consequences on Mental Health Social isolation caused by the COVID 19 pandemic has drastically affected lifestyles from sedentary behaviors to reduced physical activity from disrupted sleep patterns to altered dietary habits As a consequence serious mental and emotional responses have been registered There was a significant decline in physical and other meaningful activities of daily living leisure social activity and education In children collateral effects of the pandemic include inadequate nutrition with a risk of both overweight and underweight addiction to screens lack of schooling and psychosocial difficulties Older adults are frequently unable to adapt to lockdown measures and suffer from depression and cognitive complaints Recent studies focusing on changes in lifestyle during the Covid 19 pandemic and consequences on mental health have been identified in PubMed Medline Scopus Embase and ScienceDirect All the available literature has been retrospectively reviewed The results of the present narrative review suggest that mental distress caused by social isolation seems to be linked not only to personality characteristics but also to several lifestyle components sleep disruption altered eating habits reduced physical activity This review aims to explore major changes in the lifestyle and quality of life and the impact of these changes on mental health and to inform clinicians and policymakers about elements that may reduce the negative psychological effects of the quarantine period imposed during this worldwide crisis There is an urgent need for tailored preventive diagnostic and therapeutic mental health interventions for the general population and for higher risk groups 0 +321 Autoantibodies stabilize neutrophil extracellular traps in COVID 19 The release of neutrophil extracellular traps b NETs b by hyperactive neutrophils is recognized to play an important role in the thromboinflammatory milieu inherent to severe presentations of COVID 19 At the same time a variety of functional autoantibodies have been observed in individuals with severe COVID 19 where they likely contribute to immunopathology Here we aimed to determine the extent to which autoantibodies might target NETs in COVID 19 and if detected to elucidate their potential functions and clinical associations We measured anti NET antibodies in 328 individuals hospitalized with COVID 19 alongside 48 healthy controls We found high anti NET activity in the IgG and IgM fractions of 27 and 60 of patients respectively There was a strong correlation between anti NET IgG and anti NET IgM r 0 4 p 0 0001 Both anti NET IgG and IgM tracked with high levels of circulating NETs impaired oxygenation efficiency and high circulating D dimer Furthermore patients who required mechanical ventilation had a greater burden of anti NET antibodies than did those not requiring oxygen supplementation Levels of anti NET IgG and to a lesser extent anti NET IgM demonstrated an inverse correlation with the efficiency of NET degradation by COVID sera Furthermore purified IgG from COVID sera with high levels of anti NET antibodies impaired the ability of healthy control serum to degrade NETs In summary many individuals hospitalized with COVID 19 have anti NET antibodies which likely impair NET clearance and may potentiate SARS CoV 2 mediated thromboinflammation 1 +309 Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID Long COVID is characterised by a range of potentially debilitating symptoms which develop in at least 10 of people who have recovered from acute SARS CoV 2 infection This study has quantified corneal sub basal nerve plexus morphology and dendritic cell DC density in patients with and without long COVID Forty subjects who had recovered from COVID 19 and 30 control participants were included in this cross sectional comparative study undertaken at a university hospital All patients underwent assessment with the National Institute for Health and Care Excellence NICE long COVID Douleur Neuropathique 4 DN4 and Fibromyalgia questionnaires and corneal confocal microscopy CCM to quantify corneal nerve fibre density CNFD corneal nerve branch density CNBD corneal nerve fibre length CNFL and total mature and immature DC density The mean time after the diagnosis of COVID 19 was 3 7 1 5 months Patients with neurological symptoms 4 weeks after acute COVID 19 had a lower CNFD p 0 032 CNBD p 0 020 and CNFL p 0 012 and increased DC density p 0 046 compared with controls while patients without neurological symptoms had comparable corneal nerve parameters but increased DC density p 0 003 There were significant correlations between the total score on the NICE long COVID questionnaire at 4 and 12 weeks with CNFD ρ 0 436 p 0 005 ρ 0 387 p 0 038 respectively and CNFL ρ 0 404 p 0 010 ρ 0 412 p 0 026 respectively Corneal confocal microscopy identifies corneal small nerve fibre loss and increased DCs in patients with long COVID especially those with neurological symptoms CCM could be used to objectively identify patients with long COVID 1 +423 The Rise of Wearable Devices during the COVID 19 Pandemic A Systematic Review The COVID 19 pandemic has wreaked havoc globally and still persists even after a year of its initial outbreak Several reasons can be considered people are in close contact with each other i e at a short range 1 m and the healthcare system is not sufficiently developed or does not have enough facilities to manage and fight the pandemic even in developed countries such as the USA and the U K and countries in Europe There is a great need in healthcare for remote monitoring of COVID 19 symptoms In the past year a number of IoT based devices and wearables have been introduced by researchers providing good results in terms of high accuracy in diagnosing patients in the prodromal phase and in monitoring the symptoms of patients i e respiratory rate heart rate temperature etc In this systematic review we analyzed these wearables and their need in the healthcare system The research was conducted using three databases IEEE Xplore sup sup Web of Science sup sup and PubMed Central sup sup between December 2019 and June 2021 This article was based on the PRISMA guidelines Initially 1100 articles were identified while searching the scientific literature regarding this topic After screening ultimately 70 articles were fully evaluated and included in this review These articles were divided into two categories The first one belongs to the on body sensors wearables their types and positions and the use of AI technology with ehealth wearables in different scenarios from screening to contact tracing In the second category we discuss the problems and solutions with respect to utilizing these wearables globally This systematic review provides an extensive overview of wearable systems for the remote management and automated assessment of COVID 19 taking into account the reliability and acceptability of the implemented technologies 0 +438 Pediatric bronchoscopy recent advances and clinical challenges b Introduction b During the last 40 years equipment has been improved with smaller instruments and sufficient size working channels This has ensured that bronchoscopy offers therapeutic and interventional options b Areas covered b We provide a review of recent advances and clinical challenges in pediatric bronchoscopy This includes single use bronchoscopes endobronchial ultrasound and cryoprobe Bronchoscopy in persistent preschool wheezing and asthma is included The indications for interventional bronchoscopy have amplified and included balloon dilatation endoscopic intubation the use of airway stents whole lung lavage closing of fistulas and air leak as well as an update on removal of foreign bodies Others include the use of laser and microdebrider in airway surgery Experience with bronchoscope during the COVID 19 pandemic has been included in this review PubMed was searched for articles on pediatric bronchoscopy including rigid bronchoscopy as well as interventional bronchoscopy with a focus on reviewing literature in the past 5 years b Expert opinion b As the proficiency of pediatric interventional pulmonologists continues to grow more interventions are being performed There is a scarcity of published evidence in this field Courses for pediatric interventional bronchoscopy need to be developed The COVID 19 experience resulted in safer bronchoscopy practice for all involved 0 +604 SARS CoV 2 infection and paediatric endocrine disorders Risks and management considerations Coronavirus 19 COVID 19 is a disease caused by the SARS CoV 2 virus the seventh coronavirus identified as causing disease in humans The SARS CoV 2 virus has multiple potential pathophysiologic interconnections with endocrine systems potentially causing disturbances in glucose metabolism hypothalamic and pituitary function adrenal function and mineral metabolism A growing body of data is revealing both the effects of underlying endocrine disorders on COVID 19 disease outcome and the effects of the SARS CoV 2 virus on endocrine systems However comprehensive assessment of the relationship to endocrine disorders in children has been lacking In this review we present the effects of SARS CoV 2 infection on endocrine systems and review the current literature on complications of COVID 19 disease in underlying paediatric endocrine disorders We provide recommendations on management of endocrinopathies related to SARS CoV 2 infection in this population With the surge in COVID 19 cases worldwide it is important for paediatric endocrinologists to be aware of the interaction of SARS CoV 2 with the endocrine system and management considerations for patients with underlying disorders who develop COVID 19 disease While children and adults share some risk factors that influence risk of complications in SARS CoV 2 infection it is becoming clear that responses in the paediatric population are distinct and outcomes from adult studies cannot be extrapolated Evidence emerging from paediatric studies provides some guidance but highlights the need for more research in this area 0 +674 Virtual CROI 2020 Highlights of Epidemiology Public Health and Prevention Research At the 2020 Conference on Retroviruses and Opportunistic Infections held virtually as a result of the emerging COVID 19 pandemic trends in the HIV epidemic were highlighted with decreasing HIV incidence reported across several countries although key regions remain heavily impacted including the US South Adolescent girls and young women men who have sex with men MSM transgender persons and people who inject drugs continue to experience a high burden of new infections Sexually transmitted infections during pregnancy can lead to a number of adverse outcomes in infants novel strategies to detect and treat these infections are needed Innovative HIV testing strategies including self testing and assisted partner services are expanding the reach of testing however linkage to care can be improved Novel preexposure prophylaxis PrEP delivery strategies are increasing uptake of PrEP in different groups although adherence and persistence remain a challenge Use of on demand PrEP is increasing among MSM in the US Strategies are needed to address barriers to PrEP uptake and persistence among cis and transgender women Several novel regimens for postexposure prophylaxis show promise 0 +624 The use of head helmets to deliver noninvasive ventilatory support a comprehensive review of technical aspects and clinical findings A helmet comprising a transparent hood and a soft collar surrounding the patients head can be used to deliver noninvasive ventilatory support both as continuous positive airway pressure and noninvasive positive pressure ventilation NPPV the latter providing active support for inspiration In this review we summarize the technical aspects relevant to this device particularly how to prevent CO sub 2 sub rebreathing and improve patient ventilator synchrony during NPPV Clinical studies describe the application of helmets in cardiogenic pulmonary oedema pneumonia COVID 19 postextubation and immune suppression A section is dedicated to paediatric use In summary helmet therapy can be used safely and effectively to provide NIV during hypoxemic respiratory failure improving oxygenation and possibly leading to better patient centred outcomes than other interfaces 0 +326 Late Conditions Diagnosed 1 4 Months Following an Initial Coronavirus Disease 2019 COVID 19 Encounter A Matched Cohort Study Using Inpatient and Outpatient Administrative Data United States 1 March 30 June 2020 Late sequelae of COVID 19 have been reported however few studies have investigated the time course or incidence of late new COVID 19 related health conditions post COVID conditions after COVID 19 diagnosis Studies distinguishing post COVID conditions from late conditions caused by other etiologies are lacking Using data from a large administrative all payer database we assessed type association and timing of post COVID conditions following COVID 19 diagnosis Using the Premier Healthcare Database Special COVID 19 Release release date 20 October 2020 data during March June 2020 27 589 inpatients and 46 857 outpatients diagnosed with COVID 19 case patients were 1 1 matched with patients without COVID 19 through the 4 month follow up period control patients by using propensity score matching In this matched cohort study adjusted ORs were calculated to assess for late conditions that were more common in case patients than control patients Incidence proportion was calculated for conditions that were more common in case patients than control patients during 31 120 days following a COVID 19 encounter During 31 120 days after an initial COVID 19 inpatient hospitalization 7 0 of adults experienced 1 of 5 post COVID conditions Among adult outpatients with COVID 19 7 7 experienced 1 of 10 post COVID conditions During 31 60 days after an initial outpatient encounter adults with COVID 19 were 2 8 times as likely to experience acute pulmonary embolism as outpatient control patients and also more likely to experience a range of conditions affecting multiple body systems eg nonspecific chest pain fatigue headache and respiratory nervous circulatory and gastrointestinal symptoms than outpatient control patients These findings add to the evidence of late health conditions possibly related to COVID 19 in adults following COVID 19 diagnosis and can inform healthcare practice and resource planning for follow up COVID 19 care 1 +535 Metabolomics in the Diagnosis and Prognosis of COVID 19 Coronavirus disease 2019 COVID 19 pandemic triggered an unprecedented global effort in developing rapid and inexpensive diagnostic and prognostic tools Since the genome of SARS CoV 2 was uncovered detection of viral RNA by RT qPCR has played the most significant role in preventing the spread of the virus through early detection and tracing of suspected COVID 19 cases and through screening of at risk population However a large number of alternative test methods based on SARS CoV 2 RNA or proteins or host factors associated with SARS CoV 2 infection have been developed and evaluated The application of metabolomics in infectious disease diagnostics is an evolving area of science that was boosted by the urgency of COVID 19 pandemic Metabolomics approaches that rely on the analysis of volatile organic compounds exhaled by COVID 19 patients hold promise for applications in a large scale screening of population in point of care POC setting On the other hand successful application of mass spectrometry to detect specific spectral signatures associated with COVID 19 in nasopharyngeal swab specimens may significantly save the cost and turnaround time of COVID 19 testing in the diagnostic microbiology and virology laboratories Active research is also ongoing on the discovery of potential metabolomics based prognostic markers for the disease that can be applied to serum or plasma specimens Several metabolic pathways related to amino acid lipid and energy metabolism were found to be affected by severe disease with COVID 19 In particular tryptophan metabolism via the kynurenine pathway were persistently dysregulated in several independent studies suggesting the roles of several metabolites of this pathway such as tryptophan kynurenine and 3 hydroxykynurenine as potential prognostic markers of the disease However standardization of the test methods and large scale clinical validation are necessary before these tests can be applied in a clinical setting With rapidly expanding data on the metabolic profiles of COVID 19 patients with varying degrees of severity it is likely that metabolomics will play an important role in near future in predicting the outcome of the disease with a greater degree of certainty 0 +237 More than 50 long term effects of COVID 19 a systematic review and meta analysis COVID 19 can involve persistence sequelae and other medical complications that last weeks to months after initial recovery This systematic review and meta analysis aims to identify studies assessing the long term effects of COVID 19 LitCOVID and Embase were searched to identify articles with original data published before the 1st of January 2021 with a minimum of 100 patients For effects reported in two or more studies meta analyses using a random effects model were performed using the MetaXL software to estimate the pooled prevalence with 95 CI PRISMA guidelines were followed A total of 18 251 publications were identified of which 15 met the inclusion criteria The prevalence of 55 long term effects was estimated 21 meta analyses were performed and 47 910 patients were included age 17 87 years The included studies defined long COVID as ranging from 14 to 110 days post viral infection It was estimated that 80 of the infected patients with SARS CoV 2 developed one or more long term symptoms The five most common symptoms were fatigue 58 headache 44 attention disorder 27 hair loss 25 and dyspnea 24 Multi disciplinary teams are crucial to developing preventive measures rehabilitation techniques and clinical management strategies with whole patient perspectives designed to address long COVID 19 care 1 +172 In vivo evidence of systemic endothelial vascular dysfunction in COVID 19 Endothelial dysfunction is one of the underlying mechanisms to vascular and cardiac complications in patients with COVID 19 We sought to investigate the systemic vascular endothelial function and its temporal changes in COVID 19 patients from a non invasive approach with reactive hyperemia peripheral arterial tonometry PAT This is a prospective observational case control and blinded study The population was comprised by 3 groups patients investigated during acute COVID 19 group 1 patients investigated during past COVID 19 group 2 and controls 1 1 matched to COVID 19 patients by demographics and cardiovascular risk factors group 3 The natural logarithmic scaled reactive hyperemia index LnRHI a measure of endothelium mediated dilation of peripheral arteries was obtained in all the participants and compared between study groups 144 participants were enrolled 72 COVID 19 patients and 72 matched controls Median time from COVID 19 symptoms to PAT assessment was 9 5 and 101 5 days in groups 1 and 2 respectively LnRHI was significantly lower in group 2 compared to both group 1 and controls 0 53 0 23 group 2 vs 0 72 0 26 group 1 p 0 0043 and 0 79 0 23 in group 3 p 0 0001 In addition within group 1 it was observed a markedly decrease in LnRHI from acute COVID 19 to post infection stage 0 73 0 23 vs 0 42 0 26 p 0 0042 This study suggests a deleterious effect of SARS CoV 2 infection on systemic vascular endothelial function These findings open new venues to investigate the clinical implication and prognostic role of vascular endothelial dysfunction in COVID 19 patients and post COVID syndrome using non invasive techniques 1 +318 Evidence for impaired chronotropic responses to and recovery from 6 minute walk test in women with post acute COVID 19 syndrome What is the central question of this study Are chronotropic responses to a 6 minute walk test different in women with post acute coronavirus disease 2019 COVID 19 syndrome compared with control subjects What is the main finding and its importance Compared with control subjects the increase in heart rate was attenuated and recovery delayed after a 6 minute walk test in participants after infection with severe acute respiratory syndrome coronavirus 2 SARS CoV 2 Women reporting specific symptoms at time of testing had greater impairments compared with control subjects and SARS CoV 2 participants not actively experiencing these symptoms Such alterations have potential to constrain not only exercise tolerance but also participation in free living physical activity in women during post acute recovery from COVID 19 The short term cardiopulmonary manifestations of severe acute respiratory syndrome coronavirus 2 SARS CoV 2 are well defined However the implications of cardiopulmonary sequelae persisting beyond acute illness on physical function are largely unknown Herein we characterized heart rate responses to and recovery from a 6 minute walk test 6MWT in women 3 months after mild to moderate SARS CoV 2 infection compared with non infected control subjects Forty five women n 29 SARS CoV 2 n 16 controls age 56 11 years body mass index 25 8 6 0 kg m sup 2 sup completed pulmonary function testing and a 6MWT The SARS CoV 2 participants demonstrated reduced total lung capacity 84 8 vs 93 13 P 0 006 vital capacity 87 10 vs 93 10 P 0 040 functional residual capacity 75 16 vs 88 16 P 0 006 and residual volume 76 18 vs 93 22 P 0 001 compared with control subjects No between group differences were observed in 6MWT distance P 0 194 however the increase in heart rate with exertion was attenuated among SARS CoV 2 participants compared with control subjects 52 20 vs 65 18 beats min P 0 029 The decrease in heart rate was also delayed for minutes 1 5 of recovery among SARS CoV 2 participants all P 0 05 Women reporting specific symptoms at the time of testing had greater impairments compared with control subjects and SARS CoV 2 participants not actively experiencing these symptoms Our findings provide evidence for marked differences in chronotropic responses to and recovery from a 6MWT in women several months after acute SARS CoV 2 infection 1 +260 Echocardiographic Indicators Associated with Adverse Clinical Course and Cardiac Sequelae in Multisystem Inflammatory Syndrome in Children with Coronavirus Disease 2019 Multisystem inflammatory syndrome in children MIS C associated with coronavirus disease 2019 causes significant cardiovascular involvement which can be a determinant of clinical course and outcome The aim of this study was to investigate whether echocardiographic measures of ventricular function were independently associated with adverse clinical course and cardiac sequelae in patients with MIS C In a longitudinal observational study of 54 patients with MIS C mean age 6 8 4 4 years 46 male 56 African American measures of ventricular function and morphometry at initial presentation predischarge and at a median of 3 and 10 week follow up were retrospectively analyzed and were compared with those in 108 age and gender matched normal control subjects The magnitude of strain is expressed as an absolute value Risk stratification for adverse clinical course and outcomes were analyzed among the tertiles of clinical and echocardiographic data using analysis of variance and univariate and multivariate regression Median left ventricular apical four chamber peak longitudinal strain LVA4LS and left ventricular global longitudinal strain LVGLS at initial presentation were significantly decreased in patients with MIS C compared with the normal cohort 16 2 and 15 1 vs 22 3 and 22 0 respectively P 01 Patients in the lowest LVA4LS tertile 13 had significantly higher C reactive protein and high sensitivity troponin need for intensive care and need for mechanical life support as well as longer hospital length of stay compared with those in the highest tertile 18 5 P 01 Initial LVA4LS and LVGLS were normal in 13 of 54 and 10 of 39 patients respectively There was no mortality In multivariate regression only LVA4LS was associated with both the need for intensive care and length of stay At median 10 week follow up to date seven of 36 patients 19 and six of 25 patients 24 had abnormal LVA4LS and LVGLS respectively Initial LVA4LS 16 2 indicated abnormal LVA4LS at follow up with 100 sensitivity Impaired LVGLS and LVA4LS at initial presentation independently indicate a higher risk for adverse acute clinical course and persistent subclinical left ventricular dysfunction at 10 week follow up suggesting that they could be applied to identify higher risk children with MIS C 1 +602 SARS CoV 2 detection in nasopharyngeal swabs performance characteristics of a real time RT qPCR and a droplet digital RT PCR assay based on the exonuclease region ORF1b nsp 14 The emergence and spread of SARS CoV 2 has led to a compelling request for accurate diagnostic tests The aim of this study was assessing the performance of a real time RT qPCR rt RT qPCR assay and of a droplet digital RT PCR dd RT PCR targeting the nsp14 genome region for the detection of SARS CoV 2 in nasopharyngeal swabs A total of 258 nasopharyngeal swabs were analyzed with the nsp14 assays and for comparison with a reference assay targeting the RdRp and E genes Conflicting results were further investigated by two additional protocols the Centers for Disease Control and Prevention CDC real time targeting N1 N2 and a nested RT PCR for the spike region Agreement of results was achieved on 226 samples 156 positive and 70 negative 8 samples were positive in the reference assay and in the nsp14 rt RT qPCR but negative with the dd RT PCR and 24 samples provided different combinations of results with the three assays Sensitivity specificity and accuracy 95 C I of the nsp14 assays were 100 0 97 4 100 0 98 7 92 1 100 0 and 99 6 97 5 100 0 for the rt RT qPCR 92 4 87 4 95 6 100 0 94 2 100 0 and 94 7 91 1 97 0 for the dd RT PCR The results of the study support the use of the nsp14 real time RT qPCR and ddPCR for the detection of SARS CoV 2 in nasopharyngeal swabs 0 +463 Surveillance and prevalence of antimicrobial resistant bacteria from public settings within urban built environments Challenges and opportunities for hygiene and infection control Antimicrobial resistant AMR bacteria present one of the biggest threats to public health this must not be forgotten while global attention is focussed on the COVID 19 pandemic Resistant bacteria have been demonstrated to be transmittable to humans in many different environments including public settings in urban built environments where high density human activity can be found including public transport sports arenas and schools However in comparison to healthcare settings and agriculture there is very little surveillance of AMR in the built environment outside of healthcare settings and wastewater In this review we analyse the existing literature to aid our understanding of what surveillance has been conducted within different public settings and identify what this tells us about the prevalence of AMR We highlight the challenges that have been reported and make recommendations for future studies that will help to fill knowledge gaps present in the literature 0 +472 Glasgow Early Treatment Arm Favirpiravir GETAFIX for adults with early stage COVID 19 A structured summary of a study protocol for a randomised controlled trial The GETAFIX trial will test the hypothesis that favipiravir is a more effective treatment for COVID 19 infection in patients who have early stage disease compared to current standard of care This study will also provide an important opportunity to investigate the safety and tolerability of favipiravir the pharmacokinetic and pharmacodynamic profile of this drug and mechanisms of resistance in the context of COVID 19 infection as well as the effect of favipiravir on hospitalisation duration and the post COVID 19 health and psycho social wellbeing of patients recruited to the study GETAFIX is an open label parallel group two arm phase II III randomised trial with 1 1 treatment allocation ratio Patients will be randomised to one of two arms and the primary endpoint will assess the superiority of favipiravir plus standard treatment compared to standard treatment alone This trial will recruit adult patients with confirmed positive valid COVID 19 test who are not pregnant or breastfeeding and have no prior major co morbidities This is a multi centre trial patients will be recruited from in patients and outpatients from three Glasgow hospitals Royal Alexandra Hospital Queen Elizabeth University Hospital and the Glasgow Royal Infirmary Patients must meet all of the following criteria 1 Age 16 or over at time of consent 2 Exhibiting symptoms associated with COVID 19 3 Positive for SARS CoV 2 on valid COVID 19 test 4 Point 1 2 3 or 4 on the WHO COVID 19 ordinal severity scale at time of randomisation Asymptomatic with positive valid COVID 19 test Symptomatic Independent Symptomatic assistance needed Hospitalized with no oxygen therapy 5 Have 10 risk of death should they be admitted to hospital as defined by the ISARIC4C risk index https isaric4c net risk 6 Able to provide written informed consent 7 Negative pregnancy test women of childbearing potential 8 Able to swallow oral medication Patients will be excluded from the trial if they meet any of the following criteria 1 Renal impairment requiring or likely to require dialysis or haemofiltration 2 Pregnant or breastfeeding 3 Of child bearing potential women or with female partners of child bearing potential men who do not agree to use adequate contraceptive measures for the duration of the study and for 3 months after the completion of study treatment 4 History of hereditary xanthinuria 5 Other patients judged unsuitable by the Principal Investigator or sub Investigator 6 Known hypersensitivity to favipiravir its metabolites or any excipients 7 Severe co morbidities including patients with severe hepatic impairment defined as greater than Child Pugh grade A AST or ALT 5 x ULN AST or ALT 3 x ULN and Total Bilirubin 2xULN 8 More than 96 hours since first positive COVID 19 test sample was taken 9 Unable to discontinue contra indicated concomitant medications This is a multi centre trial patients will be recruited from in patients and outpatients from three Glasgow hospitals Royal Alexandra Hospital Queen Elizabeth University Hospital and the Glasgow Royal Infirmary Patients randomised to the experimental arm of GETAFIX will receive standard treatment for COVID 19 at the discretion of the treating clinician plus favipiravir These patients will receive a loading dose of favipiravir on day 1 of 3600mg 1800mg 12 hours apart On days 2 10 patients in the experimental arm will receive a maintenance dose of favipiravir of 800mg 12 hours apart total of 18 doses Patients randomised to the control arm of the GETAFIX trial will receive standard treatment for COVID 19 at the discretion of the treating clinician The primary outcome being assessed in the GETAFIX trial is the efficacy of favipiravir in addition to standard treatment in patients with COVID 19 in reducing the severity of disease compared to standard treatment alone Disease severity will be assessed using WHO COVID 10 point ordinal severity scale at day 15 48 hours All randomised participants will be followed up until death or 60 days post randomisation whichever is sooner Patients will be randomised 1 1 to the experimental versus control arm using computer generated random sequence allocation A minimisation algorithm incorporating a random component will be used to allocate patients The factors used in the minimisation will be site age 16 50 51 70 71 history of hypertension or currently obsess BMI 30 or obesity clinically evident yes no 7 days duration of symptoms yes no unknown sex male female WHO COVID 19 ordinal severity score at baseline 1 2or 3 4 No blinding will be used in the GETAFIX trial Both participants and those assessing outcomes will be aware of treatment allocation In total 302 patients will be randomised to the GETAFIX trial 151 to the control arm and 151 to the experimental arm There will be an optional consent form for patients who may want to contribute to more frequent PK and PD sampling The maximum number of patients who will undergo this testing will be sixteen eight males and eight females This option will be offered to all patients who are being treated in hospital at the time of taking informed consent however only patients in the experimental arm of the trial will be able to undergo this testing The current GETAFIX protocol is version 4 0 12 sup th sup September 2020 GETAFIX opened to recruitment on 26 sup th sup October 2020 and will recruit patients over a period of approximately six months GETAFIX was registered on the European Union Drug Regulating Authorities Clinical Trials EudraCT Database on 15 sup th sup April 2020 Reference number 2020 001904 41 https www clinicaltrialsregister eu ctr search trial 2020 001904 41 GB GETAFIX was registered on ISRCTN on 7 sup th sup September 2020 Reference number ISRCTN31062548 https www isrctn com ISRCTN31062548 The full protocol is attached as an additional file accessible from the Trials website Additional file 1 In the interest in expediting dissemination of this material the familiar formatting has been eliminated this Letter serves as a summary of the key elements of the full protocol The study protocol has been reported in accordance with the Standard Protocol Items Recommendations for Clinical Interventional Trials SPIRIT guidelines see Additional file 2 0 +91 Characteristics of pediatric multi system inflammatory syndrome PMIS associated with COVID 19 a meta analysis and insights into pathogenesis There was an outbreak of pediatric multisystem inflammation syndrome PMIS was observed in multiple countries recently and this syndrome was suspected to be associated with SARS CoV 2 infection At present there is still no standardized diagnostic criteria and treatment regimen for PMIS while the etiology and pathogenesis still remain unclear We performed a systematic review on PubMed and Embase from the time of inception to June 24th 2020 in order to find relevant cases There are seven studies included and 80 of patients suffered persistent fever and 90 appeared gastrointestinal symptoms IgG antibody against SARS CoV 2 was positive on 81 of patients while 37 of the patients were nucleic acid positive C reactive protein IL 6 and PCT were elevated and intravenous immunoglobulin was a routine treatment for PMIS There were more than half of patients required inotropic supports and mechanical ventilation were applied to 33 of patients The median length of hospital stay was 10 66 days and 74 had admitted to accept intensive care Our study documented three common types of PMIS clinical presentation persistent fever and gastrointestinal symptoms shocked with heart dysfunction and Kawasaki disease like syndrome PMIS patients proved with a marked inflammatory state were possibly associated with SARS CoV 2 infection 1 +296 Multisystem inflammatory syndrome in children MIS C a mini review Multisystem inflammatory syndrome in children MIS C is a novel life threatening hyperinflammatory condition that develops in children a few weeks after infection with severe acute respiratory syndrome coronavirus 2 SARS CoV 2 This disease has created a diagnostic challenge due to overlap with Kawasaki disease KD and KD shock syndrome The majority of patients with MIS C present with the involvement of at least four organ systems and all have evidence of a marked inflammatory state Most patients show an increase in the level of at least four inflammatory markers C reactive protein neutrophil count ferritin procalcitonin fibrinogen interleukin 6 and triglycerides Therapy is primarily with immunomodulators suggesting that the disease is driven by post infectious immune dysregulation Most patients even those with severe cardiovascular involvement recover without sequelae Since coronary aneurysms have been reported echocardiographic follow up is needed Further study is needed to create uniform diagnostic criteria therapy and follow up protocols 1 +542 Acute disseminated encephalomyelitis and COVID 19 A systematic synthesis of worldwide cases Acute disseminated encephalomyelitis ADEM has been reported after coronavirus disease 2019 COVID 19 In this review we systematically included worldwide reported cases on this association We included 30 case reports pediatric and adults and explored epidemiological and clinical evidence We described time to diagnosis clinical imaging and laboratory features response to treatment regimens and differences regarding severity Also an original case report was presented Neurologists must be alert to the occurrence of multifocal neurological symptoms with or without encephalopathy in patients recovered from COVID 19 Timely MRI studies should be performed to establish the diagnosis and to consider early corticosteroid based treatment 0 +54 Review of Cardiac Involvement in Multisystem Inflammatory Syndrome in Children Coronavirus disease 2019 COVID 19 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 SARS CoV 2 with substantial cardiovascular implications Although infection with SARS CoV 2 is usually mild in children some children later develop a severe inflammatory disease that can have manifestations similar to toxic shock syndrome or Kawasaki disease This syndrome has been defined by the US Centers for Disease Control and Prevention as multisystem inflammatory syndrome in children Although the prevalence is unknown 600 cases have been reported in the literature Multisystem inflammatory syndrome in children appears to be more common in Black and Hispanic children in the United States Multisystem inflammatory syndrome in children typically occurs a few weeks after acute infection and the putative etiology is a dysregulated inflammatory response to SARS CoV 2 infection Persistent fever and gastrointestinal symptoms are the most common symptoms Cardiac manifestations are common including ventricular dysfunction coronary artery dilation and aneurysms arrhythmia and conduction abnormalities Severe cases can present as vasodilatory or cardiogenic shock requiring fluid resuscitation inotropic support and in the most severe cases mechanical ventilation and extracorporeal membrane oxygenation Empirical treatments have aimed at reversing the inflammatory response using immunomodulatory medications Intravenous immunoglobulin steroids and other immunomodulatory agents have been used frequently Most patients recover within days to a couple of weeks and mortality is rare although the medium and long term sequelae particularly cardiovascular complications are not yet known This review describes the published data on multisystem inflammatory syndrome in children focusing on cardiac complications and provides clinical considerations for cardiac evaluation and follow up 1 +68 Physical and mental health complications post COVID 19 Scoping review Several long lasting health complications have been reported in previous coronavirus infections Therefore the aim of this study was to review studies that evaluated physical and mental health problems post COVID 19 Articles for inclusion in this scoping review were identified by searching the PubMed Scopus Web of Science and Google Scholar databases for items dated from 1 January to 7 November 2020 Observational studies evaluating physical health musculoskeletal symptoms functional status or mental health status with a follow up period longer than 1 month after discharge or after the onset of symptoms were included This scoping review included 34 studies with follow up periods of up to 3 months post COVID 19 The most commonly reported physical health problems were fatigue range 28 to 87 pain myalgia 4 5 to 36 arthralgia 6 0 to 27 reduced physical capacity six minute walking test range 180 to 561 m and declines in physical role functioning usual care and daily activities reduced in 15 to 54 of patients Common mental health problems were anxiety range 6 5 to 63 depression 4 to 31 and post traumatic stress disorder 12 1 to 46 9 Greater fatigue pain anxiety and depression were reported in female patients and individuals admitted to intensive care An overall lower quality of life was seen up to 3 months post COVID 19 This review highlights the presence of several physical and mental health problems up to 3 months post COVID 19 The findings point to the need for comprehensive evaluation and rehabilitation post COVID 19 to promote quality of life 1 +482 Circular economy approach in solid waste management system to achieve UN SDGs Solutions for post COVID recovery The COVID 19 pandemic and the ensuing socioeconomic crisis has impeded progress towards the UN Sustainable Development Goals UN SDGs This paper investigates the impact of COVID 19 on the progress of the SDGs and provides insight into how green recovery stimulus driven by circular economy CE based solid waste management SWM could assist in attaining the intended targets of UN SDG It was understood in this review that the guiding principles of the UN SDGs such as public health environmental concerns resource value and economic development are similar to those that have driven the growth of waste management activities thus in order to achieve the goals of UN SDG a circular economy approach in solid waste management system should be prioritized in the post COVID economic agenda However policy technology and public involvement issues may hinder the shift to the CE model therefore niche growth might come from developing distinctive waste management driven green jobs formalizing informal waste pickers and by focusing in education and training of informal worker The review also emphasized in creating green jobs by investing in recycling infrastructure which would enable us to address the climate change related concerns which is one of the key target of UN SDG The CE based product designs and business models would emphasize multifunctional goods extending the lifespan of products and their parts and intelligent manufacturing to help the public and private sectors maximise product utility thus reducing waste generation while providing long term economic and environmental benefits The study also recommended strong policies that prioritized investments in decentralization of solid waste systems localization of supply chains recycling and green recovery information sharing and international collaboration in order to achieve the UN SDGs 0 +49 Cardiac manifestations in SARS CoV 2 associated multisystem inflammatory syndrome in children a comprehensive review and proposed clinical approach Initial reports on COVID 19 described children as largely spared from severe manifestations with only 2 6 of children requiring intensive care treatment However since mid April 2020 clusters of pediatric cases of severe systemic hyperinflammation and shock epidemiologically linked with COVID 19 have been reported This condition was named as SARS Cov 2 associated multisystem inflammatory syndrome in children and showed similarities to Kawasaki disease Here we present a narrative review of cases reported in literature and we discuss the clinical acute and follow up management of these patients Patients with SARS Cov 2 associated multisystem inflammatory syndrome frequently presented with persistent fever gastrointestinal symptoms polymorphic rash conjunctivitis and mucosal changes Elevated inflammatory markers and evidence of cytokine storm were frequently observed A subset of these patients also presented with hypotension and shock 20 100 from either acute myocardial dysfunction or systemic hyperinflammation vasodilation Coronary artery dilation or aneurysms have been described in 6 24 and arrhythmias in 7 60 Cardiac support immunomodulation and anticoagulation are the key aspects for the management of the acute phase Long term structured follow up of these patients is required due to the unclear prognosis and risk of progression of cardiac manifestations Conclusion Multisystem inflammatory syndrome is a novel syndrome related to SARS CoV 2 infection Evidence is still scarce but rapidly emerging in the literature Cardiac manifestations are frequent including myocardial and coronary involvement and need to be carefully identified and monitored over time What is Known Multisystem inflammatory syndrome in children MIS C has been described associated with SARS CoV 2 What is New Patients with MIS C often present with fever gastrointestinal symptoms and shock Cardiac involvement is found in a high proportion of these patients including ventricular dysfunction coronary artery dilation or aneurysm and arrhythmias Management is based on expert consensus and includes cardiac support immunomodulatory agents and anticoagulation Long term follow up is required due to the unclear prognosis and risk of progression of cardiac manifestation 1 +522 SARS CoV 2 nosocomial infection acquired in a French university hospital during the 1st wave of the Covid 19 pandemic a prospective study In healthcare facilities nosocomial transmissions of respiratory viruses are a major issue SARS CoV 2 is not exempt from nosocomial transmission Our goals were to describe COVID 19 nosocomial cases during the first pandemic wave among patients in a French university hospital and compliance with hygiene measures We conducted a prospective observational study in Grenoble Alpes University Hospital from 01 03 2020 to 11 05 2020 We included all hospitalised patients with a documented SARS CoV 2 diagnosis Nosocomial case was defined by a delay of 5 days between hospitalisation and first symptoms Hygiene measures were evaluated between 11 05 2020 and 22 05 2020 Lockdown measures were effective in France on 17 03 2020 and ended on 11 05 2020 Systematic wearing of mask was mandatory for all healthcare workers HCW and visits were prohibited in our institution from 13 03 2021 and for the duration of the lockdown period Among 259 patients included 14 5 4 were considered as nosocomial COVID 19 Median time before symptom onset was 25 days interquartile range 12 42 Eleven patients 79 had risk factors for severe COVID 19 Five died 36 including 4 deaths attributable to COVID 19 Two clusters were identified The first cluster had 5 cases including 3 nosocomial acquisitions and no tested HCWs were positive The second cluster had 3 cases including 2 nosocomial cases and 4 HCWs were positive Surgical mask wearing and hand hygiene compliance were adequate for 95 and 61 of HCWs respectively The number of nosocomial COVID 19 cases in our hospital was low Compliance regarding mask wearing hand hygiene and lockdown measures drastically reduced transmission of the virus Monitoring of nosocomial COVID 19 cases during the first wave enabled us to determine to what extent the hygiene measures taken were effective and patients protected Trial registration Study ethics approval was obtained retrospectively on 30 September 2020 CECIC Rhône Alpes Auvergne Clermont Ferrand IRB 5891 0 +466 Characteristics of viral pneumonia in the COVID 19 era an update Influenza virus rhinovirus and adenovirus frequently cause viral pneumonia an important cause of morbidity and mortality especially in the extreme ages of life During the last two decades three outbreaks of coronavirus associated pneumonia namely Severe Acute Respiratory Syndrome Middle East Respiratory Syndrome and the ongoing Coronavirus Infectious Disease 2019 COVID 19 were reported The rate of diagnosis of viral pneumonia is increasingly approaching 60 among children identified as having community acquired pneumonia CAP Clinical presentation ranges from mild to severe pneumonitis complicated by respiratory failure in severe cases The most vulnerable patients the elderly and those living with cancer report a relevant mortality rate No clinical characteristics can be useful to conclusively distinguish the different etiology of viral pneumonia However accessory symptoms such as anosmia or ageusia together with respiratory symptoms suggest COVID 19 An etiologic based treatment of viral pneumonia is possible in a small percentage of cases only Neuraminidase inhibitors have been proven to reduce the need for ventilatory support and mortality rate while only a few data support the large scale use of other antivirals A low middle dose of dexamethasone and heparin seems to be effective in COVID 19 patients but data regarding their possible efficacy in viral pneumonia caused by other viruses are conflicting In conclusion viral pneumonia is a relevant cause of CAP whose interest is increasing due to the current COVID 19 outbreak To set up a therapeutic approach is difficult because of the low number of active molecules and the conflicting data bearing supportive treatments such as steroids 0 +79 Role of rehabilitation amidst the COVID 19 pandemic a review COVID 19 remains globally a highly infectious disease targeting multiple organs Rehabilitation is increasingly valued among the supportive care fields to combat COVID 19 as currently definitive curative treatment remains largely absent This narrative review is to address rehabilitation related topics associated with the treatment of COVID 19 patients Nosocomial spread remains a high risk for healthcare workers with comparable high ratios of exposed workers suffering from the disease with more severe clinical course Primary principle of rehabilitation is to protect rehabilitation physicians and cover all person to person interactions Translating perspectives are encouraged through each multidisciplinary approach Rehabilitation for the outpatient remains a potential beneficial approach Artificial intelligence can potentially provide aid and possible answers to important problems that may emerge involving COVID 19 The real value of rehabilitation in COVID 19 may be very impactful and beneficial for patients physical and mental health 1 +593 Battery for deep brain stimulation depletion in Parkinsons Disease and dystonia patients a systematic review Deep brain stimulation DBS therapy for Parkinsons Disease PD and dystonia is associated with the possibility of both minor and major complications One possible side effect is the depletion of implantable pulse generator IPG battery and the associated sudden recurrence of PD or dystonia symptoms which can be potentially life threatening Delayed or postponed outpatient visits due to COVID 19 may be a risk factor of battery end of life consequences To analyse the clinical outcomes in reported PD and dystonia patients treated with DBS who as a result of the sudden depletion of the neurostimulator battery developed life threatening symptoms The databases of PubMed Scopus EMBASE and Google Scholar were searched using pre established criteria A total of 244 articles was found of which 12 met the adopted criteria Selected papers presented a total of 17 case reports of DBS treated patients 11 with PD and six with dystonia who had depleted IPG batteries and due to rapid worsening of PD dystonia symptoms required urgent hospital admission IPG battery replacement was the only effective treatment in the majority of cases IPG battery depletion can result in fatal outcomes Sudden recurrence of PD or dystonia symptoms in patients treated by DBS can be potentially life threatening so scheduling the replacement of a discharged IPG battery should not be postponed The COVID 19 pandemic should alert staff at emergency neurology and movement disorders wards not to postpone the visits of patients with an implanted DBS system 0 +345 COVID 19 and post traumatic stress disorder The perfect storm for mental health Review Since its outbreak in December 2019 in the Chinese city of Wuhan coronavirus disease 2019 COVID 19 caused by severe acute respiratory syndrome coronavirus 2 SARS CoV 2 has evolved into an ongoing global pandemic Due to the novel antigenic properties of this virus the world population could not develop immunity effectively and this led to the subsequent spread of COVID 19 This caused an unprecedented emergency situation with significant negative effects on health and well being both on an individual and societal level Apart from health economic and social consequences the impact of this pandemic on mental health is increasingly being reported in the scientific literature The present review aimed to provide a comprehensive discussion of the possible neurological and neuropsychiatric manifestations of SARS CoV 2 together with the related underlying molecular pathways In addition the present review focused on populations which are at a higher risk of developing psychiatric disturbances due to the COVID 19 pandemic and discussed possible routes of clinical management and therapeutics to minimize the burden associated with psychiatric disorders Moreover research findings exploring the prevalence of COVID 19 related post traumatic stress disorder PTSD symptoms across vulnerable groups including children adolescents and COVID 19 survivors are presented with particular emphasis on those with severe disease who required hospitalization and or intensive care unit admission Based on the available literature the identification of potential determinants associated with PTSD across the different populations is underlined Lessons learnt from the pandemics across the globe together with the ongoing research on COVID 19 and its impact on mental health highlight the utmost importance for evidence based proactive and targeted interventions in high risk groups aiming to mitigate the risks and manage vulnerabilities 0 +677 Challenges of modeling and analysis in cybermanufacturing a review from a machine learning and computation perspective In Industry 4 0 smart manufacturing is facing its next stage cybermanufacturing founded upon advanced communication computation and control infrastructure Cybermanufacturing will unleash the potential of multi modal manufacturing data and provide a new perspective called computation service as a part of service oriented architecture SOA where on demand computation requests throughout manufacturing operations are seamlessly satisfied by data analytics and machine learning However the complexity of information technology infrastructure leads to fundamental challenges in modeling and analysis under cybermanufacturing ranging from information poor datasets to a lack of reproducibility of analytical studies Nevertheless existing reviews have focused on the overall architecture of cybermanufacturing SOA or its technical components e g communication protocol rather than the potential bottleneck of computation service with respect to modeling and analysis In this paper we review the fundamental challenges with respect to modeling and analysis in cybermanufacturing Then we introduce the existing efforts in computation pipeline recommendation which aims at identifying an optimal sequence of method options for data analytics machine learning without time consuming trial and error We envision computation pipeline recommendation as a promising research field to address the fundamental challenges in cybermanufacturing We also expect that computation pipeline recommendation can be a driving force to flexible and resilient manufacturing operations in the post COVID 19 industry 0 +428 Enhancing Teaching Recovery Techniques TRT with Parenting Skills RCT of TRT Parenting with Trauma Affected Syrian Refugees in Lebanon Utilising Remote Training with Implications for Insecure Contexts and COVID 19 Child psychosocial recovery interventions in humanitarian contexts often overlook the significant effect that caregivers can have on improving childrens future trajectory We enhanced the well established evidenced based child trauma recovery programme Teaching Recovery Techniques TRT intervention with parenting sessions i e TRT Parenting TRT P which aims to improve parent mental health and their ability to support their childrens mental health We describe the findings of a three arm randomised controlled trial comparing enhanced TRT P vs TRT and waitlist The primary aim was to test if children in the enhanced arm of the programme show improved child and caregiver mental health We recruited 119 Syrian refugee children and one of their caregivers in Beqaa Valley in Lebanon They were randomised to the TRT TRT P or waitlist control group Data were collected at baseline and 2 weeks and 12 weeks post intervention Training of facilitators was via remote training from the United Kingdom Results showed a highly consistent pattern with children in the enhanced TRT P group showing the greatest levels of improvement in behavioural and emotional difficulties compared to children in the TRT or waitlist control groups Caregivers in the TRT P group also reported significant reductions in depression anxiety and stress Findings indicate that the addition of the evidence based parenting skills components has the potential to enhance the effects of interventions designed to improve childrens mental health in contexts of trauma conflict and displacement Implications for COVID 19 remote learning are also discussed 0 +520 A Rapid Review on the Influence of COVID 19 Lockdown and Quarantine Measures on Modifiable Cardiovascular Risk Factors in the General Population Preceding coronavirus outbreaks resulted in social isolation which in turn is associated with cardiovascular consequences Whether the current COVID 19 pandemic negatively impacts cardiovascular health is unclear The aim of the rapid review was to investigate whether COVID 19 lockdown influences modifiable cardiovascular risk factors i e physical inactivity sedentary behaviour smoking alcohol use unhealthy diet obesity bad blood lipids and hypertension in the general population Medline and EMBASE were searched until March 2021 Title abstracts and full texts were screened by one reviewer and 20 by a second reviewer Only studies using probability sampling were included in order to ensure the representativeness of the target population Data extraction and critical appraisal were done by one reviewer and double checked by another reviewer We identified 32 studies that fulfilled our inclusion criteria Findings show that physical activity decreased and sedentary behaviour increased among all age groups during the COVID 19 lockdown Among adults alcohol consumption increased dietary quality worsened and the amount of food intake increased Some adults reported weight gain Studies on children and adolescents were sparse This rapid review found a high number of epidemiological studies on the impact of COVID 19 lockdown measures on modifiable cardiovascular risk factors but only a few used probability sampling methods 0 +5 Long COVID postural tachycardia syndrome an American Autonomic Society statement COVID 19 is a global pandemic that has had a devastating effect on the health and economy of much of human civilization While the acute impacts of COVID 19 were the initial focus of concern it is becoming clear that in the wake of COVID 19 many patients are developing chronic symptoms that have been called Long COVID Some of the symptoms and signs include those of postural tachycardia syndrome POTS Understanding and managing long COVID POTS will require a significant infusion of health care resources and a significant additional research investment In this document from the American Autonomic Society we outline the scope of the problem and the resources and research needed to properly address the impact of Long COVID POTS 1 +155 Long COVID 19 Syndrome A Comprehensive Review of Its Effect on Various Organ Systems and Recommendation on Rehabilitation Plans The majority of people infected with SARS CoV 2 fully recovered within a few weeks However a considerable number of patients of different ages still suffer from long lasting problems similar to the multi organ damage in its acute phase of infection or experience symptoms continuously for a longer term after the recovery The severity of the primary infection seems not to be associated with the possibility and severity of long term symptoms Various unresolved symptoms have been reported in COVID 19 survivors months after hospital discharge Long COVID 19 Syndrome refers to survivors 4 months after initial symptoms onset It is important to understand the systemic effects of Long COVID 19 Syndrome its presentations and the need for rehabilitations to restore functional recovery in survivors Government healthcare workers and survivor groups should collaborate to establish a self sustaining system to facilitate follow up and rehabilitations with prioritization of resources to more severely Long COVID 19 Syndrome survivors This review looks into the systemic effects of Long COVID 19 Syndrome in various aspects respiratory cardiovascular hematological renal gastrointestinal neurological and metabolic effects of Long COVID 19 Syndromes Recommendations for follow up and rehabilitations details have been explored to cope with the tremendous Long COVID 19 Syndrome patients 1 +324 Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID 19 A Systematic Review Infection with COVID 19 has been associated with long term symptoms but the frequency variety and severity of these complications are not well understood Many published commentaries have proposed plans for pandemic control that are primarily based on mortality rates among older individuals without considering long term morbidity among individuals of all ages Reliable estimates of such morbidity are important for patient care prognosis and development of public health policy To conduct a systematic review of studies examining the frequency and variety of persistent symptoms after COVID 19 infection A search of PubMed and Web of Science was conducted to identify studies published from January 1 2020 to March 11 2021 that examined persistent symptoms after COVID 19 infection Persistent symptoms were defined as those persisting for at least 60 days after diagnosis symptom onset or hospitalization or at least 30 days after recovery from the acute illness or hospital discharge Search terms included COVID 19 SARS CoV 2 coronavirus 2019 nCoV long term after recovery long haul persistent outcome symptom follow up and longitudinal All English language articles that presented primary data from cohort studies that reported the prevalence of persistent symptoms among individuals with SARS CoV 2 infection and that had clearly defined and sufficient follow up were included Case reports case series and studies that described symptoms only at the time of infection and or hospitalization were excluded A structured framework was applied to appraise study quality A total of 1974 records were identified of those 1247 article titles and abstracts were screened After removal of duplicates and exclusions 92 full text articles were assessed for eligibility 47 studies were deemed eligible and 45 studies reporting 84 clinical signs or symptoms were included in the systematic review Of 9751 total participants 5266 54 0 were male 30 of 45 studies reported mean or median ages younger than 60 years Among 16 studies most of which comprised participants who were previously hospitalized the median proportion of individuals experiencing at least 1 persistent symptom was 72 5 interquartile range IQR 55 0 80 0 Individual symptoms occurring most frequently included shortness of breath or dyspnea 26 studies median frequency 36 0 IQR 27 6 50 0 fatigue or exhaustion 25 studies median frequency 40 0 IQR 31 0 57 0 and sleep disorders or insomnia 8 studies median 29 4 IQR 24 4 33 0 There were wide variations in the design and quality of the studies which had implications for interpretation and often limited direct comparability and combinability Major design differences included patient populations definitions of time zero ie the beginning of the follow up interval follow up lengths and outcome definitions including definitions of illness severity This systematic review found that COVID 19 symptoms commonly persisted beyond the acute phase of infection with implications for health associated functioning and quality of life Current studies of symptom persistence are highly heterogeneous and future studies need longer follow up improved quality and more standardized designs to reliably quantify risks 1 +688 The clinical spectrum of SARS CoV 2 infection in Gaucher disease Effect of both a pandemic and a rare disease that disrupts the immune system The impact of SARS CoV 2 in rare disease populations has been underreported Gaucher disease GD is a prototype rare disease that shares with SARS CoV 2 a disruption of the lysosomal pathway Retrospective analysis of 11 patients with Type 1 GD who developed COVID 19 between March 2020 and March 2021 Seven male and 4 female patients with Type 1 GD developed COVID 19 One was a pediatric patient 8 years old while the remainder were adults median age of 44 years old range 21 to 64 years old Two patients required hospitalization though none required intensive care or intubation All 11 patients recovered from COVID 19 and there were no reported deaths Our case series suggests that GD patients acquired COVID 19 at a similar frequency as the general population though experienced a milder overall course despite harboring underlying immune system dysfunction and other known co morbidities that confer high risk of adverse outcomes from SARS CoV 2 infection 0 +256 Case report and systematic review suggest that children may experience similar long term effects to adults after clinical COVID 19 Persistent symptoms in adults after COVID 19 are emerging and the term long COVID is increasingly appearing in the literature However paediatric data are scarce This paper contains a case report of five Swedish children and the long term symptoms reported by their parents It also includes a systematic literature review of the MEDLINE EMBASE and Web of Science databases and the medRxiv bioRxiv pre print servers up to 2 November 2020 The five children with potential long COVID had a median age of 12 years range 9 15 and four were girls They had symptoms for 6 8 months after their clinical diagnoses of COVID 19 None were hospitalised at diagnosis but one was later admitted for peri myocarditis All five children had fatigue dyspnoea heart palpitations or chest pain and four had headaches difficulties concentrating muscle weakness dizziness and sore throats Some had improved after 6 8 months but they all suffered from fatigue and none had fully returned to school The systematic review identified 179 publications and 19 of these were deemed relevant and read in detail None contained any information on long COVID in children Children may experience similar long COVID symptoms to adults and females may be more affected 1 +78 A systematic review of pathological findings in COVID 19 a pathophysiological timeline and possible mechanisms of disease progression Since the outbreak of the COVID 19 pandemic much has been learned regarding its clinical course prognostic inflammatory markers disease complications and mechanical ventilation strategy Clinically three stages have been identified based on viral infection pulmonary involvement with inflammation and fibrosis Moreover low and high elastance phenotypes can be distinguished in mechanically ventilated patients based on lung mechanics ventilation to perfusion ratio and CT scans these two phenotypes have presumed differences in their underlying pathophysiology Although essential for therapeutic guidance the pathophysiology of COVID 19 is poorly understood Here we systematically reviewed published case reports and case series in order to increase our understanding of COVID 19 pathophysiology by constructing a timeline and correlating histopathological findings with clinical stages of COVID 19 Using PRISMA IPD guidelines 42 articles reporting 198 individual cases were included in our analysis In lung samples n 131 cases we identified three main histological patterns epithelial n 110 85 with reactive epithelial changes and DAD vascular n 76 59 with microvascular damage micro thrombi and acute fibrinous and organizing pneumonia and fibrotic n 28 22 with interstitial fibrosis The epithelial and vascular patterns can present in all stages of symptomatic COVID 19 whereas the fibrotic pattern presents starting at 3 weeks Moreover patients can present with more than one pattern either simultaneously or consecutively These findings are consistent with knowledge regarding clinical patterns of viral infection development of hyperinflammation and hypercoagulability and fibrosis Close collaboration among medical staff is necessary in order to translate this knowledge and classification of pathophysiological mechanisms into clinical stages of disease in individual patients Moreover further research including histopathological studies is warranted in order to develop reliable clinically relevant biomarkers by correlating these pathological findings with laboratory results and radiological findings thus increasing our understanding of COVID 19 and facilitating the move to precision medicine for treating patients 1 +643 Long Term Non invasive Ventilation in Children Current Use Indications and Contraindications This review focuses on the delivery of non invasive ventilation i e intermittent positive pressure ventilation in children lasting more than 3 months Several recent reviews have brought to light a dramatic escalation in the use of long term non invasive ventilation in children over the last 30 years This is due both to the growing number of children receiving care for complex and severe diseases necessitating respiratory support and to the availability of LT NIV equipment that can be used at home While significant gaps in availability persist for smaller children and especially infants home LT NIV for children with chronic respiratory insufficiency has improved their quality of life and decreased the overall cost of care While long term NIV is usually delivered during sleep it can also be delivered 24 h a day in selected patients Close collaboration between the hospital complex care team the home LT NIV program and family caregivers is of the utmost importance for successful home LT NIV Long term NIV is indicated for respiratory disorders responsible for chronic alveolar hypoventilation with the aim to increase life expectancy and maximize quality of life LT NIV is considered for conditions that affect respiratory muscle performance alterations in central respiratory drive or neuromuscular function and or impose an excessive respiratory load airway obstruction lung disease or chest wall anomalies Relative contraindications for LT NIV include the inability of the local medical infrastructure to support home LT NIV and poor motivation or inability of the patient caregivers to cooperate or understand recommendations Anatomic abnormalities that interfere with interface fitting inability to protect the lower airways due to excessive airway secretions and or severely impaired swallowing or failure of LT NIV to support respiration can lead to considering invasive ventilation via tracheostomy Of note providing home LT NIV during the COVID 19 pandemic has become more challenging This is due both to the disruption of medical systems and the fear of contaminating care providers and family with aerosols generated by a patient positive for SARS CoV 2 during NIV Delay in initiating LT NIV decreased frequency of home visits by the home ventilation program and decreased availability of polysomnography and oximetry transcutaneous PCO sub 2 sub monitoring are observed Teleconsultations and telemonitoring are being developed to mitigate these challenges 0 +458 Clinical features and follow up of pediatric patients hospitalized for COVID 19 This report summarizes the clinical features and 1 month follow up observations for pediatric patients who were hospitalized with coronavirus disease 2019 COVID 19 in Wuhan Women and Childrens Hospital The 1 month follow up data included clinical manifestations and results from serum severe acute respiratory syndrome coronavirus 2 SARS CoV 2 IgG and IgM tests reverse transcription polymerase chain reaction RT PCR for SARS CoV 2 lung computed tomography CT scans and laboratory tests Between January 20 and March 15 2020 127 patients aged 0 15 years were hospitalized for COVID 19 treatment including 3 severe cases and 124 mild or moderate cases The main therapies included inhalation of aerosolized interferon α 122 127 and additional antiviral drugs 28 127 Among the 81 patients who had pneumonia at admission 35 with right lobe pneumonia had the longest hospital stay mean 14 5 7 days 17 with left lobe pneumonia had the highest creatine kinase 154 106 U L and creatine kinase myocardial band CK MB 43 48 U L levels and 29 with bilateral pneumonia had the highest white blood cell counts 8 3 4 10 sup 9 sup L Among the 46 patients who were successfully followed up 1 month after discharge two notable findings were right lobe pneumonia in 22 95 confidence interval CI 11 37 of patients and persistently elevated serum creatine kinase and CK MB levels The median duration of elevated CK MB was 45 days The mean concentrations of serum SARS CoV 2 IgG and IgM in 41 patients were 8 0 7 5 and 98 40 ng ml respectively At follow up four patients retested positive for SARS CoV 2 The involvement of different lung lobes in patients with COVID 19 was associated with variations in the persistence of pneumonia and elevation of CK MB levels and body temperature 0 +538 Response strategies for promoting gender equality in public health emergencies a rapid scoping review The COVID 19 pandemic threatens to widen existing gender inequities worldwide A growing body of literature assesses the harmful consequences of public health emergencies PHEs for women and girls however evidence of what works to alleviate such impacts is limited To inform viable mitigation strategies we reviewed the evidence on gender based interventions implemented in PHEs including disease outbreaks and natural disasters We conducted a rapid scoping review to identify eligible studies by systematically searching the databases MEDLINE Global Health and Web of Science with the latest search update on 28 May 2021 We used the Sustainable Development Goals as a guiding framework to identify eligible outcomes of gender in equality Out of 13 920 records 16 studies met our eligibility criteria These included experimental 3 cohort 2 case control 3 and cross sectional 9 studies conducted in the context of natural disasters earthquakes droughts and storms or epidemics Zika Ebola and COVID 19 Six studies were implemented in Asia seven in North Central America and three in Africa Interventions included economic empowerment programmes 5 health promotion largely focused on reproductive health 10 and a postearthquake resettlement programme 1 Included studies assessed gender based outcomes in the domains of sexual and reproductive health equal opportunities access to economic resources violence and health There was a dearth of evidence for other outcome domains relevant to gender equity such as harmful practices sanitation and hygiene practices workplace discrimination and unpaid work Economic empowerment interventions showed promise in promoting womens and girls economic and educational opportunities as well as their sexual and reproductive health during PHEs However some programme beneficiaries may be at risk of experiencing unintended harms such as an increase in domestic violence Focused reproductive health promotion may also be an effective strategy for supporting womens sexual and reproductive health although additional experimental evidence is needed This study identified critical evidence gaps to guide future research on approaches to alleviating gender inequities during PHEs We further highlight that interventions to promote gender equity in PHEs should take into account possible harmful side effects such as increased gender based violence DOI 10 17605 OSF IO 8HKFD 0 +249 Kidney Outcomes in Long COVID COVID 19 is associated with increased risk of post acute sequelae involving pulmonary and extrapulmonary organ systems referred to as long COVID However a detailed assessment of kidney outcomes in long COVID is not yet available We built a cohort of 1 726 683 US Veterans identified from March 1 2020 to March 15 2021 including 89 216 patients who were 30 day survivors of COVID 19 and 1 637 467 non infected controls We examined risks of AKI eGFR decline ESKD and major adverse kidney events MAKE MAKE was defined as eGFR decline 50 ESKD or all cause mortality We used inverse probability weighted survival regression adjusting for predefined demographic and health characteristics and algorithmically selected high dimensional covariates including diagnoses medications and laboratory tests Linear mixed models characterized intra individual eGFR trajectory Beyond the acute illness 30 day survivors of COVID 19 exhibited a higher risk of AKI aHR 1 94 95 CI 1 86 to 2 04 eGFR decline 30 aHR 1 25 95 CI 1 14 to 1 37 eGFR decline 40 aHR 1 44 95 CI 1 37 to 1 51 eGFR decline 50 aHR 1 62 95 CI 1 51 to 1 74 ESKD aHR 2 96 95 CI 2 49 to 3 51 and MAKE aHR 1 66 95 CI 1 58 to 1 74 Increase in risks of post acute kidney outcomes was graded according to the severity of the acute infection whether patients were non hospitalized hospitalized or admitted to intensive care Compared with non infected controls 30 day survivors of COVID 19 exhibited excess eGFR decline 95 CI of 3 26 3 58 to 2 94 5 20 6 24 to 4 16 and 7 69 8 27 to 7 12 ml min per 1 73 m sup 2 sup per year respectively in non hospitalized hospitalized and those admitted to intensive care during the acute phase of COVID 19 infection Patients who survived COVID 19 exhibited increased risk of kidney outcomes in the post acute phase of the disease Post acute COVID 19 care should include attention to kidney disease 1 +510 Gamification as Online Teaching Strategy During COVID 19 A Mini Review The ongoing pandemic caused by coronavirus disease 2019 COVID 19 has enforced a shutdown of educative institutions of all levels including high school and university students and has forced educators and institutions to adapt teaching strategies in a hasty way This work reviews the use of gamification based teaching during the pandemic lockdown through a search in Scopus PsycINFO ERIC and Semantic Scholar databases A total of 11 papers from Chemistry Business Computer Science Biology and Medical areas have been identified and included in the present work All of them analyzed the use of gamification strategies during the COVID 19 pandemic and assessed students learning and motivation outcomes In general students reported that gamification was innovative engaging and an efficient strategy to deliver curricula material moreover it was perceived as a fun activity Some students reported that gamified videoconferences aided to connect with their classmates during isolation time providing effective social support However some students reported a bad physical or psychological condition as consequence of the confinement and did not get involved in the activity Some weaknesses of the reviewed studies are the small sample size and its homogeneity which makes it difficult to generalize their results to other scenarios and academic areas Furthermore although there is a feeling of learning during the activity this result is mainly based on subjective perceptions and any of the studies demonstrated that superior learning was achieved in comparison with traditional teaching strategies Nevertheless gamification can be implemented together with traditional lectures and can be a valuable instrument during post COVID times 0 +131 Post covid 19 pulmonary fibrosis Is it real threat After the COVID 19 outbreak increasing number of patients worldwide who have survived COVID 19 continue to battle the symptoms of the illness long after they have been clinically tested negative for the disease As we battle through this pandemic the challenging part is to manage COVID 19 sequelae which may vary from fatigue and body aches to lung fibrosis This review addresses underlying mechanism risk factors course of disease and treatment option for post covid pulmonary fibrosis Elderly patient who require ICU care and mechanical ventilation are at the highest risk to develop lung fibrosis Currently no fully proven options are available for the treatment of post inflammatory COVID 19 pulmonary fibrosis 1 +491 Awake Rhinology Surgery in Response to the COVID 19 Pandemic in Europe European health care systems are faced with a backlog of surgical procedures following the suspension of routine surgery during the COVID 19 crisis Routine rhinology surgery under general anaesthetic GA is now faced with significant challenges which include limited theatre capacity the negative ramifications of surgical prioritization reduced patient throughput in secondary care and additional personal protective equipment requirements Delayed surgery in rhinology particularly with regards to chronic rhinosinusitis has previously been shown to have poorer surgical outcomes a detrimental effect on quality of life and long term negative health socio economic effects Awake rhinology surgery under local anaesthetic LA provides an ideal alternative to GA It provides a means of operating on patients in a setting alternative to currently oversubscribed main theatres by utilizing satellite facilities while ensuring identical surgical outcomes for patients who may otherwise have been forced to wait a long time for their procedure It also confers additional benefits in terms of shorter recovery time and hospital stay for patients We have developed a set of recommendations that are intended to help support clinicians and managers to better adopt LA rhinology protocols and minimize the risk to the patient and health care professionals involved International roundtable forums were conducted and supplemented by individual interviews The international board consisted of 12 rhinologists experienced in awake rhinology surgery Feedback was analysed and shared to develop a consensus of best practice Local and national guidelines need to be adhered to with specific focus on patient and clinician safety When performing awake rhinology procedures in the COVID 19 recovery process consider implementing specific safety measures and workflow practices to safeguard patients and staff and minimize the risk of infection Awake surgery potentially provides quicker access to routine rhinology surgery in the post COVID 19 recovery phase ensuring patients are treated in a timely matter thereby avoiding higher downstream costs and improving outcomes 0 +383 Preparing for the 2020 2021 influenza season The COVID 19 pandemic has altered health seeking behaviors and has increased attention to non pharmaceutical interventions that reduce the risk of transmission of respiratory viruses including SARS CoV 2 and influenza While the potential impact of the COVID 19 pandemic on influenza is not fully known in the Southern hemisphere influenza infection rates appear to be very low Influenza vaccine efficacy for 2019 2020 season was comparable to prior season and influenza vaccine recommendations for pediatric immunizations remain similar to prior years Influenza treatments continue to include neuraminidase inhibitors as well as baloxavir for treatment and in some instances prophylaxis 0 +181 A further plot twist will long COVID have an impact on dentistry and the dental workforce COVID 19 has dominated our lives since the start of the pandemic in 2020 as well as greatly impacting dentistry its patients and the dental profession A new and potentially further problematic phenomenon is that of long COVID a term used to describe the effects of COVID 19 that continue for weeks or even months beyond the initial illness It is characterised by debilitating symptoms including extreme fatigue shortness of breath insomnia heart palpitations and prolonged high temperature With one in ten people in the UK suffering from long COVID there will undoubtedly be a considerable impact on dentistry provision there will be ramifications not only for patients but also the workforce both physically and mentally The aim of this article is to explore the obstacles we will face due to long COVID examining possible challenges but also possible solutions 1 +42 Lasting Changes to Circulating Leukocytes in People with Mild SARS CoV 2 Infections Survivors of severe SARS CoV 2 infections frequently suffer from a range of post infection sequelae Whether survivors of mild or asymptomatic infections can expect any long term health consequences is not yet known Herein we investigated lasting changes to soluble inflammatory factors and cellular immune phenotype and function in individuals who had recovered from mild SARS CoV 2 infections i n i 22 compared to those that had recovered from other mild respiratory infections i n i 11 Individuals who had experienced mild SARS CoV 2 infections had elevated levels of C reactive protein 1 3 months after symptom onset and changes in phenotype and function of circulating T cells that were not apparent in individuals 6 9 months post symptom onset Markers of monocyte activation and expression of adherence and chemokine receptors indicative of altered migratory capacity were also higher at 1 3 months post infection in individuals who had mild SARS CoV 2 but these were no longer elevated by 6 9 months post infection Perhaps most surprisingly significantly more T cells could be activated by polyclonal stimulation in individuals who had recently experienced a mild SARS CoV 2 infection compared to individuals with other recent respiratory infections These data are indicative of prolonged immune activation and systemic inflammation that persists for at least three months after mild or asymptomatic SARS CoV 2 infections 1 +39 SARS CoV 2 associated multisystem inflammatory syndrome in children MIS C A single centers experience SARS CoV 2 related multisystem inflammatory syndrome in children MIS C is a newly defined clinical entity in pediatric ages resembles Kawasaki Disease or toxic shock syndrome Here we aimed to raise awareness about this SARS CoV 2 related syndrome Children diagnosed with MIS C and followed in Pediatric Clinic between November 2020 and January 2021 were included in study Data about patients demographic characteristics clinical and laboratory findings treatment and outcomes were collected from medical records The median age of 20 children with MIS C was 80 5 months 11 of them were male The most common symptoms at admission were fever 100 abdominal pain 70 myalgia 50 and rash 50 Lymphopenia elevated inflammatory markers and cardiac enzymes were their main laboratory findings Cardiac involvement 90 consisted of myopericarditis valvulitis left ventricular dysfunction and coronary arteritis Symptoms mimicking acute appendicitis and ileus were due to gastrointestinal involvement 50 Macular rash on the trunk erythema on upper eyelids were striking Empiric antibiotics and intravenous immunoglobulin were used in all patients glucocorticoids 90 anti thrombotic 65 and vasoactive 45 agents were used according to severity of disease Response to IVIG treatment was poor whereas glucocorticoids have dramatic affect Seven patients 35 were monitored in intensive care unit none of them required intubation mechanic ventilation or ECMO The median recovery time that is the period when fever subside and inflammatory markers returned to normal was 9 5 days Glucocorticoids has critical role in treatment of MIS C early recognition and treatment may decrease need for intensive care by providing rapid recovery 1 +311 Long term clinical follow up of patients suffering from moderate to severe COVID 19 infection a monocentric prospective observational cohort study Various symptoms and considerable organ dysfunction persist following infection with severe acute respiratory syndrome coronavirus 2 SARS CoV 2 Uncertainty remains about the potential mid and long term health sequelae This prospective study of patients hospitalized with coronavirus disease 2019 COVID 19 in Liège University Hospital Belgium aimed to determine the persistent consequences of COVID 19 Patients admitted to the University Hospital of Liège with moderate to severe confirmed COVID 19 discharged between 2 March and 1 October 2020 were recruited prospectively Follow up at 3 and 6 months after hospital discharge included demographic and clinical data biological data pulmonary function tests PFTs and high resolution computed tomography CT scans of the chest In total 199 individuals were included in the analysis Most patients received oxygen supplementation 80 4 Six months after discharge 47 and 32 of patients still had exertional dyspnoea and fatigue PFTs at 3 month follow up revealed a reduced diffusion capacity of carbon monoxide mean 71 6 18 6 and this increased significantly at 6 month follow up P 0 0001 Chest CT scans showed a high prevalence 68 9 of the cohort of persistent abnormalities mainly ground glass opacities Duration of hospitalization intensive care unit admission and mechanical ventilation were not associated with the persistence of symptoms 3 months after discharge The prevalence of persistent symptoms following hospitalization with COVID 19 is high and stable for up to 6 months after discharge However biological functional and iconographic abnormalities improved significantly over time 1 +247 SARS CoV 2 plays a pivotal role in inducing hyperthyroidism of Graves disease Coronavirus disease 2019 COVID 19 advances to affect every part of the globe and remains a challenge to the human race Severe acute respiratory syndrome coronavirus 2 SARS CoV 2 was shown to affect many organs and organ systems including the thyroid gland as these parts highly express angiotensin converting enzyme 2 ACE2 protein which functions as a receptor for initially entering the virus into the cells Furthermore some categories of the population including older people and persons with comorbidities are prone to be more vulnerable to COVID 19 and its complications Recent reports showed that SARS CoV 2 infection could cause Graves disease autoimmune hyperthyroidism in post COVID 19 patients Factors that may boost the mortality risk of COVID 19 patients are not completely known yet and a clear perception of the group of vulnerable people is also essential This review briefly summarizes the features of Graves disease such as symptoms risk factors including environmental genetic immunological and other factors associated disorders and therapeutic options It comprehensively describes the recent advances in SARS CoV 2 induced Graves disease and the pivotal role of autoimmune factors in inducing the disease The review also discusses the possible risks of SARS CoV 2 infection and associated COVID 19 in people with hyperthyroidism Furthermore it explains thyroid disease and its association with the severity of COVID 19 1 +439 Changes in undergraduate medical education due to COVID 19 a systematic review This study aims to provide medical educators with insights into the current status and prospects of undergraduate medical education which has been affected by the COVID 19 pandemic We conducted a database search of PubMed Embase and ERIC and identified articles on COVID 19 related undergraduate medical education We independently reviewed titles and abstracts and extracted data on the geographic location of the study area of specialty phase in medical school preclinical year clerkship year etc type of paper and the main content of the study A total of 49 articles published across multiple countries were included in this study These were categorized as dealing with either 1 curriculum changes in undergraduate medical education due to COVID 19 or 2 student led educational activities related to COVID 19 The 41 articles in the first category showed two main trends replacing in person lectures with online classes in the preclinical years and adopting various remote educational methods to compensate for the discontinued or truncated clerkship in the clinical years The eight articles in the second category showcased various student educational activities that were conducted to meet the publics medical needs during the pandemic This review summarized the essential changes in undergraduate medical education worldwide and reflected on the various teaching methods adopted by medical schools In preparation for the post COVID era a comprehensive online curriculum and evaluation tools are needed which require the development of necessary infrastructure and adequate resources Education aimed at helping students be more socially aware and responsible as medical professionals must be promoted 0 +425 The impact of artificial intelligence and digital style on industry and energy post COVID 19 pandemic The SARS CoV 2 virus caused crises in social economic and energy areas and medical life worldwide throughout 2020 This crisis had many direct and indirect effects on all areas of society In the meantime the digital and artificial intelligence industry can be used as a professional assistant to manage and control the outbreak of the virus The present articles objective is to investigate the effects of COVID 19 on each of the various fields of medicine industry and energy What sets this article apart is studying the impact of artificial intelligence and digital style on reducing the damage of this fatal virus Energy and related industries are of the areas affected by the SARS CoV 2 virus The most exciting approach in this article is to encourage countries with economies based on non renewable energy to develop solar and wind energies Renewable energies can operate well in the event of another phenomenon such as COVID 19 and reduce the viruss destructive effects and lead to economic prosperity 0 +319 Old wine in a new bottle post COVID 19 infection central serous chorioretinopathy and the steroids Corona virus disease COVID 19 pandemic can cause myriad of ocular manifestations We report a case of unilateral multi focal central serous retinopathy post COVID 19 infection in an Asian Indian female A 42 year old female presented to us with unilateral blurring in the right eye OD 12 days after COVID 19 infection She had fever chills shortness of breath and cough with tiredness and was COVID RT PCR positive She was administered intravenous and oral antibiotics with injection heparin remdesivir during her 7 day stay at the hospital She was also on steroid inhalers She had no systemic history of note On ocular evaluation her corrected distance visual acuity was 20 40 in OD and 20 20 in left eye OS Anterior segment was normal Anterior vitreous was clear Fundus examination of the OD showed central serous retinopathy CSCR with OS being normal CSCR can occur post COVID 19 due to steroid administration and physicians administering it should be aware of this and refer the patients to an ophthalmologist earlier 1 +102 Fibromyalgia a new facet of the post COVID 19 syndrome spectrum Results from a web based survey Postacute COVID 19 syndrome PACS is an emerging entity characterised by a large array of manifestations including musculoskeletal complaints fatigue and cognitive or sleep disturbances Since similar symptoms are present also in patients with fibromyalgia FM we decided to perform a web based cross sectional survey aimed at investigating the prevalence and predictors of FM in patients who recovered from COVID 19 Data were anonymously collected between 5 and 18 April 2021 The collection form consisted of 28 questions gathering demographic information features and duration of acute COVID 19 comorbid diseases and other individuals attributes such as height and weight The American College of Rheumatology ACR Survey Criteria and the Italian version of the Fibromyalgia Impact Questionnaire completed the survey A final sample of 616 individuals 77 4 women filled the form 6 3 months after the COVID 19 diagnosis Of these 189 30 7 satisfied the ACR survey criteria for FM 56 6 women A multivariate logistic regression model including demographic and clinical factors showed that male gender OR 9 95 95 CI 6 02 to 16 43 p 0 0001 and obesity OR 41 20 95 CI 18 00 to 98 88 p 0 0001 were the strongest predictors of being classified as having post COVID 19 FM Hospital admission rate was significantly higher in men 15 8 vs 9 2 p 0 001 and obese 19 2 vs 10 8 p 0 016 respondents Our data suggest that clinical features of FM are common in patients who recovered from COVID 19 and that obesity and male gender affect the risk of developing post COVID 19 FM 1 +57 Refining Long COVID by a Prospective Multimodal Evaluation of Patients with Long Term Symptoms Attributed to SARS CoV 2 Infection COVID 19 long haulers also decribed as having long COVID or post acute COVID 19 syndrome represent 10 of COVID 19 patients and remain understudied In this prospective study we recruited 30 consecutive patients seeking medical help for persistent symptoms 30 days attributed to COVID 19 All reported a viral illness compatible with COVID 19 The patients underwent a multi modal evaluation including clinical psychologic virologic and specific immunologic assays and were followed longitudinally A group of 17 convalescent COVID 19 individuals without persistent symptoms were included as a comparison group The median age was 40 interquartile range 35 54 years and 18 60 were female At a median time of 152 102 164 days after symptom onset fever cough and dyspnea were less frequently reported compared with the initial presentation but paresthesia and burning pain emerged in 18 60 and 13 43 patients respectively The clinical examination was unremarkable in all patients although the median fatigue and pain visual analog scales were 7 5 8 and 5 2 6 respectively Extensive biologic studies were unremarkable and multiplex cytokines and ultra sensitive interferon α2 measurements were similar between long haulers and convalescent COVID 19 individuals without persistent symptoms Using SARS CoV 2 serology and IFN γ ELISPOT we found evidence of a previous SARS CoV 2 infection in 50 15 30 of patients with evidence of a lack of immune response or a waning immune response in two patients Finally psychiatric evaluation showed that 11 36 7 13 43 3 and 9 30 patients had a positive screening for anxiety depression and post traumatic stress disorder respectively Half of patients seeking medical help for post acute COVID 19 syndrome lack SARS CoV 2 immunity The presence of SARS CoV 2 immunity or not had no consequence on the clinical or biologic characteristics of post acute COVID 19 syndrome patients all of whom reported severe fatigue altered quality of life and psychologic distress 1 +578 Not the great equalizers Covid 19 1918 20 influenza and the need for a paradigm shift in pandemic preparedness Despite common perceptions to the contrary pandemic diseases do not affect populations indiscriminately In this paper we review literature produced by demographers historians epidemiologists and other researchers on disparities during the 1918 20 influenza pandemic and the Covid 19 pandemic Evidence from these studies demonstrates that lower socio economic status and minority stigmatized race or ethnicity are associated with higher morbidity and mortality However such research often lacks theoretical frameworks or appropriate data to explain the mechanisms underlying these disparities fully We suggest using a framework that considers proximal and distal factors contributing to differential exposure susceptibility and consequences as one way to move this research forward Further current pandemic preparedness plans emphasize medically defined risk groups and epidemiological approaches Therefore we conclude by arguing in favour of a transdisciplinary paradigm that recognizes socially defined risk groups includes input from the social sciences and humanities and other diverse perspectives and contributes to the reduction of health disparities before a pandemic hits 0 +419 Association of COVID 19 Mitigation Measures With Changes in Cardiorespiratory Fitness and Body Mass Index Among Children Aged 7 to 10 Years in Austria Previous studies have shown reductions in self reported physical activity levels in children associated with implementation of COVID 19 mitigation measures and data on objectively assessed health parameters are limited To examine the association of COVID 19 mitigation measures with changes in cardiorespiratory fitness CRF measures and body mass index BMI among primary schoolchildren This cohort study included children aged 7 to 10 years from 12 randomly selected primary schools in urban and rural districts of Klagenfurt Austria Baseline CRF and BMI measurements were obtained in September 2019 before COVID 19 mitigation measures were implemented and follow up measurements were obtained in June and September 2020 COVID 19 mitigation measures Cardiorespiratory fitness was measured with a 6 minute endurance run test Height and weight were objectively measured Standard deviation scores were calculated for CRF and BMI Changes over time were analyzed using analyses of variance Secondary analyses were performed for subgroups stratified by sex A total of 764 children 383 girls 50 1 aged 7 to 10 years had all measurements completed From September 2019 to September 2020 CRF SD scores changed by 1 06 95 CI 1 13 to 1 00 with a similar decrease in both boys and girls Body mass index SD scores had increased by 0 12 95 CI 0 06 0 16 in June 2020 and by 0 16 95 CI 0 12 0 20 in September 2020 compared with September 2019 The increase in BMI SD scores from September 2019 to September 2020 was greater among boys 0 23 95 CI 0 18 0 29 than among girls 0 09 95 CI 0 04 0 15 During the 1 year period the percentage of children with overweight or obesity increased from 20 3 155 children to 24 1 184 children difference 3 8 29 children In this cohort study of children in Austria COVID 19 mitigation measures were associated with decreases in CRF measures and increases in BMI The findings suggest that collaborative efforts are needed to reverse these changes in childrens health to prevent long term negative health outcomes 0 +334 Long COVID and breathlessness an overview This article offers a review of what is known so far about post acute covid 19 and the underlying pathophysiology related to this condition The main focus will be on the respiratory symptoms It will then explore how community nurses can monitor and support patients with symptoms of breathlessness with a supporting discussion of the current recommendations for the management and treatment of patients presenting with symptoms of breathlessness Palliation of symptoms will be highlighted but managing the supportive care needs for patients affected by COVID 19 and nearing the end of life is outside the scope of this article 1 +268 Comparison of Clinical Features and Outcome of Dengue Fever and Multisystem Inflammatory Syndrome in Children Associated With COVID 19 MIS C To identify clinical and laboratory features that differentiate dengue fever patients from MIS C patients and determine their outcomes This comparative cross sectional study was done at a tertiary care teaching institute We enrolled all hospitalized children aged 1 month 18 years and diagnosed with either MIS C and or dengue fever according to WHO criteria between June and December 2020 Clinical and laboratory features and outcomes were recorded on a structured proforma During the study period 34 cases of MIS C and 83 cases of Dengue fever were enrolled Mean age of MIS C cases male 86 3 was 7 89 4 61 years MIS C with shock was seen in 15 cases 44 MIS C without shock in 17 cases 50 and Kawasaki disease like presentation in 2 cases 6 Patients of MIS C were younger as compared to dengue fever P 0 002 Abdominal pain and erythematous rash were more common in dengue fever Of the inflammatory markers mean C reactive protein was higher in MIS C patients 100 2 85 1 vs 16 9 29 3 mg dL P 0 001 In contrast serum ferritin levels were higher in dengue fever patients P 0 03 Mean hospital stay patient days was longer in MIS C compared to dengue fever 8 6 vs 6 5 days P 0 014 Clinical and laboratory features can give important clues to differentiate dengue fever and MIS C and help initiate specific treatment 1 +9 Possible Adrenal Involvement in Long COVID Syndrome i Background i A significant number of patients with COVID 19 experience prolonged symptoms known as Long COVID The most frequent symptoms are fatigue and cognitive dysfunction We describe a patient suffering from Long COVID in whom adrenal involvement was highlighted i Methods i The patient described Long COVID symptoms that persist 3 months after the negativization of the molecular swab test The main symptoms were weakness brain fog dizziness and muscular and joint pain All routine lab panels for inflammation anemia and thyroid and liver function were conducted Moreover salivary cortisol and DHEA S determinations were used to compute the adrenal stress index ASI i Results i All tests were negative except the ASI that showed very low levels of free cortisol The patient started hydrocortisone acetate supplementation i Conclusion i Long COVID symptoms could be explained by an adrenal involvement due to a COVID 19 action on adrenal glands and by a iatrogenic side effect of high glucocorticoid therapy during the COVID 19 infection Salivary cortisol determination is effective for establishing a correct recovery plan 1 +166 Staying tuned for post COVID 19 syndrome looking for new research to sniff out Post COVID 19 syndrome was defined as a persistent and protracted illness which follows acute COVID 19 infection This condition continues for more than 12 weeks and cannot be attributed to other clinical situations Researchers and clinicians are allied in unraveling the molecular pathogenetic mechanisms and the clinical development of this unexpected SARS CoV 2 infectious evolution Anosmia dysgeusia fatigue dyspnea and brain fog are common symptoms observed in the Post COVID 19 syndrome depicting a multiorgan involvement associated with injuries involving mainly cardiovascular pulmonary musculoskeletal and neuropsychiatric systems This commentary analyzes the state of the art of Post COVID 19 interdisciplinary studies confirming that we are facing a truly intricate biomedicine story 1 +447 Public health consequences after ten years of the Syrian crisis a literature review Ten years of the Syrian war had a devastating effect on Syrian lives including millions of refugees and displaced people enormous destruction in the infrastructure and the worst economic crisis Syria has ever faced The health sector was hit hard by this war up to 50 of the health facilities have been destroyed and up to 70 of the healthcare providers fled the country seeking safety which increased the workload and mental pressure for the remaining medical staff Five databases were searched and 438 articles were included according to the inclusion criteria the articles were divided into categories according to the topic of the article Through this review the current health status of the Syrian population living inside Syria whether under governmental or opposition control was reviewed and also the health status of the Syrian refugees was examined according to each host country Public health indicators were used to summarize and categorize the information This research reviewed mental health children and maternal health oral health non communicable diseases infectious diseases occupational health and the effect of the COVID 19 pandemic on the Syrian healthcare system The results of the review are irritating as still after ten years of war and millions of refugees there is an enormous need for healthcare services and international organization has failed to respond to those needs The review ended with the current and future challenges facing the healthcare system and suggestions about rebuilding the healthcare system Through this review the major consequences of the Syrian war on the health of the Syrian population have been reviewed and highlighted Considerable challenges will face the future of health in Syria which require the collaboration of the health authorities to respond to the growing needs of the Syrian population This article draws an overview about how the Syrian war affected health sector for Syrian population inside and outside Syria after ten years of war which makes it an important reference for future researchers to get the main highlight of the health sector during the Syrian crisis 0 +592 Practice patterns in surgical neuro oncology among low and middle income countries during the coronavirus 19 pandemic A scoping review and situational report from the Philippines The coronavirus disease 2019 COVID 19 pandemic has negatively impacted the outcomes of surgical neuro oncology patients worldwide We aimed to review the practice patterns in surgical neuro oncology in low and middle income countries LMICs We also present a situational report from our own country A scoping review was performed following the Preferred Reporting Items for Systematic reviews and Meta Analyses Extension for Scoping Reviews Guidelines Twelve studies were included in the review Most of the studies were from Asia India China Iran Turkey and one was from Brazil Quantitative reports showed a decrease in the number of surgical neuro oncology operations between pre and post COVID 19 time frames but similar proportions of neuro oncology procedures Qualitative review showed similar practice patterns between LMICs and high income countries HICs except for limitations in resources such as negative pressure operating rooms and intensive care units and maintenance of face to face consults despite the adoption of telemedicine Limited data on adjuvant therapy was available in LMICs In our review we found that the practice patterns in surgical neuro oncology in LMICs during the COVID 19 pandemic are similar to those in HICs except for a few modifications due to resource limitation and patient preferences 0 +479 Building resilient societies after COVID 19 the case for investing in maternal neonatal and child health Resilient societies respond rapidly and effectively to health challenges and the associated economic consequences and adapt to be more responsive to future challenges Although it is only possible to recognise resilience retrospectively the COVID 19 pandemic has occurred at a point in human history when uniquely sufficient knowledge is available on the early life determinants of health to indicate clearly that a focus on maternal neonatal and child health MNCH will promote later resilience This knowledge offers an unprecedented opportunity to disrupt entrenched strategies and to reinvest in MNCH in the post COVID 19 so called new normal Furthermore analysis of the short term medium term and longer term consequences of previous socioeconomic shocks provides important insights into those domains of MNCH such as neurocognitive development and nutrition for which investment will generate the greatest benefit Such considerations apply to high income countries HICs and low income and middle income countries LMICs However implementing appropriate policies in the post COVID 19 recovery period will be challenging and requires political commitment and public engagement 0 +109 Post COVID 19 syndrome epidemiology diagnostic criteria and pathogenic mechanisms involved Many patients with mild or severe COVID 19 do not make a full recovery and have a wide range of chronic symptoms for weeks or months after infection often of a neurological cognitive or psychiatric nature The epidemiological evidence diagnostic criteria and pathogenesis of post COVID 19 syndrome are reviewed Post COVID 19 syndrome is defined by persistent clinical signs and symptoms that appear while or after suffering COVID 19 persist for more than 12 weeks and cannot be explained by an alternative diagnosis The symptoms can fluctuate or cause relapses It is a heterogeneous condition that includes post viral chronic fatigue syndrome sequelae in multiple organs and the effects of severe hospitalisation post intensive care syndrome It has been reported in patients with mild or severe COVID 19 and irrespective of the severity of the symptoms in the acute phase Between 10 and 65 of survivors who had mild moderate COVID 19 present symptoms of post COVID 19 syndrome for 12 weeks or more At six months subjects report an average of 14 persistent symptoms The most common symptoms are fatigue dyspnoea anxiety depression and impaired attention concentration memory and sleep The underlying biological mechanisms are unknown although an abnormal or excessive autoimmune and inflammatory response may play an important role Clinical manifestations are diverse fluctuating and variable although fatigue and neurocognitive complaints predominate There is no defined consensus on post COVID 19 syndrome and its diagnostic criteria have not been subjected to adequate psychometric evaluation 1 +169 Post COVID Syndrome An Insight on Its Pathogenesis Post COVID syndrome is increasingly recognized as a new clinical entity in the context of SARS CoV 2 infection Symptoms persisting for more than three weeks after the diagnosis of COVID 19 characterize the post COVID syndrome Its incidence ranges from 10 to 35 however rates as high as 85 have been reported among patients with a history of hospitalization Currently there is no consensus on the classification of post COVID syndrome We reviewed the published information on post COVID syndrome putting emphasis on its pathogenesis The pathogenesis of post COVID syndrome is multi factorial and more than one mechanism may be implicated in several clinical manifestations Prolonged inflammation has a key role in its pathogenesis and may account for some neurological complications cognitive dysfunction and several other symptoms A multisystem inflammatory syndrome in adults MIS A of all ages has been also described recently similarly to multisystem inflammatory syndrome in children MIS C The post infectious inflammatory pathogenetic mechanism of MIS A is supported by the fact that its diagnosis is established through serology in up to one third of cases Other pathogenetic mechanisms that are implicated in post COVID syndrome include immune mediated vascular dysfunction thromboembolism and nervous system dysfunction Although the current data are indicating that the overwhelming majority of patients with post COVID syndrome have a good prognosis registries to actively follow them are needed in order to define the full clinical spectrum and its long term outcome A consensus based classification of post COVID syndrome is essential to guide clinical diagnostic and therapeutic management Further research is also imperative to elucidate the pathogenesis of post COVID syndrome 1 +302 Long COVID syndrome associated brain fog and chemofog Luteolin to the rescue COVID 19 leads to severe respiratory problems but also to long COVID syndrome associated primarily with cognitive dysfunction and fatigue Long COVID syndrome symptoms especially brain fog are similar to those experienced by patients undertaking or following chemotherapy for cancer chemofog or chemobrain as well in patients with myalgic encephalomyelitis chronic fatigue syndrome ME CFS or mast cell activation syndrome MCAS The pathogenesis of brain fog in these illnesses is presently unknown but may involve neuroinflammation via mast cells stimulated by pathogenic and stress stimuli to release mediators that activate microglia and lead to inflammation in the hypothalamus These processes could be mitigated by phytosomal formulation in olive pomace oil of the natural flavonoid luteolin 1 +71 Long COVID and Myalgic Encephalomyelitis Chronic Fatigue Syndrome ME CFS A Systemic Review and Comparison of Clinical Presentation and Symptomatology i Background and Objectives i Long COVID defines a series of chronic symptoms that patients may experience after resolution of acute COVID 19 Early reports from studies with patients with long COVID suggests a constellation of symptoms with similarities to another chronic medical illness myalgic encephalomyelitis chronic fatigue syndrome ME CFS A review study comparing and contrasting ME CFS with reported symptoms of long COVID may yield mutualistic insight into the characterization and management of both conditions i Materials and Methods i A systemic literature search was conducted in MEDLINE and PsycInfo through to 31 January 2021 for studies related to long COVID symptomatology The literature search was conducted in accordance with PRISMA methodology i Results i Twenty one studies were included in the qualitative analysis Long COVID symptoms reported by the included studies were compared to a list of ME CFS symptoms compiled from multiple case definitions Twenty five out of 29 known ME CFS symptoms were reported by at least one selected long COVID study i Conclusions i Early studies into long COVID symptomatology suggest many overlaps with clinical presentation of ME CFS The need for monitoring and treatment for patients post COVID is evident Advancements and standardization of long COVID research methodologies would improve the quality of future research and may allow further investigations into the similarities and differences between long COVID and ME CFS 1 +322 A dermatologic perspective on multisystem inflammatory syndrome in children As of May 2020 an emerging immune mediated syndrome primarily affecting children has been detected primarily in Europe and the United States The incidence of this syndrome appears to mirror the initial infectious assault with a delay of several weeks This syndrome has been termed multisystem inflammatory syndrome in children MIS C and is observed in association with the coronavirus disease 2019 The phenotypes of presentation include several characteristic features including prolonged fever skin eruptions neck stiffness and gastrointestinal manifestations with pronounced abdominal pain Shock and organ dysfunction on presentation are frequent but inconsistent whereas respiratory distress is typically and notably absent We have reviewed the recent published data aiming to better understand MIS C with a focus on its mucocutaneous manifestations 1 +455 Insight into the emerging role of SARS CoV 2 nonstructural and accessory proteins in modulation of multiple mechanisms of host innate defense Coronavirus disease 19 COVID 19 is an extremely infectious disease caused by severe acute respiratory syndrome coronavirus 2 SARS CoV 2 that has become a major global health concern The induction of a coordinated immune response is crucial to the elimination of any pathogenic infection However SARS CoV 2 can modulate the host immune system to favor viral adaptation and persistence within the host The virus can counteract type I interferon IFN I production attenuating IFN I signaling pathway activation and disrupting antigen presentation Simultaneously SARS CoV 2 infection can enhance apoptosis and the production of inflammatory mediators which ultimately results in increased disease severity SARS CoV 2 produces an array of effector molecules including nonstructural proteins NSPs and open reading frames ORFs accessory proteins We describe the complex molecular interplay of SARS CoV 2 NSPs and accessory proteins with the hosts signaling mediating immune evasion in the current review In addition the crucial role played by immunomodulation therapy to address immune evasion is discussed Thus the current review can provide new directions for the development of vaccines and specific therapies 0 +229 Rapid implementation of a cohort for the study of post acute sequelae of SARS CoV 2 infection COVID 19 As the coronavirus disease 2019 COVID 19 pandemic continues and millions remain vulnerable to infection with severe acute respiratory syndrome coronavirus 2 SARS CoV 2 attention has turned to characterizing post acute sequelae of SARS CoV 2 infection PASC From April 21 to December 31 2020 we assembled a cohort of consecutive volunteers who a had documented history of SARS CoV 2 RNA positivity b were 2 weeks past onset of COVID 19 symptoms or if asymptomatic first test for SARS CoV 2 and c were able to travel to our site in San Francisco Participants learned about the study by being identified on medical center based registries and being notified or by responding to advertisements At 4 month intervals we asked participants about physical symptoms that were new or worse compared to the period prior to COVID 19 mental health symptoms and quality of life We described 4 time periods 1 acute illness 0 3 weeks 2 early recovery 3 10 weeks 3 late recovery 1 12 20 weeks and 4 late recovery 2 28 36 weeks Blood and oral specimens were collected at each visit We have to date enrolled 179 adults During acute SARS CoV 2 infection 10 had been asymptomatic 125 symptomatic but not hospitalized and 44 symptomatic and hospitalized In the acute phase the most common symptoms were fatigue fever myalgia cough and anosmia dysgeusia During the post acute phase fatigue shortness of breath concentration problems headaches trouble sleeping and anosmia dysgeusia were the most commonly reported symptoms but a variety of others were endorsed by at least some participants Some experienced symptoms of depression anxiety and post traumatic stress as well as difficulties with ambulation and performance of usual activities The median visual analogue scale value rating of general health was lower at 4 and 8 months 80 interquartile range IQR 70 90 and 80 IQR 75 90 compared to prior to COVID 19 85 IQR 75 90 Biospecimens were collected at nearly 600 participant visits Among a cohort of participants enrolled in the post acute phase of SARS CoV 2 infection we found many with persistent physical symptoms through 8 months following onset of COVID 19 with an impact on self rated overall health The presence of participants with and without symptoms and ample biological specimens will facilitate study of PASC pathogenesis Similar evaluations in a population representative sample will be needed to estimate the population level prevalence of PASC 1 +105 Persistent Post COVID 19 Interstitial Lung Disease An Observational Study of Corticosteroid Treatment b Rationale b The natural history of recovery from severe acute respiratory syndrome coronavirus 2 SARS CoV 2 remains unknown Because fibrosis with persistent physiological deficit is a previously described feature of patients recovering from similar coronaviruses treatment represents an early opportunity to modify the disease course potentially preventing irreversible impairment b Objectives b Determine the incidence of and describe the progression of persistent inflammatory interstitial lung disease ILD following SARS CoV 2 when treated with prednisolone b Methods b A structured assessment protocol screened for sequelae of SARS CoV 2 pneumonitis Eight hundred thirty seven patients were assessed by telephone 4 weeks after discharge Those with ongoing symptoms had outpatient assessment at 6 weeks Thirty patients diagnosed with persistent interstitial lung changes at a multidisciplinary team meeting were reviewed in the interstitial lung disease service and offered treatment These patients had persistent nonimproving symptoms b Results b At 4 weeks after discharge 39 of patients reported ongoing symptoms 325 837 and were assessed Interstitial lung disease predominantly organizing pneumonia with significant functional deficit was observed in 35 837 survivors 4 8 Thirty of these patients received steroid treatment resulting in a mean relative increase in transfer factor following treatment of 31 6 standard deviation SD 27 6 i P i 0 001 and forced vital capacity of 9 6 SD 13 0 i P i 0 014 with significant symptomatic and radiological improvement b Conclusions b Following SARS CoV 2 pneumonitis a cohort of patients are left with both radiological inflammatory lung disease and persistent physiological and functional deficit Early treatment with corticosteroids was well tolerated and associated with rapid and significant improvement These preliminary data should inform further study into the natural history and potential treatment for patients with persistent inflammatory ILD following SARS CoV 2 infection 1 +270 Some patients complain of persisting symptoms after acute COVID 19 There is no universal definition yet for these post acute sequelae also termed Long COVID Although their prevalence remains to be established a delayed recovery seems to be more common than after other acute infectious diseases Common complaints include fatigue with exercise intolerance dyspnea on exertion chest pain and neuropsychiatric symptoms Female sex comorbidities and severity of the acute disease have been identified as risk factors for persisting symptoms It is however important to highlight that they are not limited to patients after severe COVID 19 Whilst their pathogenesis and prognosis is largely unknown diagnostic evaluation should focus on exclusion of objective organ dysfunctions Due to the variable presentation management is interdisciplinary and may include physiotherapy rehabilitation programmes and psychological support This article aims to summarize the current limited evidence on persisting symptoms after COVID 19 1 +107 Molecular Pathophysiology of Cardiac Injury and Cardiac Microthrombi in Fatal COVID 19 Insights from Clinico histopathologic and Single Nuclei RNA Sequencing Analyses Cardiac injury is associated with critical COVID 19 yet its etiology remains debated To elucidate the pathogenic mechanisms of COVID 19 associated cardiac injury we conducted a single center prospective cohort study of 69 COVID 19 decedents Of six cardiac histopathologic features microthrombi was the most commonly detected n 48 70 We tested associations of cardiac microthrombi with biomarkers of inflammation cardiac injury and fibrinolysis and with in hospital antiplatelet therapy therapeutic anticoagulation and corticosteroid treatment while adjusting for multiple clinical factors including COVID 19 therapies Higher peak ESR and CRP during hospitalization were independently associated with higher odds of microthrombi Using single nuclei RNA sequence analysis we discovered an enrichment of pro thrombotic anti fibrinolytic extracellular matrix remodeling and immune potentiating signaling amongst cardiac fibroblasts in microthrombi positive COVID 19 hearts relative to microthrombi negative COVID 19 Non COVID 19 non failing hearts were used as reference controls Our cumulative findings identify the specific transcriptomic changes in cardiac fibroblasts as salient features of COVID 19 associated cardiac microthrombi 1 +127 Post COVID 19 multisystem inflammatory syndrome in children The effect of acute coronavirus disease 2019 COVID 19 on morbidity and mortality in children has been relatively small If a child presents to my office with persistent fever and systemic hyperinflammation but no known exposure to COVID 19 how likely are they to have multisystem inflammatory syndrome in children MIS C What is currently known about MIS C and what is the prognosis for children affected by it Amid the COVID 19 pandemic the emergence of a novel condition presents yet another challenge to clinicians public health professionals and the pediatric population Multisystem inflammatory syndrome in children is a rare but potentially severe condition seen in children with evidence of COVID 19 approximately 2 to 6 weeks before symptom onset Common signs and symptoms include persistent fever systemic hyperinflammation gastrointestinal symptoms eg abdominal pain vomiting diarrhea mucocutaneous changes eg rash conjunctivitis headache or cardiac dysfunction As many children present as asymptomatic or with mild symptoms of COVID 19 the development of MIS C can seem sudden and surprising to families and providers Although children with MIS C usually require hospitalization the outcomes are largely favourable with prompt recognition and intense therapy 1 +177 Inflammation type dysbiosis of the oral microbiome associates with the duration of COVID 19 symptoms and long COVID In the COVID 19 pandemic caused by SARS CoV 2 many individuals experience prolonged symptoms termed long lasting COVID 19 symptoms long COVID Long COVID is thought to be linked to immune dysregulation due to harmful inflammation with the exact causes being unknown Given the role of the microbiome in mediating inflammation we aimed to examine the relationship between the oral microbiome and the duration of long COVID symptoms Tongue swabs were collected from patients presenting with COVID 19 symptoms Confirmed infections were followed until resolution of all symptoms Bacterial composition was determined by metagenomic sequencing We used random forest modeling to identify microbiota and clinical covariates that are associated with long COVID symptoms Of the patients followed 63 developed ongoing symptomatic COVID 19 and 37 went on to long COVID Patients with prolonged symptoms had significantly higher abundances of microbiota that induced inflammation such as members of the genera Prevotella and Veillonella which of note are species that produce LPS The oral microbiome of patients with long COVID was similar to that of patients with chronic fatigue syndrome Altogether our findings suggest an association with the oral microbiome and long COVID revealing the possibility that dysfunction of the oral microbiome may have contributed to this draining disease 1 +641 Assessment of tryptophan and kynurenine as prognostic markers in patients with SARS CoV 2 Immune dysregulation and inflammation in patients with SARS CoV 2 is associated with a poor clinical outcome We investigated the value of the inflammatory markers tryptophan and kynurenine in predicting the survival outcome of patients with SARS CoV 2 The study included 252 inpatients with a SARS CoV 2 infection hospitalized between August 2020 and April 2021 Two groups were generated based on disease survival survival group n 199 deceased group n 53 Plasma concentrations of tryptophan kynurenine and interleukin 6 IL 6 were measured on admission In a subset of patients n 105 81 survivors and 24 deceased concentrations of tryptophan and kynurenine were checked 7 days after admission The kynurenine tryptophan ratio TRP KYN ratio was calculated On admission the deceased group showed significantly higher concentrations of kynurenine and a significantly higher KYN TRP ratio compared to the survival group p values 0 001 Kynurenine and the KYN TRP ratio significantly correlated with IL 6 ρ 0 441 and 0 448 p values 0 001 In the survival group kynurenine and the KYN TRP ratio were significantly lower after seven days p values 0 001 In the deceased group no significant differences were found between the measurements Kynurenine and the KYN TRP ratio are potentially useful parameters in predicting the survival outcome in SARS CoV 2 positive patients 0 +473 Prevalence of childhood mental disorders in high income countries a systematic review and meta analysis to inform policymaking Mental disorders typically start in childhood and persist causing high individual and collective burdens To inform policymaking to address childrens mental health in high income countries we aimed to identify updated data on disorder prevalence We identified epidemiological studies reporting mental disorder prevalence in representative samples of children aged 18 years or younger including a range of disorders and ages and assessing impairment searching January 1990 through February 2021 We extracted associated service use data where studies assessed this We conducted meta analyses using a random effects logistic model using R metafor package Fourteen studies in 11 countries met inclusion criteria published from 2003 to 2020 with a pooled sample of 61 545 children aged 4 18 years including eight reporting service use All data were collected pre COVID 19 Overall prevalence of any childhood mental disorder was 12 7 95 CI 10 1 to 15 9 I sup 2 sup 99 1 Significant heterogeneity pertained to diagnostic measurement and study location Anxiety 5 2 attention deficit hyperactivity 3 7 oppositional defiant 3 3 substance use 2 3 conduct 1 3 and depressive 1 3 disorders were the most common Among children with mental disorders only 44 2 95 CI 37 6 to 50 9 received any services for these conditions An estimated one in eight children have mental disorders at any given time causing symptoms and impairment therefore requiring treatment Yet even in high income countries most children with mental disorders are not receiving services for these conditions We discuss the implications particularly the need to substantially increase public investments in effective interventions We also discuss the policy urgency given the emerging increases in childhood mental health problems since the onset of the COVID 19 pandemic PROSPERO CRD42020157262 0 +316 Post Ebola sequelae among Ebola child survivors in Sierra Leone There are limited data regarding the long term health effects of child survivors of the 2013 2016 West African Ebola virus disease EVD outbreak Here we assess post Ebola sequelae among EVD child survivors by comparing the self reported symptoms between EVD child survivors and their close household contacts over one year after the end of the outbreak EVD child survivors n 159 and their close contacts n 303 were enrolled in Western and Eastern Sierra Leone Demographics and self reported symptoms data were collected using an interviewer administered questionnaire We compared a list of self reported symptoms between EVD child survivors and their close household contacts using backward stepwise logistic regression EVD child survivors were more likely to be orphans compared to their close contacts Musculoskeletal ocular auditory and neurological symptoms were more prevalent among Ebola child survivors than their close contacts p 0 001 Joint pain and headache were the most common self reported symptoms in EVD child survivors and their close contacts Joint pain AOR 2 633 95 CI 1 31 5 28 p 0 006 eye pain AOR 4 56 95 CI 2 16 9 64 p 0 001 hearing loss AOR 3 85 95 CI 1 15 12 87 p 0 029 memory impairment AOR 7 76 0 95 CI 1 34 45 01 p 0 022 mood changes AOR 5 07 95 CI 2 35 10 94 p 0 001 were more common among survivors than their contacts Our data suggest that EVD child survivors have higher odds than their close contacts of suffering from musculoskeletal ophthalmic auditory and neurological impairment more than a year after the end of the EVD outbreak Routine screening treatment and monitoring of these symptoms is required to prevent long term disability among EVD child survivors 1 +157 Gastrointestinal Perspective of Coronavirus Disease 2019 in Children An Updated Review Gastrointestinal symptoms are common findings in children with severe acute respiratory syndrome coronavirus 2 infection including vomiting diarrhoea abdominal pain and difficulty in feeding although these symptoms tend to be mild The hepato biliary system and the pancreas may also be involved usually with a mild elevation of transaminases and rarely pancreatitis In contrast a late hyper inflammatory phenomenon termed multisystem inflammatory syndrome MIS C is characterized by more frequent gastrointestinal manifestations with greater severity sometimes presenting as peritonitis Gastrointestinal and hepato biliary manifestations are probably related to a loss in enterocyte absorption capability and microscopic mucosal damage caused by a viral infection of intestinal epithelial cells hepatocytes and other cells through the angiotensin conversion enzyme 2 receptor resulting in immune cells activation with subsequent release of inflammatory cytokines Specific conditions such as inflammatory bowel disease IBD and liver transplantation may pose a risk for the more severe presentation of coronavirus disease 2019 COVID 19 but as adult data accumulate paediatric data is still limited The aim of this review is to summarize the current evidence about the effect of COVID 19 on the gastrointestinal system in children with emphasis on the emerging MIS C and specific considerations such as patients with IBD and liver transplant recipients 1 +406 The effects of school closures on SARS CoV 2 among parents and teachers To reduce the transmission of severe acute respiratory syndrome coronavirus 2 SARS CoV 2 most countries closed schools despite uncertainty if school closures are an effective containment measure At the onset of the pandemic Swedish upper secondary schools moved to online instruction while lower secondary schools remained open This allows for a comparison of parents and teachers differently exposed to open and closed schools but otherwise facing similar conditions Leveraging rich Swedish register data we connect all students and teachers in Sweden to their families and study the impact of moving to online instruction on the incidence of SARS CoV 2 and COVID 19 We find that among parents exposure to open rather than closed schools resulted in a small increase in PCR confirmed infections odds ratio OR 1 17 95 CI CI95 1 03 to 1 32 Among lower secondary teachers the infection rate doubled relative to upper secondary teachers OR 2 01 CI95 1 52 to 2 67 This spilled over to the partners of lower secondary teachers who had a higher infection rate than their upper secondary counterparts OR 1 29 CI95 1 00 to 1 67 When analyzing COVID 19 diagnoses from healthcare visits and the incidence of severe health outcomes results are similar for teachers but weaker for parents and teachers partners The results for parents indicate that keeping lower secondary schools open had minor consequences for the overall transmission of SARS CoV 2 in society The results for teachers suggest that measures to protect teachers could be considered 0 +75 Implementation of post intensive care outpatient clinic I POINT for critically ill COVID 19 survivors Although we have enough and cumulative information about acute effects of COVID 19 our knowledge is extremely limited about long term consequences of COVID 19 in terms of its impacts and burdens on patients families and the health system Considering the underlying pathophysiological mechanisms affecting all of the organ systems in critically ill COVID 19 patients who are admitted to intensive care units the development of post intensive care syndrome PICS is inevitable This situation brings along the development of long COVID These patients should be followed regarding cognitive physical and psychiatric aspects and necessary specialist referrals should be carried out In this article we are presenting the experience and recommendations of our center as a guide for the establishment process of post intensive care outpatient clinics for the critically ill patients who required intensive care admission due to COVID 19 and could be discharged 1 +462 Psychological Impact of COVID 19 on Children and Adolescents A Systematic Review The outbreak of COVID 19 led to a significant psychological impact on individuals particularly those belonging to vulnerable groups This study aimed to synthesize literature on the psychological impact of COVID 19 among children and adolescents Electronic search engines were used to identify studies till March 2021 that reported symptoms of psychological origin in children and adolescents Information was extracted using a predefined template and qualitative analysis was conducted using STROBE One hundred and two relevant papers were identified Most of the studies were conducted online or telephonically The study designs were primarily single group cross sectional though a few prospective retrospective designs were also identified Studies assessing emotional distress showed variable levels of anxiety and depressive symptoms in the study population with greater severity of anxiety symptoms among females and older adolescents Reduced physical activity delayed sleep time increased sleep duration screen time internet use and sedentary habits poor quality of life were other notable findings often correlating with anxiety depression Efforts to address bias discussion on generalizability of their results and sample size calculation were not reported in most studies Psychological impact on children adolescents is significant either due to the fear of the illness or social isolation related to COVID 19 One may focus on improving sleep habits and physical activity and regulating internet use for maintaining psychological well being 0 +577 Caring for refugees and newcomers in the post COVID 19 era Evidence review and guidance for FPs and health providers To guide clinicians working in a range of primary care clinical settings on how to provide effective care and support for refugees and newcomers during and after the coronavirus disease 2019 COVID 19 pandemic The described approach integrates recommendations from evidence based clinical guidelines on refugee health and COVID 19 practical lessons learned from Canadian Refugee Health Network clinicians working in a variety of primary care settings and contributions from persons with lived experience of forced migration The COVID 19 pandemic has amplified health and social inequities for refugees asylum seekers undocumented migrants transient migrant workers and other newcomers Refugees and newcomers face front line exposure risks difficulties accessing COVID 19 testing exacerbation of mental health concerns and challenges accessing health care social and settlement supports Existing guidelines for clinical care of refugees are useful but creative case by case strategies must be employed to overcome additional barriers in the context of COVID 19 and new care environments such as the need for virtual interpretation and digital literacy skills Clinicians can address inequities and advocate for improved services in collaboration with community partners The COVID 19 pandemic is amplifying structural inequities Refugees and newcomers require and deserve effective health care and support during this challenging time This article outlines practical approaches and advocacy priorities for providing care in the COVID 19 context 0 +513 Critical analysis of acute kidney injury in pediatric COVID 19 patients in the intensive care unit COVID 19 is responsible for the 2019 novel coronavirus disease pandemic Despite the vast research about the adult population there has been little data collected on acute kidney injury AKI epidemiology associated risk factors treatments and mortality in pediatric COVID 19 patients admitted to the ICU AKI is a severe complication of COVID 19 among children and adolescents A comprehensive literature search was conducted in PubMed MEDLINE and Cochrane Center Trials to find all published literature related to AKI in COVID 19 patients including incidence and outcomes Twenty four studies reporting the outcomes of interest were included Across all studies the overall sample size of COVID positive children was 1 247 and the median age of this population was 9 1 years old Among COVID positive pediatric patients there was an AKI incidence of 30 51 with only 0 56 of these patients receiving KRT The mortality was 2 55 among all COVID positive pediatric patients The incidence of multisystem inflammatory syndrome in children MIS C among COVID positive patients was 74 29 AKI has shown to be a negative prognostic factor in adult patients with COVID 19 and now also in the pediatric cohort with high incidence and mortality rates Additionally our findings show a strong comparison in epidemiology between adult and pediatric COVID 19 patients however they need to be confirmed with additional data and studies 0 +279 Incomplete Systemic Recovery and Metabolic Phenoreversion in Post Acute Phase Nonhospitalized COVID 19 Patients Implications for Assessment of Post Acute COVID 19 Syndrome We present a multivariate metabotyping approach to assess the functional recovery of nonhospitalized COVID 19 patients and the possible biochemical sequelae of Post Acute COVID 19 Syndrome colloquially known as long COVID Blood samples were taken from patients ca 3 months after acute COVID 19 infection with further assessment of symptoms at 6 months Some 57 of the patients had one or more persistent symptoms including respiratory related symptoms like cough dyspnea and rhinorrhea or other nonrespiratory symptoms including chronic fatigue anosmia myalgia or joint pain Plasma samples were quantitatively analyzed for lipoproteins glycoproteins amino acids biogenic amines and tryptophan pathway intermediates using Nuclear Magnetic Resonance NMR spectroscopy and mass spectrometry Metabolic data for the follow up patients i n i 27 were compared with controls i n i 41 and hospitalized severe acute respiratory syndrome SARS CoV 2 positive patients i n i 18 with multiple time points Univariate and multivariate statistics revealed variable patterns of functional recovery with many patients exhibiting residual COVID 19 biomarker signatures Several parameters were persistently perturbed e g elevated taurine i p i 3 6 10 sup 3 sup versus controls and reduced glutamine glutamate ratio i p i 6 95 10 sup 8 sup versus controls indicative of possible liver and muscle damage and a high energy demand linked to more generalized tissue repair or immune function Some parameters showed near complete normalization e g the plasma apolipoprotein B100 A1 ratio was similar to that of healthy controls but significantly lower i p i 4 2 10 sup 3 sup than post acute COVID 19 patients reflecting partial reversion of the metabolic phenotype phenoreversion toward the healthy metabolic state Plasma neopterin was normalized in all follow up patients indicative of a reduction in the adaptive immune activity that has been previously detected in active SARS CoV 2 infection Other systemic inflammatory biomarkers such as GlycA and the kynurenine tryptophan ratio remained elevated in some but not all patients Correlation analysis principal component analysis PCA and orthogonal partial least squares discriminant analysis O PLS DA showed that the follow up patients were as a group metabolically distinct from controls and partially comapped with the acute phase patients Significant systematic metabolic differences between asymptomatic and symptomatic follow up patients were also observed for multiple metabolites The overall metabolic variance of the symptomatic patients was significantly greater than that of nonsymptomatic patients for multiple parameters χ sup 2 sup i p i 0 014 Thus asymptomatic follow up patients including those with post acute COVID 19 Syndrome displayed a spectrum of multiple persistent biochemical pathophysiology suggesting that the metabolic phenotyping approach may be deployed for multisystem functional assessment of individual post acute COVID 19 patients 1 +43 SARS CoV 2 and the Brain What Do We Know about the Causality of Cognitive COVID The second year of the COVID 19 coronavirus disease pandemic has seen the need to identify and assess the long term consequences of a SARS CoV 2 infection on an individuals overall wellbeing including adequate cognitive functioning Cognitive COVID is an informal term coined to interchangeably refer to acute changes in cognition during COVID 19 and or cognitive sequelae with various deficits following the infection These may manifest as altered levels of consciousness encephalopathy like symptoms delirium and loss of various memory domains Dysexecutive syndrome is a peculiar manifestation of Cognitive COVID as well In the previous major outbreaks of viruses like SARS CoV MERS CoV and Influenza There have been attempts to understand the underlying mechanisms describing the causality of similar symptoms following SARS CoV 2 infection This review therefore is attempting to highlight the current understanding of the various direct and indirect mechanisms focusing on the role of neurotropism of SARS CoV 2 the general pro inflammatory state and the pandemic associated psychosocial stressors in the causality of Cognitive COVID Neurotropism is associated with various mechanisms including retrograde neuronal transmission via olfactory pathway a general hematogenous spread and the virus using immune cells as vectors The high amounts of inflammation caused by COVID 19 compounded with potential intubation are associated with a deleterious effect on the cognition as well Finally the pandemics unique psychosocial impact has raised alarm due to its possible effect on cognition Furthermore with surfacing reports of post COVID vaccination cognitive impairments after vaccines containing mRNA encoding for spike glycoprotein of SARS CoV 2 we hypothesize their causality and ways to mitigate the risk The potential impact on the quality of life of an individual and the fact that even a minor proportion of COVID 19 cases developing cognitive impairment could be a significant burden on already overwhelmed healthcare systems across the world make it vital to gather further evidence regarding the prevalence presentation correlations and causality of these events and reevaluate our approach to accommodate early identification management and rehabilitation of patients exhibiting cognitive symptoms 1 +495 COVID 19 pandemic and reasons to prioritize the needs of the health care system to ensure its sustainability A scoping review from January to October 2020 Review The worldwide spread of severe acute respiratory syndrome coronavirus 2 SARS CoV 2 led the World Health Organization to characterize the pandemic as a public health emergency of international concern National health care systems in countries during the initial surge of the pandemic were unable to handle the sanitarian crisis that had emerged Thus the prevention and control of future global health emergencies must be a priority The present scoping review aimed to retrieve articles that summarize the current experience on issues related to historical knowledge and epidemiology clinical features and overall burden of SARS CoV 2 on health care services In summary a comprehensive overview of the information that has been learnt during this period is presented in the current review Furthermore taking into account the global experience the need for planning cohesive and functional health services before similar pandemic events occur in the future is highlighted The next public health issue should be prevented rather than treated In spite of the vaccination benefits a number of sporadic cases of SARS CoV 2infections will persist Information collected remains relevant for appraising how similar threats can be faced in the future Overall collaborative health care plans need to be rethought to increase preparedness 0 +470 COVID 19 and the Blitz compared mental health outcomes in the UK The Blitz narrative of resilience stands in contrast to the mental health risks identified as consequences of the COVID 19 pandemic Although evidence from then classified studies of World War 2 showed that most people managed the stress of bombing those vulnerable and exposed to substantial trauma had lasting or severe mental illness Studies of different towns and occupational groups identified the proportion of people killed and wounded the percentage of housing destroyed and the loss of paid employment as risk factors for psychological breakdown Mothers and children suffered not only with evacuation but also from the trauma of bombing and damage to schools A general association between civilian physical and psychological casualties suggests that population groups with high rates of infection and mortality might be susceptible to mental illness as a result of the pandemic Lockdown and distancing measures contrast with the wartime sense of belonging and shared identity reinforced by community networks and social activities 0 +267 Visualizing in deceased COVID 19 patients how SARS CoV 2 attacks the respiratory and olfactory mucosae but spares the olfactory bulb Anosmia the loss of smell is a common and often the sole symptom of COVID 19 The onset of the sequence of pathobiological events leading to olfactory dysfunction remains obscure Here we have developed a postmortem bedside surgical procedure to harvest endoscopically samples of respiratory and olfactory mucosae and whole olfactory bulbs Our cohort of 85 cases included COVID 19 patients who died a few days after infection with SARS CoV 2 enabling us to catch the virus while it was still replicating We found that sustentacular cells are the major target cell type in the olfactory mucosa We failed to find evidence for infection of olfactory sensory neurons and the parenchyma of the olfactory bulb is spared as well Thus SARS CoV 2 does not appear to be a neurotropic virus We postulate that transient insufficient support from sustentacular cells triggers transient olfactory dysfunction in COVID 19 Olfactory sensory neurons would become affected without getting infected 1 +198 Incidence and risk factors for persistent symptoms in adults previously hospitalized for COVID 19 The long term sequalae of COVID 19 remain poorly characterized We assessed persistent symptoms in previously hospitalized patients with COVID 19 and assessed potential risk factors Data were collected from patients discharged from 4 hospitals in Moscow Russia between 8 April and 10 July 2020 Participants were interviewed via telephone using an ISARIC Long term Follow up Study questionnaire 2 649 of 4755 56 discharged patients were successfully evaluated at median 218 IQR 200 236 days post discharge COVID 19 diagnosis was clinical in 1291 and molecular in 1358 Most cases were mild but 902 34 required supplemental oxygen and 68 2 6 needed ventilatory support Median age was 56 years IQR 46 66 and 1 353 51 1 were women Persistent symptoms were reported by 1247 47 1 participants with fatigue 21 2 shortness of breath 14 5 and forgetfulness 9 1 the most common symptoms and chronic fatigue 25 and respiratory 17 2 the most common symptom categories Female sex was associated with any persistent symptom category OR 1 83 95 CI 1 55 to 2 17 with association being strongest for dermatological 3 26 2 36 to 4 57 symptoms Asthma and chronic pulmonary disease were not associated with persistent symptoms overall but asthma was associated with neurological 1 95 1 25 to 2 98 and mood and behavioural changes 2 02 1 24 to 3 18 and chronic pulmonary disease was associated with chronic fatigue 1 68 1 21 to 2 32 Almost half of adults admitted to hospital due to COVID 19 reported persistent symptoms 6 to 8 months after discharge Fatigue and respiratory symptoms were most common and female sex was associated with persistent symptoms 1 +118 Acute and post acute neurological manifestations of COVID 19 present findings critical appraisal and future directions Acute and post acute neurological symptoms signs and diagnoses have been documented in an increasing number of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 SARS CoV 2 which causes Coronavirus Disease 2019 COVID 19 In this review we aimed to summarize the current literature addressing neurological events following SARS CoV 2 infection discuss limitations in the existing literature and suggest future directions that would strengthen our understanding of the neurological sequelae of COVID 19 The presence of neurological manifestations symptoms signs or diagnoses both at the onset or during SARS CoV 2 infection is associated with a more severe disease as demonstrated by a longer hospital stay higher in hospital death rate or the continued presence of sequelae at discharge Although biological mechanisms have been postulated for these findings evidence based data are still lacking to clearly define the incidence range of characteristics and outcomes of these manifestations particularly in non hospitalized patients In addition data from low and middle income countries are scarce leading to uncertainties in the measure of neurological findings of COVID 19 with reference to geography ethnicity socio cultural settings and health care arrangements As a consequence at present a specific phenotype that would specify a post COVID or long COVID neurological syndrome has not yet been identified 1 +320 Blood Cytokine Analysis Suggests That SARS CoV 2 Infection Results in a Sustained Tumour Promoting Environment in Cancer Patients Cytokines chemokines and angiogenic growth factors CCGs have been shown to play an intricate role in the progression of both solid and haematological malignancies Recent studies have shown that SARS CoV 2 infection leads to a worse outcome in cancer patients especially in haematological malignancy patients Here we investigated how SARS CoV 2 infection impacts the already altered CCG levels in solid or haematological malignancies specifically whether there is a protective effect or rather a potentially higher risk for major COVID 19 complications in cancer patients due to elevated CCGs linked to cancer progression Serially analysing immune responses with 55 CCGs in cancer patients under active treatment with or without SARS CoV 2 infection we first showed that cancer patients without SARS CoV 2 infection i n i 54 demonstrate elevated levels of 35 CCGs compared to the non cancer non infected control group of health care workers i n i 42 Of the 35 CCGs 19 were common to both the solid and haematological malignancy groups and comprised previously described cytokines such as IL 6 TNF α IL 1Ra IL 17A and VEGF but also several less well described cytokines chemokines such as Fractalkine Tie 2 and T cell chemokine CTACK Importantly we show here that 7 CCGs are significantly altered in SARS CoV 2 exposed cancer patients i n i 52 Of these TNF α IFN β TSLP and sVCAM 1 identified to be elevated in haematological cancers are also known tumour promoting factors Longitudinal analysis conducted over 3 months showed persistence of several tumour promoting CCGs in SARS CoV 2 exposed cancer patients These data demonstrate a need for increased vigilance for haematological malignancy patients as a part of long COVID follow up 1 +687 Adolescent Dental Fear and Anxiety Background Assessment and Nonpharmacologic Behavior Guidance Adolescence the period from 11 to 21 years of age bridges the chasm between childhood and adulthood Adolescence can be challenging as bodies cognition and personality go through major transformations but it is also a time of great joy as confident adults with a clear identity develop Dentists need to be knowledgeable about the developmental characteristics of this group because some of the cognitive and emotional changes make adolescents vulnerable to new fears Dentists must tailor behavior guidance to this developing psyche in a way that respects independence and promotes confidence to foster lifelong positive views of dentistry 0 +147 Confronting COVID 19 associated cough and the post COVID syndrome role of viral neurotropism neuroinflammation and neuroimmune responses Cough is one of the most common presenting symptoms of COVID 19 along with fever and loss of taste and smell Cough can persist for weeks or months after SARS CoV 2 infection often accompanied by chronic fatigue cognitive impairment dyspnoea or pain a collection of long term effects referred to as the post COVID syndrome or long COVID We hypothesise that the pathways of neurotropism neuroinflammation and neuroimmunomodulation through the vagal sensory nerves which are implicated in SARS CoV 2 infection lead to a cough hypersensitivity state The post COVID syndrome might also result from neuroinflammatory events in the brain We highlight gaps in understanding of the mechanisms of acute and chronic COVID 19 associated cough and post COVID syndrome consider potential ways to reduce the effect of COVID 19 by controlling cough and suggest future directions for research and clinical practice Although neuromodulators such as gabapentin or opioids might be considered for acute and chronic COVID 19 cough we discuss the possible mechanisms of COVID 19 associated cough and the promise of new anti inflammatories or neuromodulators that might successfully target both the cough of COVID 19 and the post COVID syndrome 1 +590 Whats New in Neuraxial Labor Analgesia This article provides an update of recent practice trends in neuraxial labor analgesia It reviews available evidence regarding management of labor pain in obstetric patients with COVID 19 serious adverse events in obstetric anesthesia to help inform risk benefit decisions and increasingly popular neuraxial labor analgesia techniques and adjuvants State of the art modes of epidural drug delivery are also discussed There has recently been a focus on several considerations specific to obstetric anesthesia such as anesthetic management of obstetric patients with COVID 19 platelet thresholds for the safe performance of neuraxial analgesia in obstetric patients with thrombocytopenia and drug delivery modes for initiation and maintenance of neuraxial labor analgesia Neuraxial labor analgesia via standard epidural dural puncture epidural and combined spinal epidural techniques is the most effective therapy to alleviate the pain of childbirth SARS CoV 2 infection is not in and of itself a contraindication to neuraxial labor analgesia or cesarean delivery anesthesia Early initiation of neuraxial labor analgesia in patients with COVID 19 is recommended if not otherwise contraindicated as it may reduce the need for general anesthesia should emergency cesarean delivery become necessary Consensus regarding platelet thresholds for safe initiation of neuraxial procedures has historically been lacking Recent studies have concluded that the risk of spinal epidural hematoma formation after neuraxial procedures is likely low at or above an imprecise range of platelet count of 70 75 000 10 sup 6 sup L Thrombocytopenia has been reported in obstetric patients with COVID 19 but severe thrombocytopenia precluding initiation of neuraxial anesthesia is extremely rare High neuraxial blockade has emerged as one of the most common serious complications of neuraxial analgesia and anesthesia in obstetric patients Growing awareness of factors that contribute to failed conversion of epidural labor analgesia to cesarean delivery anesthesia may help avoid the risks associated with performance of repeat neuraxial techniques and induction of general anesthesia after failed epidural blockade Dural puncture techniques to alleviate the pain of childbirth continue to become more popular as do adjuvant drugs to enhance or prolong neuraxial analgesia Novel techniques for epidural drug delivery have become more widely disseminated 0 +252 sup 18 sup F FDG brain PET hypometabolism in post SARS CoV 2 infection substrate for persistent delayed disorders Several brain complications of SARS CoV 2 infection have been reported It has been moreover speculated that this neurotropism could potentially cause a delayed outbreak of neuropsychiatric and neurodegenerative diseases of neuroinflammatory origin A propagation mechanism has been proposed across the cribriform plate of the ethmoid bone from the nose to the olfactory epithelium and possibly afterward to other limbic structures and deeper parts of the brain including the brainstem Review of clinical examination and whole brain voxel based analysis of sup 18 sup F FDG PET metabolism in comparison with healthy subjects p voxel 0 001 p cluster 0 05 uncorrected of two patients with confirmed diagnosis of SARS CoV 2 explored at the post viral stage of the disease Hypometabolism of the olfactory rectus gyrus was found on the two patients especially one with 4 week prolonged anosmia Additional hypometabolisms were found within amygdala hippocampus parahippocampus cingulate cortex pre post central gyrus thalamus hypothalamus cerebellum pons and medulla in the other patient who complained of delayed onset of a painful syndrome These preliminary findings reinforce the hypotheses of SARS CoV 2 neurotropism through the olfactory bulb and the possible extension of this impairment to other brain structures sup 18 sup F FDG PET hypometabolism could constitute a cerebral quantitative biomarker of this involvement Post viral cohort studies are required to specify the exact relationship between such hypometabolisms and the possible persistent disorders especially involving cognitive or emotion disturbances residual respiratory symptoms or painful complaints 1 +1 Long COVID And the fire rages on With the increasing cohort of COVID 19 survivors worldwide we now realize the proportionate rise in post COVID 19 syndrome In this review article we try to define summarize and classify this syndrome systematically This would help clinicians to identify and manage this condition more efficiently We propose a tool kit that might be useful in recording follow up data of COVID 19 survivors 1 +258 Development of ACE2 autoantibodies after SARS CoV 2 infection Activation of the immune system is implicated in the Post Acute Sequelae after SARS CoV 2 infection PASC but the mechanisms remain unknown Angiotensin converting enzyme 2 ACE2 cleaves angiotensin II Ang II resulting in decreased activation of the AT1 receptor and decreased immune system activation We hypothesized that autoantibodies against ACE2 may develop after SARS CoV 2 infection as anti idiotypic antibodies to anti spike protein antibodies We tested plasma or serum for ACE2 antibodies in 67 patients with known SARS CoV 2 infection and 13 with no history of infection None of the 13 patients without history of SARS CoV 2 infection and 1 of the 20 outpatients that had a positive PCR test for SARS CoV 2 had levels of ACE2 antibodies above the cutoff threshold In contrast 26 32 81 in the convalescent group and 14 15 93 of patients acutely hospitalized had detectable ACE2 antibodies Plasma from patients with antibodies against ACE2 had less soluble ACE2 activity in plasma but similar amounts of ACE2 protein compared to patients without ACE2 antibodies We measured the capacity of the samples to inhibit ACE2 enzyme activity Addition of plasma from patients with ACE2 antibodies led to decreased activity of an exogenous preparation of ACE2 compared to patients that did not have antibodies Many patients with a history of SARS CoV 2 infection have antibodies specific for ACE2 Patients with ACE2 antibodies have lower activity of soluble ACE2 in plasma Plasma from these patients also inhibits exogenous ACE2 activity These findings are consistent with the hypothesis that ACE2 antibodies develop after SARS CoV 2 infection and decrease ACE2 activity This could lead to an increase in the abundance of Ang II which causes a proinflammatory state that triggers symptoms of PASC 1 +287 Long COVID or Post acute Sequelae of COVID 19 PASC An Overview of Biological Factors That May Contribute to Persistent Symptoms The novel virus severe acute respiratory syndrome coronavirus 2 SARS CoV 2 has caused a pandemic of coronavirus disease 2019 COVID 19 Across the globe a subset of patients who sustain an acute SARS CoV 2 infection are developing a wide range of persistent symptoms that do not resolve over the course of many months These patients are being given the diagnosis Long COVID or Post acute sequelae of COVID 19 PASC It is likely that individual patients with a PASC diagnosis have different underlying biological factors driving their symptoms none of which are mutually exclusive This paper details mechanisms by which RNA viruses beyond just SARS CoV 2 have be connected to long term health consequences It also reviews literature on acute COVID 19 and other virus initiated chronic syndromes such as post Ebola syndrome or myalgic encephalomyelitis chronic fatigue syndrome ME CFS to discuss different scenarios for PASC symptom development Potential contributors to PASC symptoms include consequences from acute SARS CoV 2 injury to one or multiple organs persistent reservoirs of SARS CoV 2 in certain tissues re activation of neurotrophic pathogens such as herpesviruses under conditions of COVID 19 immune dysregulation SARS CoV 2 interactions with host microbiome virome communities clotting coagulation issues dysfunctional brainstem vagus nerve signaling ongoing activity of primed immune cells and autoimmunity due to molecular mimicry between pathogen and host proteins The individualized nature of PASC symptoms suggests that different therapeutic approaches may be required to best manage care for specific patients with the diagnosis 1 +293 Long COVID Syndrome A Study on the Persistence of Neurological Psychological and Physiological Symptoms Emerging aspects of the Covid 19 clinical presentation are its long term effects which are characteristic of the so called long COVID The aim of the present study was to investigate the prevalence of physical psychological and sleep disturbances and the quality of life in the general population during the ongoing pandemic This study based on an online survey collected demographic data information related to COVID 19 sleep disturbances and quality of life data from 507 individuals The level of sleep disturbances and quality of life was assessed through the Insomnia Severity Index ISI and the EuroQol 5D EQ 5D respectively In total 507 individuals M 91 and F 416 women completed the online survey The main symptoms associated with long COVID were headache fatigue muscle aches myalgia articular pains cognitive impairment loss of concentration and loss of smell Additionally the subjects showed significant levels of insomnia i p i 0 05 and an overall reduced quality of life i p i 0 05 The results of the study appear in line with recent publications but uncertainty regarding the definition and specific features of long COVID remains Further studies are needed in order to better define the clinical presentation of the long COVID condition and related targeted treatments 1 +336 Care of the postcoronavirus disease 2019 patient In under a year coronavirus disease 2019 COVID 19 has taken the lives of hundreds of thousands of Americans leaving millions of survivors in its wake The enormous number of people who survived acute illness but continue to have symptoms has highlighted the need for standardized evaluation of the post COVID 19 patient This review based on the current literature and our experience aims to guide the care of patients who have survived COVID 19 The literature on this topic is rapidly expanding and covers both pulmonary and nonpulmonary complications of COVID 19 Pulmonary complications include dyspnea with normoxia organizing pneumonia and pulmonary fibrosis Nonpulmonary complications include neurologic cardiac and thromboembolic disease Special consideration should be taken for COVID 19 survivors of intensive care The current review outlines the major clinical findings in post COVID 19 patients and provides a guidelines to the evaluation and management of prolonged symptoms 1 +453 Admission of a minor to a psychiatric hospital under Polish law Part I Within the scope of mental health protection numerous practical problems arise concerning the issue of providing health services to a minor Admission of a minor to a psychiatric hospital is associated in practice with numerous doubts This part of the article describes the conditions of admission to hospital with the consent of the patient It distinguishes and accurately describes situations where a minor is under or over 16 years of age In addition it explains situations where there is a contradiction of declarations of will by legal guardians in relation to admission their inability to perform legal acts or a contradiction of the statements of the minor and guardian It also addresses the aspect of receiving written consent during the COVID 19 epidemic 0 +524 The interplay of DAMPs TLR4 and proinflammatory cytokines in pulmonary fibrosis Pulmonary fibrosis is a chronic debilitating condition characterized by progressive deposition of connective tissue leading to a steady restriction of lung elasticity a decline in lung function and a median survival of 4 5 years The leading causes of pulmonary fibrosis are inhalation of foreign particles such as silicosis and pneumoconiosis infections such as post COVID 19 autoimmune diseases such as systemic autoimmune diseases of the connective tissue and idiopathic pulmonary fibrosis The therapeutics currently available for pulmonary fibrosis only modestly slow the progression of the disease This review is centered on the interplay of damage associated molecular pattern DAMP molecules Toll like receptor 4 TLR4 and inflammatory cytokines such as TNF α IL 1β and IL 17 as they contribute to the pathogenesis of pulmonary fibrosis and the possible avenues to develop effective therapeutics that disrupt this interplay 0 +369 Challenges and Opportunities of Preclinical Medical Education COVID 19 Crisis and Beyond COVID 19 pandemic has disrupted face to face teaching in medical schools globally The use of remote learning as an emergency measure has affected students faculty support staff and administrators The aim of this narrative review paper is to examine the challenges and opportunities faced by medical schools in implementing remote learning for basic science teaching in response to the COVID 19 crisis We searched relevant literature in PubMed Scopus and Google Scholar using specific keywords e g COVID 19 pandemic preclinical medical education online learning remote learning challenges and opportunities The pandemic has posed several challenges to premedical education e g suspension of face to face teaching lack of cadaveric dissections and practical laboratory sessions but has provided many opportunities as well such as the incorporation of online learning in the curriculum and upskilling and reskilling in new technologies To date many medical schools have successfully transitioned their educational environment to emergency remote teaching and assessments During COVID 19 crisis the preclinical phase of medical curricula has successfully introduced the novel culture of online home learning using technology oriented innovations which may extend to post COVID era to maintain teaching and learning in medical education However the lack of hands on training in the preclinical years may have serious implications on the training of the current cohort of students and they may struggle later in the clinical years The use of emergent technology e g artificial intelligence for adaptive learning virtual simulation and telehealth for education is most likely to be indispensable components of the transformative change and post COVID medical education 0 +140 Long Term Impact of COVID 19 A Systematic Review of the Literature and Meta Analysis The long term impact of COVID 19 is still unknown This study aimed to explore post COVID 19 effects on patients chest computed tomography CT lung function respiratory symptoms fatigue functional capacity health related quality of life HRQoL and the ability to return to work beyond 3 months post infection A systematic search was performed on PubMed Web of Science and Ovid MEDLINE on 22 May 2021 to identify studies that reported persistent effects of COVID 19 beyond 3 months follow up Data on the proportion of patients who had the outcome were collected and analyzed using a one group meta analysis Data were extracted from 24 articles that presented information on a total of 5323 adults post infection between 3 to 6 months after symptom onset or hospital discharge The pooled prevalence of CT abnormalities was 59 95 CI 44 73 I sup 2 sup 96 abnormal lung function was 39 95 CI 24 55 I sup 2 sup 94 fatigue was 38 95 CI 27 49 I sup 2 sup 98 dyspnea was 32 95 CI 24 40 I sup 2 sup 98 chest paint tightness was 16 95 CI 12 21 I sup 2 sup 94 and cough was 13 95 CI 9 17 I sup 2 sup 94 Decreased functional capacity and HRQoL were found in 36 95 CI 22 49 I sup 2 sup 97 and 52 95 CI 33 71 I sup 2 sup 94 respectively On average 8 out of 10 of the patients had returned to work or reported no work impairment Post COVID 19 patients may experience persistent respiratory symptoms fatigue decreased functional capacity and decreased quality of life up to 6 months after infection Further studies are needed to establish the extent to which post COVID 19 effects continue beyond 6 months how they interact with each other and to clarify their causes and their effective management 1 +387 Raising the bar to ultradisciplinary collaborations in management of chronic thromboembolic pulmonary hypertension Chronic thromboembolic pulmonary hypertension is an underdiagnosed and potentially fatal subgroup of pulmonary hypertension if left untreated Clinical signs include exertional dyspnea and non specific symptoms Diagnosis requires multimodality imaging and heart catheterization Pulmonary endarterectomy an open heart surgery is the gold standard treatment of choice in selected patients in specialized centers Targeted medical therapy and balloon pulmonary angioplasty can be effective in high risk patients with significant comorbidities distal pulmonary vascular obstructions or recurrent persistent pulmonary hypertension after pulmonary endarterectomy Currently there is a limited number of data regarding novel coronavirus 2019 infection in patients with chronic thromboembolic pulmonary hypertension and the changing spectrum of the disease during the pandemic Challenging times during this outbreak due to healthcare crisis and relatively higher case fatality rates require convergence that is an ultradisciplinary collaboration which crosses disciplinary and sectorial boundaries to develop integrated knowledge and new paradigms Management strategies for the new normal such as virtual care preparedness for further threats redesigned standards and working conditions reevaluation of specific recommendations and online collaborations for optimal decisions for chronic thromboembolic pulmonary hypertension patients may change the poor outcomes 0 +353 COVID Related Stress and Work Intentions in a Sample of US Health Care Workers To evaluate relationships between coronavirus disease 2019 COVID 19 related stress and work intentions in a sample of US health care workers Between July 1 and December 31 2020 health care workers were surveyed for fear of viral exposure or transmission COVID 19 related anxiety or depression work overload burnout and intentions to reduce hours or leave their jobs Among 20 665 respondents at 124 institutions median organizational response rate 34 intention to reduce hours was highest among nurses 33 7 n 776 physicians 31 4 n 2914 and advanced practice providers APPs 28 9 n 608 while lowest among clerical staff 13 6 n 242 and administrators 6 8 n 50 all i P i 001 Burnout odds ratio OR 2 15 95 CI 1 93 to 2 38 fear of exposure COVID 19 related anxiety depression and workload were independently related to intent to reduce work hours within 12 months all i P i 01 Intention to leave ones practice within 2 years was highest among nurses 40 0 n 921 APPs 33 0 n 694 other clinical staff 29 4 n 718 and physicians 23 8 n 2204 while lowest among administrators 12 6 n 93 all i P i 001 Burnout OR 2 57 95 CI 2 29 to 2 88 fear of exposure COVID 19 related anxiety depression and workload were predictors of intent to leave Feeling valued by ones organization was protective of reducing hours OR 0 65 95 CI 0 59 to 0 72 and intending to leave OR 0 40 95 CI 0 36 to 0 45 all i P i 01 Approximately 1 in 3 physicians APPs and nurses surveyed intend to reduce work hours One in 5 physicians and 2 in 5 nurses intend to leave their practice altogether Reducing burnout and improving a sense of feeling valued may allow health care organizations to better maintain their workforces postpandemic 0 +294 Impact of HIV Infection on COVID 19 Outcomes Among Hospitalized Adults in the U S Whether HIV infection is associated with differences in clinical outcomes among people hospitalized with COVID 19 is uncertain To evaluate the impact of HIV infection on COVID 19 outcomes among hospitalized patients Using the American Heart Associations COVID 19 Cardiovascular Disease registry we used hierarchical mixed effects models to assess the association of HIV with in hospital mortality accounting for patient demographics and comorbidities and clustering by hospital Secondary outcomes included major adverse cardiac events MACE severity of illness and length of stay LOS The registry included 21 528 hospitalization records of people with confirmed COVID 19 from 107 hospitals in 2020 including 220 people living with HIV PLWH PLWH were younger 56 0 13 0 versus 61 3 17 9 years old and more likely to be male 72 3 vs 52 7 Non Hispanic Black 51 4 vs 25 4 on Medicaid 44 5 vs 24 5 and active tobacco users 12 7 versus 6 5 Of the study population 36 PLWH 16 4 had in hospital mortality compared with 3 290 15 4 without HIV Risk ratio 1 06 95 CI 0 79 1 43 risk difference 0 9 95 CI 4 2 to 6 1 p 0 71 After adjustment for age sex race and insurance HIV was not associated with in hospital mortality aOR 1 13 95 CI 0 77 1 6 p 0 54 even after adding body mass index and comorbidities aOR 1 15 95 CI 0 78 1 70 p 0 48 HIV was not associated with MACE aOR 0 99 95 CI 0 69 1 44 p 0 91 severity of illness aOR 0 96 95 CI 0 62 1 50 p 0 86 or LOS aOR 1 03 95 CI 0 76 1 66 p 0 21 HIV was not associated with adverse outcomes of COVID 19 including in hospital mortality MACE or severity of illness We studied 21 528 patients hospitalized with COVID 19 at 107 hospitals in AHAs COVID 19 registry to examine the association between HIV and COVID 19 outcomes More patients with HIV were younger male non Hispanic Black on Medicaid and current smokers HIV was not associated with worse COVID 19 in hospital mortality Risk ratio 1 06 95 CI 0 79 1 43 p 0 71 even after adjustment aOR 1 15 95 CI 0 78 1 70 p 0 48 HIV was also not associated with MACE aOR 0 99 95 CI 0 69 1 44 p 0 91 or severity of illness aOR 0 96 95 CI 0 62 1 50 p 0 86 Our findings do not support that HIV is a major risk factor for adverse COVID 19 outcomes 1 +45 Investigation of Long COVID Prevalence and Its Relationship to Epstein Barr Virus Reactivation Coronavirus disease 2019 COVID 19 patients sometimes experience long term symptoms following resolution of acute disease including fatigue brain fog and rashes Collectively these have become known as long COVID Our aim was to first determine long COVID prevalence in 185 randomly surveyed COVID 19 patients and subsequently to determine if there was an association between occurrence of long COVID symptoms and reactivation of Epstein Barr virus EBV in 68 COVID 19 patients recruited from those surveyed We found the prevalence of long COVID symptoms to be 30 3 56 185 which included 4 initially asymptomatic COVID 19 patients who later developed long COVID symptoms Next we found that 66 7 20 30 of long COVID subjects versus 10 2 20 of control subjects in our primary study group were positive for EBV reactivation based on positive titers for EBV early antigen diffuse EA D IgG or EBV viral capsid antigen VCA IgM The difference was significant i p i 0 001 Fishers exact test A similar ratio was observed in a secondary group of 18 subjects 21 90 days after testing positive for COVID 19 indicating reactivation may occur soon after or concurrently with COVID 19 infection These findings suggest that many long COVID symptoms may not be a direct result of the SARS CoV 2 virus but may be the result of COVID 19 inflammation induced EBV reactivation 1 +171 Attributes and predictors of long COVID Reports of long lasting coronavirus disease 2019 COVID 19 symptoms the so called long COVID are rising but little is known about prevalence risk factors or whether it is possible to predict a protracted course early in the disease We analyzed data from 4 182 incident cases of COVID 19 in which individuals self reported their symptoms prospectively in the COVID Symptom Study app sup 1 sup A total of 558 13 3 participants reported symptoms lasting 28 days 189 4 5 for 8 weeks and 95 2 3 for 12 weeks Long COVID was characterized by symptoms of fatigue headache dyspnea and anosmia and was more likely with increasing age and body mass index and female sex Experiencing more than five symptoms during the first week of illness was associated with long COVID odds ratio 3 53 2 76 4 50 A simple model to distinguish between short COVID and long COVID at 7 days total sample size n 2 149 showed an area under the curve of the receiver operating characteristic curve of 76 with replication in an independent sample of 2 472 individuals who were positive for severe acute respiratory syndrome coronavirus 2 This model could be used to identify individuals at risk of long COVID for trials of prevention or treatment and to plan education and rehabilitation services 1 +672 Vaccine induced immune thrombotic thrombocytopenia and cerebral venous sinus thrombosis post COVID 19 vaccination a systematic review The common reported adverse effects of COVID 19 vaccination consist of the injection sites local reaction followed by several non specific flu like symptoms However rare cases of vaccine induced immune thrombotic thrombocytopenia VITT and cerebral venous sinus thrombosis CVST after viral vector vaccines ChAdOx1 nCoV 19 vaccine Ad26 COV2 vaccine have been reported Herein we systemically reviewed the reported cases of CVST and VITT following the COVID 19 vaccination This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses PRISMA statement We searched PubMed until May 19 2021 and the following Keywords were used COVID Vaccine Neurology AstraZeneca COVID vaccine ChAdOx1 nCoV 19 COVID vaccine AZD1222 COVID vaccine Janssen COVID vaccine Johnson Johnson COVID vaccine Ad26 COV2 COVID vaccine The authors evaluated the abstracts and titles of each article for screening and inclusion English reports about post vaccine CVST and VITT in humans were collected Until May 19 we found 877 articles with the searched terms We found 12 articles which overall present clinical features of 36 patients with CVST and VITT after the ChAdOx1 nCoV 19 vaccine Moreover two articles were noted which present 13 patients with CVST and VITT after Ad26 COV2 vaccine The majority of the patients were females Symptom onset occurred within one week after the first dose of vaccination Range 4 19 days Headache was the most common presenting symptom Intracerebral hemorrhage ICH and or Subarachnoid hemorrhage SAH were reported in 49 of the patients The platelet count of the patients was between 5 and 127 cells 10 sup 9 sup l PF4 IgG Assay and d Dimer were positive in the majority of the reported cases Among 49 patients with CVST at least 19 patients died 39 due to complications of CVST and VITT Health care providers should be familiar with the clinical presentations pathophysiology diagnostic criteria and management consideration of this rare but severe and potentially fatal complication of the COVID 19 vaccination Early diagnosis and quick initiation of the treatment may help to provide patients with a more favorable neurological outcome 0 +303 Pulmonary fibrosis secondary to COVID 19 a narrative review b Introduction b Coronavirus disease 2019 COVID 19 is still increasing worldwide and as a result the number of patients with pulmonary fibrosis secondary to COVID 19 will expand over time Risk factors histopathological characterization pathophysiology prevalence and management of post COVID 19 pulmonary fibrosis are poorly understood and few studies have addressed these issues b Areas covered b This article reviews the current evidence regarding post COVID 19 pulmonary fibrosis with an emphasis on the potential risk factors histopathology pathophysiology functional and tomographic features and potential therapeutic modalities A search on the issue was performed in the MEDLINE Embase and SciELO databases and the Cochrane library between 1 December 2019 and 25 January 2021 Studies were reviewed and relevant topics were incorporated into this narrative review b Expert opinion b Pulmonary sequelae may occur secondary to COVID 19 which needs to be included as a potential etiology in the current differential diagnosis of pulmonary fibrosis Therefore serial clinical tomographic and functional screening for pulmonary fibrosis is recommended after COVID 19 mainly in patients with pulmonary involvement in the acute phase of the disease Further studies are necessary to determine the risk factors markers pathophysiology and appropriate management of post COVID 19 pulmonary fibrosis 1 +110 The Long COVID Syndrome a New Clinical Picture after COVID 19 Infection The Long COVID Syndrome a New Clinical Picture after COVID 19 Infection b Abstract b Long term consequences are increasingly reported in the current literature after COVID 19 infections Some patients suffer from persistent pulmonary and extrapulmonary symptoms even months after the acute infection Pulmonary impairment but also dysregulation and effects on immune system cardiovascular system neurological system skin and kidney are described or anticipated This mini review gives a short update to the practitioner about the current knowledge about Long COVID 1 +76 Kidney in the net of acute and long haul coronavirus disease 2019 a potential role for lipid mediators in causing renal injury and fibrosis Severe COVID 19 disease is often complicated by acute kidney injury AKI which may transition to chronic kidney disease CKD Better understanding of underlying mechanisms is important in advancing therapeutic approaches SARS CoV 2 induced endothelial injury initiates platelet activation platelet neutrophil partnership and release of neutrophil extracellular traps The resulting thromboinflammation causes ischemia reperfusion I R injury to end organs Severe COVID 19 induces a lipid mediator storm with massive increases in thromboxane A2 TxA2 and PGD2 which promote thromboinflammation and apoptosis of renal tubular cells respectively and thereby enhance renal fibrosis COVID 19 associated AKI improves rapidly in the majority However 15 30 have protracted renal injury raising the specter of transition from AKI to CKD In COVID 19 the lipid mediator storm promotes thromboinflammation ischemia reperfusion injury and cytotoxicity The thromboxane A2 and PGD2 signaling presents a therapeutic target with potential to mitigate AKI and transition to CKD Ramatroban the only dual antagonist of the thromboxane A2 TPr and PGD2 DPr2 signaling could potentially mitigate renal injury in acute and long haul COVID Urgent studies targeting the lipid mediator storm are needed to potentially reduce the heavy burden of kidney disease emerging in the wake of the current pandemic 1 +625 Paediatric Liver Transplantation During COVID 19 Pandemic Lessons Learned and Unanswered Questions COVID 19 pandemic has imposed many challenges on paediatric liver transplantation PLT services and has necessitated several adaptations in different stages of the process to ensure transplant centres can still deliver the proposed services in addition to protecting patients and staff against infection This review article digs through the current literature to clarify the challenges imposed by SARS CoV2 on PLT centres globally It provides an overview of current practice as well as suggestions from experts in the field to overcome multiple obstacles In paediatrics the reaction to SARS CoV2 may be less severe than that seen in the adult population but this can change in view of newly discovered virus strains Response of transplant centres to the current pandemic was variable depending on the anticipated risk and available resources Telemedicine has helped PLT programmes to continue their activities while protecting patients as well as staff against the risk of SARS CoV2 virus Further studies are needed to guide immunosuppression management in post transplant infected candidates answering this critical question will help PLT centres solve this dilemma 0 +191 Post acute COVID 19 syndrome Severe acute respiratory syndrome coronavirus 2 SARS CoV 2 is the pathogen responsible for the coronavirus disease 2019 COVID 19 pandemic which has resulted in global healthcare crises and strained health resources As the population of patients recovering from COVID 19 grows it is paramount to establish an understanding of the healthcare issues surrounding them COVID 19 is now recognized as a multi organ disease with a broad spectrum of manifestations Similarly to post acute viral syndromes described in survivors of other virulent coronavirus epidemics there are increasing reports of persistent and prolonged effects after acute COVID 19 Patient advocacy groups many members of which identify themselves as long haulers have helped contribute to the recognition of post acute COVID 19 a syndrome characterized by persistent symptoms and or delayed or long term complications beyond 4 weeks from the onset of symptoms Here we provide a comprehensive review of the current literature on post acute COVID 19 its pathophysiology and its organ specific sequelae Finally we discuss relevant considerations for the multidisciplinary care of COVID 19 survivors and propose a framework for the identification of those at high risk for post acute COVID 19 and their coordinated management through dedicated COVID 19 clinics 1 +496 Patient electronic communication data in clinical care what is known and what is needed The novel coronavirus COVID 19 and physical distancing guidelines around the world have resulted in unprecedented changes to normal routine and increased smartphone use to maintain social relationships and support Reports of depressive and anxiety symptom are on the rise contributing to suffering among people especially adolescents and young adults with pre existing mental health conditions Psychiatric care has shifted primarily to telehealth limiting the important patient nonverbal communication that has been part of in person clinical sessions Supplementing clinical care with patient electronic communication EC data may provide valuable information and influence treatment decision making Research in the impact of patient EC data on managing psychiatric symptoms is in its infancy This review aims to identify how patient EC has been used in clinical care and its benefits in psychiatry and research We discuss smartphone applications used to gather different types of EC data how data have been integrated into clinical care and implications for clinical care and research 0 +263 sup 18 sup F FDG PET CT in SARS CoV 2 infection and its sequelae In recent months much of the scientific efforts have focused on research on SARSCoV 2 infection and its consequences in humans Still many aspects remain unknown It is known that the damage caused by SARS CoV 2 is multifactorial and that its extension goes beyond lung inflammation and the acute phase with the appearance of numerous complications and sequelae To date knowledge about the usefulness of sup 18 sup F FDG PET CT in the acute phase has been limited to the incidental detection of SARS CoV 2 unsuspected pneumonia Recent studies have been appearing collecting the findings of sup 18 sup F FDG PET CT in long COVID 19 or persistent COVID 19 state as well as the alterations caused after mass vaccination of the population in the metabolic studies This work aims to review the existing literature focusing on these three issues and to briefly present our own preliminary experience 1 +299 Post Acute Sequelae of COVID 19 and Cardiovascular Autonomic Dysfunction What Do We Know Post acute sequelae of SARS CoV 2 PASC or long COVID syndrome is emerging as a major health issue in patients with previous SARS CoV 2 infection Symptoms commonly experienced by patients include fatigue palpitations chest pain dyspnea reduced exercise tolerance and brain fog Additionally symptoms of orthostatic intolerance and syncope suggest the involvement of the autonomic nervous system Signs of cardiovascular autonomic dysfunction appear to be common in PASC and are similar to those observed in postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia In this review we report on the epidemiology of PASC discuss current evidence and possible mechanisms underpinning the dysregulation of the autonomic nervous system and suggest nonpharmacological and pharmacological interventions to treat and relieve symptoms of PASC associated dysautonomia 1 +115 Post COVID 19 exacerbation of fibrodysplasia ossificans progressiva with multiple flare ups and extensive heterotopic ossification in a 45 year old female patient Fibrodyplasia ossificans progressiva FOP is a rare hereditary disease which has a variable course characterized by occasional flare ups of heterotopic ossification HO in soft tissues that are followed by swelling stiffness pain and warmth Here we report for the first time a case of a 45 year old female patient with known FOP recovering from COVID 19 with disease progression potentially linked with the viral illness In December 2020 the patient contracted a mild form of COVID 19 infection without need for hospital admission Since January 2021 the patient felt unwell with occasional abdominal pain which progressively intensified In March 2021 she presented with new onset of HO complaining of pain swelling and thickening sensation in the lower abdomen and left part of the neck Computerized tomography CT and cytokine analysis were performed CT scan revealed new heterotopic bone formation in multiple soft tissue areas of the neck indicating clear radiological progression Radiotherapy which has proven to be an efficient tool to control HO in this patient was not able to halt HO formation after COVID 19 infection Cytokine analysis of a plasma sample obtained during a flare up after COVID 19 infection showed a significantly elevated pro inflammatory cytokines compared to a flare up panel prior to infection Of the 23 analyzed levels of cytokines a staggering number of 21 were above normal levels This case is the first confirmation of uncontrolled post COVID 19 effects in a FOP patient which manifested with flare ups followed by progressive HO possibly caused by a thus far never described form of post COVID syndrome 1 +228 Severe acute respiratory syndrome coronavirus 2 related multisystem inflammatory syndrome in children mimicking Kawasaki disease The severe acute respiratory syndrome coronavirus 2 SARS CoV 2 pandemic has been characterized by high transmission rates and high mortality in adults with predisposing factors including age 70 years obesity diabetes systemic hypertension and other underlying diseases During the second week of viral pneumonia acute respiratory distress syndrome can occur and carries high mortality Unlike most common respiratory viruses children seem to be less susceptible to SARS CoV 2 infection and generally develop mild disease with low mortality However clusters of severe shock associated with high levels of cardiac biomarkers and unusual vasoplegia requiring inotropes vasopressors and volume loading have recently been described Both the clinical symptoms i e high and persistent fever gastrointestinal disorders skin rash conjunctival injection and dry cracked lips and the biological signs e g elevated C reactive protein procalcitonin and high levels of ferritinaemia mimicked Kawasaki disease In most cases intravenous immunoglobin therapy improved cardiac function and led to full recovery within a few days Adjunctive steroid therapy and sometimes biotherapy e g anti interleukin 1Ra and anti interleukin 6 monoclonal antibodies were often necessary Although almost all children fully recovered within a week some of them later developed coronary artery dilation or aneurysm Thus a new multisystem inflammatory syndrome in children related to SARS CoV 2 has recently been described Similarities with Kawasaki disease and the physiopathology of this syndrome still need further exploration 1 +86 Characterizing the COVID 19 illness experience to inform the study of post acute sequelae and recovery a qualitative study We aimed to characterize the variability in the illness experience and recovery process from COVID 19 We conducted in depth individual interviews with participants enrolled in the Long term Immunological Impact of Novel Coronavirus LIINC cohort study in San Francisco California from June through October of 2020 Participants were adults who had a previously confirmed positive SARV CoV 2 nucleic acid amplification test result had recovered or were recovering from acute infection and underwent serial evaluations at our clinical research center We purposefully sampled 24 English and Spanish speaking adults with asymptomatic mild and severe symptomatic infection including those who were hospitalized and those with HIV co infection Half of our sample 50 0 identified as Latinx Hispanic and most of the participants were men 62 5 We used thematic analysis to characterize the illness experience recovery process and mental health impact of experiencing COVID 19 and present clinical data for each participant Emergent themes were 1 across symptom profiles and severity experiencing COVID 19 was associated with psychological distress 2 among participants with symptomatic infection the illness experience was characterized by uncertainty in terms of managing symptoms and recovery and 3 despite wide ranging illness experiences participants shared many common characteristics including health information seeking behavior facilitated by access to medical care and uncertainty regarding the course of their illness and recovery COVID 19 was associated with elevated levels of psychological distress regardless of symptoms 1 +474 COVID 19 potential therapeutics for pediatric patients The global spread of COVID 19 has imparted significant economic medical and social burdens Like adults children are affected by this pandemic However milder clinical symptoms are often experienced by them Only a minimal proportion of the affected patients may develop severe and complicated COVID 19 Supportive treatment is recommended in all patients Antiviral and immunomodulatory medications are spared for hospitalized children with respiratory distress or severe to critical disease Up till now remdesivir is the only USFDA approved anti COVID 19 medication indicated in the majority of symptomatic patients with moderate to severe disease Dexamethasone is solely recommended in patients with respiratory distress maintained on oxygen or ventilatory support The use of these medications in pediatric patients is founded on evidence deriving from adult studies No randomized controlled trials RCTs involving pediatric COVID 19 patients have assessed these medications efficacy and safety among others Similarly three novel monoclonal anti SARS CoV 2 spike protein antibodies bamlanivimab casirivimab and imdevimab have been recently authorized by the USFDA Nonetheless their efficacy has not been demonstrated by multiple RCTs In this review we aim to dissect the various potential therapeutics used in children with COVID 19 We aspire to provide a comprehensive review of the available evidence and display the mechanisms of action and the pharmacokinetic properties of the studied therapeutics Our review offers an efficient and practical guide for treating children with COVID 19 0 +342 Long COVID 19 A Primer for Cardiovascular Health Professionals on Behalf of the CCS Rapid Response Team It is now widely recognized that COVID 19 illness can be associated with significant intermediate and potentially longer term physical limitations The term long COVID 19 is used to define any patient with persistent symptoms after acute COVID 19 infection ie after 4 weeks It is postulated that cardiac injury might be linked to symptoms that persist after resolution of acute infection as part of this syndrome The Canadian Cardiovascular Society Rapid Response Team has generated this document to provide guidance to health care providers on the optimal management of patients with suspected cardiac complications of long COVID 19 1 +331 Coronasomnia promoting resilience through insomnia treatment The term coronasomnia is used in popular science to describe sleep disorders associated with the COVID 19 pandemic These disorders may also affect part of the population in the aftermath of the pandemic Early scientific evidence suggests that COVID 19 associated insomnia and insomniac symptoms can become chronic and will continue to preoccupy the sleep medicine community even after the pandemic has ended A literature review was conducted in Medline and Google Scholar using the following combination of keywords insomnia and COVID 19 insomnia and long COVID insomnia PTSD and COVID 19 and fatigue and insomnia in long COVID In addition the authors reviewed several recent articles published by members of the European Insomnia Network Studies on insomnia and COVID 19 show significant associations between acute infection and insomnia in affected individuals The prevalence of insomnia symptoms in COVID 19 affected individuals was 36 to 88 which is significantly higher than the estimated 10 to 40 prevalence of insomnia in the general population Digital therapy as a current treatment option for insomnia can be offered to patients regardless of physical distance Accordingly not only early approval of therapy apps but also person led digital therapy options for insomnia would be recommended The inclusion of personalised and sleep coaching measures in the area of occupational health management is encouraged 1 +493 Probiotics as Adjuvants in Vaccine Strategy Is There More Room for Improvement It has been recognized that microbiota plays a key role in shaping immune system maturation and activity Since probiotic administration influences the microbiota composition and acts as a biological response modifier the efficacy of an adjuvant for boosting vaccine specific immunity is investigated A review of the literature was performed starting from the mechanisms to laboratory and clinical evidence The mechanisms and in vitro and animal models provide biological plausibility for microbiota use Probiotics have been investigated as adjuvants in farm conditions and as models to understand their potential in human vaccinations with promising results In human studies although probiotics were effective in ameliorating seroconversion to vaccines for influenza rotavirus and other micro organisms the results for clinical use are still controversial especially in particular settings such as during the last trimester of pregnancy Although this topic remains controversial the use of probiotics as adjuvant factors in vaccination represents a strategic key for different applications The available data are deeply influenced by heterogeneity among studies in terms of strains timing and duration of administration and patients Although these do not allow us to draw definitive conclusions probiotics as adjuvants in vaccination should be considered in future studies especially in the elderly and in children where vaccine effectiveness and duration of immunization really matter 0 +224 Sequelae persistent symptomatology and outcomes after COVID 19 hospitalization the ANCOHVID multicentre 6 month follow up study Long term effects of COVID 19 also called Long COVID affect more than 10 of patients The most severe cases i e those requiring hospitalization present a higher frequency of sequelae but detailed information on these effects is still lacking The objective of this study is to identify and quantify the frequency and outcomes associated with the presence of sequelae or persistent symptomatology SPS during the 6 months after discharge for COVID 19 Retrospective observational 6 month follow up study conducted in four hospitals of Spain A cohort of all 969 patients who were hospitalized with PCR confirmed SARS CoV 2 from March 1 to April 15 2020 was included We collected all the SPS during the 6 months after discharge reported by patients during follow up from primary care records Cluster analyses were performed to validate the measures The main outcome measures were return to the Emergency Services hospital readmission and post discharge death Surviving patients outcomes were collected through clinical histories and primary care reports Multiple logistic regression models were applied The 797 82 2 patients who survived constituted the sample followed while the rest died from COVID 19 The mean age was 63 0 years 53 7 of them were men and 509 63 9 reported some sequelae during the first 6 months after discharge These sequelae were very diverse but the most frequent were respiratory 42 0 systemic 36 1 neurological 20 8 mental health 12 2 and infectious 7 9 SPS with some differences by sex Women presented higher frequencies of headache and mental health SPS among others A total of 160 20 1 patients returned to the Emergency Services 35 4 4 required hospital readmission and 8 1 0 died during follow up The main factors independently associated with the return to Emergency Services were persistent fever dermatological SPS arrythmia or palpitations thoracic pain and pneumonia COVID 19 cases requiring hospitalization during the first wave of the pandemic developed a significant range of mid to long term SPS A detailed list of symptoms and outcomes is provided in this multicentre study Identification of possible factors associated with these SPS could be useful to optimize preventive follow up strategies in primary care for the coming months of the pandemic 1 +502 Safe Pulmonary Scintigraphy in the Era of COVID 19 One of the major effects of the COVID 19 pandemic within nuclear medicine was to halt performance of lung ventilation studies due to concern regarding spread of contaminated secretions into the ambient air A number of variant protocols for performing lung scintigraphy emerged in the medical literature which minimized or eliminated the ventilation component due to the persistent need to provide this critical diagnostic service without compromising the safety of staff and patients We have summarized and reviewed these protocols many of which are based on concepts developed earlier in the history of lung scintigraphy It is possible that some of these interim remedies may gain traction and earn a more permanent place in the ongoing practice of nuclear medicine 0 +323 Is the Endothelium the Missing Link in the Pathophysiology and Treatment of COVID 19 Complications Patients with COVID 19 present a wide spectrum of disease severity from asymptomatic cases in the majority to serious disease leading to critical care and even death Clinically four different scenarios occur within the typical disease timeline first an incubation and asymptomatic period second a stage with mild symptoms due mainly to the virus itself third in up to 20 of the patients a stage with severe symptoms where a hyperinflammatory response with a cytokine storm driven by host immunity induces acute respiratory distress syndrome and finally a post acute sequelae PASC phase which present symptoms that can range from mild or annoying to actually quite incapacitating Although the most common manifestation is acute respiratory failure of the lungs other organs are also frequently involved The clinical manifestations of the COVID 19 infection support a key role for endothelial dysfunction in the pathobiology of this condition The virus enters into the organism via its interaction with angiotensin converting enzyme 2 receptor that is present prominently in the alveoli but also in endothelial cells which can be directly infected by the virus Cytokine release syndrome can also drive endothelial damage independently Consequently a distinctive feature of SARS CoV 2 infection is vascular harm with severe endothelial injury widespread thrombosis microangiopathy and neo angiogenesis in response to endothelial damage Therefore endothelial dysfunction seems to be the pathophysiological substrate for severe COVID 19 complications Biomarkers of endothelial injury could constitute strong indicators of disease progression and severity In addition the endothelium could represent a very attractive target to both prevent and treat these complications To establish an adequate therapy the underlying pathophysiology and corresponding clinical stage should be clearly identified In this review the clinical features of COVID 19 the central role of the endothelium in COVID 19 and in other pathologies and the potential of specific therapies aimed at protecting the endothelium in COVID 19 patients are addressed 1 +312 Assessment of activities of daily living in patients post COVID 19 a systematic review Coronavirus disease has provoked much discussion since its first appearance Despite it being widely studied all over the world little is known about the impact of the disease on functional ability related to performing activities of daily living ADL in patients post COVID 19 infection To understand the impact of COVID 19 on ADL performance of adult patients and to describe the common scales used to assess performance of ADL on patients post COVID 19 A systematic review was conducted We included studies that applied a physical capacity test in COVID 19 patients post infection Two independent reviewers analyzed the studies extracted the data and assessed the quality of the evidence A total of 1 228 studies were included after removing duplicates 1 005 abstracts were screened and of those 983 were excluded A final number of nine studies which met the eligibility criteria were included The findings revealed worsening of physical function and ADL performance in all patients post COVID 19 infection All included studies found a reduction of ADL beyond the test or scale used revealing a vital worsening of functional ability in ADL performance and consequently loss of independence in COVID 19 patients after the acute phase of infection Functional ability status previous to COVID 19 is crucial for predicting the severity of the disease and mortality Barthel Index and ADL score were the most used assessment tools across subjects with different intrinsic capacity and context levels 1 +362 Erythema Multiforme and COVID 19 What Do We Know i Background i Erythema multiforme EM is an acute cutaneous eruption often associated with infections and more rarely with drugs This review aimed to evaluate the association between erythema multiforme and coronavirus disease 2019 COVID 19 i Methods i A systematic search of PubMed MEDLINE Scimago Scopus and ISI Web of Science was performed Original articles case series or case reports were evaluated and selected i Results i Fourteen articles were selected describing a total of 70 patients EM is a cutaneous eruption rarely occurring in COVID 19 and is in most cases associated with a hypersensitivity reaction to the virus In these cases EM seems to affect patients younger than 30 years or older than 55 years Infrequently some drugs used in the management of COVID 19 may induce EM especially hydroxychloroquine The three groups of patients seem to have different clinical characteristics and courses i Conclusions i From these data it is possible to preliminarily propose that EM or EM like eruptions linked to COVID 19 might be divided into three types the virus related juvenile type affecting patients 30 year old the virus related older type affecting patients 55 years and the drug induced type The occurrence of a skin rash does not seem to be related to the severity and clinical course of COVID 19 0 +36 Long term sequelae are highly prevalent one year after hospitalization for severe COVID 19 Many coronavirus disease 2019 Covid 19 survivors show symptoms months after acute illness The aim of this work is to describe the clinical evolution of Covid 19 one year after discharge We performed a prospective cohort study on 238 patients previously hospitalized for Covid 19 pneumonia in 2020 who already underwent clinical follow up 4 months post Covid 19 200 consented to participate to a 12 months clinical assessment including pulmonary function tests with diffusing lung capacity for carbon monoxide DLCO post traumatic stress PTS symptoms evaluation by the Impact of Event Scale IES motor function evaluation by Short Physical Performance Battery and 2 min walking test chest Computed Tomography CT After 366 363 369 days 79 patients 39 5 reported at least one symptom A DLCO 80 was observed in 96 patients 49 0 Severe DLCO impairment 60 was reported in 20 patients 10 2 related to extent of CT scan abnormalities Some degree of motor impairment was observed in 25 8 of subjects 37 200 patients 18 5 showed moderate to severe PTS symptoms In the time elapsed from 4 to 12 months after hospital discharge motor function improves while respiratory function does not being accompanied by evidence of lung structural damage Symptoms remain highly prevalent one year after acute illness 1 +476 An environmental scan of impacts and interventions for women with methamphetamine use in pregnancy and their children Indigenous women are overrepresented among people who use PWU methamphetamine MA due to colonialism and intergenerational trauma Prenatal methamphetamine exposure PME is increasing as the number of PWUMA of childbearing age grows Yet impacts of MA in pregnancy and effective interventions are not yet well understood We conducted an environmental scan of published and grey literature 2010 2020 to determine effects of MA use in pregnancy for mothers and their offspring effective interventions and implications for Indigenous women A strategic search of Ovid Medline Embase ProQuest Public Health and CINAHL databases identified academic literature while Google and ProQuest Public Health identified grey literature Article selection was based on titles abstracts and keywords The time frame captured recent MA composition and excluded literature impacted by coronavirus disease 2019 Data extracted from 80 articles identified 463 results related to 210 outcomes and seven interventions Analysis focused on six categories maternal neonatal infant cognitive behavioral neurological and interventions Maternal outcomes were more congruent than child outcomes The most prevalent outcomes were general neonatal infant outcomes A lack of Indigenous specific research on PME and interventions highlights a need for future research that incorporates relevant historical and sociocultural contexts 0 +585 Application of the PCR number of cycle threshold value Ct in COVID 19 The SARS CoV 2 pandemic persists with all its virulence despite 650 382 819 doses of COVID vaccine worldwide The reference test for infection identification is reverse transcription polymerase chain reaction RT qPCR The usefulness of this test may be diminished by simplifying its result as positive or negative Determining the number of cycles Ct in positive RT qPCR tests can assist in decision making when interpreted in the clinical context of patients 0 +591 Investigating the association between mass transit adoption and COVID 19 infections in US metropolitan areas Urbanization introduces the threat of increased epidemic disease transmission resulting from crowding on mass transit The coronavirus disease 2019 COVID 19 pandemic which has directly led to over 600 000 deaths in the US as of July 2021 triggered mass social distancing policies to be enacted as a key deterrent of widespread infections Social distancing can be challenging in confined spaces required for transportation such as mass transit systems Little is published regarding the degree to which mass transit system adoption effects impacted the rise of the COVID 19 pandemic in urban centers Taking an ecological approach where areal data are the unit of observation this national scale study aims to measure the association between the adoption of mass transit and COVID 19 spread through confirmed cases in US metropolitan areas National survey based transit adoption measures are entered in a negative binomial regression model to evaluate differences between areas The model results demonstrate that mass transit adoption in US metropolitan areas was associated with the magnitude of outbreaks Higher incidence of COVID 19 early in the pandemic was associated with survey results conveying higher transit use Increasing weekly bus transit usage in metropolitan statistical areas by one scaled unit was associated with a 1 38 95 CI 1 25 1 90 times increase in incidence rate of COVID 19 a 10 increase in weekly train transit usage was associated with an increase in incidence rate of 1 54 95 CI 1 42 2 07 times These conclusions should inform early action practices in urban centers with busy transit systems in the event of future infectious disease outbreaks Deeper understanding of these observed associations may also benefit modeling efforts by allowing researchers to include mathematical adjustments or better explain caveats to results when communicating with decision makers and the public in the crucial early stages of an epidemic 0 +689 Neural and Self report Measures of Sensitivity to Uncertainty as Predictors of COVID Related Negative Affect The COVID 19 pandemic has been a period of unprecedented uncertainty Research indicates individuals differ in their response to uncertainty and these differences are mediated by anterior insula aINS function Those most sensitive to uncertainty are likely vulnerable to negative affect in the context of the pandemic The current study was designed to directly test this question using both neural and self reported measures of sensitivity to uncertainty Fifty nine volunteers completed a task designed to probe neural response to anticipation of predictable P and unpredictable U threat of electric shock during functional magnetic resonance imaging and a self report measure of intolerance of uncertainty IU Approximately two years later during the peak of the pandemic participants reported their emotional reactions to the COVID 19 crisis Multilevel mixed models revealed that greater aINS activation to U threat and greater self reported IU were independent predictors of increased COVID related negative affect These findings were significant when adjusting for biological sex and depression and anxiety symptom severity The results add to a growing literature demonstrating that individual differences in response to uncertainty have a robust impact on mood and functioning Results also highlight that individuals highly sensitive to uncertainty may be at increased risk for poor mental health during the ongoing pandemic 0 +111 The BEMED study BMJ 2016 352 DOI 10 1136 was designed as multi centric double blind plaebo controlled study in patients with Menières disease It should compare a low level 2 24 mg d vs high level 3 48 mg d betahstine intake vs placebo The primary endpoint was the number of vertigo attacks lasting longer than 20 min as documented in a patients diary The main finding of the study was that betahistine did not significantly better reduced the number of vertigo attacks than placebo Therefore the BEMED study should be critically discussed in the present paper 1 +290 Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection A State of the Art Review The vast majority of patients 99 with severe acute respiratory syndrome coronavirus 2 survive immediate infection but remain at risk for persistent and or delayed multisystem This review of published reports through May 31 2021 found that manifestations of postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection PASC affect between 33 and 98 of coronavirus disease 2019 survivors and comprise a wide range of symptoms and complications in the pulmonary cardiovascular neurologic psychiatric gastrointestinal renal endocrine and musculoskeletal systems in both adult and pediatric populations Additional complications are likely to emerge and be identified over time Although data on PASC risk factors and vulnerable populations are scarce evidence points to a disproportionate impact on racial ethnic minorities older patients patients with preexisting conditions and rural residents Concerted efforts by researchers health systems public health agencies payers and governments are urgently needed to better understand and mitigate the long term effects of PASC on individual and population health 1 +440 Case Report Rhino orbital Mucormycosis Related to COVID 19 A Case Series Exploring Risk Factors There has been a surge of rhino orbital mucormycosis cases in India in the wake of the second wave of the COVID 19 pandemic It has been widely suggested that dysglycemia resulting from diabetes which is a common comorbidity in COVID 19 patients and indiscriminate steroid use has resulted in this surge We report a series of 13 cases of rhino orbital mucormycosis in COVID 19 patients admitted to our center between mid April and early June 2021 The cases showed a male preponderance two patients had loss of vision and four of them showed intracranial extension of disease Twelve patients had received steroids and 12 had preexisting or newly diagnosed diabetes both steroid use and diabetes being the most common identified risk factors Considering other possible risk factors immunosuppressed state antiviral or ayurvedic Indian traditional medications and oxygen therapy were not associated with a definite risk of mucormycosis because they were not present uniformly in the patients We propose that COVID 19 itself through molecular mechanisms predisposes to mucormycosis with other factors such as dysglycemia or steroid use increasing the risk 0 +129 Long COVID and Health Inequities The Role of Primary Care Policy Points An estimated 700 000 people in the United States have long COVID that is symptoms of COVID 19 persisting beyond three weeks COVID 19 and its long term sequelae are strongly influenced by social determinants such as poverty and by structural inequalities such as racism and discrimination Primary care providers are in a unique position to provide and coordinate care for vulnerable patients with long COVID Policy measures should include strengthening primary care optimizing data quality and addressing the multiple nested domains of inequity 1 +655 Factors associated with COVID 19 preventive health behaviors among the general public in Mexico City and the State of Mexico To evaluate factors associated with COVID 19 preventive health behaviors among adults in Mexico City and the State of Mexico We conducted a cross sectional survey from June to October 2020 through a structured internet based questionnaire in a non probabilistic sample of adults 18 years living in Mexico City and the State of Mexico The independent variables included sociodemographic and clinical factors health literacy access to COVID 19 information and perception of COVID 19 risk and of preventive measures effectiveness The dependent variable was COVID 19 preventive health behaviors defined as the number of preventive actions adopted by participants The data were analyzed through multivariate negative binomial regression analysis The survey was completed by 1 030 participants Most participants were women 70 7 had a high school or above level of education 98 8 and had adequate health literacy and access to COVID 19 information Only 18 perceived having a high susceptibility to COVID 19 though 83 8 recognized the diseases severity and 87 1 the effectiveness of preventive measures The median number of COVID 19 preventive actions was 13 5 range 0 19 The factors associated with preventive health behavior were being female of older age a professional worker a homemaker or a retiree engaging in regular physical exercise having high health literacy and access to COVID 19 information sources and perceiving COVID 19 as severe and preventive measures as effective People with high education and internet access in Mexico City and the State of Mexico reported significant engagement in COVID 19 preventive actions during the first wave of the COVID 19 pandemic 0 +475 SARS CoV 2 Nucleocapsid protein attenuates stress granules and interacts with mRNAs to impair host stress response Severe acute respiratory syndrome coronavirus 2 SARS CoV 2 nucleocapsid N protein is essential for viral replication making it a promising target for antiviral drug and vaccine development SARS CoV 2 infected patients exhibit an uncoordinated immune response however the underlying mechanistic details of this imbalance remain obscure Here starting from a functional proteomics workflow we catalogued the protein protein interactions of SARS CoV 2 proteins including an evolutionarily conserved specific interaction of N with the stress granule resident proteins G3BP1 and G3BP2 N localizes to stress granules and sequesters G3BPs away from their typical interaction partners thus attenuating stress granule formation We found that N binds directly to host mRNAs in cells with a preference for 3 UTRs and modulates target mRNA stability We show that the N protein rewires the G3BP1 mRNA binding profile and suppresses the physiological stress response of host cells which may explain the imbalanced immune response observed in SARS CoV 2 infected patients 0 +486 Pathophysiology of COVID 19 Why Children Fare Better than Adults The world is facing Coronavirus Disease 2019 COVID 19 pandemic which is causing a large number of deaths and burden on intensive care facilities It is caused by Severe Acute Respiratory Syndrome coronavirus 2 SARS CoV 2 originating in Wuhan China It has been seen that fewer children contract COVID 19 and among infected children have less severe disease Insights in pathophysiological mechanisms of less severity in children could be important for devising therapeutics for high risk adults and elderly Early closing of schools and day care centers led to less frequent exposure and hence lower infection rate in children The expression of primary target receptor for SARS CoV 2 i e angiotensin converting enzyme 2 ACE 2 decreases with age ACE 2 has lung protective effects by limiting angiotensin 2 mediated pulmonary capillary leak and inflammation Severe COVID 19 disease is associated with high and persistent viral loads in adults Children have strong innate immune response due to trained immunity secondary to live vaccines and frequent viral infections leading to probably early control of infection at the site of entry Adult patients show suppressed adaptive immunity and dysfunctional over active innate immune response in severe infections which is not seen in children These could be related to immune senescence in elderly Excellent regeneration capacity of pediatric alveolar epithelium may be contributing to early recovery from COVID 19 Children less frequently have risk factors such as co morbidities smoking and obesity But young infants and children with pre existing illnesses could be high risk groups and need careful monitoring Studies describing immune pathogenesis in COVID 19 are lacking in children and need urgent attention 0 +573 Identification of homologous human miRNAs as antivirals towards COVID 19 genome The COVID 19 fatality rate is 57 worldwide The investigation of possible antiviral therapy using host microRNA miRNA to inhibit viral replication and transmission is the need of the hour Computational techniques were used to predict the hairpin precursor miRNA pre miRNAs of COVID 19 genome with high homology towards human host miRNA Top 21 host miRNAs with 80 homology towards 18 viral pre miRNAs were identified The Gibbs free energy ΔG between host miRNAs and viral pre miRNAs hybridization resulted in the best 5 host miRNAs having the highest base pair complementarity miR 4476 had the strongest binding with viral pre miRNA ΔG 21 8 kcal mol due to maximum base pairing in the seed sequence Pre miR 651 secondary structure was most stable due to the 1 least minimum free energy ΔG 24 4 kcal mol energy frequency and noncanonical base pairing and 2 maximum number of stem base pairing and small loop size Host miRNAs viral mRNAs interaction can effectively inhibit viral transmission and replication Furthermore miRNAs gene network and gene ontology studies indicate top 5 host miRNAs interaction with host genes involved in transmembrane receptor signaling cell migration RNA splicing nervous system formation and tumor necrosis factor mediated signaling in respiratory diseases This study identifies host miRNA virus pre miRNAs strong interaction structural stability and their gene network analysis provides strong evidence of host miRNAs as antiviral COVID 19 agents 0 +183 SARS CoV 2 Neuronal Invasion and Complications Potential Mechanisms and Therapeutic Approaches Clinical reports suggest that the coronavirus disease 19 COVID 19 pandemic caused by severe acute respiratory syndrome SARS coronavirus 2 CoV 2 has not only taken millions of lives but has also created a major crisis of neurologic complications that persist even after recovery from the disease Autopsies of patients confirm the presence of the coronaviruses in the CNS especially in the brain The invasion and transmission of SARS CoV 2 in the CNS is not clearly defined but because the endocytic pathway has become an important target for the development of therapeutic strategies for COVID 19 it is necessary to understand endocytic processes in the CNS In addition mitochondria and mechanistic target of rapamycin mTOR signaling pathways play a critical role in the antiviral immune response and may also be critical for endocytic activity Furthermore dysfunctions of mitochondria and mTOR signaling pathways have been associated with some high risk conditions such as diabetes and immunodeficiency for developing severe complications observed in COVID 19 patients However the role of these pathways in SARS CoV 2 infection and spread are largely unknown In this review we discuss the potential mechanisms of SARS CoV 2 entry into the CNS and how mitochondria and mTOR pathways might regulate endocytic vesicle mitochondria interactions and dynamics during SARS CoV 2 infection The mechanisms that plausibly account for severe neurologic complications with COVID 19 and potential treatments with Food and Drug Administration approved drugs targeting mitochondria and the mTOR pathways are also addressed 1 +98 What is the recovery rate and risk of long term consequences following a diagnosis of COVID 19 A harmonised global longitudinal observational study protocol Very little is known about possible clinical sequelae that may persist after resolution of acute COVID 19 A recent longitudinal cohort from Italy including 143 patients followed up after hospitalisation with COVID 19 reported that 87 had at least one ongoing symptom at 60 day follow up Early indications suggest that patients with COVID 19 may need even more psychological support than typical intensive care unit patients The assessment of risk factors for longer term consequences requires a longitudinal study linked to data on pre existing conditions and care received during the acute phase of illness The primary aim of this study is to characterise physical and psychosocial sequelae in patients post COVID 19 hospital discharge This is an international open access prospective observational multisite study This protocol is linked with the International Severe Acute Respiratory and emerging Infection Consortium ISARIC and the WHOs Clinical Characterisation Protocol which includes patients with suspected or confirmed COVID 19 during hospitalisation This protocol will follow up a subset of patients with confirmed COVID 19 using standardised surveys to measure longer term physical and psychosocial sequelae The data will be linked with the acute phase data Statistical analyses will be undertaken to characterise groups most likely to be affected by sequelae of COVID 19 The open access follow up survey can be used as a data collection tool by other follow up studies to facilitate data harmonisation and to identify subsets of patients for further in depth follow up The outcomes of this study will inform strategies to prevent long term consequences inform clinical management interventional studies rehabilitation and public health management to reduce overall morbidity and improve long term outcomes of COVID 19 The protocol and survey are open access to enable low resourced sites to join the study to facilitate global standardised longitudinal data collection Ethical approval has been given by sites in Colombia Ghana Italy Norway Russia the UK and South Africa New sites are welcome to join this collaborative study at any time Sites interested in adopting the protocol as it is or in an adapted version are responsible for ensuring that local sponsorship and ethical approvals in place as appropriate The tools are available on the ISARIC website www isaric org PROTOCOL REGISTRATION NUMBER osf io c5rw3 PROTOCOL VERSION 3 August 2020 EUROQOL ID 37035 1 +276 Persistent symptoms and decreased health related quality of life after symptomatic pediatric COVID 19 A prospective study in a Latin American tertiary hospital To prospectively evaluate demographic anthropometric and health related quality of life HRQoL in pediatric patients with laboratory confirmed coronavirus disease 2019 COVID 19 This was a longitudinal observational study of surviving pediatric post COVID 19 patients n 53 and pediatric subjects without laboratory confirmed COVID 19 included as controls n 52 was performed The median duration between COVID 19 diagnosis n 53 and follow up was 4 4 months 0 8 10 7 Twenty three of 53 43 patients reported at least one persistent symptom at the longitudinal follow up visit and 12 53 23 had long COVID 19 with at least one symptom lasting for 12 weeks The most frequently reported symptoms at the longitudinal follow up visit were headache 19 severe recurrent headache 9 tiredness 9 dyspnea 8 and concentration difficulty 4 At the longitudinal follow up visit the frequencies of anemia 11 versus 0 p 0 030 lymphopenia 42 versus 18 p 0 020 C reactive protein level of 30 mg L 35 versus 0 p 0 0001 and D dimer level of 1000 ng mL 43 versus 6 p 0 0004 significantly reduced compared with baseline values Chest X ray abnormalities 11 versus 2 p 0 178 and cardiac alterations on echocardiogram 33 versus 22 p 0 462 were similar at both visits Comparison of characteristic data between patients with COVID 19 at the longitudinal follow up visit and controls showed similar age p 0 962 proportion of male sex p 0 907 ethnicity p 0 566 family minimum monthly wage p 0 664 body mass index p 0 601 and pediatric pre existing chronic conditions p 1 000 The Pediatric Quality of Live Inventory 4 0 scores median physical score 69 0 100 versus 81 34 100 p 0 012 and school score 60 15 100 versus 70 15 95 p 0 028 were significantly lower in pediatric patients with COVID 19 at the longitudinal follow up visit than in controls Pediatric patients with COVID 19 showed a longitudinal impact on HRQoL parameters particularly in physical school domains reinforcing the need for a prospective multidisciplinary approach for these patients These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID 19 1 +379 Consequences of visiting restrictions during the COVID 19 pandemic An integrative review During the COVID 19 pandemic visiting restrictions of different extents have been implemented However despite the long history of visiting restrictions in health care systems little is known about their effects This review sought to explore the consequences of visitor restrictions in health care services during the COVID 19 pandemic A systematic integrative review was conducted in accordance with the PRISMA guidelines based on a systematic search in PubMed CHINAL full plus Web of Science PsychInfo Scopus and the Cochrane Library A total of 17 scientific papers covering intensive care pediatric care general medical care hospital care palliative care and nursing home settings were included Although appreciation for the technical solutions enabling remote meetings was reported visiting restrictions had several consequences mainly negative for the patients health the health and wellbeing of family members and the provision of care Among physical health consequences reduced nutrition intake decreased activities of daily living and increased physical pain and symptoms were reported Among mental health consequences for the patient loneliness depressive symptoms agitation aggression reduced cognitive ability and overall dissatisfaction were observed For family members worry anxiety and uncertainty occurred and they reported an increased need for information from care providers Family members of neonatal intensive care unit patients reported less bonding with their child and family relation disturbances due to the restrictions For care providers visiting restrictions added the burdens of ethical dilemmas learning new technical means to enable social interaction and an increased demand for communication with families and providing social support to both family members and patients When implementing visiting restrictions in health care services decision makers and nurses need to be aware of their potential negative effects and adapt the provision of care to compensate for such effects Nurses in all sectors should be aware that visiting restrictions may affect patients families and health care services for longer than the actual pandemic Since the level of evidence regarding effect from visiting restrictions is low further studies is strongly needed 0 +531 The need for gentle medicine in a post Covid 19 world As it has historically been the case with many pandemics the Covid 19 experience will induce many philosophers to reconsider the value of medical practice This should be a good opportunity to critically scrutinize the way medical research and medical interventions are carried out For much of its history medicine has been very inefficient But even in its contemporary forms a review of common protocols in medical research and medical interventions reveal many shortcomings especially related to methodological flaws and more importantly conflicts of interests due to profit incentives In the face of these problems we propose a program of gentle medicine This term originally formulated by philosopher Jacob Stegenga describes a form of medicine in which physicians intervene less than they currently do As part of this general program we advance a series of reform recommendations that could be enacted both by medical staff in their everyday practice but also by public health officials and policymakers 0 +560 Could Probiotics and Postbiotics Function as Silver Bullet in the Post COVID 19 Era We are currently experiencing the realities of the most severe pandemic within living memory with major impacts on the health and economic well being of our planet The scientific community has demonstrated an unprecedented mobilization capability with the rapid development of vaccines and drugs targeting the protection of human life and palliative measures for infected individuals However are we adequately prepared for ongoing defense against COVID 19 and its variants in the post pandemic world Moreover are we equipped to provide a satisfactory quality of life for individuals who are recovering from COVID 19 disease What are the possibilities for the acceleration of the recovery process Here we give special consideration to the potential and already demonstrated role of probiotics and traditional medical approaches to the management of current and potential future encounters with our major virus adversaries 0 +634 Evolution of Human Memory B Cells From Childhood to Old Age High quality medical assistance and preventive strategies including pursuing a healthy lifestyle result in a progressively growing percentage of older people The population and workforce is aging in all countries of the world It is widely recognized that older individuals show an increased susceptibility to infections and a reduced response to vaccination suggesting that the aged immune system is less able to react and consequently protect the organism The SARS CoV 2 pandemic is dramatically showing us that the organism reacts to novel pathogens in an age dependent manner The decline of the immune system observed in aging remains unclear We aimed to understand the role of B cells We analyzed peripheral blood from children 4 18 years young people 23 60 years and elderly people 65 91 years by flow cytometry We also measured antibody secretion by ELISA following a T independent stimulation Here we show that the elderly have a significant reduction of CD27 sup dull sup memory B cells a population that bridges innate and adaptive immune functions In older people memory B cells are mostly high specialized antigen selected CD27 sup bright sup Moreover after i in vitro i stimulation with CpG B cells from older individuals produced significantly fewer IgM and IgA antibodies compared to younger individuals Aging is a complex process characterized by a functional decline in multiple physiological systems The immune system of older people is well equipped to react to often encountered antigens but has a low ability to respond to new pathogens 0 +533 Mental health problems in Indonesian internship doctors during the COVID 19 pandemic All new graduate medical doctors in Indonesia will work in government healthcare facilities for one year as internship doctors Problems such as the shortage of PPE no specific treatment guidelines and inadequate support from authorities contributed to mental health problems This study aimed to determine mental health problems and associated demographics and concerns of Indonesian internship doctors in the COVID 19 pandemic era This cross sectional study was performed from 1 31 Januari 2021 via Google Form questionnaire to collect data Logistic regression analysis was used to identify the association between demographic data concerns in internship doctors working place and mental health using Depression Anxiety Stress Scale 21 Depression anxiety and stress in internship doctors were 32 6 44 1 and 19 5 consecutively Multivariate analysis showed that the only demographic factor associated with depression was female sex Concerns of internship doctors were the most factors associated with mental health Working in triage was associated with depression and stress Donning and doffing training of PPE difficulty to practice physical distancing and hesitancy to attend patients were associated with depression and anxiety Difficulty to practice physical distancing in hospital w associated with anxiety and stress Firstly some difficulties in data collection Secondly the self reported tools of mental health are not always aligned with the psychiatric assessment Lastly possibility of recall biases from each batch To minimize mental health problems of internship doctors their concerns must be tackled Medical schools have an important role to manage concerns of these internship doctors 0 +246 Long term SARS CoV 2 specific immune and inflammatory responses in individuals recovering from COVID 19 with and without post acute symptoms We describe severe acute respiratory syndrome coronavirus 2 SARS CoV 2 specific T cell responses soluble markers of inflammation and antibody levels and neutralization capacity longitudinally in 70 individuals with PCR confirmed SARS CoV 2 infection Participants represent a spectrum of illness and recovery including some with persistent viral shedding in saliva and many experiencing post acute sequelae of SARS CoV 2 infection PASC T cell responses remain stable for up to 9 months Whereas the magnitude of early CD4 sup sup T cell immune responses correlates with severity of initial infection pre existing lung disease is independently associated with higher long term SARS CoV 2 specific CD8 sup sup T cell responses Among participants with PASC 4 months following coronavirus disease 2019 COVID 19 symptom onset we observe a lower frequency of CD8 sup sup T cells expressing CD107a a marker of degranulation in response to Nucleocapsid N peptide pool stimulation and a more rapid decline in the frequency of N specific interferon γ producing CD8 sup sup T cells Neutralizing antibody levels strongly correlate with SARS CoV 2 specific CD4 sup sup T cell responses 1 +238 The Importance of Listening in Treating Invisible Illness and Long Haul COVID 19 Primary and specialty care clinicians strive to base diagnoses and treatment on specific measurable abnormalities Yet those with invisible controversial illnesses such as myalgic encephalomyelitis chronic fatigue syndrome ME CFS often have symptoms not explained by standard laboratory values For instance one of the cardinal features of ME CFS is postexertional malaise the exacerbation of symptoms fatigue pain cognitive dysfunction following exertion which contradicts studies showing the health benefits of exercise In these cases overly physicalist approaches to caring for patients are not likely to be helpful and a clinicians willingness to listen to a patients experience of illness becomes essential 1 +211 Post Acute Sequelae of SARS CoV 2 Infection Among Adults Aged 18 Years Long Beach California April 1 December 10 2020 Post acute sequelae of COVID 19 also known as long COVID is used to describe the long term symptoms that might be experienced weeks to months after primary infection with SARS CoV 2 the virus that causes COVID 19 Among persons with a previous COVID 19 diagnosis estimates of the prevalence of sequelae range from 5 among nonhospitalized persons to 80 among hospitalized persons 1 2 Studies have analyzed the aftereffects of COVID 19 but few have assessed the demographic characteristics associated with long COVID 3 4 Health disparities resulting from pervasive structural and socioeconomic barriers in the U S health care system might contribute to differences in these effects and might continue to exacerbate existing inequities 5 To identify trends in post acute sequelae the Long Beach Department of Health and Human Services LBDHHS interviewed a random sample of 366 persons aged 18 years who received a positive SARS CoV 2 test result during April 1 December 10 2020 One third of the persons interviewed reported having at least one symptom 2 months after their positive test result with higher odds of sequelae among persons aged 40 54 years females and those with preexisting conditions Black or African American Black participants had higher odds of reporting dyspnea and myalgia arthralgia compared with other racial ethnic groups Persons who were aged 40 years female Black or who reported known preexisting conditions also reported higher numbers of distinct sequelae As the number of recovered COVID 19 patients increases monitoring the prevalence of post acute sequelae among larger cohorts in diverse populations will be necessary to understand and manage this condition Identification of groups disproportionately affected by post acute COVID 19 sequelae can help develop efforts to prioritize preventions and treatment strategies including vaccination of groups at higher risk for these long term sequelae and access to testing and care for post acute sequelae 1 +420 Model for utilizing distance learning post COVID 19 using PACT a cross sectional qualitative study COVID 19 pandemic pressured medical schools globally to shift to Distance learning DL as an alternative way to ensure that the content delivered is satisfactory for student progression This work aims at mapping priorities for post COVID planning for better balance between distance learning and face to face learning This qualitative study aimed to develop a model for utilizing DL using The Polarity Approach for Continuity and Transformation PACT A virtual mapping session was held with 79 faculty from 19 countries They worked in small groups to determine upsides and downsides of face to face and DL subsequently An initial polarity map was generated identifying five tension areas Faculty Students Curriculum Social aspects and Logistics A 63 item assessment tool was generated based on this map piloted and then distributed as a self administered assessment The outcomes of this assessment were utilized for another mapping session to discuss warning signs and action steps to maintain upsides and avoid downsides of each pole Participants agreed that face to face teaching allows them to inspire students and have meaningful connections with them They also agreed that DL provides a good environment for most students However students with financial challenges and special needs may not have equal opportunities to access technology As regards social issues participants agreed that face to face learning provides a better chance for professionalism through enhanced team work Cognitive communication and clinical skills are best achieved in face to face Participants agreed that logistics for conducting DL are much more complicated when compared to face to face learning Participants identified around 10 warning signs for each method that need to be continuously monitored in order to minimize the drawbacks of over focusing on one pole at the expense of the other Action steps were determined to ensure optimized use of in either method In order to plan for the future we need to understand the dynamics of education within the context of polarities Educators need to understand that the choice of DL although was imposed as a no alternative solution during the COVID era yet it has always existed as a possible alternative and will continue to exist after this era The value of polarity mapping and leveraging allows us to maximize the benefit of each method and guide educators decisions to minimize the downsides for the good of the learning process 0 +99 Burdens of post acute sequelae of COVID 19 by severity of acute infection demographics and health status The Post Acute Sequelae of SARS CoV 2 infection PASC have been characterized however the burden of PASC remains unknown Here we used the healthcare databases of the US Department of Veterans Affairs to build a cohort of 181 384 people with COVID 19 and 4 397 509 non infected controls and estimated that burden of PASC defined as the presence of at least one sequela in excess of non infected controls was 73 43 72 10 74 72 per 1000 persons at 6 months Burdens of individual sequelae varied by demographic groups age race and sex but were consistently higher in people with poorer baseline health and in those with more severe acute infection In sum the burden of PASC is substantial PASC is non monolithic with sequelae that are differentially expressed in various population groups Collectively our results may be useful in informing health systems capacity planning and care strategies of people with PASC 1 +405 A narrative review on characterization of acute respiratory distress syndrome in COVID 19 infected lungs using artificial intelligence COVID 19 has infected 77 4 million people worldwide and has caused 1 7 million fatalities as of December 21 2020 The primary cause of death due to COVID 19 is Acute Respiratory Distress Syndrome ARDS According to the World Health Organization WHO people who are at least 60 years old or have comorbidities that have primarily been targeted are at the highest risk from SARS CoV 2 Medical imaging provides a non invasive touch free and relatively safer alternative tool for diagnosis during the current ongoing pandemic Artificial intelligence AI scientists are developing several intelligent computer aided diagnosis CAD tools in multiple imaging modalities i e lung computed tomography CT chest X rays and lung ultrasounds These AI tools assist the pulmonary and critical care clinicians through a faster detection of the presence of a virus b classifying pneumonia types and c measuring the severity of viral damage in COVID 19 infected patients Thus it is of the utmost importance to fully understand the requirements of for a fast and successful and timely lung scans analysis This narrative review first presents the pathological layout of the lungs in the COVID 19 scenario followed by understanding and then explains the comorbid statistical distributions in the ARDS framework The novelty of this review is the approach to classifying the AI models as per the by school of thought SoTs exhibiting based on segregation of techniques and their characteristics The study also discusses the identification of AI models and its extension from non ARDS lungs pre COVID 19 to ARDS lungs post COVID 19 Furthermore it also presents AI workflow considerations of for medical imaging modalities in the COVID 19 framework Finally clinical AI design considerations will be discussed We conclude that the design of the current existing AI models can be improved by considering comorbidity as an independent factor Furthermore ARDS post processing clinical systems must involve include i the clinical validation and verification of AI models ii reliability and stability criteria and iii easily adaptable and iv generalization assessments of AI systems for their use in pulmonary critical care and radiological settings 0 +498 Retinal nerve fibre layer and ganglion cell layer changes in children who recovered from COVID 19 a cohort study To investigate the optic nerve and macular parameters of children who recovered from COVID 19 compared with healthy children using optical coherence tomography OCT Cohort study Hospital Clinico San Carlos Madrid Children between 6 and 18 years old who recovered from COVID 19 with laboratory confirmed SARS CoV 2 infection and historical controls were included All patients underwent an ophthalmological examination including macular and optic nerve OCT Demographic data medical history and COVID 19 symptoms were noted Peripapillary retinal nerve fibre layer thickness macular retinal nerve fibre layer thickness macular ganglion cell layer thickness and retinal thickness 90 patients were included 29 children who recovered from COVID 19 and 61 controls Patients with COVID 19 presented an increase in global peripapillary retinal nerve fibre layer thickness mean difference 7 7 95 CI 3 4 to 12 1 temporal superior mean difference 11 0 95 CI 3 3 to 18 6 temporal inferior mean difference 15 6 95 CI 6 5 to 24 7 and nasal mean difference 9 8 95 CI 2 9 to 16 7 sectors Macular retinal nerve fibre layer analysis showed decreased thickness in the nasal outer p 0 011 and temporal inner p 0 036 sectors in patients with COVID 19 while macular ganglion cell layer thickness increased in these sectors p 0 001 and p 0 015 respectively No differences in retinal thickness were noted Children with recent history of COVID 19 present significant changes in peripapillary and macular OCT analyses 0 +434 Planning for disposal of COVID 19 pandemic wastes in developing countries a review of current challenges The health sector is critical to the well being of any country but developing countries have several obstacles that prevent them from providing adequate health care This became an even larger concern after the COVID 19 outbreak left millions of people dead worldwide and generated huge amounts of infected or potentially infected wastes The management and disposal of medical wastes during and post COVID 19 represent a major challenge in all countries but this challenge is particularly great for developing countries that do not have robust waste disposal infrastructure The main problems in developing countries include inefficient treatment procedures limited capacity of healthcare facilities and improper waste disposal procedures The management of medical wastes in most developing countries was primitive prior to the pandemic The improper treatment and disposal of these wastes in our current situation may further speed COVID 19 spread creating a serious risk for workers in the medical and sanitation fields patients and all of society Therefore there is a critical need to discuss emerging challenges in handling treating and disposing of medical wastes in developing countries during and after the COVID 19 outbreak There is a need to determine best disposal techniques given the conditions and limitations under which developing countries operate Several open questions need to be investigated concerning this global issue such as to what extent developing countries can control the expected environmental impacts of COVID 19 particularly those related to medical wastes What are the projected management scenarios for medical wastes under the COVID 19 outbreak And what are the major environmental risks posed by contaminated wastes related to COVID 19 treatment Studies directed at the questions above careful planning the use of large capacity mobile recycling facilities and following established guidelines for disposal of medical wastes should reduce risk of COVID 19 spread in developing countries 0 +534 The impact of COVID 19 lockdown on child and adolescent mental health systematic review COVID 19 was declared a pandemic in March 2020 resulting in many countries worldwide calling for lockdowns This study aimed to review the existing literature on the effects of the lockdown measures established as a response to the COVID 19 pandemic on the mental health of children and adolescents Embase Ovid Global Health PsycINFO Web of Science and pre print databases were searched in this PRISMA compliant systematic review PROSPERO CRD42021225604 We included individual studies reporting on a wide range of mental health outcomes including risk and protective factors conducted in children and adolescents aged 19 years exposed to COVID 19 lockdown Data extraction and quality appraisal were conducted by independent researchers and results were synthesised by core themes 61 articles with 54 999 children and adolescents were included mean age 11 3 years 49 7 female Anxiety symptoms and depression symptoms were common in the included studies and ranged 1 8 49 5 and 2 2 63 8 respectively Irritability range 16 7 73 2 and anger range 30 0 51 3 were also frequently reported by children and adolescents Special needs and the presence of mental disorders before the lockdown alongside excessive media exposure were significant risk factors for anxiety Parent child communication was protective for anxiety and depression The COVID 19 lockdown has resulted in psychological distress and highlighted vulnerable groups such as those with previous or current mental health difficulties Supporting the mental health needs of children and adolescents at risk is key Clinical guidelines to alleviate the negative effects of COVID 19 lockdown and public health strategies to support this population need to be developed 0 +189 Post COVID 19 assessment in a specialist clinical service a 12 month single centre prospective study in 1325 individuals Post COVID 19 complications require simultaneous characterisation and management to plan policy and health system responses We describe the 12 month experience of the first UK dedicated post COVID 19 clinical service to include hospitalised and non hospitalised patients In a single centre observational analysis we report the demographics symptoms comorbidities investigations treatments functional recovery specialist referral and rehabilitation of 1325 individuals assessed at the University College London Hospitals post COVID 19 service between April 2020 and April 2021 comparing by referral route posthospitalised PH non hospitalised NH and post emergency department PED Symptoms associated with poor recovery or inability to return to work full time were assessed using multivariable logistic regression 1325 individuals were assessed PH 547 41 3 PED 212 16 NH 566 42 7 Compared with the PH and PED groups the NH group were younger median 44 6 35 6 52 8 years vs 58 3 47 0 67 7 years and 48 5 39 4 55 7 years more likely to be female 68 2 43 0 and 59 9 less likely to be of ethnic minority 30 9 52 7 and 41 0 or seen later after symptom onset median IQR 194 118 298 days 69 51 111 days and 76 55 128 days all p 0 0001 All groups had similar rates of onward specialist referral NH 18 7 PH 16 1 and PED 18 9 p 0 452 and were more likely to require support for breathlessness 23 7 5 5 and 15 1 p 0 001 and fatigue 17 8 4 8 and 8 0 p 0 001 Hospitalised patients had higher rates of pulmonary emboli persistent lung interstitial abnormalities and other organ impairment 716 54 0 individuals reported 75 optimal health median 70 IQR 55 85 Less than half of employed individuals could return to work full time at first assessment Post COVID 19 symptoms were significant in PH and NH patients with significant ongoing healthcare needs and utilisation Trials of interventions and patient centred pathways for diagnostic and treatment approaches are urgently required 1 +373 Paediatric dental care during and post COVID 19 era Changes and challenges ahead COVID 19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 SARS CoV 2 The virus is transmitted through respiratory droplets and by physical contact from contaminated surfaces to the mucosa Its route of transmission has caused a significant challenge in medical and dental healthcare This article aims to review the literature and information available on the provision of paediatric dental treatment during and post pandemic and to provide specific recommendations on the safe provision of paediatric dental care Children infected by SARS CoV 2 have no or milder COVID 19 symptoms and are potential vectors in spreading the disease Routine dental treatment is suspended in many countries because of the increased risk of cross infection in dental practices Only emergency dental care is provided for urgent conditions It is necessary to gradually reinstate regular dental care to paediatric patients and maintain their good oral health To control the disease transmission and maintain the oral health of the population minimally intervention techniques that minimise or eliminate aerosol generation plus comprehensive oral health preventive measures should be practised to safeguard safety at dental practices in this unprecedented time Robust infection control guidelines should be implemented in dental clinics to minimise the risk of infection and to ensure the safety of patients and staff during the pandemic Three levels of preventive care should be practised to prevent oral diseases and improve childrens oral health in this COVID 19 era Treatment should be prioritized to patients in urgent needs and aerosol generating procedures should be minimized 0 +399 Immunomodulation and immunotherapeutics of COVID 19 Severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 a pandemic which was originated from Wuhan city of China The pandemic has affected millions of people worldwide The pathogenesis of SARS CoV 2 is characterized by a cytokine storm in the blood cytokinemia and tissues especially the lungs One of the major repercussions of this inflammatory process is the endothelial injury causing intestinal bleeding coagulopathy and thromboembolism which result in various sudden and unexpected post COVID complications including kidney failure myocardial infarction or multiorgan failure In this review we have summarized the immune responses biochemical changes and inflammatory responses in the human body after infection with the SARS CoV 2 virus The increased amount of inflammatory cytokines chemokines and involvement of complement proteins in inflammatory reaction increase the risk of occurrence of disease 0 +283 Hospitalizations Associated with COVID 19 Among Children and Adolescents COVID NET 14 States March 1 2020 August 14 2021 Although COVID 19 associated hospitalizations and deaths have occurred more frequently in adults sup sup COVID 19 can also lead to severe outcomes in children and adolescents 1 2 Schools are opening for in person learning and many prekindergarten children are returning to early care and education programs during a time when the number of COVID 19 cases caused by the highly transmissible B 1 617 2 Delta variant of SARS CoV 2 the virus that causes COVID 19 is increasing sup sup Therefore it is important to monitor indicators of severe COVID 19 among children and adolescents This analysis uses Coronavirus Disease 2019 Associated Hospitalization Surveillance Network COVID NET sup sup data to describe COVID 19 associated hospitalizations among U S children and adolescents aged 0 17 years During March 1 2020 August 14 2021 the cumulative incidence of COVID 19 associated hospitalizations was 49 7 per 100 000 children and adolescents The weekly COVID 19 associated hospitalization rate per 100 000 children and adolescents during the week ending August 14 2021 1 4 was nearly five times the rate during the week ending June 26 2021 0 3 among children aged 0 4 years the weekly hospitalization rate during the week ending August 14 2021 was nearly 10 times that during the week ending June 26 2021 During June 20 July 31 2021 the hospitalization rate among unvaccinated adolescents aged 12 17 years was 10 1 times higher than that among fully vaccinated adolescents Among all hospitalized children and adolescents with COVID 19 the proportions with indicators of severe disease such as intensive care unit ICU admission after the Delta variant became predominant June 20 July 31 2021 were similar to those earlier in the pandemic March 1 2020 June 19 2021 Implementation of preventive measures to reduce transmission and severe outcomes in children is critical including vaccination of eligible persons universal mask wearing in schools recommended mask wearing by persons aged 2 years in other indoor public spaces and child care centers sup sup and quarantining as recommended after exposure to persons with COVID 19 sup sup 1 +278 Children with long covid Almost half of children who contract covid 19 may have lasting symptoms which should factor into decisions on reopening schools reports b Helen Thomson b 1 +489 Renin Angiotensin System RAS and Immune System Profile in Specific Subgroups with COVID 19 The identification of vulnerable subgroups and risk factors associated with the susceptibility to severe acute respiratory syndrome coronavirus 2 SARS CoV 2 infection and coronavirus disease 2019 COVID 19 is of utmost importance in a pandemic scenario Potential interactions between renin angiotensin system RAS immune markers and COVID 19 play a role in disease outcome in specific groups of patients This review aimed to describe the particularities of the RAS and the immune system profile of particular subgroups of patients This non systematic review summarizes evidence on SARS CoV 2 infection in specific subgroups of patients and possible relationships between immune system RAS and the pathophysiology of COVID 19 The RAS and the immune system exert a role in the pathogenesis and prognosis of COVID 19 mainly in cases of hypertension diabetes obesity and other chronic diseases The overactivation of the ACE Ang II AT1R axis and the enhancement of inflammation contribute to deleterious effects of COVID 19 Likewise pregnant women and elderly patients usually display immune responses that are less effective in withstanding exposition to viruses while children are relatively protected against severe complications of COVID 19 Women conversely exhibit stronger antiviral responses and are less sensitive to the effects of increased Ang II Future Perspectives The recognition of vulnerable subgroups and risk factors for disease severity is essential to better understand the pandemic Precision medicine tools including proteomics and metabolomics approaches identified metabolic patterns of the severe form of disease and might be the alternative to diagnose evaluate and predict the prognosis and the efficiency of therapies 0 +82 Hyperventilation A Possible Explanation for Long Lasting Exercise Intolerance in Mild COVID 19 Survivors Since the outbreak of the coronavirus COVID 19 pandemic most attention has focused on containing transmission and addressing the surge of critically ill patients in acute care settings As we enter the second phase of the pandemic emphasis must evolve to post acute care of COVID 19 survivors Persisting cardiorespiratory symptoms have been reported at several months after the onset of the infection Information is lacking on the pathophysiology of exercise intolerance after COVID 19 Previous outbreaks of coronaviruses have been associated with persistent dyspnea muscle weakness fatigue and reduced quality of life The extent of Covid 19 sequelae remains to be evaluated but persisting cardiorespiratory symptoms in COVID 19 survivors can be described as two distinct entities The first type of post Covid symptoms are directly related to organ injury in the acute phase or the complications of treatment The second type of persisting symptoms can affect patients even with mild initial disease presentation without evidence of organ damage The mechanisms are still poorly qualified to date There is a lack of correlation between initial symptom severity and residual symptoms at exertion We report exercise hyperventilation as a major limiting factor in COVID 19 survivors The origin of this hyperventilation may be related to an abnormality of ventilatory control by either hyperactivity of activator systems automatic and cortical ventilatory control peripheral afferents and sensory cortex or failure of inhibitory systems endorphins in the aftermath of pulmonary infection Hyperventilation induced hypocapnia can cause a multitude of extremely disabling symptoms such as dyspnea tachycardia chest pain fatigue dizziness and syncope at exertion 1 +214 A clinical primer for the expected and potential post COVID 19 syndromes In late 2019 a novel coronavirus SARS CoV 2 COVID 19 spread unchecked across the worlds population With tens of millions infected the long term consequences of COVID 19 infection will be a major health care focus for years after the contagion subsides Most complications stem from direct viral invasion provoking an over exuberant inflammatory response driven by innate immune cells and activation of the clotting cascade causing thrombosis Injury to individual organs and their protective linings are frequent presentations in respiratory cardiovascular and neurological systems Reviewing the historical context of postviral fatiguing symptoms seems relevant to understanding reports of uneven recoveries and persistent symptoms that are emerging as long haul COVID 19 The pandemic is also an unprecedented sociocultural event transforming how people consider their health gather in groups and navigate their daily lives The unprecedented sociocultural stresses of the pandemic will have an invisible ubiquitous and predictable impact on neurologic endocrine and immune functioning even in people untouched by the virus COVID 19 may also have a surprise or two in store with unique clinical presentations and novel mechanisms of injury which are yet to clearly emerge Although challenging and unfortunate these times also represent a unique opportunity to start to unravel the physiology that underlie how viruses may trigger cancers neurological disease and postviral fatiguing syndromes 1 +20 Vaccination boosts protective responses and counters SARS CoV 2 induced pathogenic memory B cells Much is to be learned about the interface between immune responses to SARS CoV 2 infection and vaccination We monitored immune responses specific to SARS CoV 2 Spike Receptor Binding Domain RBD in convalescent individuals for eight months after infection diagnosis and following vaccination Over time neutralizing antibody responses which are predominantly RBD specific generally decreased while RBD specific memory B cells persisted RBD specific antibody and B cell responses to vaccination were more vigorous than those elicited by infection in the same subjects or by vaccination in infection naïve comparators Notably the frequencies of double negative B memory cells which are dysfunctional and potentially pathogenic increased in the convalescent subjects over time Unexpectedly this effect was reversed by vaccination Our work identifies a novel aspect of immune dysfunction in mild moderate COVID 19 supports the practice of offering SARS CoV 2 vaccination regardless of infection history and provides a potential mechanistic explanation for the vaccination induced reduction of Long COVID symptoms 1 +186 Pediatric COVID toes and fingers The emergence of the coronavirus disease 2019 COVID 19 worldwide pandemic has been associated with a new constellation of cutaneous features in children Among the unusual dermatologic presentations are the so called COVID toes inflammatory nodules of the feet and toes sometimes involving the hands and fingers These lesions mimic acral pernio the synonym being chilblains Unlike adult patients with COVID toes children are less likely to manifest symptomatic COVID 19 Although a few studies have found some linkage to COVID 19 through the serum IgA or IgG severe acute respiratory syndrome coronavirus 2 SARS CoV 2 spike protein other studies have no demonstrable linkage suggesting that barefoot children in cold weather develop such lesions It appears that the chilblain like lesions related to the period of the COVID 19 pandemic may reflect a brisk immune response portending a good prognosis and perhaps some form of innate immunity The possible need to screen for coagulopathy is unclear but this has been suggested in one report Until we fully understand the pattern of immune response to COVID 19 questions may persist as to how disease manifestations are linked to SARS CoV 2 exposures 1 +124 Long COVID Distinction between Organ Damage and Deconditioning 1 Background Long COVID syndrome refers to long term sequelae of the novel viral disease which occur even in patients with initially mild disease courses However there is still little evidence of the actual organic consequences and their frequency and there is no standardized workup to diagnose long COVID syndrome yet In this study we aim to determine the efficiency of a stepwise diagnostic approach for reconvalescent COVID 19 patients with cardiopulmonary symptoms 2 Methods The diagnostic workup for long COVID syndrome included three steps In the first step the focus was on broad applicability e g blood tests and body plethysmography In the second step cardiopulmonary exercise testing CPET and cardiac MRI CMR were used The third step was tailored to the individual needs of each patient The observation period lasted from 22 February to 14 May 2021 3 Results We examined 231 patients in our long COVID unit mean SD age 47 8 14 9 132 57 1 women Acute illness occurred a mean SD of 121 77 days previously Suspicious findings in the first visit were seen in 80 34 6 patients prompting further diagnostics Thirty six patients were further examined with CPET and CMR Of those 16 44 4 had pathological findings The rest had functional complaints without organ damage functional long COVID Cardiopulmonary sequelae were found in asymptomatic as well as severe courses of the initial COVID 19 disease 4 Conclusions A structured diagnostic pathway for the diagnosis of long COVID syndrome is practicable and rational in terms of resource allocation With this approach manifest organ damage can be accurately and comprehensively diagnosed and distinguished from functional complaints 1 +580 Myocarditis and Pericarditis Following mRNA COVID 19 Vaccination What Do We Know So Far This is a cross sectional study of 29 published cases of acute myopericarditis following COVID 19 mRNA vaccination The most common presentation was chest pain within 1 5 days after the second dose of mRNA COVID 19 vaccination All patients had an elevated troponin Cardiac magnetic resonance imaging revealed late gadolinium enhancement consistent with myocarditis in 69 of cases All patients recovered clinically rapidly within 1 3 weeks Most patients were treated with non steroidal anti inflammatory drugs for symptomatic relief and 4 received intravenous immune globulin and corticosteroids We speculate a possible causal relationship between vaccine administration and myocarditis The data from our analysis confirms that all myocarditis and pericarditis cases are mild and resolve within a few days to few weeks The bottom line is that the risk of cardiac complications among children and adults due to severe acute respiratory syndrome coronavirus 2 SARS CoV 2 infection far exceeds the minimal and rare risks of vaccination related transient myocardial or pericardial inflammation 0 +56 Severe Fatigue in Long COVID Web Based Quantitative Follow up Study in Members of Online Long COVID Support Groups Fatigue is the most commonly reported symptom in patients with persistent complaints following COVID 19 ie long COVID Longitudinal studies examining the intensity of fatigue and differentiating between physical and mental fatigue are lacking The objectives of this study were to 1 assess the severity of fatigue over time in members of online long COVID peer support groups and 2 assess whether members of these groups experienced mental fatigue physical fatigue or both A 2 wave web based follow up study was conducted in members of online long COVID peer support groups with a confirmed diagnosis approximately 3 and 6 months after the onset of infectious symptoms Demographics COVID 19 diagnosis received health care from medical professionals or allied health care professionals fatigue Checklist Individual Strength subscale subjective fatigue CIS Fatigue 8 56 points and physical and mental fatigue self constructed questions 3 21 points were assessed Higher scores indicated more severe fatigue A CIS Fatigue score 36 points was used to qualify patients as having severe fatigue A total of 239 patients with polymerase chain reaction computed tomography confirmed COVID 19 completed the survey 10 weeks SD 2 and 23 weeks SD 2 after onset of infectious symptoms respectively T1 and T2 Of these 239 patients 198 82 8 were women 142 59 4 had no self reported pre existing comorbidities 208 87 self reported being in good health before contracting COVID 19 and 62 25 9 were hospitalized during acute infection The median age was 50 years IQR 39 56 The vast majority of patients had severe fatigue at T1 and T2 n 204 85 4 and n 188 78 7 respectively No significant differences were found in the prevalence of normal mild and severe fatigue between T1 and T2 P 12 The median CIS Fatigue score was 48 points IQR 42 53 at T1 and it decreased from T1 to T2 median change 2 points IQR 7 to 3 P 001 At T1 a median physical fatigue score of 19 points IQR 16 20 and a median mental fatigue score of 15 points IQR 10 17 were reported these scores were lower at T2 for physical but not for mental fatigue median change for physical fatigue 1 point IQR 3 to 0 P 001 median change for mental fatigue 0 points IQR 3 to 3 P 52 At the time of completing the follow up survey 194 239 81 2 and 164 239 68 6 of all patients had received care from at least one medical professional and one allied health care professional respectively Fatigue in members of online long COVID support groups with a confirmed COVID 19 diagnosis decreases from 10 to 23 weeks after onset of symptoms Despite this severe fatigue remains highly prevalent Both physical and mental fatigue are present It remains unclear whether and to what extent fatigue will resolve spontaneously in the longer term Netherlands Trial Register NTR8705 https www trialregister nl trial 8705 1 +568 Clinical Nutrition Research and the COVID 19 Pandemic A Scoping Review of the ASPEN COVID 19 Task Force on Nutrition Research The purpose of this scoping review by the American Society for Parenteral and Enteral Nutrition ASPEN Coronavirus Disease 2019 COVID 19 Nutrition Task Force was to examine nutrition research applicable to the COVID 19 pandemic The rapid pace of emerging scientific information has prompted this activity to discover research knowledge gaps This methodology adhered with recommendations from the Joanna Briggs Institute There were 2301 citations imported Of these there were 439 articles fully abstracted with 23 main topic areas identified across 24 article types and sourced across 61 countries and 51 specialties in 8 settings and among 14 populations Epidemiological mechanistic relationships between nutrition and COVID 19 were reviewed and results mapped to the Population Intervention Comparator Outcome and Time PICO T questions The aggregated data were analyzed by clinical stage pre COVID 19 acute COVID 19 and chronic post COVID 19 Research gaps were discovered for all PICO T questions Nutrition topics meriting urgent research included food insecurity societal infrastructure and transcultural factors pre COVID 19 cardiometabolic based chronic disease pediatrics nutrition support and hospital infrastructure acute COVID 19 registered dietitian nutritionist counseling chronic post COVID 19 and malnutrition and management all stages The paucity of randomized controlled trials RCTs was particularly glaring Knowledge gaps were discovered for PICO T questions on pediatrics micronutrients bariatric surgery and transcultural factors pre COVID 19 enteral nutrition protein energy requirements and glycemic control with nutrition acute COVID 19 and home enteral and parenteral nutrition support chronic post COVID 19 In conclusion multiple critical areas for urgent nutrition research were identified particularly using RCT design to improve nutrition care for patients before during and after COVID 19 0 +199 Characteristics and predictors of acute and chronic post COVID syndrome A systematic review and meta analysis A significant proportion of individuals experience lingering and debilitating symptoms following acute COVID 19 infection The National Institute for Health and Care Excellence NICE have coined the persistent cluster of symptoms as post COVID syndrome This has been further sub categorised into acute post COVID syndrome for symptoms persisting three weeks beyond initial infection and chronic post COVID syndrome for symptoms persisting beyond twelve weeks The aim of this review was to detail the prevalence of clinical features and identify potential predictors for acute and chronic post COVID syndrome A systematic literature search with no language restrictions was performed to identify studies detailing characteristics and outcomes related to survivorship of post COVID syndrome The last search was performed on 6 March 2021 and all pre dating published articles included A means of proportion meta analysis was performed to quantify characteristics of acute and chronic post COVID syndrome Study quality was assessed with a specific risk of bias tool PROSPERO Registration CRD42020222855 A total of 43 studies met the eligibility criteria of which 38 allowed for meta analysis Fatigue and dyspnoea were the most prevalent symptoms in acute post COVID 0 37 and 0 35 and fatigue and sleep disturbance in chronic post COVID syndrome 0 48 and 0 44 respectively The available evidence is generally of poor quality with considerable risk of bias and are of observational design In conclusion this review highlights that flaws in data capture and interpretation noted in the uncertainty within our meta analysis affect the applicability of current knowledge Policy makers and researchers must focus on understanding the impact of this condition on individuals and society with appropriate funding initiatives and global collaborative research 1 +651 Myocarditis With COVID 19 mRNA Vaccines Myocarditis has been recognized as a rare complication of coronavirus disease 2019 COVID 19 mRNA vaccinations especially in young adult and adolescent males According to the US Centers for Disease Control and Prevention myocarditis pericarditis rates are 12 6 cases per million doses of second dose mRNA vaccine among individuals 12 to 39 years of age In reported cases patients with myocarditis invariably presented with chest pain usually 2 to 3 days after a second dose of mRNA vaccination and had elevated cardiac troponin levels ECG was abnormal with ST elevations in most and cardiac MRI was suggestive of myocarditis in all tested patients There was no evidence of acute COVID 19 or other viral infections In 1 case a cardiomyopathy gene panel was negative but autoantibody levels against certain self antigens and frequency of natural killer cells were increased Although the mechanisms for development of myocarditis are not clear molecular mimicry between the spike protein of severe acute respiratory syndrome coronavirus 2 SARS CoV 2 and self antigens trigger of preexisting dysregulated immune pathways in certain individuals immune response to mRNA and activation of immunologic pathways and dysregulated cytokine expression have been proposed The reasons for male predominance in myocarditis cases are unknown but possible explanations relate to sex hormone differences in immune response and myocarditis and also underdiagnosis of cardiac disease in women Almost all patients had resolution of symptoms and signs and improvement in diagnostic markers and imaging with or without treatment Despite rare cases of myocarditis the benefit risk assessment for COVID 19 vaccination shows a favorable balance for all age and sex groups therefore COVID 19 vaccination is recommended for everyone 12 years of age 0 +281 A Paradigm for Post Covid 19 Fatigue Syndrome Analogous to ME CFS A significant proportion of COVID 19 patients are suffering from prolonged Post COVID 19 Fatigue Syndrome with characteristics typically found in Myalgic Encephalomyelitis Chronic Fatigue Syndrome ME CFS However no clear pathophysiological explanation as yet has been provided A novel paradigm for a Post COVID 19 Fatigue Syndrome is developed here from a recent unifying model for ME CFS Central to its rationale SARS CoV 2 in common with the triggers viral and non viral of ME CFS is proposed to be a physiologically severe i stressor i which could be targeting a i stress integrator i within the brain the hypothalamic paraventricular nucleus PVN It is proposed that inflammatory mediators released at the site of COVID 19 infection would be transmitted as i stress signals via i humoral and neural pathways which overwhelm this i stress center i In genetically susceptible people an intrinsic i stress threshold i is suggested to be exceeded causing ongoing dysfunction to the hypothalamic PVNs complex neurological circuitry In this compromised state the hypothalamic PVN might then be hyper sensitive to a wide range of lifes ongoing physiological i stressors i This could result in the reported post exertional malaise episodes and more severe relapses in common with ME CFS that perpetuate an ongoing disease state When a certain i stress tolerance level i is exceeded the hypothalamic PVN can become an epicenter for microglia induced activation and neuroinflammation affecting the hypothalamus and its proximal limbic system which would account for the range of reported ME CFS like symptoms A model for Post COVID 19 Fatigue Syndrome is provided to stimulate discussion and critical evaluation Brain scanning studies incorporating increasingly sophisticated imaging technology should enable chronic neuroinflammation to be detected even at a low level in the finite detail required thus helping to test this model while advancing our understanding of Post COVID 19 Fatigue Syndrome pathophysiology 1 +243 Home and Community Based Physical Therapist Management of Adults With Post Intensive Care Syndrome More than 4 million adults survive a stay in the intensive care unit each year with many experiencing new or worsening physical disability mental health problems and or cognitive impairments known as post intensive care syndrome PICS Given the prevalence and magnitude of physical impairments after critical illness many survivors including those recovering from COVID 19 could benefit from physical therapist services after hospital discharge However due to the relatively recent recognition and characterization of PICS there may be limited awareness and understanding of PICS among physical therapists practicing in home health care and community based settings This lack of awareness may lead to inappropriate and or inadequate rehabilitation service provision While this perspective article provides information relevant to all physical therapists it is aimed toward those providing rehabilitation services outside of the acute and postacute inpatient settings This article reports the prevalence and clinical presentation of PICS and provides recommendations for physical examination and outcomes measures plan of care and intervention strategies The importance of providing patient and family education coordinating community resources including referring to other health care team members and community based rehabilitation service options is emphasized Finally this perspective article discusses current challenges for optimizing outcomes for people with PICS and suggests future directions for research and practice 1 +220 COVID 19 cardiac injury Implications for long term surveillance and outcomes in survivors Up to 20 30 of patients hospitalized with coronavirus disease 2019 COVID 19 have evidence of myocardial involvement Acute cardiac injury in patients hospitalized with COVID 19 is associated with higher morbidity and mortality There are no data on how acute treatment of COVID 19 may affect the convalescent phase or long term cardiac recovery and function Myocarditis from other viral pathogens can evolve into overt or subclinical myocardial dysfunction and sudden death has been described in the convalescent phase of viral myocarditis This raises concerns for patients recovering from COVID 19 Some patients will have subclinical and possibly overt cardiovascular abnormalities Patients with ostensibly recovered cardiac function may still be at risk of cardiomyopathy and cardiac arrhythmias Screening for residual cardiac involvement in the convalescent phase for patients recovered from COVID 19 associated cardiac injury is needed The type of testing and therapies for post COVID 19 myocardial dysfunction will need to be determined Therefore now is the time to plan for appropriate registries and clinical trials to properly assess these issues and prepare for long term sequelae of post COVID 19 cardiac syndrome 1 +355 Coronavirus occurrence surveillance and persistence in wastewater The coronavirus disease COVID 19 outbreak reported in China in December 2019 has spread throughout the world The WHO declared it as a pandemic in March 2020 The pandemic severely affected public health and the global economy Many studies conducted on the coronavirus have helped us to elucidate its pathogenicity and pathophysiology However it is important to study the behavior of the pathogen in the environment to develop effective control measures While studying the persistence and transmission of viruses in drinking water and wastewater systems a low concentration of coronavirus and its nucleic acids have been detected in municipal wastewaters This could be due to their high susceptibilities to degradation in aqueous environments Epidemiological study on coronaviruses in wastewater will serve two purposes i e in early detection of outbreak and in identifying asymptomatic carriers In such cases the epidemiological study will help in early detection of the presence of the virus in the community Secondly it will help in knowing if there are asymptomatic carriers as such people do not show any signs of symptoms but shed the viruses in feces The present review focuses on the epidemiological surveillance of wastewater for coronaviruses as in recent years these are increasingly causing global pandemics In this review we have discussed the four pertinent areas of coronavirus study 1 occurrence of coronavirus in wastewater 2 wastewater based epidemiological surveillance of coronaviruses 3 epidemiological surveillance tools used for detection of coronaviruses in sewage and 4 persistence and sustainability of coronaviruses in wastewater 0 +144 Use of Cardiopulmonary Stress Testing for Patients With Unexplained Dyspnea Post Coronavirus Disease The authors used cardiopulmonary exercise testing CPET to define unexplained dyspnea in patients with post acute sequelae of severe acute respiratory syndrome coronavirus 2 SARS CoV 2 infection PASC We assessed participants for criteria to diagnose myalgic encephalomyelitis chronic fatigue syndrome ME CFS Approximately 20 of patients who recover from coronavirus disease COVID remain symptomatic This syndrome is named PASC Its etiology is unclear Dyspnea is a frequent symptom The authors performed CPET and symptom assessment for ME CFS in 41 patients with PASC 8 9 3 3 months after COVID All patients had normal pulmonary function tests chest X ray and chest computed tomography scans Peak oxygen consumption peak VO sub 2 sub slope of minute ventilation to CO sub 2 sub production VE VCO sub 2 sub slope and end tidal pressure of CO sub 2 sub PetCO sub 2 sub were measured Ventilatory patterns were reviewed with dysfunctional breathing defined as rapid erratic breathing Eighteen men and 23 women average age 45 13 years were studied Left ventricular ejection fraction was 59 9 Peak VO sub 2 sub averaged 20 3 7 mL kg min 77 21 predicted VO sub 2 sub VE VCO sub 2 sub slope was 30 7 PetCO sub 2 sub at rest was 33 5 4 5 mm Hg Twenty four patients 58 5 had a peak VO sub 2 sub 80 predicted All patients with peak VO sub 2 sub 80 had a circulatory limitation to exercise Fifteen of 17 patients with normal peak VO sub 2 sub had ventilatory abnormalities including peak respiratory rate 55 n 3 or dysfunctional breathing n 12 For the whole cohort 88 of patients n 36 had ventilatory abnormalities with dysfunctional breathing n 26 increased VE VCO sub 2 sub n 17 and or hypocapnia PetCO sub 2 sub 35 n 25 Nineteen patients 46 met criteria for ME CFS Circulatory impairment abnormal ventilatory pattern and ME CFS are common in patients with PASC The dysfunctional breathing resting hypocapnia and ME CFS may contribute to symptoms CPET is a valuable tool to assess these patients 1 +328 Metabolic Reprogramming in COVID 19 Plenty of research has revealed virus induced alternations in metabolic pathways which is known as metabolic reprogramming Studies focusing on COVID 19 have uncovered significant changes in metabolism resulting in the perspective that COVID 19 is a metabolic disease Reprogramming of amino acid glucose cholesterol and fatty acid is distinctive characteristic of COVID 19 infection These metabolic changes in COVID 19 have a critical role not only in producing energy and virus constituent elements but also in regulating immune response offering new insights into COVID 19 pathophysiology Remarkably metabolic reprogramming provides great opportunities for developing novel biomarkers and therapeutic agents for COVID 19 infection Such novel agents are expected to be effective adjuvant therapies In this review we integrate present studies about major metabolic reprogramming in COVID 19 as well as the possibility of targeting reprogrammed metabolism to combat virus infection 1 +671 Emergent Crisis of COVID 19 Pandemic Mental Health Challenges and Opportunities Mental health is a fundamental human right and is part of the well being of society The public health burden of mental health disorders affects peoples social and economic status around the world Coronaviruss COVID 19 negative impact on the economy and mental health worldwide is concerning This is a worldwide emergency and there is an urgent need for research about this topic to prevent long lasting adverse effects on the population Unpreparedness and inconsistencies in guidelines lockdowns containment strategies unemployment financial losses physical distancing isolation chaos and uncertainty are among factors that lead to a rise in emotional distress anxiety and depression Governments decisions affect the socioeconomic status of a country and the psychological well being of the people COVID 19 pandemic exposed disparities in multiple mental health care systems by having adverse mental health effects in people with pre existing mental health disorders and previously healthy individuals Aggregation of concurrent or cumulative comorbid risk factors for COVID 19 disease and its psychosocial sequelae could provide invaluable information for the public health stakeholders This review aims to address the burden and the psychosocial impact of the COVID 19 pandemic the challenges and opportunities facing mental health systems and proposes new strategies to improve the mental health outcomes in the post COVID era 0 +409 Lung Transplantation of COVID 19 Patients How I Do It The COVID 19 pandemic has caused acute lung injury in millions of individuals worldwide Some patients develop COVID related acute respiratory distress syndrome CARDS and cannot be liberated from mechanical ventilation Others may develop post COVID fibrosis resulting in substantial disability and need for long term supplemental oxygen In both of these situations treatment teams often inquire about the possibility of lung transplantation In fact lung transplantation has been successfully employed for both CARDS and post COVID fibrosis in a limited number of patients worldwide Lung transplantation after COVID infection presents a number of unique challenges that transplant programs must consider In those with severe CARDS the inability to conduct proper psychosocial evaluation and pretransplantation education marked deconditioning from critical illness and infectious concerns regarding viral reactivation are major hurdles In those with post COVID fibrosis our limited knowledge about the natural history of recovery after COVID 19 infection is problematic Increased knowledge of the likelihood and degree of recovery after COVID 19 acute lung injury is essential for appropriate decision making with regard to transplantation Transplant physicians must weigh the risks and benefits of lung transplantation differently in a post COVID fibrosis patient who is likely to remain stable or gradually improve in comparison with a patient with a known progressive fibrosing interstitial lung disease fILD Clearly lung transplantation can be a life saving therapeutic option for some patients with severe lung injury from COVID 19 infection In this review we discuss how lung transplant providers from a number of experienced centers approach lung transplantation for CARDS or post COVID fibrosis 0 +194 Post COVID syndrome A reflection and opinion paper A high proportion of people who have suffered from COVID 19 report after recovery from the acute phase of the disease clinical manifestations both subjective and objective that continue beyond 3 weeks or even 3 months after the original clinical disease There is still no agreed nomenclature to refer to this condition but perhaps the most commonly used is post COVID syndrome The Scientific Committee on COVID of the Madrid College of Physicians ICOMEM has discussed this problem with a multidisciplinary approach in which internists infectious disease specialists psychiatrists pneumologists surgeons geriatricians pediatricians microbiologists family physicians and other specialists have participated trying to gather the existing information and discussing it in the group The clinical manifestations are very variable and range from simple fatigue to persistent fibrosing lung lesions with objective alterations of pulmonary function Post COVID syndrome seems to be particularly frequent and severe in adults who have required admission to Intensive Care Units and has a peculiar behavior in a very small group of children The post COVID syndrome which undoubtedly exists is at first sight not clearly distinguishable from clinical manifestations that which occur after other acute viral diseases and after prolonged stays in ICUs due to other diseases Therefore it offers excellent research opportunities to clarify its pathogenesis and possibly that of other related entities It is possible that progressively there will be an increased demand for care among the millions of people who have suffered and overcome acute COVID for which the health authorities should design mechanisms for the agile management of care that will possibly require well coordinated multidisciplinary groups This paper structured in questions on different aspects of the post COVID syndrome attempts to stage the current state of this problem 1 +657 Vaccines for COVID 19 Where do we stand in 2021 As of July 2021 over 3 billion doses of a COVID 19 vaccines have been administered globally and there are now 19 COVID 19 vaccines approved for use in at least one country Several of these have been shown to be highly effective both in clinical trials and real world observational studies some of which have included special populations of interest A small number of countries have approved a COVID 19 vaccine for use in adolescents or children These are laudable achievements but the global vaccination effort has been challenged by inequitable distribution of vaccines predominantly to high income countries with only 0 9 of people in low income countries having received at least one dose of a COVID 19 vaccine Addressing this inequity is of critical importance and will result in better control of SARS CoV 2 globally Other challenges include the reduced protection from COVID 19 vaccines against some strains of SARS CoV 2 necessitating the development of variant specific vaccines and uncertainties around the duration of protection from vaccine induced immunity 0 +94 Guidance for Health Care Leaders During the Recovery Stage of the COVID 19 Pandemic A Consensus Statement The COVID 19 pandemic is the greatest global test of health leadership of our generation There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage To create an evidence and expertise informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic A literature search in PubMed MEDLINE and Embase revealed 10 910 articles published between 2000 and 2021 that included the terms leadership and variations of emergency crisis disaster pandemic COVID 19 or public health Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development this assessment adopted a 6 round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives The 10 imperatives in the framework are 1 acknowledge staff and celebrate successes 2 provide support for staff well being 3 develop a clear understanding of the current local and global context along with informed projections 4 prepare for future emergencies personnel resources protocols contingency plans coalitions and training 5 reassess priorities explicitly and regularly and provide purpose meaning and direction 6 maximize team organizational and system performance and discuss enhancements 7 manage the backlog of paused services and consider improvements while avoiding burnout and moral distress 8 sustain learning innovations and collaborations and imagine future possibilities 9 provide regular communication and engender trust and 10 in consultation with public health and fellow leaders provide safety information and recommendations to government other organizations staff and the community to improve equitable and integrated care and emergency preparedness systemwide Leaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities 1 +401 Thrombotic risk in children with COVID 19 infection A systematic review of the literature Coagulation and inflammatory parameters are mildly altered in children with SARS CoV 2 COVID 19 infection and laboratory evidence of a proinflammatory and procoagulant state has been noted in multisystem inflammatory syndrome in children MIS C It is not clear whether this pediatric condition is related to thrombotic events With this study we reviewed the literature for thrombotic complications in children with COVID 19 infection and MIS C We searched the Medline PubMed Advanced Search Builder Scopus Web Of Science and Google Scholar electronic databases until 1 January 2021 using the medical subject headings MeSH terms and text words their combinations and truncated synonyms THROMBOSIS OR THROMBOPHILIA AND CHILD OR CHILDREN OR INFANT AND COVID 19 OR SARS CoV 2 Inclusion criteria were children with COVID 19 or SARS COV 2 infection The search was limited to articles published in English Exclusion criteria were reviews of published studies studies published only as abstracts letters or conference proceedings discussion papers animal studies or editorials After screening for duplicates the initial search yielded 86 records 12 were case reports involving 19 children comorbidities were absent or mild in 73 7 The most common site of thrombosis the lung 21 the most often used drug was heparin 42 Two studies were an international survey n 337 patients and a large multicenter study n 186 patients with MIS C The risk of ischemic stroke in SARS CoV 2 infection 0 82 and deep venous thrombosis in MIS C 4 3 was lower in children than in adults Thrombodic or thromboembolic events are rare in pediatric patients with COVID 19 infection and MIS C Nonetheless as in adults a high index of suspicion should be maintained in children with COVID 19 infection or MIS C particularly in those with comorbidities predisposing to thrombotic events 0 +24 Post COVID 19 Tachycardia Syndrome A Distinct Phenotype of Post Acute COVID 19 Syndrome In this paper we highlight the presence of tachycardia in post acute COVID 19 syndrome by introducing a new label for this phenomenon post COVID 19 tachycardia syndrome and argue that this constitutes a phenotype or sub syndrome in post acute COVID 19 syndrome We also discuss epidemiology putative mechanisms treatment options and future research directions in this novel clinical syndrome 1 +34 Identification of a Vulnerable Group for Post Acute Sequelae of SARS CoV 2 PASC People with Autoimmune Diseases Recover More Slowly from COVID 19 Evidence is emerging that a significant percentage of COVID 19 cases experience symptom persistence beyond 30 days and go on to develop post acute sequelae Our objective was to compare the risk for COVID 19 symptom persistence by self reported use of medications for autoimmune disease among participants of an on line COVID 19 registry A community based online survey collected weekly data on COVID 19 symptom presentation Participants who completed informed consent online reported a positive COVID 19 test result within 14 days prior to enrollment and also reported demographics underlying illnesses and medication use were included Symptom presence and severity were evaluated weekly after enrollment and compared between participants reporting use of medications for autoimmune conditions and all others Logistic regression was used to evaluate the odds of more severe acute illness and symptom persistence approximately 30 days after enrollment A total of 1 518 COVID 19 positive participants were included Participants reporting use of medications for autoimmune disease n 70 were more likely to have experienced symptoms at all time points over a 30 day time period and were more likely to report more severe presentation of COVID 19 during acute illness adjusted OR 95 CI 1 32 0 76 2 29 compared to those reporting not taking medications for autoimmune disease At about 30 days after enrollment users of medications for autoimmune disease were more than twice as likely to report three or more symptoms adjusted OR 95 CI 2 53 1 21 5 29 In particular their risk of persistent shortness of breath and fatigue was elevated adjusted OR 95 CI 2 66 1 15 6 18 and 4 73 2 17 10 34 respectively Individuals with underlying autoimmune conditions appear to be particularly vulnerable to post acute sequelae from COVID 19 early intervention might be considered 1 +286 Long COVID and COVID 19 associated cystitis CAC There is scarce literature regarding genitourinary symptoms in COVID 19 especially post acute disease otherwise known as Long COVID We identified recovered COVID 19 patients presenting with new or worsening overactive bladder symptoms known as COVID 19 associated cystitis CAC We used the American Urological Association Urology Care Foundation Overactive Bladder OAB Assessment Tool to screen COVID 19 recovered patients presenting with urological complaints at our urban located institution from 5 22 2020 to 12 31 2020 Patients 10 14 weeks post discharge responded to 5 symptom and 4 quality of life QoL questions We reported median symptom scores as well as QoL scores based on new or worsening urinary symptoms and by sex We identified 350 patients with de novo or worsening OAB symptoms 10 14 weeks after hospitalization with COVID 19 The median total OAB symptom score in both men and women was 18 The median total QoL score for both men and women was 19 Patients with worsening OAB symptoms had a median pre COVID 19 symptom score of 8 4 10 compared to post COVID 19 median symptom score of 19 17 21 Median age was 64 5 range 47 82 Median hospital length of stay was 10 days range 5 30 We report survey based results of patients suffering from new or worsening OAB symptoms months after their hospitalization from COVID 19 Future studies with larger sample sizes and more extensive testing will hopefully elucidate the specific pathophysiology of OAB symptoms in the context of long COVID so urologists can timely and appropriately treat their patients 1 +108 Post COVID syndrome a new challenge for medicine The huge concern raised by SARS CoV2 pandemic about public health management and social impact is still under debate particularly because COVID 19 may affect infected people much longer than expected from a typical air borne viral disease The scientific community is actually wondering about the etiopathogenesis and clinical development of this post COVID complex symptomatology very close to symptoms typically observed in chronic fatigue syndrome so recently named as post acute sequelae of COVID 19 PASC This commentary tries to focus on the most recent news about this issue 1 +297 Similarities and differences between multiple inflammatory syndrome in children associated with COVID 19 and Kawasaki disease clinical presentations diagnosis and treatment Severe acute respiratory syndrome coronavirus 2 SARS CoV 2 infection has been spreading rapidly around the world while multisystem inflammatory syndrome in children MIS C is a new type of syndrome that has now been reported in many countries Similar and different characteristics between KD and MIS C have been reported in a variety of literature We aimed to focus on reviewing clinical presentations diagnosis and treatment of KD and MIS C We searched articles in the electronic databases including the Cochrane Library database EMBASE and MEDLINE with the keywords multiple inflammatory syndrome and or COVID 19 and or Kawasaki disease and children Main presentations of MIS C and KD include fever rashes mucous membrane involvement conjunctivitis hands and feet erythema edema and cervical lymphadenopathy However compared with the highest incidence of KD among some Asian countries MIS C is common among Black and Hispanic children MIS C is common in older children and teenagers whereas classic KD is common in children under five years of age Gastrointestinal symptoms shock and coagulopathy are common in MIS C patients but are not common in classic KD Cardiac manifestations are more common than KD including myocarditis with cardiac dysfunction and coronary artery dilation or aneurysms Severe cases in MIS C present with vasodilated or cardiogenic shock that requires fluid resuscitation muscular support and even mechanical ventilation and extracorporeal membrane oxygenation ECMO whereas KD rarely presents with these manifestations and requires these treatments Increased serum ferritin leukopenia lymphopenia and thrombocytopenia are common in MIS C However thrombocytosis is a characteristic feature of KD Intravenous immunoglobulin IVIG and moderate high dose aspirin are still a standard recommended treatment for KD In addition to the above mentioned medications steroids and biological drugs are frequently used in patients with MIS C Most of the children with KD have a good prognosis however the long term clinical outcomes of MIS C are not clear The overall presentation and treatment of MIS C appear to overlap with KD However there are still great differences between the syndromes and it is controversial to say whether MIS C is a new entity or is a severe type of KD 1 +141 Pediatric Inflammatory Multisystem Syndrome Temporally Related With SARS CoV 2 Immunological Similarities With Acute Rheumatic Fever and Toxic Shock Syndrome Several studies demonstrated that COVID 19 in children is a relatively mild disease However recently a more serious condition characterized by systemic inflammation with clinical or microbiological evidence of exposure to SARS CoV 2 has been described This syndrome is now known as either Pediatric Inflammatory Multisystem Syndrome temporally related with COVID 19 PIMS TS 1 or Multisystem Inflammatory Syndrome in Children MIS C 2 and is currently considered a rare post COVID 19 complication which in a minority of cases can lead to death The signs and symptoms of PIMS TS are largely overlapping with the for Kawasaki disease KD and toxic shock syndrome TSS and are characterized by fever systemic inflammation abdominal pain and cardiac involvement In this study we describe clinical and immunological characteristics shared by PIMS TS acute rheumatic fever and TSS in order to provide hypotheses to direct future clinical and basic research studies 1 +15 How and why patients made Long Covid Patients collectively made Long Covid and cognate term Long haul Covid in the first months of the pandemic Patients many with initially mild illness used various kinds of evidence and advocacy to demonstrate a longer more complex course of illness than laid out in initial reports from Wuhan Long Covid has a strong claim to be the first illness created through patients finding one another on Twitter it moved from patients through various media to formal clinical and policy channels in just a few months This initial mapping of Long Covid by two patients with this illness focuses on actors in the UK and USA and demonstrates how patients marshalled epistemic authority Patient knowledge needs to be incorporated into how COVID 19 is conceptualised researched and treated 1 +230 Recognition of Long COVID 19 Patients in a Canadian Tertiary Hospital Setting A Retrospective Analysis of Their Clinical and Laboratory Characteristics A proportion of patients with COVID 19 have symptoms past the acute disease phase which may affect quality of life It is important for clinicians to be aware of this long COVID 19 syndrome to better diagnose treat and prevent it We reviewed clinical and laboratory characteristics of a COVID 19 cohort in a Toronto Ontario tertiary care center Demographic clinical and laboratory data were collected and patients were classified as long COVID 19 or non long COVID 19 using consensus criteria Of 397 patients who tested positive for COVID 19 223 met inclusion criteria and 62 27 had long COVID 19 These patients had a similar age distribution compared to non long COVID 19 patients overall but were younger in the admitted long COVID 19 group The long COVID 19 group had more inpatients compared to the non long COVID 19 group 39 vs 25 and more frequent supplemental oxygen or mechanical ventilation use However long COVID 19 patients did not differ by duration of mechanical ventilation length of stay comorbidities or values of common laboratory tests ordered The most frequent symptoms associated with long COVID 19 were fatigue and weakness as reported most commonly by the infectious disease respirology and cardiology disciplines In conclusion by retrospective chart review 27 of COVID 19 patients presenting to a tertiary care center in Toronto Canada were found to meet criteria for long COVID 19 Past medical history and routine laboratory testing at presentation did not predict for long COVID 19 development 1 +50 Implications of Innate Immunity in Post Acute Sequelae of Non Persistent Viral Infections Non persistent viruses classically cause transient acute infections triggering immune responses aimed at the elimination of the pathogen Successful viruses evolved strategies to manipulate and evade these anti viral defenses Symptoms during the acute phase are often linked to dysregulated immune responses that disappear once the patient recovers In some patients however symptoms persist or new symptoms emerge beyond the acute phase Conditions resulting from previous transient infection are termed post acute sequelae PAS and were reported for a wide range of non persistent viruses such as rota influenza or polioviruses Here we provide an overview of non persistent viral pathogens reported to be associated with diverse PAS among them chronic fatigue auto immune disorders or neurological complications and highlight known mechanistic details Recently the emergence of post acute sequelae of COVID 19 PASC or long COVID highlighted the impact of PAS Notably PAS of non persistent infections often resemble symptoms of persistent viral infections defined by chronic inflammation Inflammation maintained after the acute phase may be a key driver of PAS of non persistent viruses Therefore we explore current insights into aberrant activation of innate immune signaling pathways in the post acute phase of non persistent viruses Finally conclusions are drawn and future perspectives for treatment and prevention of PAS are discussed 1 +21 Post COVID 19 rehabilitation a special look at chronic kidney disease patients Severe acute respiratory syndrome coronavirus 2 SARS CoV 2 can infect the kidney and the presence of chronic kidney disease CKD constitutes a higher risk of negative prognosis SARS CoV 2 main sequelae in CKD patients are an incomplete recovery of kidney function muscle weakness and atrophy breathiness tiredness pulmonary fibrosis and initiation of kidney replacement therapy The overall aim of this review is to provide a theoretical basis for early improvements of physical function health to all CKD stages by rehabilitation therapies Chronic kidney disease patients infected with SARS CoV 2 should be monitored by rehabilitation professionals as the cardiopulmonary musculoskeletal and cognitive systems might be deteriorated Long term consequences of SARS CoV 2 are unknown and preventive rehabilitation may attenuate them 1 +18 Clinical characterization of dysautonomia in long COVID 19 patients Increasing numbers of COVID 19 patients continue to experience symptoms months after recovering from mild cases of COVID 19 Amongst these symptoms several are related to neurological manifestations including fatigue anosmia hypogeusia headaches and hypoxia However the involvement of the autonomic nervous system expressed by a dysautonomia which can aggregate all these neurological symptoms has not been prominently reported Here we hypothesize that dysautonomia could occur in secondary COVID 19 infection also referred to as long COVID infection 39 participants were included from December 2020 to January 2021 for assessment by the Department of physical medicine to enhance their physical capabilities 12 participants with COVID 19 diagnosis and fatigue 15 participants with COVID 19 diagnosis without fatigue and 12 control participants without COVID 19 diagnosis and without fatigue Heart rate variability HRV during a change in position is commonly measured to diagnose autonomic dysregulation In this cohort to reflect HRV parasympathetic sympathetic balance was estimated using the NOL index a multiparameter artificial intelligence driven index calculated from extracted physiological signals by the PMD 200 pain monitoring system Repeated measures mixed models testing group effect were performed to analyze NOL index changes over time between groups A significant NOL index dissociation over time between long COVID 19 participants with fatigue and control participants was observed p 0 046 A trend towards significant NOL index dissociation over time was observed between long COVID 19 participants without fatigue and control participants p 0 109 No difference over time was observed between the two groups of long COVID 19 participants p 0 904 Long COVID 19 participants with fatigue may exhibit a dysautonomia characterized by dysregulation of the HRV that is reflected by the NOL index measurements compared to control participants Dysautonomia may explain the persistent symptoms observed in long COVID 19 patients such as fatigue and hypoxia Trial registration The study was approved by the Foch IRB IRB00012437 Approval Number 20 12 02 on December 16 2020 1 +87 Mid term Psychiatric Outcomes of Patients Recovered From COVID 19 From an Italian Cohort of Hospitalized Patients b Background b Although the usual primary clinical manifestation of Coronavirus disease COVID 19 is respiratory several non respiratory symptoms have been described including neuropsychiatric ones The aim of this study was to investigate the mid term mental health outcomes in patients recovered from COVID 19 3 4 months after discharge from the University Hospital Maggiore della Carità Novara Italy Furthermore we investigated the possible association of the mid term mental health consequences of the COVID 19 infection with patients clinical current status persistent physical impairment and severity of acute phase of the disease b Methods b Prospective study involving 238 individuals recovered from COVID 19 In the context of a multi disciplinary approach patients assessment included both a clinical interview performed by an experienced psychiatrist trained in the use of the Mini International Neuropsychiatric Interview to assess the presence of anxiety and depressive symptoms and self administered questionnaires Beck Anxiety Inventory BAI Beck Depression Inventory II BDI II Resilience Scale for Adults RSA Impact of Event Scale IES b Results b At the psychiatric assessment 32 9 and 29 5 of participants showed anxiety and depressive symptoms respectively Changes in appetite and sleep patterns emerged for 15 6 and 31 2 of patients According to the self administered questionnaires 7 1 of participants had moderate severe anxiety levels BAI while 10 5 had mild to severe depression BDI II Twenty six 11 participants were referred to further psychiatric consultation Psychiatric symptoms showed no correlation with acute COVID 19 severity in our sample patients with depressive symptoms at the clinical interview as well as those with mild to severe levels of depression according to BDI II scores had lower forced expiratory volume in the 1st second FEV1 values than those without and greater odds for persistent poor tolerance for physical efforts b Conclusions b As could be expected an approach including both a psychiatric interview and the use of self administered questionnaires is likely to capture the psychiatric outcome of patients recovered from COVID 19 better than questionnaires alone Anxiety and depressive symptoms at follow up had no correlation with the severity of COVID acute manifestations but rather with ongoing and persistent physical symptoms Further studies and longer follow up duration will allow a better understanding of the complex relationship between residual physical symptoms quality of life and psychological health 1 +363 Health Related Physical Fitness and Activity in Homeschool A Systematic Review With Implications for Return to Public School The purpose of this systematic review is to summarize what is known about health related physical fitness cardiovascular endurance muscular strength and endurance flexibility and body composition and physical activity among homeschool youth Findings from this study have implications for all American youth as they return to public school from mandated schooling at home during the COVID 19 pandemic Database engines identified over 22 000 articles with 82 abstracts screened for further review Of these 18 full text articles were additionally screened with 10 cross sectional articles included in the final review Articles were condensed into a standard review template and findings were summarized by topic Cardiovascular endurance findings were inconsistent Abdominal but not upper body muscular strength and endurance were significantly lower in homeschool students There were no reports on flexibility Body composition was generally healthy in homeschool students and no differences in physical activity were seen Research on health related physical fitness in homeschool youth is limited and descriptive Further testing and potential remediation may be needed for cardiovascular endurance muscular strength and endurance and flexibility in homeschool youth and their public school counterparts as they return to campus However existing literature supports healthy body composition and physical activity in this population 0 +636 Effect of Covid 19 pandemic on tourist travel risk and management perceptions This study aims to explore the impact of the Covid 19 pandemic on tourists travel risk and management perceptions Driven on the effect of the pandemic we investigate tourists travel risk and management perceptions and its effect on society using a sample of 716 respondents The data was collected through social media platforms using a representative sampling method and analyzed applying the PLS SEM tool The findings reveal that Covid 19 pandemic has greatly affected travel risk and management perceptions Travel risk and management perception had a significant association with risk management service delivery transportation patterns distribution channels avoidance of overpopulated destinations and hygiene and safety The results also identified the mediating effect of travel risk and management perceptions The finding of this study contributes to tourism crises and provides future research insights in the travel and tourism sector and response to change tourists travel risk and management perceptions in the post covid recovery period 0 +546 Prevalence of Mental Health Problems During Virus Epidemics in the General Public Health Care Workers and Survivors A Rapid Review of the Evidence b Background b The swift spread of SARS CoV 2 provides a challenge worldwide As a consequence of restrictive public health measures like isolation quarantine and community containment the provision of mental health services is a major challenge Evidence from past virus epidemics and the current SARS CoV 2 outbreak indicate high prevalence rates of mental health problems MHP as short and long term consequences However a broader picture of MHP among different populations is still lacking b Methods b We conducted a rapid review on MHP prevalence rates published since 2000 during and after epidemics including the general public health care workers and survivors Any quantitative articles reporting on MHP rates were included Out of 2 855 articles screened a total of 74 were included in this review b Results b Most original studies on MHP were conducted in China in the context of SARS CoV 1 and reported on anxiety depression post traumatic stress symptoms disorder general psychiatric morbidity and psychological symptoms The MHP rates across studies populations and epidemics vary substantially While some studies show high and persistent rates of MHP in populations directly affected by isolation quarantine threat of infection infection or life threatening symptoms e g health care workers other studies report minor effects Furthermore even less affected populations e g distant to epidemic epicenter no contact history with suspected or confirmed cases can show high rates of MHP b Discussion b MHP vary largely across countries and risk groups in reviewed studies The results call attention to potentially high MHP during epidemics Individuals affected directly by an epidemic might be at a higher risk of short or even long term mental health impairments This study delivers insights stemming from a wide range of psychiatric instruments and questionnaires The results call for the use of validated and standardized instruments reference norms and pre post measurements to better understand the magnitude of the MHP during and after the epidemics Nevertheless emerging MHP should be considered during epidemics including the provision of access to mental health care to mitigate potential mental impairments 0 +579 Telehealth and Autism Prior to and in the Age of COVID 19 A Systematic and Critical Review of the Last Decade There has been growing interest in the use of telehealth however the COVID 19 pandemic and the subsequent isolation and restrictions placed on in person services have fast tracked implementation needs for these services Individuals with autism spectrum disorder ASD have been particularly affected due to the often intensive service needs required by this population As a result the aim of this review was to examine the evidence base methodology and outcomes of studies that have used telehealth for assessment and or intervention with children and adolescents with ASD as well as their families over the last decade Further the goal is to highlight the advances in telehealth and its use with this special population A systematic search of the literature was undertaken with 55 studies meeting inclusion criteria and quality analysis Specified details were extracted from each article including participant characteristics technology measures methodology study design and clinical and implementation outcomes Services provided via telehealth included diagnostic assessments preference assessments early intervention applied behavior analysis ABA functional assessment and functional communication training and parent training Findings although still emerging encouragingly suggested that services via telehealth were equivalent or better to services face to face Results support the benefits to using telehealth with individuals with ASD Future research should continue to explore the feasibility of both assessments and interventions via telehealth with those having ASD to make access to assessment services and interventions more feasible for families while acknowledging the digital divide it could create 0 +225 Infectivity of human coronavirus in the brain A new strain of human coronaviruses hCoVs Severe Acute Respiratory Syndrome Coronavirus 2 SARS CoV 2 has been identified to be responsible for the current outbreak of the coronavirus disease 2019 COVID 19 Though major symptoms are primarily generated from the respiratory system neurological symptoms are being reported in some of the confirmed cases raising concerns of its potential for intracranial invasion and neurological manifestations both in the acute phase and in the long term At present it remains unclear the extent to which SARS CoV 2 is present in the brain and if so its pathogenic role in the central nervous system CNS Evidence for neuroinvasion and neurovirulence of hCoVs has been recognised in animal and human studies Given that SARS CoV 2 belongs to the same family and shares characteristics in terms of receptor binding properties it is worthwhile exploring its potential CNS manifestations This review summarises previous findings from hCoVs in relation to the CNS and compares these with the new strain aiming to provide a better understanding of the effects of SARS CoV 2 on the CNS 1 +645 Coronavirus Disease 2019 Infection among Children Pathogenesis Treatment and Outcome Coronavirus disease 2019 COVID 19 is a contagious disease that may lead to respiratory distress syndrome and even death Neonates and children are most vulnerable population to COVID 19 infection however the infection is usually milder and has a better prognosis in pediatric patients compared with adults It remains unclear why pediatric population is less symptomatic than adults Children frequently experience respiratory infections and their immune system is in developing stage However large proportion of the asymptomatic pediatric population may contribute to transmission This review explored several aspects of COVID 19 infection such as its epidemiology its molecular pathogenesis with respect to angiotensin converting enzyme 2 receptor and inflammatory mediators intrauterine vertical transmission imaging findings and complications like cytokine release syndrome multisystem inflammatory syndrome in children We also looked at prognostic factors and treatment modalities like corticosteroids RNA replicate inhibitors protease inhibitors Bruton tyrosine kinase inhibitor that is acalabrutinib and convalescent plasma therapy Since there is no strong evidence for the intrauterine transmission early isolation should be performed to protect a neonate from a COVID 19 infected mother Development of vaccine and an effective antiviral drug are the need of the hour 0 +530 Persistent behavioral and neurobiological consequences of social isolation during adolescence Meaningful social interactions are a fundamental human need the lack of which can pose serious risks to an individuals physical and mental health Across species peer oriented social behaviors are dramatically reshaped during adolescence a developmental period characterized by dynamic changes in brain structure and function as individuals transition into adulthood Thus the experience of social isolation during this critical developmental stage may be especially pernicious as it could permanently derail typical neurobiological processes that are necessary for establishing adaptive adult behaviors The purpose of this review is to summarize investigations in which rodents were isolated during adolescence then re housed in typical social groups prior to testing thus allowing the investigators to resolve the long term consequences of social adversity experienced during adolescent sensitive periods despite subsequent normalization of the social environment Here we discuss alterations in social anxiety like cognitive and decision making behaviors in previously isolated adult rodents We then explore corresponding neurobiological findings focusing on the prefrontal cortex including changes in synaptic densities and protein levels white matter and oligodendrocyte function and neuronal physiology Made more urgent by the recent wave of social deprivation resulting from the COVID 19 pandemic especially amongst school aged adolescents understanding the mechanisms by which even transient social adversity can negatively impact brain function across the lifespan is of paramount importance 0 +332 Post COVID 19 Syndrome and the Potential Benefits of Exercise The coronavirus disease COVID 19 caused by severe acute respiratory syndrome coronavirus 2 SARS CoV 2 infection is leading to unknown and unusual health conditions that are challenging to manage Post COVID 19 syndrome is one of those challenges having become increasingly common as the pandemic evolves The latest estimates suggest that 10 to 20 of the SARS CoV 2 patients who undergo an acute symptomatic phase are experiencing effects of the disease beyond 12 weeks after diagnosis Although research is beginning to examine this new condition there are still serious concerns about the diagnostic identification which limits the best therapeutic approach Exercise programs and physical activity levels are well known modulators of the clinical manifestations and prognosis in many chronic diseases This narrative review summarizes the up to date evidence on post COVID 19 syndrome to contribute to a better knowledge of the disease and explains how regular exercise may improve many of these symptoms and could reduce the long term effects of COVID 19 1 +23 COVID 19 New challenges in dysphagia and respiratory therapy Coronavirus disease 2019 COVID 19 can lead to severe disease courses with multiple organ involvement respiratory and neurological functional impairments Swallowing disorders dysphagia in this patient group can result from primary damage to the central and peripheral neuronal swallowing network but also from the frequently prolonged intensive care treatment and mechanical ventilation Clinical observations indicate persistence of dysphagia in post acute COVID 19 syndrome long COVID so that these patients probably also need long term interventions for rehabilitation of safe and sufficient oral feeding Therefore structured disease specific monitoring of dysphagia symptoms should be integrated into the treatment of COVID 19 patients and respiratory therapy should be an essential part of dysphagia management to re establish cough effectiveness and breathing swallowing coordination Challenges arise from necessary adjustments to established treatment standards to prevent infections Furthermore the selection and intensity of therapeutic measures have to be adapted to the capacities and the specific pathophysiology of COVID 19 and long COVID patients to prevent further functional deterioration 1 +53 Neuro COVID long haulers exhibit broad dysfunction in T cell memory generation and responses to vaccination The high prevalence of post acute sequelae of SARS CoV 2 infection PASC is a significant health concern In particular virus specific immunity in patients who suffer from chronic neurologic symptoms after mild acute COVID remain poorly understood Here we report that neuro PASC patients have a specific signature composed of humoral and cellular immune responses that are biased towards different structural proteins compared to healthy COVID convalescents Interestingly the severity of cognitive deficits or quality of life markers in neuro PASC patients are associated with reduced effector molecule expressionn in memory T cells Furthermore we demonstrate that T cell responses to SARS CoV 2 mRNA vaccines are aberrantly elevated in longitudinally sampled neuro PASC patients compared with healthy COVID convalescents These data provide a framework for the rational design of diagnostics and predictive biomarkers for long COVID disease as well as a blueprint for improved therapeutics 1 +386 Problems of Pathogenesis and Pathogenetic Therapy of COVID 19 from the Perspective of the General Theory of Pathological Systems General Pathological Processes The COVID 19 pandemic examines not only the state of actual health care but also the state of fundamental medicine in various countries Pro inflammatory processes extend far beyond the classical concepts of inflammation They manifest themselves in a variety of ways beginning with extreme physiology then allostasis at low grade inflammation and finally the shockogenic phenomenon of inflammatory systemic microcirculation The pathogenetic core of critical situations including COVID 19 is this phenomenon Microcirculatory abnormalities on the other hand lie at the heart of a specific type of general pathological process known as systemic inflammation SI Systemic inflammatory response cytokine release cytokine storm and thrombo inflammatory syndrome are all terms that refer to different aspects of SI As a result the metabolic syndrome model does not adequately reflect the pathophysiology of persistent low grade systemic inflammation ChSLGI Diseases associated with ChSLGI on the other hand are risk factors for a severe COVID 19 course The review examines the role of hypoxia metabolic dysfunction scavenger receptors and pattern recognition receptors as well as the processes of the hemophagocytic syndrome in the systemic alteration and development of SI in COVID 19 0 +503 SARS CoV 2 and pathological matrix remodeling mediators Recognizing only sharp elevation in a short period of time the COVID 19 SARS CoV 2 propagation is more and more marked in the whole world Induced inflammation afterwards infection engenders a high infiltration of immune cells and cytokines that triggers matrix metalloproteinases MMPs activation These endopeptidases are mediators of the lung extracellular matrix ECM a basic element for alveoli structure and gas exchange When immune cells MMPs secreted cytokines and several other mediators are gathered a pathological matrix remodeling occurs This phenomenon tends to tissue destruction in the first place and a pulmonary hypertrophy and fibrosis in the second place After pathological matrix remodeling establishment pathological diseases take place even after infection state Since post COVID 19 pulmonary fibrosis is an emerging complication of the disease there is an urge to better understand and characterize the implication of ECM remodeling during SARS CoV 2 infection Targeting MMPs and their inhibitors could be a probable solution for occurred events since there are many cured patients that remain with severe sequels even after the end of infection 0 +594 SARS CoV 2 Infection in the Immunodeficient Host Necessary and Dispensable Immune Pathways Since its outbreak in late December 2019 in Wuhan coronavirus disease 2019 pandemic has posed a therapeutic challenge for the world population with a plenty of clinical pictures and a broad spectrum of severity of the manifestations In spite of initial speculations on a direct role of primary or acquired immune deficiency in determining a worse disease outcome recent studies have provided evidence that specific immune defects may either serve as an experimentum naturae entailing this risk or may not be relevant enough to impact the host defense against the virus Taken together these observations may help unveil pathogenetic mechanisms of the infection and suggest new therapeutic strategies Thus in this review we summarize current knowledge regarding the mechanisms of immune response against severe acute respiratory syndrome coronavirus 2 infection and clinical manifestations with a special focus on children and patients presenting with congenital or acquired immune deficiency 0 +241 Burden of post COVID 19 syndrome and implications for healthcare service planning A population based cohort study Longer term consequences after SARS CoV 2 infection are becoming an important burden to societies and healthcare systems Data on post COVID 19 syndrome in the general population are required for the timely planning of healthcare services and resources The objective of this study was to assess the prevalence of impaired health status and physical and mental health symptoms among individuals at least six months after SARS CoV 2 infection and to characterize their healthcare utilization This population based prospective cohort study Zurich SARS CoV 2 Cohort enrolled 431 adults from the general population with polymerase chain reaction confirmed SARS CoV 2 infection reported to health authorities between 27 February 2020 and 05 August 2020 in the Canton of Zurich Switzerland We evaluated the proportion of individuals reporting not to have fully recovered since SARS CoV 2 infection and the proportion reporting fatigue Fatigue Assessment Scale dyspnea mMRC dyspnea scale or depression DASS 21 at six to eight months after diagnosis Furthermore the proportion of individuals with at least one healthcare contact after their acute illness was evaluated Multivariable logistic regression models were used to assess factors associated with these main outcomes Symptoms were present in 385 89 participants at diagnosis and 81 19 were initially hospitalized At six to eight months 111 26 reported not having fully recovered 233 55 participants reported symptoms of fatigue 96 25 had at least grade 1 dyspnea and 111 26 had DASS 21 scores indicating symptoms of depression 170 40 participants reported at least one general practitioner visit related to COVID 19 after acute illness and 10 8 81 of initially hospitalized individuals were rehospitalized Individuals that have not fully recovered or suffer from fatigue dyspnea or depression were more likely to have further healthcare contacts However a third of individuals 37 111 that have not fully recovered did not seek further care In this population based study a relevant proportion of participants suffered from longer term consequences after SARS CoV 2 infection With millions infected across the world our findings emphasize the need for the timely planning of resources and patient centered services for post COVID 19 care 1 +686 Pulmonary Embolism in Patients with COVID 19 Comparison between Different Care Settings The clinical characteristics and outcomes of patients with coronavirus disease 2019 COVID 19 who develop pulmonary embolism PE in the full spectrum of patient care settings need to be elucidated The aim of this study was to compare the clinical characteristics treatment and 90 day outcomes in patients diagnosed with PE while recovering from COVID 19 in the outpatient setting versus those who were diagnosed with PE while being hospitalized with COVID 19 Data from the international Registro Informatizado de Enfermedad TromboEmbólica RIETE registry were used The major study outcomes were all cause death major bleeding and venous thromboembolism VTE recurrences during the first 90 days after PE From March 2020 to March 2021 737 patients with COVID 19 experienced acute PE Of these 340 46 were recovering from COVID 19 as outpatients 267 patients who had been treated at home for COVID 19 and 73 discharged after being hospitalized with COVID 19 Compared with inpatients with COVID 19 those recovering in the outpatient setting upon PE were less likely to be men odds ratio OR 0 54 95 confidence interval CI 0 40 0 72 and less likely to have hypertension OR 0 55 95 CI 0 41 0 74 or diabetes OR 0 51 95 CI 0 33 0 76 At 90 day follow up eight patients none recovering from COVID 19 as outpatient vs 2 4 of inpatients with COVID 19 developed recurrent VTE 34 1 9 vs 7 9 had major bleeding and 128 10 vs 24 died On multivariable analysis inpatients with COVID 19 were at a higher risk of major bleeding adjusted hazard ratio HR 6 80 95 CI 1 52 30 4 or death adjusted HR 2 24 95 CI 1 40 3 58 In conclusion using a large multinational registry of patients with COVID 19 who experienced PE thromboembolic episodes occurring in those recovering from COVID 19 as outpatients were associated with less ominous outcomes than inpatients with COVID 19 0 +358 Oral and Maxillofacial Minor Surgery Practice Post COVID 2019 Pandemic An Insight COVID 19 a worldwide pandemic has given an awakening and introspective moment for all surgeons involved with aerosol generating procedures We ought to modify our practices to learn to live with it if we wish to prevail over it This article outlines similar small changes that can be done in our minor maxillofacial surgery practice to safeguard both patients and healthcare workers 0 +627 Prevalence of mental health problems among children and adolescents during the COVID 19 pandemic A systematic review and meta analysis This systematic review and meta analysis examined the prevalence of depression anxiety sleep disorders and posttraumatic stress symptoms among children and adolescents during global COVID 19 pandemic in 2019 to 2020 and the potential modifying effects of age and gender A literature search was conducted in PubMed Web of Science PsycINFO and two Chinese academic databases China National Knowledge Infrastructure and Wanfang for studies published from December 2019 to September 2020 that reported the prevalence of above mental health problems among children and adolescents Random effects meta analyses were used to estimate the pooled prevalence Twenty three studies 21 cross sectional studies and 2 longitudinal studies from two countries i e China and Turkey with 57 927 children and adolescents were identified Depression anxiety sleep disorders and posttraumatic stress symptoms were assessed in 12 13 2 and 2 studies respectively Meta analysis of results from these studies showed that the pooled prevalence of depression anxiety sleep disorders and posttraumatic stress symptoms were 29 95 CI 17 40 26 95 CI 16 35 44 95 CI 21 68 and 48 95 CI 0 25 1 21 respectively The subgroup meta analysis revealed that adolescents and females exhibited higher prevalence of depression and anxiety compared to children and males respectively All studies in meta analysis were from China limited the generalizability of our findings Early evidence highlights the high prevalence of mental health problems among children and adolescents during the COVID 19 pandemic especially among female and adolescents Studies investigating the mental health of children and adolescents from countries other than China are urgently needed 0 +561 Facing the COVID 19 pandemic inside maternities in Brazil A mixed method study within the REBRACO initiative COVID 19 pandemic posed major challenges in obstetric health care services Preparedness development and implementation of new protocols were part of the needed response This study aims to describe the strategies implemented and the perspectives of health managers on the challenges to face the pandemic in 16 different maternity hospitals that comprise a multicenter study in Brazil called REBRACO Brazilian network of COVID 19 during pregnancy Mixed method study with quantitative and qualitative approaches Quantitative data on the infrastructure of the units maternal and perinatal health indicators modifications on staff and human resources from January to July 2020 Also information on total number of cases and availability for COVID 19 testing A qualitative study by purposeful and saturation sampling was undertaken with healthcare managers to understand perspectives on local challenges in facing the pandemic Most maternities early implemented their contingency plan REBRACO centers reported 338 confirmed COVID 19 cases among pregnant and post partum women up to July 2020 There were 29 maternal deaths and 15 51 8 attributed to COVID 19 All maternities performed relocation of beds designated to labor ward most 75 acquired mechanical ventilators only the minority 25 installed new negative air pressure rooms Considering human resources around 40 hired extra health professionals and increased weekly workload and the majority 68 7 also suspended annual leaves Only one center implemented universal screening for childbirth and 6 37 5 implemented COVID 19 testing for all suspected cases while around 60 of the centers only tested moderate severe cases with hospital admission Qualitative results showed that main challenges experienced were related to the fear of the virus concerns about reliability of evidence and lack of resources with a clear need for mental health support among health professionals Study findings suggest that maternities of the REBRACO initiative underwent major changes in facing the pandemic with limitations on testing difficulties in infrastructure and human resources Leadership continuous training implementation of evidence based protocols and collaborative initiatives are key to transpose the fear of the virus and ascertain adequate healthcare inside maternities especially in low and middle income settings Policy makers need to address the specificities in considering reproductive health and childbirth during the COVID 19 pandemic and prioritize research and timely testing availability 0 +584 Persistent Detection and Infectious Potential of SARS CoV 2 Virus in Clinical Specimens from COVID 19 Patients The Severe Acute Respiratory Syndrome Coronavirus SARS CoV 2 that emerged in December 2019 as the causative agent of Coronavirus 2019 COVID 19 and was declared a pandemic by the World Health Organization in March 2020 has several distinctive features including extensive multiorgan involvement with a robust systemic inflammatory response significant associated morbidity and mortality and prolonged persistence of viral RNA in the clinical specimens of infected individuals as detected by Reverse Transcription Polymerase Chain Reaction RT PCR amplification This review begins with an overview of SARS CoV 2 morphology and replication and summarizes what is known to date about the detection of the virus in nasal oropharyngeal and fecal specimens of patients who have recovered from COVID 19 with a focus on the factors thought to contribute to prolonged detection This review also provides a discussion on the infective potential of this material from asymptomatic pre symptomatic and convalescing individuals to include a discussion of the relative persistence and infectious potential of virus in clinical specimens recovered from pediatric COVID 19 patients 0 +95 Feasibility of Vitamin C in the Treatment of Post Viral Fatigue with Focus on Long COVID Based on a Systematic Review of IV Vitamin C on Fatigue Fatigue is common not only in cancer patients but also after viral and other infections Effective treatment options are still very rare Therefore the present knowledge on the pathophysiology of fatigue and the potential positive impact of treatment with vitamin C is illustrated Additionally the effectiveness of high dose IV vitamin C in fatigue resulting from various diseases was assessed by a systematic literature review in order to assess the feasibility of vitamin C in post viral especially in long COVID fatigue Nine clinical studies with 720 participants were identified Three of the four controlled trials observed a significant decrease in fatigue scores in the vitamin C group compared to the control group Four of the five observational or before and after studies observed a significant reduction in pre post levels of fatigue Attendant symptoms of fatigue such as sleep disturbances lack of concentration depression and pain were also frequently alleviated Oxidative stress inflammation and circulatory disorders which are important contributors to fatigue are also discussed in long COVID fatigue Thus the antioxidant anti inflammatory endothelial restoring and immunomodulatory effects of high dose IV vitamin C might be a suitable treatment option 1 +391 COVID 19 in the light of current clinical eye research COVID 19 is a disease caused by a SARS CoV 2 virus infection first reported in Wuhan city Chinese province of Hubei in December 2019 Previously known as 2019 Novel Coronavirus 2019 nCoV respiratory disease COVID 19 was declared official name by the World Health Organization WHO as COVID 19 in February 2020 By July 2nd 2020 10 818 005 confirmed cases with 519 467 COVID 19 deaths worldwide The aim of this review article is to inform the audience of what is available in the current literature on how COVID 19 affects the eyes in adults children and elderly PubMed search was used between December 2019 and July 2nd 2020 Randomized trials observational studies case series or case reports and letters of research letters to editors were selected for confirmed cases of COVID 19 According to current scientific literature since the outbreak in December 2019 there have been 218 papers written Conjunctivitis and keratoconjunctvitis have been reported in adults with COVID 19 Further studies are needed in children and geriatric patients 0 +4 Post acute COVID 19 syndrome Összefoglaló A posztakut COVID 19 szindróma PACS az akut betegséget követő 4 12 hét szubakut tünetes szakasznak valamint az ezt követő krónikus poszt COVID időszaknak az együttesét jelenti A PACS különböző általános tünetekkel és szervi pulmonalis cardiovascularis neuropszichiátriai endokrin mozgásszervi bőrgyógyászati renalis manifesztációkkal jár Ebben az összefoglalóban áttekintjük a PACS kialakulásához vezető patogenetikai és rizikótényezőket Bemutatjuk a klinikumot és a diagnosztikát A PACS ellátása alapvetően háziorvosi feladat mely a szervi tünetek gyógyszeres és nem gyógyszeres kezeléséből multidiszciplináris rehabilitációból és gondozásból áll Kitérünk a háziorvos feladataira a szakellátásba történő beutalás indokaira és a poszt COVID hálózat létrehozásának és működtetésének szükségességére is Orv Hetil 2021 162 27 1067 1078 Summary Post acute COVID 19 syndrome PACS includes the subacute symptomatic phase 4 12 weeks after acute COVID 19 as well as the subsequent chronic post COVID 19 period PACS is associated with various general symptoms and organ pulmonary cardiovascular neuropsychiatric endocrine musculoskeletal dermatological renal manifestations In this summary we review the pathogenetic and risk factors leading to the development of PACS We present the clinical picture and diagnostics PACS should usually be managed by the general practitioner The management of PACS includes pharmacological and non pharmacological treatment multidisciplinary rehabilitation and regular follow ups Here we also discuss the tasks of the general practitioner the reasons for referral to specialists and the need to set up and operate a post COVID 19 network Orv Hetil 2021 162 27 1067 1078 1 +277 Rehabilitation of patients post COVID 19 infection a literature review Rehabilitation is important for patients with coronavirus disease 2019 COVID 19 infection Given the lack of guidelines in English on the rehabilitation of these patients we conducted a review of the most recent reports We performed this literature review using the principal research databases and included randomized trials recommendations quasi randomized or prospective controlled clinical trials reports guidelines field updates and letters to the editor We identified 107 studies in the database search among which 85 were excluded after screening the full text or abstract In total 22 studies were finally included The complexity of the clinical setting and the speed of spread of the severe acute respiratory syndrome coronavirus 2 which leads to rapid occupation of beds in the intensive care unit make it necessary to discharge patients with COVID 19 who have mild symptoms as soon as possible For these reasons it is necessary to formulate rehabilitation programs for these patients to help them restore physical and respiratory function and to reduce anxiety and depression particularly patients with comorbidities and those who live alone or in rural settings to restore a good quality of life 1 +449 Stethoscope hygiene A legal consideration for cardiologists practicing in a new era of infection control COVID 19 The stethoscope is a tool cherished by the field of cardiology and ubiquitous throughout medicine However little consideration has been given to its safe usage regarding its potential for pathogenic contamination despite thorough evidence that stethoscopes can harbor pathogens that can be transmitted to patients upon contact The COVID 19 SARS COV 2 pandemic has led to increased infection control vigilance including toward the stethoscope as evidenced by a recent increase in literature highlighting stethoscope hygiene contamination A consequence of this increase in awareness is that stethoscopes may be implicated in medical malpractice lawsuits as a potential cause of healthcare associated infections HAIs While there is limited evidence demonstrating a direct connection between stethoscope contamination and HAIs malpractice lawsuits often do not require direct causative evidence Regardless efforts should be made to bolster stethoscope hygiene to not only mitigate patient harm but also prevent providers from potential medical legal conflicts The continued relevance and utility of the stethoscope as a rapid cost effective diagnostic tool needs to be appropriately balanced with increased hygiene performance Providers should anticipate increased scientific evidence and patient awareness regarding stethoscope contamination in the post COVID 19 era 0 +239 Lung Ultrasound in COVID 19 and Post COVID 19 Patients an Evidence Based Approach Worldwide lung ultrasound LUS was utilized to assess coronavirus disease 2019 COVID 19 patients Often imaging protocols were however defined arbitrarily and not following an evidence based approach Moreover extensive studies on LUS in post COVID 19 patients are currently lacking This study analyses the impact of different LUS imaging protocols on the evaluation of COVID 19 and post COVID 19 LUS data LUS data from 220 patients were collected 100 COVID 19 positive and 120 post COVID 19 A validated and standardized imaging protocol based on 14 scanning areas and a 4 level scoring system was implemented We utilized this dataset to compare the capability of 5 imaging protocols respectively based on 4 8 10 12 and 14 scanning areas to intercept the most important LUS findings This to evaluate the optimal trade off between a time efficient imaging protocol and an accurate LUS examination We also performed a longitudinal study aimed at investigating how to eventually simplify the protocol during follow up Additionally we present results on the agreement between AI models and LUS experts with respect to LUS data evaluation A 12 areas protocol emerges as the optimal trade off for both COVID 19 and post COVID 19 patients For what concerns follow up studies it appears not to be possible to reduce the number of scanning areas Finally COVID 19 and post COVID 19 LUS data seem to show differences capable to confuse AI models that were not trained on post COVID 19 data supporting the hypothesis of the existence of LUS patterns specific to post COVID 19 patients A 12 areas acquisition protocol is recommended for both COVID 19 and post COVID 19 patients also during follow up 1 +368 Immune mediating molecules and pathogenesis of COVID 19 associated neurological disease Long period of SARS CoV 2 infection has been associated with psychiatric and cognitive disorders in adolescents and children SARS CoV 2 remains dormant in the CNS leading to neurological complications The wide expression of ACE2 in the brain raises concern for its involvement in SARS CoV 2 infection Though the mechanistic insights about blood brain barriers BBB crossing by SARS CoV 2 and further brain infection are still not clear Moreover the mechanism behind dormant SARS CoV 2 infections leading to chronic neurological disorders needs to be unveiled There is an urgent need to find out the risk factor involved in COVID 19 associated neurological disease Therefore the role of immune associated genes in the pathogenesis of COVID 19 associated neurological diseases is presented which could contribute to finding associated genetic risk factors The search utilizing multiple databases specifically EMBASE PubMed Medline and Google Scholar was performed Moreover the literature survey on the involvement of COVID 19 neuropathogenesis and its consequences was done Persistent inflammatory stimuli may promote the progression of neurodegenerative diseases An increased expression level of cytokine chemokine and decreased expression level of immune cells has been associated with the COVID 19 patient Cytokine storm was observed in severe COVID 19 patients The nature of SARS CoV 2 infection can be neuroinflammatory Genes of immune response could be associated with neurodegenerative diseases The present review will provide a useful framework and help in understanding COVID 19 associated neuropathogenesis Experimental studies on immune associated genes in COVID 19 patients with neurological manifestations could be helpful to establish its neuropathogenesis 0 +647 Randomized Controlled Trial of a Video Gaming Based Social Skills Program for Children on the Autism Spectrum Families often face financial and geographical barriers to services for children with autism The current study explored the effectiveness of a parent supported adaptation of the computer game based social skills program Secret Agent Society SAS Seventy child parent dyads were randomized to SAS n 35 or a caregiver supported cognitive skills training game CIA control comparison n 35 both completed over 10 weeks Child participants were on the autism spectrum and aged seven to 12 years 60 boys 10 girls SAS participants improved more than CIA participants on parent rated social skills and problem behaviors and teacher rated social skills Findings suggest the intervention may be a convenient cost effective therapeutic approach especially during times of restricted face to face service access such as COVID 19 0 +371 Exploring the Regulatory Function of the i N i terminal Domain of SARS CoV 2 Spike Protein through Molecular Dynamics Simulation SARS CoV 2 is what has caused the COVID 19 pandemic Early viral infection is mediated by the SARS CoV 2 homo trimeric Spike S protein with its receptor binding domains RBDs in the receptor accessible state Molecular dynamics simulation on the S protein with a focus on the function of its i N i terminal domains NTDs is performed The study reveals that the NTD acts as a wedge and plays a crucial regulatory role in the conformational changes of the S protein The complete RBD structural transition is allowed only when the neighboring NTD that typically prohibits the RBDs movements as a wedge detaches and swings away Based on this NTD wedge model it is proposed that the NTD RBD interface should be a potential drug target 0 +289 Episodic long term memory in post infectious SARS CoV 2 patients Episodic long term memory LTM difficulties deficits are frequent in COVID 19 recovered patients and negatively impact on prognosis and outcome However little is known about their semiology and prevalence also being still debated whether they arise from primary amnesic features or are secondary to dysexecutive inattentive processes and disease related premorbid status Hence this study aimed at 1 assessing LTM functioning in post infectious SARS CoV 2 patients by accounting for premorbid and disease related confounders and 2 exploring its cognitive etiology Measures of global cognition Mini Mental State Examination MMSE and Montreal Cognitive Assessment MoCA and LTM Babcock Memory Test BMT of fifty four COVID 19 recovered patients were retrospectively collected Patients were subdivided into those being already at risk or not for cognitive decline RCD RCD Cognitive measures were converted into equivalent scores ESs LTM sub clinical clinical deficits ESs 0 1 were mildly to moderately prevalent in both RCD MoCA Memory 31 8 BMT 31 8 and RCD MoCA Memory 28 6 BMT 39 3 patients MMSE and MoCA total scores but not the MoCA Attention subtest were associated with the BMT RCD asymptomatic patients performed better on the BMT p 033 than those requiring O sub 2 sub therapy but not ventilation COVID 19 recovered individuals might show LTM deficits of both primary and secondary etiology and should be thus screened for them especially those having suffered mid to moderate COVID 19 and those already being at risk for cognitive decline Both I and II level measures of verbal LTM can be adopted although the former might be more sensitive 1 +330 Small fiber neuropathy associated with SARS CoV 2 infection The development and persistence of neurological symptoms following severe acute respiratory syndrome coronavirus 2 SARS CoV 2 infection is referred to as long haul syndrome We aimed to determine whether small fiber neuropathy SFN was associated with SARS CoV 2 infection We retrospectively studied the clinical features and outcomes of patients who were referred to us between May 2020 and May 2021 for painful paresthesia and numbness that developed during or after SARS CoV 2 infection and who had nerve conduction studies showing no evidence of a large fiber polyneuropathy We identified 13 patients Eight women and five men with age ranging from 38 67 y Follow up duration ranged from 8 to 12 mo All patients developed new onset paresthesias within 2 mo following SARS CoV 2 infection with an acute onset in seven and co existing autonomic symptoms in seven Three patients had pre existing but controlled neuropathy risk factors Skin biopsy confirmed SFN in six all of whom showed both neuropathy symptoms and signs and two also showed autonomic dysfunction by autonomic function testing AFT Of the remaining seven patients who had normal skin biopsies six showed no clinical neuropathy signs and one exhibited signs and had abnormal AFT Two patients with markedly reduced intraepidermal nerve fiber densities and one with normal skin biopsy had severe and moderate coronavirus disease 2019 COVID 19 the remainder experienced mild COVID 19 symptoms Nine patients received symptomatic neuropathy treatment with paresthesias controlled in seven 77 8 Our findings suggest that symptoms of SFN may develop during or shortly after COVID 19 SFN may underlie the paresthesias associated with long haul post COVID 19 symptoms 1 +555 Case Study Comparison Limitations in Telehealth Relating to Poverty and Family Support Telehealth appointments have grown in popularity due to the COVID 19 global pandemic Three cases presented in this article show several different perspectives where telehealth was utilized For the first patient appointments were successfully completed via telehealth however the patients family opted to continue with an unsecure internet connection at a local laundromat For the second patient a stable internet connection could not be obtained in his home thus making telehealth appointments unavailable The caregiver of this patient ended up driving to the clinic to have adjustments made in person For the third patient telehealth appointments were unavailable due to unstable internet connections as well as difficulty setting up video interpreting services These cases highlight the idea that telehealth can be incredibly beneficial when used correctly For some the option to attend appointments virtually gives them access to specialists that otherwise may not be available For other patients aspects such as access to smart devices and steady internet access must be considered to ensure a successful connection The hope is that this article sheds light on some of the potential setbacks that can come from the use of telehealth appointments in a practice and provides discussion regarding for whom telehealth may be appropriate even in pediatric patients After reading this article readers should be able to discuss ways in which there could be solutions for these barriers that may prevent some patients from utilizing these types of virtual appointments 0 +154 Altered cardiac autonomic function after recovery from COVID 19 Autonomic dysfunction may occur during the acute phase of COVID 19 Heart rate variability HRV is a useful tool for the assessment of cardiac sympathetic and parasympathetic balance We aimed to evaluate cardiac autonomic function by using HRV in subjects after recovery from COVID 19 who had previously symptomatic and were followed outpatiently The study group composed of 50 subjects with a confirmed history of COVID 19 and the control group composed of 50 healthy subjects without a history of COVID 19 and vaccination All the study participants underwent 2 dimensional pulsed and tissue Doppler echocardiographic examinations and 24 hour Holter monitoring for HRV analysis Time domain parameters of SDNN SDANN SDNNi RMSSD pNN50 and HRV triangular index were all decreased in the study group when compared with the control group Frequency domain parameters of TP VLF LF HF and HFnu were also decreased in the study group in comparison with the control group LFnu was similar between groups Nonlinear parameters of HRV including α sub 1 sub and α sub 2 sub decreased in the study group By contrast Lmax Lmean DET REC and Shannon entropy increased in the study population Approximate and sample entropies also enhanced in the study group The present study showed that all three domain HRV significantly altered in patients after recovery from COVID 19 indicating some degree of dysfunction in cardiac autonomic nervous system HRV may be a useful tool for the detection of preclinical autonomic dysfunction in this group of patients 1 +139 Acute Care Management During a Pandemic During the global pandemic of Covid 19 the hospital setting transitional care management was challenged by the complexities of the rapidly changing health care environment requiring the implementation of an innovative approach to hospital discharge planning The purpose of this article is to review the experiences of an integrated urban health system exploring the strategic tactics to ensure effective communication between team members patient and family engagement in discharge planning establishing and maintaining trust connecting patients to appropriate next level of care services and providing transitional care management support The Covid 19 pandemic response stimulated the rapid transformation of the acute care management model amidst the tremendous challenge of meeting the discharge planning needs of the hospitalized population in one large urban integrated health care system Patients transitioning to the community setting following discharge are vulnerable and at risk for adverse sequelae and transitional care management that does not end when the patient leaves the hospital setting is integral to promoting positive patient outcomes Naylor Aiken Kurtzman Olds Hirschman 2011 The care management approach during the pandemic in one health care system precipitously shifted to an entirely virtual remote model and the team continued to provide transitional care support for hospitalized patients to avoid the common pitfalls that are associated with unfavorable outcomes The insights gleaned from one health systems experiences during the pandemic are transferable to other facets of care management in routine circumstances with emphasis on the avoidance of the common care management snares that lead to less than optimal patient outcomes The development and implementation of multifaceted interventions with the goals of supporting health promoting behavior changes and self care capacity for at risk populations are relevant in the current health care environment 1 +223 Clinical features of pediatric post acute COVID 19 a descriptive retrospective follow up study To date information on COVID 19 long term post recovery sequelae in children and adolescents remains scarce A retrospective descriptive cohort study was performed by collecting data on 92 patients age 18 years All were evaluated during a face to face visit following a specially designed post COVID 19 symptom assessment protocol at the following stage 1 3 months after COVID 19 onset Among the 92 children 45 49 were completely free of any COVID 19 related symptoms while 47 51 reported persistence of at least one symptom in particular tiredness loss of taste and or smell and headaches The most common post acute COVID 19 clinical features were noted in children aged between 10 and 18 years A detailed multidisciplinary follow up of patients with COVID 19 seems relevant whatever the severity of the symptoms 1 +275 Post acute sequelae of COVID 19 in a non hospitalized cohort Results from the Arizona CoVHORT Clinical presentation outcomes and duration of COVID 19 has ranged dramatically While some individuals recover quickly others suffer from persistent symptoms collectively known as long COVID or post acute sequelae of SARS CoV 2 PASC Most PASC research has focused on hospitalized COVID 19 patients with moderate to severe disease We used data from a diverse population based cohort of Arizonans to estimate prevalence of PASC defined as experiencing at least one symptom 30 days or longer and prevalence of individual symptoms There were 303 non hospitalized individuals with a positive lab confirmed COVID 19 test who were followed for a median of 61 days range 30 250 COVID 19 positive participants were mostly female 70 non Hispanic white 68 and on average 44 years old Prevalence of PASC at 30 days post infection was 68 7 95 confidence interval 63 4 73 9 The most common symptoms were fatigue 37 5 shortness of breath 37 5 brain fog 30 8 and stress anxiety 30 8 The median number of symptoms was 3 range 1 20 Amongst 157 participants with longer follow up 60 days PASC prevalence was 77 1 1 +662 Review of Ebola virus disease in children how far have we come Ebola virus EBOV causes an extremely contagious viral haemorrhagic fever associated with high mortality While historically children have represented a small number of total cases of Ebolavirus disease EVD in recent outbreaks up to a quarter of cases have been in children They pose unique challenges in clinical management and infection prevention and control In this review of paediatric EVD the epidemiology of past EVD outbreaks with specific focus on children is discussed the clinical manifestations and laboratory findings are described and key developments in clinical management including specific topics such as viral persistence and breastfeeding while considering unique psychosocial and anthropological considerations for paediatric care including of survivors and orphans and the stigma they face are discussed In addition to summarising the literature perspectives based on the authors experience of EVD outbreaks in the Democratic Republic of the Congo DRC are described b Abbreviations b ARDS acute respiratory distress syndrome aOR adjusted odds ratio ALT alanine transferase ALIMA Alliance for International Medical Action AST aspartate transaminase BUN blood urea nitrogen CNS central nervous system CUBE chambre durgence biosécurisée pour épidémie COVID 19 coronavirus disease 2019 C sub t sub cycle threshold DRC Democratic Republic of Congo ETC ebola treatment centre ETU ebola treatment unit EBOV ebola virus EVD ebolavirus disease FEAST fluid expansion as supportive therapy GP glycoprotein IV intravenous MEURI monitored emergency use of unregistered interventions NETEC National Ebola Training and Education Centre NP nucleoprotein ORS oral rehydration solution PALM Pamoja Tulinde Maisha PREVAIL Partnership for Research on Ebola Virus in Liberia PPE personal protective equipment PCR polymerase chain reaction PEP post exposure prophylaxis RDTs rapid diagnostic tests RT reverse transcriptase RNA ribonucleic acid UNICEF United Nations International Childrens Emergency Fund USA United States of America WHO World Health Organization 0 +137 COVID 19 sequelae in adults aged less than 50 years A systematic review There is emerging evidence of long term sequelae in a considerable proportion of COVID 19 patients after recovery and the spectrum and severity of such sequelae should be systematically reviewed This review aims to evaluate the available evidence of all intermediate and long term COVID 19 sequelae affecting formerly healthy adults A systematic literature search of Embase WHO Scopus Pubmed Litcovid bioRxiv and medRxiv was conducted with a cutoff date of the 17th September 2020 according to PRISMA guidelines and registered in PROSPERO CRD42020208725 Search terms included COVID 19 coronavirus disease 2019 SARS CoV 2 sequelae and consequence Publications on adult participants with a confirmed SARS CoV 2 infection were included Elderly 50 years old and children 18 years old were excluded Bias assessment was performed using a modified Newcastle Ottawa Scale A total of 31 papers were included Study types included prospective and retrospective cohort studies cross sectional studies and case reports Sequelae persistence since infection spanned 14 days to three months Sequelae included persistent fatigue 39 73 of assessed persons breathlessness 39 74 decrease in quality of life 44 69 impaired pulmonary function abnormal CT findings including pulmonary fibrosis 39 83 evidence of peri perimyo myocarditis 3 26 changes in microstructural and functional brain integrity with persistent neurological symptoms 55 increased incidence of psychiatric diagnoses 5 8 versus 2 5 3 4 in controls incomplete recovery of olfactory and gustatory dysfunction 33 36 of evaluated persons A variety of organ systems are affected by COVID 19 in the intermediate and longer term after recovery Main sequelae include post infectious fatigue persistent reduced lung function and carditis Careful follow up post COVID 19 is indicated to assess and mitigate possible organ damage and preserve life quality 1 +554 Prevalence of SARS CoV 2 RNA on inanimate surfaces a systematic review and meta analysis Coronavirus disease COVID 19 is a respiratory disease affecting many people and able to be transmitted through direct and perhaps indirect contact Direct contact transmission mediated by aerosols or droplets is widely demonstrated whereas indirect transmission is only supported by collateral evidence such as virus persistence on inanimate surfaces and data from other similar viruses The present systematic review aims to estimate SARS CoV 2 prevalence on inanimate surfaces identifying risk levels according to surface characteristics Data were obtained from studies in published papers collected from two databases PubMed and Embase with the last search on 1 September 2020 Included studies had to be papers in English had to deal with coronavirus and had to consider inanimate surfaces in real settings Studies were coded according to our assessment of the risk that the investigated surfaces could be contaminated by SARS CoV 2 A meta analysis and a metaregression were carried out to quantify virus RNA prevalence and to identify important factors driving differences among studies Thirty nine out of forty retrieved paper reported studies carried out in healthcare settings on the prevalence of virus RNA five studies carry out also analyses through cell culture and six tested the viability of isolated viruses Overall prevalences of SARS CoV 2 RNA on high medium and low risk surfaces were 0 22 CI sub 95 sub 0 152 0 296 0 04 CI sub 95 sub 0 007 0 090 and 0 00 CI sub 95 sub 0 00 0 019 respectively The duration surfaces were exposed to virus sources patients was the main factor explaining differences in prevalence 0 +446 The snapshot of metabolic health in evaluating micronutrient status the risk of infection and clinical outcome of COVID 19 COVID 19 has re established the significance of analyzing the organism through a metabolic perspective to uncover the dynamic interconnections within the biological systems The role of micronutrient status and metabolic health emerge as pivotal in COVID 19 pathogenesis and the immune systems response Metabolic disruption proceeding from modifiable factors has been proposed as a significant risk factor accounting for infection susceptibility disease severity and risk for post COVID complications Metabolomics the comprehensive study and quantification of intermediates and products of metabolism is a rapidly evolving field and a novel tool in biomarker discovery In this article we propose that leveraging insulin resistance biomarkers along with biomarkers of micronutrient deficiencies will allow for a diagnostic window and provide functional therapeutic targets Specifically metabolomics can be applied as a At home test to assess the risk of infection and propose nutritional support b A screening tool for high risk COVID 19 patients to develop serious illness during hospital admission and prioritize medical support c i A tool to match nutritional support with specific nutrient requirements for mildly ill patients to reduce the risk for hospitalization and c ii for critically ill patients to reduce recovery time and risk of post COVID complications d At home test to monitor metabolic health and reduce post COVID symptomatology Metabolic rewiring offers potential virtues towards disease prevention dissection of high risk patients taking actionable therapeutic measures as well as shielding against post COVID syndrome 0 +81 The Conundrum of Long COVID 19 A Narrative Review COVID 19 is an ongoing pandemic with many challenges that are now extending to its intriguing long term sequel Long COVID 19 is a term given to the lingering or protracted illness that patients of COVID 19 continue to experience even in their post recovery phase It is also being called post acute COVID 19 ongoing symptomatic COVID 19 chronic COVID 19 post COVID 19 syndrome and long haul COVID 19 Fatigue dyspnea cough headache brain fog anosmia and dysgeusia are common symptoms seen in Long COVID 19 but more varied and debilitating injuries involving pulmonary cardiovascular cutaneous musculoskeletal and neuropsychiatric systems are also being reported With the data on Long COVID 19 still emerging the present review aims to highlight its epidemiology protean clinical manifestations risk predictors and management strategies With the re emergence of new waves of SARS CoV 2 infection Long COVID 19 is expected to produce another public health crisis on the heels of current pandemic Thus it becomes imperative to emphasize this condition and disseminate its awareness to medical professionals patients the public and policymakers alike to prepare and augment health care facilities for continued surveillance of these patients Further research comprising cataloging of symptoms longer ranging observational studies and clinical trials are necessary to evaluate long term consequences of COVID 19 and it warrants setting up of dedicated post COVID care multi disciplinary clinics and rehabilitation centers 1 +338 From asymptomatic to critical illness different clinical manifestations of COVID 19 in Children The global pandemic infectious disease that was named the new coronavirus disease COVID 19 spread throughout the world causing a major public health emergency The causative virus of COVID 19 called SARS CoV 2 can infect all age groups Various clinical signs and symptoms have been observed in neonates children and adolescents during the COVID 19 outbreak The clinical manifestations of COVID 19 might be different due to the medical conditions and comorbid status in elderly and pediatric patients The rise in cases among children has been reported during the COVID 19 pandemic Although infected children generally appear to be asymptomatic or have only mild symptoms COVID 19 in children may also involve a wide spectrum of clinical manifestations ranging from asymptomatic carriers to life threatening and fatal disease as COVID 19 is a systemic disease that can affect multiple organs Due to the lack of knowledge in the current literature it is necessary to describe the atypical clinical features including extrapulmonary manifestations in pediatric patients with COVID 19 This review is conducted to identify knowledge gaps regarding the broad spectrum of clinical signs and symptoms of children with COVID 19 1 +63 Post Acute Sequelae of COVID 19 Pneumonia Six month Chest CT Follow up Background The long term post acute pulmonary sequelae of COVID 19 remain unknown Purpose To evaluate lung injury in patients affected by COVID 19 pneumonia at the 6 month follow up CT examination compared with the baseline chest CT examination Materials and Methods From March 19 2020 to May 24 2020 patients with moderate to severe COVID 19 pneumonia who had undergone baseline chest CT were prospectively enrolled at their 6 month follow up The CT qualitative findings semiquantitative Lung Severity Score LSS and the well aerated lung volume at quantitative chest CT QCCT analysis were analyzed The performance of the baseline LSS and QCCT findings for predicting fibrosis like changes reticular pattern and or honeycombing at the 6 month follow up chest CT examination was tested by using receiver operating characteristic curves Univariable and multivariable logistic regression analyses were used to test clinical and radiologic features that were predictive of fibrosis like changes The multivariable analysis was performed with clinical parameters alone clinical model radiologic parameters alone radiologic model and the combination of clinical and radiologic parameters combined model Results One hundred eighteen patients who had undergone baseline chest CT and agreed to undergo follow up chest CT at 6 months were included in the study 62 women mean age 65 years 12 standard deviation At follow up chest CT 85 of 118 72 patients showed fibrosis like changes and 49 of 118 42 showed ground glass opacities The baseline LSS 14 and QCCT findings 3 75 L and 80 showed excellent performance for predicting fibrosis like changes at follow up chest CT In the multivariable analysis the areas under the curve were 0 89 95 CI 0 77 0 96 for the clinical model 0 81 95 CI 0 68 0 9 for the radiologic model and 0 92 95 CI 0 81 0 98 for the combined model Conclusion At 6 month follow up chest CT 72 of patients showed late sequelae in particular fibrosis like changes The baseline Lung Severity Score and the well aerated lung volume at quantitative chest CT QCCT analysis showed excellent performance for predicting fibrosis like changes at the 6 month chest CT area under the curve 0 88 Male sex cough lymphocytosis and the well aerated lung volume at QCCT analysis were significant predictors of fibrosis like changes at 6 months demonstrating an inverse correlation area under the curve 0 92 RSNA 2021 See also the editorial by Wells and Devaraj in this issue 1 +114 More Than 100 Persistent Symptoms of SARS CoV 2 Long COVID A Scoping Review b Background b Persistent coronavirus disease 2019 COVID 19 symptoms are increasingly well reported in cohort studies and case series Given the spread of the pandemic number of individuals suffering from persistent symptoms termed long COVID are significant However type and prevalence of symptoms are not well reported using systematic literature reviews b Objectives b In this scoping review of the literature we aggregated type and prevalence of symptoms in people with long COVID b Eligibility Criteria b Original investigations concerning the name and prevalence of symptoms were considered in participants 4 weeks post infection b Sources of Evidence b Four electronic databases Medline Web of Science Scopus and the Cochrane Central Register of Controlled Trials CENTRAL were searched b Methods b A scoping review was conducted using the Arksey and OMalley framework Review selection and characterisation was performed by three independent reviewers using pretested forms b Results b Authors reviewed 2 711 titles and abstracts for inclusion with 152 selected for full text review 102 articles were subsequently removed as this did not meet inclusion criteria Thus fifty studies were analysed 34 of which were described as cohort studies or prospective cohort studies 14 were described as cross sectional studies one was described as a case control study and one was described as a retrospective observational study In total 100 symptoms were identified and there was considerable heterogeneity in symptom prevalence and setting of study Ten studies reported cardiovascular symptoms four examined pulmonary symptoms 25 reported respiratory symptoms 24 reported pain related symptoms 21 reported fatigue 16 reported general infection symptoms 10 reported symptoms of psychological disorders nine reported cognitive impairment 31 reported a sensory impairment seven reported a dermatological complaint 11 reported a functional impairment and 18 reported a symptom which did not fit into any of the above categories b Conclusion b Most studies report symptoms analogous to those apparent in acute COVID 19 infection i e sensory impairment and respiratory symptoms Yet our data suggest a larger spectrum of symptoms evidenced by 100 reported symptoms Symptom prevalence varied significantly and was not explained by data collection approaches study design or other methodological approaches and may be related to unknown cohort specific factors 1 +685 Assessment of a Hotel Based Protective Housing Program for Incidence of SARS CoV 2 Infection and Management of Chronic Illness Among Persons Experiencing Homelessness Persons experiencing homelessness PEH are at higher risk for SARS CoV 2 infection and severe illness due to COVID 19 because of a limited ability to physically distance and a higher burden of underlying health conditions To describe and assess a hotel based protective housing intervention to reduce incidence of SARS CoV 2 infection among PEH in Chicago Illinois with increased risk of severe illness due to COVID 19 This retrospective cohort study analyzed PEH who were provided protective housing in individual hotel rooms in downtown Chicago during the COVID 19 pandemic from April 2 through September 3 2020 Participants were PEH at increased risk for severe COVID 19 defined as 1 aged at least 60 years regardless of health conditions 2 aged at least 55 years with any underlying health condition posing increased risk or 3 aged less than 55 years with any underlying health condition posing substantially increased risk eg HIV AIDS Participants were housed in individual hotel rooms to reduce the risk of SARS CoV 2 infection on site health care workers provided daily symptom monitoring regular SARS CoV 2 testing and care for chronic health conditions Additional on site services included treatment of mental health and substance use disorders and social services The main outcome measured was SARS CoV 2 incidence with SARS Cov2 infection defined as a positive upper respiratory specimen using any polymerase chain reaction diagnostic assay authorized for emergency use by the Food and Drug Administration Secondary outcomes were blood pressure control glycemic control as measured by hemoglobin A1c and housing placements at departure Of 259 participants from 16 homeless shelters in Chicago 104 40 2 were aged at least 65 years 190 73 4 were male 185 71 4 were non Hispanic Black and 49 18 9 were non Hispanic White There was an observed reduction in SARS CoV 2 incidence during the study period among the protective housing cohort 54 7 per 1000 people 95 CI 22 4 87 1 per 1000 people compared with citywide rates for PEH residing in shelters 137 1 per 1000 people 95 CI 125 1 149 1 per 1000 people P 001 There was also an adjusted change in systolic blood pressure at a rate of 5 7 mm Hg 95 CI 9 3 to 2 1 mm Hg and hemoglobin A1c at a rate of 1 4 95 CI 2 4 to 0 4 compared with baseline More than half of participants 51 n 132 departed from the intervention to housing of some kind eg supportive housing This cohort study found that protective housing was associated with a reduction in SARS CoV 2 infection among high risk PEH during the first wave of the COVID 19 pandemic in Chicago These findings suggest that with appropriate wraparound supports ie multisector services to address complex needs such housing interventions may reduce the risk of SARS CoV 2 infection improve noncommunicable disease control and provide a pathway to permanent housing 0 +175 COVID 19 still remains a severe global health threat Despite the high speed development of vaccines that efficiently prevent COVID 19 there are still no effective treatments of the disease once people are infected MicroRNAs are powerful regulators of gene expression They are intensely investigated as therapeutic targets up to the clinical stage In addition microRNAs can be detected in the circulation and thus represent promising diagnostic and prognostic biomarkers for long COVID 19 1 +549 Selected 2020 Highlights in Congenital Cardiac Anesthesia This article is a review of the highlights of pertinent literature published during the 12 months of 2020 that are of interest to the congenital cardiac anesthesiologist After a search of the US National Library of Medicines PubMed database several topics emerged for which significant contributions were made in 2020 The authors of the present article considered the following topics noteworthy to be included in this review pediatric cardiac care in the coronavirus disease 2019 era the use of mechanical circulatory support in coronavirus disease 2019 related multisystem inflammatory syndrome in children transfusion and coagulation management in children undergoing congenital heart surgery and pulmonary vein stenosis 0 +384 SARS CoV 2 associated acute disseminated encephalomyelitis a systematic review of the literature The literature on cases of acute disseminated encephalomyelitis ADEM associated with SARS CoV 2 infection has been rapidly increasing However the specific clinical features of ADEM associated with SARS CoV 2 SARS CoV 2 ADEM have not been previously evaluated We screened all articles resulting from a search of PubMed and Web of Science databases looking for reports of ADEM published between December 01 2019 and June 5 2021 Of the 48 ADEM cases identified from 37 studies 34 71 had ADEM while 14 29 were of AHLE RT PCR for SARS CoV 2 was positive in 83 n 19 of patients 26 patients 54 were male and 18 patients 38 were female with a male to female sex ratio of 1 4 1 median age was 44 1 4 71 years 9 patients 19 9 48 were children Of the 9 children patients their median age was 9 years range 1 4 13 years 6 patients 67 were female and 2 patients 22 were male with a female to male sex ratio of 3 1 39 patients 81 was performed CSF analysis PCR for SARS CoV 2 tested positive in 3 patients 14 3 22 on CSF sample 31 64 of patients had a poor outcome on discharge from hospital Five 10 patients died in hospital Compared to classic ADEM SARS CoV 2 ADEM have a more longer duration between the onset of the antecedent infective symptoms and the start of ADEM symptoms the older age distribution of the patients relatively poor outcome a lower full recovery rate a more frequently brain lesions involved the periventricular white matter and corpus callosum and less frequently affected the deep gray matter Taken together the present comprehensive review reveals that although rare ADEM can be associated with SARS CoV 2 infection SARS CoV 2 ADEM seems to share most features of classic ADEM with moderate discrepancies from the classical ADEM 0 +572 A rapid review investigating the potential impact of a pandemic on the mental health of young people aged 12 25 years In March 2020 the World Health Organization WHO officially declared the spread of coronavirus disease 2019 COVID 19 as a pandemic Adolescence and early adulthood are peak times for the onset of mental health difficulties Exposure to a pandemic during this vulnerable developmental period places young people at significant risk of negative psychological experiences The objective of this research was to summarise existing evidence on the potential impact of a pandemic on the mental health of 12 25 year olds A rapid review of the published peer reviewed literature published between 1985 and 2020 using PsycINFO Proquest and Medline Proquest was conducted Narrative synthesis was used across studies to identify key themes and concepts This review found 3 359 papers which was reduced to 12 papers for data extraction Results regarding the prevalence of psychological difficulties in youth were mixed with some studies finding this group experience heightened distress during an infectious disease outbreak and others finding no age differences or higher distress among adults Gender coping self reported physical health and adoption of precautionary measures appear to play a role in moderating the psychological impact of an infectious disease outbreak Most studies were conducted after the peak of an epidemic pandemic or in the recovery period More longitudinal research with young people particularly adolescents in the general population before and during the early stages of an infectious disease outbreak is needed to obtain a clear understanding of how best to support young people during these events 0 +219 Systematic rapid living review on rehabilitation needs due to COVID 19 update as of April 30th 2020 This paper adds to the series of systematic rapid living reviews started in April 2020 to provide the rehabilitation community with updates on the latest scientific literature on rehabilitation needs due to COVID 19 pandemic The aim of this paper is to present the results of a systematic scientific literature search performed on papers published from April 1st to April 30th 2020 A systematic search was performed on PubMed Embase Scopus CINAHL PEDro Web of Science and the main international guideline databases for articles published including Epub in English from April 1st to April 30th 2020 Papers were included if they reported on one of the following 1 prevalence and features of the emerging disability after COVID 19 2 rehabilitation strategies applied for COVID 19 patients regardless of setting or stage 3 information about rehabilitation services after COVID 19 4 impact on diseases of rehabilitative interest 5 complications of rehabilitative interest Out of 445 articles retrieved for the time frame 50 were finally included for qualitative analysis They consist of seven guidelines one scoping review one randomized controlled trial four descriptive studies qualitative one case series one case report and 35 expert opinions This systematic rapid living review showed an increasing evidence on rehabilitation needs due to COVID 19 outbreak during April 2020 The main novelties include 1 the first appearance of epidemiological data on the likely high incidence of neurological complications disabling sequelae in patients hospitalized for COVID 19 2 rapid guidelines on the management of chronically disabled patients in the COVID 19 era 3 advices to provide COVID 19 patients with early respiratory rehabilitation in the acute phase and with telemonitoring and telerehabilitation in the post acute phase Although the overall quality of studies has increased prospective cohort studies on disability course in COVID 19 pandemic and experimental studies on the effects of rehabilitation are still warranted 1 +414 Continuing to Challenge the Paradigm of What Is Possible in Pharmacy Education and Practice Post COVID 19 The COVID 19 pandemic has caused boundless disruptions to every element of life It has also brought with it lessons from the past that will likely extend into the future as humans continue to interface with the ever increasing threats of zoonotic diseases The pandemic has challenged the profession and the Academy to adjust modify and adapt It has also stretched the bounds of what had previously been thought possible within the realms of medicine As the Academy begins to reach and crest the apex of the epidemic it should be reminded of the many lessons associated with the pandemic and of the constant need to challenge the paradigm of what is possible 0 +477 The Use of Electroconvulsive Therapy in Neuropsychiatric Complications of Coronavirus Disease 2019 A Systematic Literature Review and Case Report There is a significant prevalence of new onset neuropsychiatric symptoms NPS some severe and persistent in patients with coronavirus disease 2019 COVID 19 This study reports on the use of electroconvulsive therapy ECT to treat NPS associated with COVID 19 A review of the literature pertaining to the use of ECT in patients with COVID 19 and NPS was performed through PubMed PsycINFO and MEDLINE Search terms included Electroconvulsive Therapy and ECT combined with COVID 19 and Severe Acute Respiratory Syndrome Coronavirus 2 SARS COV 2 In addition we present a case in which ECT was used to achieve complete remission in a patient who developed new onset treatment resistant depression psychosis and catatonia associated with COVID 19 A total of 67 articles were reviewed with 3 selected for inclusion These articles detailed 3 case reports of patients with new onset NPS mania psychosis and suicidality and catatonia that developed in the context of active COVID 19 and were treated successfully with ECT ECT a broad spectrum treatment that has been found to be effective in various NPS independent of etiology is shown in our case report and others to be safe and effective for NPS associated with COVID 19 Although we identified only 3 other cases in the literature we believe that the probable antiinflammatory mechanism of ECT its safety and tolerability and the faster time to symptom remission support the need for more research and increased clinician awareness about this life saving procedure 0 +558 COVID 19 vaccines concerns beyond protective efficacy and safety Several vaccine candidates have been developed using different platforms including nucleic acids DNA and RNA viral vectors replicating and non replicating virus like particles peptide based recombinant proteins live attenuated and inactivated virus modalities Although many of these vaccines are undergoing pre clinical trials several large clinical trials investigating the clinical efficacy and safety of coronavirus disease 2019 COVID 19 vaccines have produced promising findings In this review we provide a status update on COVID 19 vaccines currently undergoing clinical trials and discuss issues of concern beyond vaccine efficacy and safety including dosing regimens the mixed vaccine strategy prior severe acute respiratory syndrome coronavirus 2 infection antibody levels cellular immunity and protection variants of concern COVID 19 vaccine distribution vaccination willingness herd immunity immunity passports and vaccine indications Four vaccines have obtained emergency use authorization 87 are at the clinical development stage and 186 are in pre clinical development While the knowledge and development of COVID 19 vaccines is rapidly expanding the benefits of COVID 19 vaccines must outweigh the potential risks of adverse events To combat the COVID 19 pandemic clinicians should consistently update COVID 19 associated information and healthcare authorities and manufacturers should work together to provide adequate and appropriate vaccinations for the prevention of COVID 19 b What is the context b Severe acute respiratory syndrome coronavirus 2 SARS CoV 2 caused a global pandemic the coronavirus disease 2019 COVID 19 outbreak The development and implementation of the COVID 19 vaccine could be an important measure to control the COVID 19 pandemic b What is new b Several phase 3 clinical trials have demonstrated the effectiveness and safety of COVID 19 vaccines for the prevention of SARS CoV 2 infections Several COVID 19 vaccines have obtained emergency use authorization and been implemented in many countries Although concerns regarding unusual blood clots and low platelet counts have been raised the benefits of COVID 19 vaccines outweigh the potential risks of adverse events b What is the impact b Except for children the COVID 19 vaccine is recommended for all people including those pregnant or immunocompromised Healthcare authorities should advise people receiving the vaccine that they must seek medical attention if they have associated thromboembolism and thrombocytopenia symptoms More studies are necessary to determine the appropriate vaccine dose and regimen strategy as well as the effectiveness of COVID 19 vaccines against variants of concerns A global effort must be made to achieve widespread vaccination and herd immunity 0 +589 The Community Engaged Lab A Case Study Introduction for Developmental Science Due to the closing of campuses museums and other public spaces during the pandemic the typical avenues for recruitment partnership and dissemination are now unavailable to developmental labs In this paper we show how a shift in perspective has impacted our labs ability to successfully transition to virtual work during the COVID 19 shut down This begins by recognizing that any lab that relies on local communities to engage in human research is i itself a community organization i From this we introduce a i community engaged lab i model and explain how it works using our own activities during the pandemic as an example To begin we introduce the vocabulary of mission driven community organizations and show how we applied the key ideas of mission vision and culture to discussions of our own labs identity We contrast the community engaged lab model with a traditional bi directional model of recruitment i from i and dissemination i to i communities and describe how the community engaged model can be used to reframe these and other ordinary lab activities Our activities during the pandemic serve as a case study we formed new community partnerships engaged with child citizen scientists in online research and opened new avenues of virtual programming One year later we see modest but quantifiable impact of this approach a return to pre pandemic diversity in our samples new engagement opportunities for trainees and new sustainable partnerships We end by discussing the promise and limitations of the community engaged lab model for the future of developmental research 0 +159 Cardiovascular and renal risk factors and complications associated with COVID 19 The current COVID 19 pandemic caused by the SARS CoV 2 virus Severe Acute Respiratory Syndrome Coronavirus 2 represents the largest medical challenge in decades It has exposed unexpected cardiovascular vulnerabilities at all stages of the disease pre infection acute phase and subsequent chronic phase The major cardiometabolic drivers identified to have epidemiological and mechanistic associations with COVID 19 are abnormal adiposity dysglycemia dyslipidemia and hypertension Hypertension is of particular interest because components of the renin angiotensin system RAS which are critically involved in the pathophysiology of hypertension are also implicated in COVID 19 Specifically ACE2 a multifunctional protein of the RAS which is part of the protective axis of the RAS is also the receptor through which SARS CoV 2 enters host cells causing viral infection Cardiovascular and cardiometabolic co morbidities not only predispose to COVID 19 but are complications of SARS CoV 2 infection In addition increasing evidence indicates that acute kidney injury is common in COVID 19 that it occurs early and in temporal association with respiratory failure and is associated with poor prognosis especially in the presence of cardiovascular risk factors Here we discuss cardiovascular and kidney disease in the context of COVID 19 and provide recent advances on putative pathophysiological mechanisms linking cardiovascular disease and COVID 19 focusing on the RAS and ACE2 as well as the immune system and inflammation We provide up to date information on the relationship between hypertension diabetes and COVID 19 and emphasize the major cardiovascular diseases associated with COVID 19 We also briefly discuss emerging cardiovascular complications associated with long COVID 19 notably postural tachycardia syndrome POTS 1 +461 Duration of Respiratory and Gastrointestinal Viral Shedding in Children With SARS CoV 2 A Systematic Review and Synthesis of Data Children with coronavirus disease 2019 COVID 19 are more likely to have mild or no symptoms compared with adults and may represent important vectors for transmitting the virus Little is known about the duration of respiratory and gastrointestinal viral shedding in children with COVID 19 To determine the average shedding times of severe acute respiratory syndrome coronavirus 2 SARS CoV 2 via the respiratory and gastrointestinal tracts in children We performed a systematic search of Ovid MEDLINE Embase and Cochrane CENTRAL databases for studies reporting real time reverse transcriptase polymerase chain reaction rt PCR results in children with COVID 19 then extracted and synthesized data on duration of viral shedding from symptom onset in respiratory and gastrointestinal samples Based on data compiled from 69 pediatric cases the duration of viral shedding through the respiratory tract is up to 24 days from symptom onset with a mean of 11 1 5 8 days Of the children who underwent testing with stool PCR rectal swab or anal swab 86 returned a positive result The mean duration of viral shedding via the gastrointestinal tract was 23 6 8 8 days from symptom onset In 89 of cases viral shedding via the gastrointestinal tract persisted after nasopharyngeal or throat swabs became negative for as long as 4 weeks To our knowledge this is the first attempt to systematically review the duration of respiratory and gastrointestinal viral shedding of SARS CoV 2 in pediatric patients These findings may have important implications for infection control strategies during the COVID 19 pandemic 0 +452 Rethinking the management of immune checkpoint inhibitor related adrenal insufficiency in cancer patients during the COVID 19 pandemic The coronavirus disease 2019 COVID 19 is currently a major pandemic challenge and cancer patients are at a heightened risk of severity and mortality from this infection In recent years immune checkpoint inhibitor ICI use to treat multiple cancers has increased in oncology but equally has raised the question of whether ICI therapy and its side effects is harmful or beneficial during this pandemic A combination of published literature in PubMed between January 2010 and December 2020 recommended guidelines in non cancer patients and clinical experience was utilized to outline recommendations on glucocorticoid timing and dosing regimens in ICI treated patients presenting with AI during this COVID 19 pandemic The potential immune interaction between ICIs and COVID 19 require major consideration because these agents act at the intersection between effective cancer immunotherapy and increasing patient susceptibility severity and complications from the SARS CoV 2 sepsis Furthermore ICI use can induce autoimmune adrenal insufficiency AI that further increases infection susceptibility Thus ICI treated cancer patients with AI may be at greater risk of COVID 19 infection Glucocorticoids are the cornerstone for replacement therapy and for treatment and mitigation of adrenal crisis and relief of mass effects in ICI related hypophysitis High dose glucocorticoids have also been used with cytotoxic chemotherapy as part of cancer treatment and iatrogenic AI may arise after glucocorticoid discontinuation that increases the risk of adrenal crisis Furthermore in patients who develop the long COVID 19 syndrome when to discontinue glucocorticoid therapy becomes crucial to avoid unnecessary prolongation of therapy and the development of iatrogenic hypercortisolemia During the COVID 19 pandemic much of cancer care have been impacted and an important clinical question is how to optimally manage ICI related AI during these unprecedented times Herein we suggest practical recommendations on the timing and dosing regimens of glucocorticoids in different clinical scenarios of ICI treated cancer patients presenting with AI during this COVID 19 pandemic 0 +676 Pediatric Telehealth in the COVID 19 Pandemic Era and Beyond The coronavirus disease 2019 COVID 19 pandemic led to an unprecedented demand for health care at a distance and telehealth the delivery of patient care using telecommunications technology became more widespread Since our 2018 state of the art review assessing the pediatric telehealth landscape there have been many changes in technology policy payment and physician and patient acceptance of this care model Clinical best practices in telehealth on the other hand have remained unchanged during this time with the primary difference being the need to implement them at scale Because of the pandemic underlying health system weaknesses that have previously challenged telehealth adoption including inequitable access to care unsustainable costs in a fee for service system and a lack of quality metrics for novel care delivery modalities were simultaneously exacerbated Higher volume use has provided a new appreciation of how patients from underrepresented backgrounds can benefit from or be disadvantaged by the shift toward virtual care Moving forward it will be critical to assess which COVID 19 telehealth changes should remain in place or be developed further to ensure children have equitable access to high quality care With this review we aim to 1 depict todays pediatric telehealth practice in an era of digital disruption 2 describe the people training processes and tools needed for its successful implementation and sustainability 3 examine health equity implications and 4 critically review current telehealth policy as well as future policy needs The American Academy of Pediatrics AAP is continuing to develop policy specific practice tips training modules checklists and other detailed resources which will be available later in 2021 0 +96 Kawasaki Disease Management Strategies Given Symptoms Overlap to COVID 19 A Review Kawasaki disease is an acute self limiting vasculitis in children Early treatment is necessary to prevent cardiovascular complications The acute phase of Kawasaki disease may present with hemodynamic instability An association between viral respiratory infections and Kawasaki disease has been reported Studies have shown that Kawasaki and Kawasaki like disease may be associated with and have symptoms overlapping COVID 19 Children with COVID 19 may present as Kawasaki like disease with pediatric inflammatory multisystem syndrome or macrophage activation syndrome Clinicians need to be aware of the early diagnosis and management of Kawasaki disease to prevent the development of coronary artery aneurysms The symptoms overlap of multisystem inflammatory disease seen in COVID 19 adds to the difficulties in timely diagnosis and treatment Children with Kawasaki disease require regular follow up plans for coronary artery aneurysms This adds to the difficulties during the changed environment of COVID 19 for control and prevention Missed diagnosis and early treatment of Kawasaki disease with immunoglobulin and aspirin results in the development of coronary artery aneurysm in up to 25 of cases with grave consequences Here we briefly review the management of typical and atypical Kawasaki disease which has symptoms overlapping with the multisystem inflammatory disease as seen in COVID 19 1 +150 Acute transverse myelitis with Dysautonomia following SARS CoV 2 infection A case report and review of literature To report a unique case and literature review of post COVID 19 associated transverse myelitis and dysautonomia with abnormal MRI and CSF findings Coronavirus disease have been reported to be associated with several neurological manifestations such as stroke Guillain Barré syndrome meningoencephalitis amongst others There are only few reported cases of transverse myelitis with the novel coronavirus n CoV 2 and only one reported case identifying dysautonomia in COVID 19 patient Here we identify a COVID 19 patient diagnosed with acute transverse myelitis in addition to dysautonomia following with complete resolution of symptoms A retrospective chart review of a patient diagnosed with post SARS CoV 2 infection acute transverse myelitis and dysautonomia and a review of literature of all the reported cases of transverse myelitis and COVID 19 from December 1st 2019 till December 25th 2020 was performed To our knowledge this is the first reported case of transverse myelitis and dysautonomia in a patient with SARS CoV 2 infection who responded to intravenous methyl prednisone and bromocriptine Follow up imaging of the spine showed complete resolution of the lesion Further studies would be recommended to identify the underlying correlation between COVID 19 and transverse myelitis 1 +395 Telemonitoring Telemedicine and Time in Range During the Pandemic Paradigm Change for Diabetes Risk Management in the Post COVID Future People with diabetes are at greater risk for negative outcomes from COVID 19 Though this risk is multifactorial poor glycaemic control before and during admission to hospital for COVID 19 is likely to contribute to the increased risk The COVID 19 pandemic and restrictions on mobility and interaction can also be expected to impact on daily glucose management of people with diabetes Telemonitoring of glucose metrics has been widely used during the pandemic in people with diabetes including adults and children with T1D allowing an exploration of the impact of COVID 19 inside and outside the hospital setting on glycaemic control To date 27 studies including 69 294 individuals with T1D have reported the effect of glycaemic control during the COVID 19 pandemic Despite restricted access to diabetes clinics glycaemic control has not deteriorated for 25 27 cohorts and improved in 23 27 study groups Significantly time in range TIR 70 180 mg dL 3 9 10 mmol L increased across 19 27 cohorts with a median 3 3 6 0 to 11 2 change Thirty per cent of the cohorts with TIR data reported an average clinically significant TIR improvement of 5 or more possibly as a consequence of more accurate glucose monitoring and improved connectivity through telemedicine Periodic consultations using telemedicine enables care of people with diabetes while limiting the need for in person attendance at diabetes clinics Reports that sustained hyperglycaemia and early stage diabetic ketoacidosis may go untreated because of the lockdown and concerns about potential exposure to the risk of infection argue for wider access to glucose telemonitoring Therefore in this paper we have critically reviewed reports concerning use of telemonitoring in the acute hospitalized setting as well as during daily diabetes management Furthermore we discuss the indications and implications of adopting telemonitoring and telemedicine in the present challenging time as well as their potential for the future 0 +669 The effects of the measures against COVID 19 pandemic on physical activity among school aged children and adolescents 6 17 years in 2020 A protocol for systematic review The pandemic of coronavirus disease COVID 19 has greatly changed peoples daily lives forcing countries to take actions such as school shutdown lockdown isolation and social distancing measures It remains unclear how the closures cancellations and restrictions of schools and courses as a response to the COVID 19 pandemic affect the engagement of school aged children and adolescents in relation to physical activity PA The articles in the databases of EBSCO including AMED CINAHL Plus Health Business Health Source MEDLINE with Full Text APA PsycArticles APA PsycINFO and SPORTDiscus published during the period from 1 January 2020 to 31 December 2020 will be retrieved and the data in the selected articles are extracted including research methods demographics and key results Search outcomes were reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses PRISMA guidelines The Mixed Methods Appraisal Tool MMAT will be used to evaluate research quality Two reviewers are responsible for completing the three tasks namely selecting the articles that meet the inclusion criteria extracting data in the articles selected and evaluating their research quality All findings and especially primary outcomes will be summarized in a table format of findings The results will provide a high quality synthesis of current evidence for researchers in this subject area The objective of this systematic review is to investigate the effects of the COVID 19 pandemic on PA in children and adolescents aged 6 17 years during 2020 1 What impact has the COVID 19 pandemic had on PA levels in school aged children and adolescents 2 Investigating changes in the locations of school aged childrens and adolescents PA between the pre COVID 19 period January 2020 and the COVID 19 period December 2020 We hope that this study will provide government authorities and health professionals with the necessary information in guiding actions and allocating resources so that the situation of physical inactivity in school aged children and adolescents during the COVID 19 pandemic can be improved thereby enhancing their physical health This review was submitted and registered under CRD42020225976 in PROSPERO 0 +304 Multi system inflammatory syndrome in children during the coronavirus disease 2019 in Saudi Arabia Clinical perspective from a case series Most of the reports about severe acute respiratory syndrome coronavirus 2 SARS CoV 2 in children reported mild to moderate disease manifestations However recent reports explored a rare pediatric multisystem syndrome possibly associated with SARS CoV 2 infection termed multisystem inflammatory syndrome in children MIS C The study prospectively enrolled 5 patients with clinical and laboratory evidence of MIS C associated with SARS CoV 2 infection They were admitted to the pediatric intensive care unit PICU Their clinical presentation laboratory and outcome were described All patients shared similar clinical presentations such as persistent documented fever for more than 3 days respiratory symptoms gastrointestinal involvement and increased inflammatory markers CRP ESR and ferritin Three patients had concurrent positive coronavirus disease 2019 COVID 19 infection and the other 2 patients had contact with suspected COVID 19 positive patients They were all managed in the PICU and received intravenous immunoglobulin systemic steroid and hydroxychloroquine The hospital stays ranged between 3 and 21 days One patient died due to severe multiorgan failures and shock and the other 4 patients were discharged with good conditions Pediatric patients with SARS CoV 2 are at risk for MIS C MIS C has a spectrum of clinical and laboratory presentations and the clinicians need to have a high index of suspicion for the diagnosis and should initiate its early treatment to avoid unfavorable outcomes Long term follow up studies will be required to explore any sequelae of MIS C precisely the cardiovascular complications 1 +667 Crossing the Rubicon A fine line between waiting and vaccinating adolescents against COVID 19 Several countries with advanced adult COVID 19 immunisation programmes have already started vaccinating adolescents with an mRNA vaccine that recently received emergency use authorisation for 12 15 year olds The decision to vaccinate adolescents remains highly divisive among parents clinicians politicians and policy makers There are very few downsides to immunising adolescents with a safe and effective COVID 19 vaccine because that would significantly reduce their risk of COVID 19 and all its complications Based on current evidence however adolescents have a very low risk of severe or fatal COVID 19 even among those with comorbidities or rare complications such as long COVID or Paediatric Multisystem Inflammatory Syndrome PIMS TS a hyperinflammatory syndrome temporally associated with SARS CoV 2 Additionally currently authorised vaccines are very reactogenic and have limited post marketing population level safety data in adolescents and young adults but these are emerging from countries that have forged ahead with vaccinating adolescents Countries that have yet to make a recommendation can afford to wait until there is sufficient information to make informed decisions on the risk benefits of vaccinating adolescents with current and future COVID 19 vaccines Alternatives to two dose vaccination in adolescents may include a single dose or a reduced dose schedule as is currently being trialled in younger children 0 +526 A review of pears Pyrus spp ancient functional food for modern times Pears have been world widely used as a sweet and nutritious food and a folk medicine for more than two millennia We conducted a review from ancient literatures to current reports to extract evidence based functions of pears We found that pears have many active compounds e g flavonoids triterpenoids and phenolic acids including arbutin chlorogenic acid malaxinic acid etc Most of researchers agree that the beneficial compounds are concentrated in the peels From various in vitro in vivo and human studies the medicinal functions of pears can be summarized as anti diabetic obese hyperlipidemic inflammatory mutagenic and carcinogenic effects detoxification of xenobiotics respiratory and cardio protective effects and skin whitening effects Therefore pears seem to be even effective for prevention from Covid 19 or PM sub 2 5 sub among high susceptible people with multiple underlying diseases For the current or post Covid 19 era pears have potential for functional food or medicine for both of communicable and non communicable disease 0 +587 COVID 19 related fear and depression of pregnant women and new mothers To explore factors associated with depression and COVID 19 related fear among pregnant women and new mothers A cross sectional survey was conducted in China from July 2020 to July 2021 A total of 3027 pregnant and new mothers were recruited Sociodemographic characteristics and the perceptions of the COVID 19 pandemic were collected The Patient Health Questionnaire 9 PHQ 9 and the Fear Scale was used to assess the depressive and fear level towards the COVID 19 pandemic respectively Approximately 17 2 of the participants had depression PHQ 9 10 In Hong Kong participants who perceived that they have increased knowledge to prevent infection were less likely to have depression adjusted odds ratio aOR 0 83 95 confidence interval CI 0 74 0 94 There was no association between perceived severity if infected and severity of spread and the depression level in our sample An inverse relationship was found between the COVID 19 related fear level and perceived knowledge to prevent infection Beta coefficient β 0 20 95 CI 0 38 to 0 02 Public health nurses need to promote accurate and up to date COVID 19 related information at clinical and community settings and implement effective screening for depression and fear symptoms to identify these high risk groups to improve womens psychological well being 0 +374 Simulated Patients for Competency Based Undergraduate Medical Education Post COVID 19 A New Normal in India The conventional medical curriculum in India needed more focus on explicit teaching and assessment of interpersonal and communication skills professionalism team work and reflection for prevention and better management of increasing incidences of violence against doctors by building good doctor patient relationships Increasing number of seats in Indian medical colleges decreasing hospital stay of patients and decrease in faculty requirements will hamper adequate supervised authentic clinical experiences of undergraduates for developing clinical skills The recent COVID 19 pandemic has led to a significant decrease in student patient encounters Simulated patients are being used in many countries to address many of these issues To make the Indian medical graduates competent to function as primary physician of first contact competency based medical education along with guidelines for use of skill lab and simulation has been introduced from 2019 The current review is focused on the need and use of simulated patients their advantages limitations and role in students teaching and assessment It also gives a brief outline of their training process Simulated patients should be used to supplement day to day learning help in transition to attending real patients and also save enormous faculty time in the post COVID 19 new normal However simulated patients are unlikely to completely replace real patients experiences 0 +70 Cardio Pulmonary Sequelae in Recovered COVID 19 Patients Considerations for Primary Care Current literature lacks characterization of the post recovery sequelae among COVID 19 patients This review characterizes the course of clinical laboratory radiological findings during the primary infection period and the complications post recovery Primary care findings are presented for long COVID care Adhering to PRISMA guidelines 4 databases were searched PubMed Embase CINAHL Plus Scopus through December 5 2020 using the keywords COVID 19 and or recovered and or cardiovascular and or long term and or sequelae and or sub acute and or complication We included published peer reviewed case reports case series and cross sectional studies providing the clinical course of COVID 19 infection and cardiopulmonary complications of patients who recovered from COVID 19 while making healthcare considerations for primary care workers We identified 29 studies across 9 countries including 37 9 Chinese and 24 1 U S studies comprising 655 patients Mean Age 45 with various ethnical backgrounds including Asian and European Based on the WHO COVID 19 severity classification scale initial disease severity was mild for 377 patients and severe for 52 patients Treatments during primary infection included corticosteroids oxygen support and antivirals The mean value in days for complication onset after acute recovery was 28 days Complete blood counts and RT PCR tests were the most common laboratory results described In 22 of the studies patients showed signs of clinical improvement and were prescribed medications such as anticoagulants or corticosteroids Post recovery infectious complications are common in long COVID 19 patients ranging from mild infections to life threatening conditions International thoracic and cardiovascular societies need to develop guidelines for patients recovering from COVID 19 pneumonia while focused patient care by the primary care physician is crucial to curb preventable adverse events Recommendations for real time and lab quality diagnostic tests are warranted to establish point of care testing detect early complications and provide timely treatment 1 +3 Contributions of dopamine related genes and environmental factors to highly sensitive personality a multi step neuronal system level approach Traditional behavioral genetic studies e g twin adoption studies have shown that human personality has moderate to high heritability but recent molecular behavioral genetic studies have failed to identify quantitative trait loci QTL with consistent effects The current study adopted a multi step approach ANOVA followed by multiple regression and permutation to assess the cumulative effects of multiple QTLs Using a system level dopamine system genetic approach we investigated a personality trait deeply rooted in the nervous system the Highly Sensitive Personality HSP 480 healthy Chinese college students were given the HSP scale and genotyped for 98 representative polymorphisms in all major dopamine neurotransmitter genes In addition two environment factors stressful life events and parental warmth that have been implicated for their contributions to personality development were included to investigate their relative contributions as compared to genetic factors In Step 1 using ANOVA we identified 10 polymorphisms that made statistically significant contributions to HSP In Step 2 these polymorphisms main effects and interactions were assessed using multiple regression This model accounted for 15 of the variance of HSP p 0 001 Recent stressful life events accounted for an additional 2 of the variance Finally permutation analyses ascertained the probability of obtaining these findings by chance to be very low p ranging from 0 001 to 0 006 Dividing these loci by the subsystems of dopamine synthesis degradation transport receptor and modulation we found that the modulation and receptor subsystems made the most significant contribution to HSP The results of this study demonstrate the utility of a multi step neuronal system level approach in assessing genetic contributions to individual differences in human behavior It can potentially bridge the gap between the high heritability estimates based on traditional behavioral genetics and the lack of reproducible genetic effects observed currently from molecular genetic studies 1 +215 Plasma metabolomic profiling of patients recovered from COVID 19 with pulmonary sequelae 3 months after discharge Elucidation of the molecular mechanisms involved in the pathogenesis of coronavirus disease COVID 19 may help to discover therapeutic targets To determine the metabolomic profile of circulating plasma from COVID 19 survivors with pulmonary sequelae 3 months after discharge a random outcome stratified case control sample was analyzed We enrolled 103 recovered COVID 19 patients as well as 27 healthy donors and performed pulmonary function tests computerized tomography CT scans laboratory examinations and liquid chromatography mass spectrometry Plasma metabolite profiles of COVID 19 survivors with abnormal pulmonary function were evidently different from those of healthy donors or subjects with normal pulmonary function These alterations were associated with disease severity and mainly involved amino acid and glycerophospholipid metabolic pathways Furthermore increased levels of triacylglycerols phosphatidylcholines prostaglandin E2 arginine and decreased levels of betain and adenosine were associated with pulmonary CO diffusing capacity and total lung capacity The global plasma metabolomic profile differed between subjects with abnormal and normal pulmonary function Further metabolite based analysis may help to identify the mechanisms underlying pulmonary dysfunction in COVID 19 survivors and provide potential therapeutic targets in the future 1 +101 COViD 19 Long Haulers Caring for Older People in the Aftermath of a Global Pandemic The coronavirus pandemic raised many questions about how to optimally care for older people as evidenced by the vulnerability of this population to the virus over the past eighteen months Not only are older people at a higher risk for contracting the disease but also for experiencing the severest forms of COVID 19 Unfortunately many have succumbed to this relentless and devastating virus Those who survive may encounter added challenges including the long term sequelae of COVID 19 In the aftermath of this pandemic how can healthcare professionals effectively care for older people experiencing long term complications of this disease 1 +146 Long Term SARS CoV 2 Specific Immune and Inflammatory Responses Across a Clinically Diverse Cohort of Individuals Recovering from COVID 19 A detailed understanding of long term SARS CoV 2 specific T cell responses and their relationship to humoral immunity and markers of inflammation in diverse groups of individuals representing the spectrum of COVID 19 illness and recovery is urgently needed Data are also lacking as to whether and how adaptive immune and inflammatory responses differ in individuals that experience persistent symptomatic sequelae months following acute infection compared to those with complete rapid recovery We measured SARS CoV 2 specific T cell responses soluble markers of inflammation and antibody levels and neutralization capacity longitudinally up to 9 months following infection in a diverse group of 70 individuals with PCR confirmed SARS CoV 2 infection The participants had varying degrees of initial disease severity and were enrolled in the northern California Long term Impact of Infection with Novel Coronavirus LIINC cohort Adaptive T cell responses remained remarkably stable in all participants across disease severity during the entire study interval Whereas the magnitude of the early CD4 T cell immune response is determined by the severity of initial infection participants requiring hospitalization or intensive care pre existing lung disease was significantly associated with higher long term SARS CoV2 specific CD8 T cell responses independent of initial disease severity or age Neutralizing antibody levels were strongly correlated with SARS CoV 2 specific CD4 T but not CD8 T cell responses Importantly we did not identify substantial differences in long term virus specific T cell or antibody responses between participants with and without COVID 19 related symptoms that persist months after initial infection 1 +291 Characterizing long COVID in an international cohort 7 months of symptoms and their impact A significant number of patients with COVID 19 experience prolonged symptoms known as Long COVID Few systematic studies have investigated this population particularly in outpatient settings Hence relatively little is known about symptom makeup and severity expected clinical course impact on daily functioning and return to baseline health We conducted an online survey of people with suspected and confirmed COVID 19 distributed via COVID 19 support groups e g Body Politic Long COVID Support Group Long Haul COVID Fighters and social media e g Twitter Facebook Data were collected from September 6 2020 to November 25 2020 We analyzed responses from 3762 participants with confirmed diagnostic antibody positive 1020 or suspected diagnostic antibody negative or untested 2742 COVID 19 from 56 countries with illness lasting over 28 days and onset prior to June 2020 We estimated the prevalence of 203 symptoms in 10 organ systems and traced 66 symptoms over seven months We measured the impact on life work and return to baseline health For the majority of respondents 91 the time to recovery exceeded 35 weeks During their illness participants experienced an average of 55 9 25 5 mean STD symptoms across an average of 9 1 organ systems The most frequent symptoms after month 6 were fatigue post exertional malaise and cognitive dysfunction Symptoms varied in their prevalence over time and we identified three symptom clusters each with a characteristic temporal profile 85 9 of participants 95 CI 84 8 to 87 0 experienced relapses primarily triggered by exercise physical or mental activity and stress 86 7 85 6 to 92 5 of unrecovered respondents were experiencing fatigue at the time of survey compared to 44 7 38 5 to 50 5 of recovered respondents 1700 respondents 45 2 required a reduced work schedule compared to pre illness and an additional 839 22 3 were not working at the time of survey due to illness Cognitive dysfunction or memory issues were common across all age groups 88 Except for loss of smell and taste the prevalence and trajectory of all symptoms were similar between groups with confirmed and suspected COVID 19 Patients with Long COVID report prolonged multisystem involvement and significant disability By seven months many patients have not yet recovered mainly from systemic and neurological cognitive symptoms have not returned to previous levels of work and continue to experience significant symptom burden All authors contributed to this work in a voluntary capacity The cost of survey hosting on Qualtrics and publication fee was covered by AAs research grant Wellcome Trust Gatsby Charity via Sainsbury Wellcome center UCL 1 +509 Child Psychiatrists and Psychologists Enhanced Collaboration in Primary Care Psychiatry and psychology have a long history of competition that too often interferes with the collaboration that can characterize complementary contributions to our common missions We hope this article will inspire our disciplines to expand on this collaboration for the sake of our children and families our communities our colleagues and honestly ourselves We are better together than apart This text is a blueprint for the assumptions attitudes skills and advocacy that can make this partnership healthy and successful 0 +601 i Fonsecaea i associated cerebral phaeohyphomycosis in a post COVID 19 patient A first case report Phaeohyphomycosis previously known as chromoblastomycosis is a chronic mycosis usually affecting the skin It is caused by dematiaceous fungi which are a group of fungi that produce melanin in their cell walls Cerebral phaeohyphomycosis occurs as a part of invasive presentation of the fungi which usually affects immunocompromised patients but may affect immunocompetent individuals as well Cerebral infection in phaeohyphomycosis is associated with a poor prognosis regardless of the immune status of the patient COVID 19 SARS CoV 2 infection and or medications used for its treatment may compromise the immune system including in the post COVID 19 period resulting in invasive fungal infections which have frequently been reported recently during the COVID 19 pandemic We report a case of i Fonsecaea i associated cerebral phaeohyphomycosis in a recently diagnosed diabetic Omani lady who presented to our hospital 6 weeks after recovery and discharge from hospitalization for moderate COVID 19 pneumonia 0 +10 Long term clinical and serological follow up of paediatric patients infected by SARS CoV 2 Studies concerning Severe Acute Respiratory Syndrome Coronavirus 2 SARS CoV 2 infection in paediatrics are limited to children mainly selected from hospitals where patients with complications and co morbidities are managed We aimed to describe the course of the Coronavirus Disease 2019 COVID 19 in a population of children enrolled by place of residence from diagnosis to recovery with a long term clinical and serological follow up We identified patients aged 14 years old living in the Turin Health District 3 who had SARS CoV 2 detected in at least one nasopharyngeal swab from 1st March to 1st June 2020 Epidemiological and clinical features of SARS CoV 2 infection were collected by way of a telephone inquiry Enrolled patients were tested for SARS CoV 2 serology in order to provide evidence of seroconversion and persistence of specific antibodies some time after the infection A total of 46 patients with SARS CoV 2 infection COVID 19 were identified The main pattern of viral transmission was intra family Eleven children were totally asymptomatic If symptoms appeared the disease had a mild course A single case of COVID 19 related respiratory insufficiency was registered Among children who underwent serological evaluation 84 had seroconversion No significant differences in antibody development were found according to the age and the burden of the disease Children tested farther from the primary infection had lower antibody index titre values than the others In conclusion COVID 19 has a good prognosis in paediatric age Children are able to develop a valid immune response although their index titres seem to decrease a long time after the disease 1 +437 Breastfeeding and COVID 19 From Nutrition to Immunity Breastfeeding not only provides the optimum source of nutrients for the neonate and its first strong shield against infection but also lays the foundation for somatic and psychological bonding between the mother and child During the current COVID 19 pandemic although the guidelines of the relevant international and national agencies recommend breastfeeding by SARS CoV 2 infected mothers considerable insecurity persists in daily clinical practice regarding the safety of the infants and the perceived advantages and disadvantages of discontinuation of breastfeeding This is a systematic review of the currently available information regarding the transmissibility of SARS CoV 2 through or while breastfeeding and the protection against infection that breast milk might provide The accumulated body of knowledge regarding the role of breast milk in the development of the neonatal immune system and protection against infection by other respiratory viruses is discussed with a focus on the anti inflammatory role of the antibodies microbes and viruses provided to the infant in breast milk and its relevance to the case of SARS CoV 2 0 +121 Recognizing the Clinical Sequelae of COVID 19 in Adults COVID 19 Long Haulers As the numbers of acute severe acute respiratory syndrome coronavirus 2 infections continue to rise we are learning that symptoms do not resolve quickly in all patients Although why some patients experience persistent symptoms is not clear these individuals suffer Long hauler is the term that is associated with these persistent symptoms and this review of the literature provides information to nurse practitioners working in primary care about symptoms risk factors and resources for disease management 1 +236 Persistent Brainstem Dysfunction in Long COVID A Hypothesis Long COVID is a postviral illness that can affect survivors of COVID 19 regardless of initial disease severity or age Symptoms of long COVID include fatigue dyspnea gastrointestinal and cardiac problems cognitive impairments myalgia and others While the possible causes of long COVID include long term tissue damage viral persistence and chronic inflammation the review proposes perhaps for the first time that persistent brainstem dysfunction may also be involved This hypothesis can be split into two parts The first is the brainstem tropism and damage in COVID 19 As the brainstem has a relatively high expression of ACE2 receptor compared with other brain regions SARS CoV 2 may exhibit tropism therein Evidence also exists that neuropilin 1 a co receptor of SARS CoV 2 may be expressed in the brainstem Indeed autopsy studies have found SARS CoV 2 RNA and proteins in the brainstem The brainstem is also highly prone to damage from pathological immune or vascular activation which has also been observed in autopsy of COVID 19 cases The second part concerns functions of the brainstem that overlap with symptoms of long COVID The brainstem contains numerous distinct nuclei and subparts that regulate the respiratory cardiovascular gastrointestinal and neurological processes which can be linked to long COVID As neurons do not readily regenerate brainstem dysfunction may be long lasting and thus is long COVID Indeed brainstem dysfunction has been implicated in other similar disorders such as chronic pain and migraine and myalgic encephalomyelitis or chronic fatigue syndrome 1 +119 Exercise performance in patients with post acute sequelae of SARS CoV 2 infection compared to patients with unexplained dyspnea Dyspnea and exercise intolerance are commonly reported post acute sequelae of SARS CoV 2 infection PASC but routine diagnostic testing is often normal Cardiopulmonary exercise testing CPET offers comprehensive assessment of dyspnea to characterize pulmonary PASC We performed a retrospective cohort study of CPET performed on patients reporting dyspnea and or exercise intolerance following confirmed Covid 19 between August 1 2020 and March 1 2021 and compared them to age and sex matched patients with unexplained dyspnea referred for CPET at the same center in the pre Covid 19 era Compared to matched unexplained dyspnea comparators PASC patients shared similar medical comorbidities and subjective dyspnea at referral mMRC score 1 6 0 9 vs 1 4 0 9 i P i 0 5 Fifteen 83 3 PASC patients underwent high resolution computed tomography of the chest of which half 46 7 were normal and 17 94 4 patients had pulmonary function testing of which the majority 76 5 were normal All patients underwent CPET and 12 67 had normal findings Compared to matched comparators PASC patients had similar peak oxygen consumption oxygen consumption at ventilatory anaerobic threshold and ventilatory efficiency measured by the minute ventilation to carbon dioxide production VE VCO sub 2 sub slope Despite prominent dyspnea physiological abnormalities on CPET were mild across a range of initial Covid 19 severity and similar to matched comparators referred for dyspnea without antecedent SARS CoV 2 The project was supported by the NHLBI R01HL131029 R01HL151841 U10HL110337 T32HL116275 and a KL2 award 5KL2TR002542 02 from Harvard Catalyst 1 +541 Degenerate CD8 Epitopes Mapping to Structurally Constrained Regions of the Spike Protein A T Cell Based Way Out From the SARS CoV 2 Variants Storm There is an urgent need for new generation anti SARS Cov 2 vaccines in order to increase the efficacy of immunization and its broadness of protection against viral variants that are continuously arising and spreading The effect of variants on protective immunity afforded by vaccination has been mostly analyzed with regard to B cell responses This analysis revealed variable levels of cross neutralization capacity for presently available SARS Cov 2 vaccines Despite the dampened immune responses documented for some SARS Cov 2 mutations available vaccines appear to maintain an overall satisfactory protective activity against most variants of concern VoC This may be attributed at least in part to cell mediated immunity Indeed the widely multi specific nature of CD8 T cell responses should allow to avoid VoC mediated viral escape because mutational inactivation of a given CD8 T cell epitope is expected to be compensated by the persistent responses directed against unchanged co existing CD8 epitopes This is particularly relevant because some immunodominant CD8 T cell epitopes are located within highly conserved SARS Cov 2 regions that cannot mutate without impairing SARS Cov 2 functionality Importantly some of these conserved epitopes are degenerate meaning that they are able to associate with different HLA class I molecules and to be simultaneously presented to CD8 T cell populations of different HLA restriction Based on these concepts vaccination strategies aimed at potentiating the stimulatory effect on SARS Cov 2 specific CD8 T cells should greatly enhance the efficacy of immunization against SARS Cov 2 variants Our review recollects discusses and puts into a translational perspective all available experimental data supporting these hot concepts with special emphasis on the structural constraints that limit SARS CoV 2 S protein evolution and on potentially invariant and degenerate CD8 epitopes that lend themselves as excellent candidates for the rational development of next generation CD8 T cell response reinforced COVID 19 vaccines 0 +83 Multisystem Inflammatory Syndrome in Children and Adolescents MIS C under the Setting of COVID 19 A Review of Clinical Presentation Workup and Management Earlier in its course SARS CoV 2 was primarily identified to cause an acute respiratory illness in adults the elderly and immunocompromised while children were known to be afflicted with milder symptoms However since mid April of 2020 latent effects of the virus have begun emerging in children and adolescents which is characterised by a multisystem hyperinflammatory state thus the term Multisystem Inflammatory Syndrome in Children MIS C was introduced by the WHO and CDC The syndrome manifests itself approximately 4 weeks after COVID 19 infection with symptoms mimicking Kawasaki Disease and Kawasaki Disease Shock Syndrome Demographically MIS C peaks in children aged 5 to 14 years with clusters in Europe North and Latin America seen later followed by Asia Although the exact pathophysiology behind the syndrome is unknown recent studies have proposed a post infectious immune aetiology which explains the increased levels of immunoglobulins seen in affected patients Patient presentation includes but is not limited to persistent fever rash gastrointestinal symptoms and cardiac complications including myocarditis These patients also have raised inflammatory markers including C reactive protein ferritin and interleukin 6 In poorly controlled patients the syndrome can lead to multiorgan failure and death The mainstay of treatment includes the use of intravenous immunoglobulins steroids immune modulators and aspirin Adjunct therapy includes the use of low molecular weight heparin or warfarin for long term anticoagulation Currently very little is known about the syndrome highlighting the need for awareness amongst healthcare workers and parents Moreover with increased cases of COVID 19 as a result of the second wave it is essential to keep MIS C in mind when attending patients with a past history of COVID 19 exposure or infection Additionally once these patients have been identified and treated strict follow up must be done in order carry out long term studies and to identify possible sequelae and complications 1 +80 Long COVID rheumatologic musculoskeletal symptoms in hospitalized COVID 19 survivors at 3 and 6 months To document the detailed characteristics including severity type and locations of rheumatic and musculoskeletal symptoms along with other COVID 19 persistent symptoms in hospitalized COVID 19 survivors at 3 and 6 months In this extension cohort study two telephone surveys at 3 and 6 months following the hospitalization were carried out In these telephone surveys participants were asked regarding their symptoms through a previously designed standard questionnaire At 3 months 89 0 of survivors had at least one symptom 74 6 had at least one rheumatic and musculoskeletal symptom and 82 1 had at least one other COVID 19 symptom At 6 months 59 6 of survivors had at least one symptom 43 2 had at least one rheumatic and musculoskeletal symptom and 51 2 had at least one other COVID 19 symptom Regarding the rheumatic and musculoskeletal symptoms 31 6 had fatigue 18 6 had joint pain and 15 1 had myalgia and regarding the other COVID 19 symptoms 25 3 had dyspnea 20 0 had hair loss and 17 2 sweat at 6 months In an adjusted model female patients were more likely to have fatigue OR 1 99 95 CI 1 18 3 34 myalgia 3 00 1 51 5 98 and joint pain 3 39 1 78 6 50 at 6 months Approximately 3 in 5 patients had at least one symptom with 2 in 5 patients had at least one rheumatic and musculoskeletal symptom Fatigue joint pain and myalgia were the most frequent rheumatic and musculoskeletal symptoms Joint pain and myalgia were mostly widespread This information guide rheumatologists to understand the nature and features of persistent rheumatic and musculoskeletal symptoms in hospitalized COVID 19 survivors and may contribute to better management of these individuals Key Points Approximately 3 in 5 patients had at least one symptom with 2 in 5 patients had at least one rheumatic and musculoskeletal symptom at 6 months Fatigue joint pain and myalgia were the most frequent rheumatic and musculoskeletal symptoms followed by back pain low back pain and neck pain Dyspnea hair loss and sweat were the most frequent other COVID 19 symptoms 1 +683 Mitigating losses how scientific organisations can help address the impact of the COVID 19 pandemic on early career researchers Scientific collaborations among nations to address common problems and to build international partnerships as part of science diplomacy is a well established notion The international flow of people and ideas has played an important role in the advancement of the Sciences and the current pandemic scenario has drawn attention towards the genuine need for a stronger role of science diplomacy science advice and science communication In dealing with the COVID 19 pandemic visible interactions across science policy science communication to the public and diplomacy worldwide have promptly emerged These interactions have benefited primarily the disciplines of knowledge that are directly informing the pandemic response while other scientific fields have been relegated The effects of the COVID 19 pandemic on scientists of all disciplines and from all world regions are discussed here with a focus on early career researchers ECRs as a vulnerable population in the research system Young academies and ECR driven organisations could suggest ECR powered solutions and actions that could have the potential to mitigate these effects on ECRs working on disciplines not related to the pandemic response In relation with governments and other scientific organisations they can have an impact on strengthening and creating fairer scientific systems for ECRs at the national regional and global level 0 +528 Comparison of in house SARS CoV 2 genome extraction procedures A need for COVID 19 pandemic Among the methods used to diagnose COVID 19 those based on genomic detection by q RT PCR are the most sensitive To perform these assays a previous genome extraction of the sample is required The dramatic increase in the number of SARS CoV 2 detection assays has increased the demand for extraction reagents hindering the supply of commercial reagents Homemade reagents and procedures could be an alternative Nasopharyngeal samples were extracted by seven different methods as well as the automatic method MagNaPure96 to detect SARS CoV 2 All protocols show sensitivity higher than 87 in comparison with reference method for detecting SARS CoV 2 as well as human β globin Our results support that these procedures using common and cheap reagents are effective to extract RNA from SARS CoV 2 or DNA from human β globin genome from nasopharyngeal swabs Furthermore these procedures could be easily adopted by routine diagnostic laboratories to implement detection methods to help to fight against COVID 19 pandemic 0 +202 Post COVID Syndrome Incidence Clinical Spectrum and Challenges for Primary Healthcare Professionals Post COVID syndrome also known as long COVID refers to symptoms persisting for more than three weeks after the diagnosis of COVID 19 We reviewed the current evidence on post COVID syndrome focusing on its clinical manifestations and addressing the challenges for its management in primary healthcare The incidence of post COVID syndrome is estimated at 10 35 while for hospitalized patients it may reach 85 Fatigue is the most common symptom reported in 17 5 72 of post COVID cases followed by residual dyspnea with an incidence ranging from 10 40 Mental problems chest pain and olfactory and gustatory dysfunction may affect up to 26 22 and 11 of patients respectively More than one third of patients with post COVID syndrome have pre existing comorbidities hypertension and diabetes mellitus being the most common Beyond the prolonged duration of symptoms the scarce published data indicate that most patients with post COVID syndrome have a good prognosis with no further complications or fatal outcomes reported Given the clinical spectrum of patients with post COVID syndrome most of them will be managed by primary healthcare professionals in conjunction with pre existing or new co morbidities which in turn may increase the burden of COVID 19 on primary healthcare In conclusion approximately 10 of patients with COVID 19 may have symptoms persisting beyond three weeks fulfilling the criteria of post COVID syndrome Primary healthcare professionals have a key role in the management of patients with post COVID syndrome Research is needed to elucidate the pathogenesis clinical spectrum and prognosis of post COVID syndrome 1 +649 Safety of Healthcare Workers During the Airway Management in Adult and Pediatric Patients with COVID 19 Since December 2019 the outbreak of coronavirus disease 2019 COVID 19 has spread worldwide Although the majority of patients show mild symptoms the disease can rapidly progress in severe cases and develop acute respiratory distress syndrome ARDS that may lead to therapeutic interventions including oxygenation tracheal intubation and mechanical ventilation It is suggested that the new coronavirus spreads mostly via droplets surface contact and natural aerosols Hence high risk aerosol producing procedures such as endotracheal intubation may put the healthcare workers at a high risk of infection In the course of managing patients with COVID 19 it is essential to prioritize the safety of healthcare workers Hence this review study aimed to summarize new guidelines and proper airway management in adult and pediatric COVID 19 patients 0 +501 Essentials in saline pharmacology for nasal or respiratory hygiene in times of COVID 19 Nasal irrigation or nebulizing aerosol of isotonic or hypertonic saline is a traditional method for respiratory or nasal care A recent small study in outpatients with COVID 19 without acute respiratory distress syndrome suggests substantial symptom resolution We therefore analyzed pharmacological pharmacodynamic effects of isotonic or hypertonic saline relevant to SARS CoV 2 infection and respiratory care Mixed search method Due to its wetting properties saline achieves an improved spreading of alveolar lining fluid and has been shown to reduce bio aerosols and viral load Saline provides moisture to respiratory epithelia and gels mucus promotes ciliary beating and improves mucociliary clearance Coronaviruses and SARS CoV 2 damage ciliated epithelium in the nose and airways Saline inhibits SARS CoV 2 replication in Vero cells possible interactions involve the viral ACE2 entry mechanism chloride dependent ACE2 configuration furin and 3CLpro inhibition by NaCl and the sodium channel ENaC Saline shifts myeloperoxidase activity in epithelial or phagocytic cells to produce hypochlorous acid Clinically nasal or respiratory airway care with saline reduces symptoms of seasonal coronaviruses and other common cold viruses Its use as aerosol reduces hospitalization rates for bronchiolitis in children Preliminary data suggest symptom reduction in symptomatic COVID 19 patients if saline is initiated within 48 h of symptom onset Saline interacts at various levels relevant to nasal or respiratory hygiene nasal irrigation gargling or aerosol If used from the onset of common cold symptoms it may represent a useful add on to first line interventions for COVID 19 Formal evaluation in mild COVID 19 is desirable as to establish efficacy and optimal treatment regimens 0 +613 COVID 19 vaccines and thrombosis with thrombocytopenia syndrome To combat COVID 19 scientists all over the world have expedited the process of vaccine development Although interim analyses of clinical trials have demonstrated the efficacy and safety of COVID 19 vaccines a serious but rare adverse event thrombosis with thrombocytopenia syndrome TTS has been reported following COVID 19 vaccination This review using data from both peer reviewed and non peer reviewed studies aimed to provide updated information about the critical issue of COVID 19 vaccine related TTS The exact epidemiological characteristics and possible pathogenesis of this adverse event remain unclear Most cases of TTS developed in women within 2 weeks of the first dose of vaccine on the receipt of the ChAdOx1 nCoV 19 and Ad26 COV2 S vaccines In countries with mass vaccination against COVID 19 clinicians should be aware of the relevant clinical features of this rare adverse event and perform related laboratory and imaging studies for early diagnosis Non heparin anticoagulants such as fondaparinux argatroban or a direct oral anticoagulant e g apixaban or rivaroxaban and intravenous immunoglobulins are recommended for the treatment of TTS However further studies are required to explore the underlying mechanisms of this rare clinical entity b What is the context b Thrombosis with thrombocytopenia syndrome TTS usually develops within 2 weeks of the first doses of the ChAdOx1 nCoV 19 and Ad26 COV2 S COVID 19 vaccines TTS mainly occurs in patients aged 55 years and is associated with high morbidity and mortality b What is new b TTS mimics autoimmune heparin induced thrombocytopenia and can be mediated by platelet activating antibodies against platelet factor 4 Non heparin anticoagulants such as fondaparinux argatroban or a direct oral anticoagulant e g apixaban or rivaroxaban should be considered as the treatment of choice if the platelet count is 50 10 sup 9 sup L and there is no serious bleeding Intravenous immunoglobulins and glucocorticoids may help increase the platelet count within days and reduce the risk of hemorrhagic transformation when anticoagulation is initiated b What is the impact b TTS should be a serious concern during the implementation of mass COVID 19 vaccination and patients should be educated about this complication along with its symptoms such as severe headache blurred vision seizure severe and persistent abdominal pain painful swelling of the lower leg and chest pain or dyspnea The incidence of TTS is low therefore maintenance of high vaccination coverage against COVID 19 should be continued 0 +298 Post COVID recovery characteristics of chronically critically ill patients admitted to a long term acute care hospital b Background b Survivors of COVID 19 pneumonia often suffer from chronic critical illness CCI and require long term hospitalization Long term acute care LTAC hospitals are vital in the care of CCI patients but their role for patients post COVID 19 infection is not known Barlow Respiratory Hospital BRH is a 105 bed LTAC hospital network serving ventilator dependent and medically complex patients transferred from the ICUs of hospitals in southern California We report patient characteristics of our first series of COVID 19 survivors admitted to the post acute venue of an LTAC hospital b Methods b Single center observational descriptive report of patients recovering from acute infectious complications of COVID 19 pneumonia requiring long term respiratory support b Results b From 28 April to 7 September 2020 41 patients were admitted to BRH for continued recovery from COVID 19 pneumonia Median age 68 44 94 years 25 41 61 male 33 41 80 5 with tracheostomy 21 41 51 2 on invasive mechanical ventilation 9 41 22 receiving hemodialysis All mechanical ventilation and hemodialysis interventions were initiated at the transferring hospital b Conclusions b To our knowledge this is the first report to characterize CCI and medically complex COVID 19 patients transferred to the post acute venue of an LTAC hospital Patients on average spent over six weeks in the transferring hospital mostly in the ICU are largely elderly carry the known risk factors for COVID 19 infection and experienced respiratory failure necessitating prolonged mechanical ventilation via tracheostomy Our findings suggest that these patients will continue to require considerable medical interventions and treatments including weaning from mechanical ventilation owing to the numerous sequelae of the infection and the burden of acute on chronic diseases As ICU survival rates improve this research further emphasizes the important role of the LTAC hospital in responding to the COVID 19 crisis 1 +38 Serum levels of laminin and von Willebrand factor in COVID 19 survivors 6 months after discharge To evaluate clinical characteristics pulmonary diffusion function chest computerized tomography CT and serum lung cell damage indicators of coronavirus disease 2019 COVID 19 survivors 6 months after discharge Data of COVID 19 survivors discharged from hospital between January 21 2020 and January 11 2021 and healthy controls were collected Serum levels of surfactant D SPD the receptor for advanced glycation products RAGE laminin and von Willebrand factor vWF were measured in healthy controls and COVID 19 survivors 6 months after discharge The relationships between serum lung cell damage indicator levels and various parameters were explored Fifty two COVID 19 survivors 31 non severe and 21 severe and 30 controls were included Serum levels of laminin in COVID 19 survivors 6 months after discharge were significantly higher than those in the controls The increase was more significant in elderly and female patients Serum levels of RAGE and vWF were not statistically different from those of the controls However 6 months after discharge COVID 19 survivors with abnormal chest CT and those in the severe group had higher vWF levels COVID 19 patients had abnormal lung injury indicators 6 months after discharge The recovery time after infection is currently unknown and long term observations are required 1 +164 Postacute COVID 19 An Overview and Approach to Classification As the coronavirus disease 2019 COVID 19 pandemic has progressed a large volume of literature has developed delineating the clinical manifestations of acute infection Recent reports have also started to describe persistent symptoms extending beyond the period of initial illness or hospitalization Anecdotes of different signs and symptoms occurring after acute infection have also arisen in the lay press Here we describe the current existing medical literature on the emerging concept of postacute COVID 19 and suggest an approach to classifying different manifestations of the syndrome We also review long term clinical manifestations observed in patients who recovered from infection due to other epidemic coronaviruses and briefly discuss potential mechanisms driving the phenomenon of postacute COVID 19 1 +7 Short term and Long term Rates of Postacute Sequelae of SARS CoV 2 Infection A Systematic Review Short term and long term persistent postacute sequelae of COVID 19 PASC have not been systematically evaluated The incidence and evolution of PASC are dependent on time from infection organ systems and tissue affected vaccination status variant of the virus and geographic region To estimate organ system specific frequency and evolution of PASC PubMed MEDLINE Scopus the World Health Organization Global Literature on Coronavirus Disease and CoronaCentral databases were searched from December 2019 through March 2021 A total of 2100 studies were identified from databases and through cited references Studies providing data on PASC in children and adults were included The Preferred Reporting Items for Systematic Reviews and Meta analyses PRISMA guidelines for abstracting data were followed and performed independently by 2 reviewers Quality was assessed using the Newcastle Ottawa Scale for cohort studies The main outcome was frequency of PASC diagnosed by 1 laboratory investigation 2 radiologic pathology and 3 clinical signs and symptoms PASC were classified by organ system ie neurologic cardiovascular respiratory digestive dermatologic and ear nose and throat as well as mental health constitutional symptoms and functional mobility From a total of 2100 studies identified 57 studies with 250 351 survivors of COVID 19 met inclusion criteria The mean SD age of survivors was 54 4 8 9 years 140 196 56 were male and 197 777 79 were hospitalized during acute COVID 19 High income countries contributed 45 studies 79 The median IQR proportion of COVID 19 survivors experiencing at least 1 PASC was 54 0 45 0 69 0 13 studies at 1 month short term 55 0 34 8 65 5 38 studies at 2 to 5 months intermediate term and 54 0 31 0 67 0 9 studies at 6 or more months long term Most prevalent pulmonary sequelae neurologic disorders mental health disorders functional mobility impairments and general and constitutional symptoms were chest imaging abnormality median IQR 62 2 45 8 76 5 difficulty concentrating median IQR 23 8 20 4 25 9 generalized anxiety disorder median IQR 29 6 14 0 44 0 general functional impairments median IQR 44 0 23 4 62 6 and fatigue or muscle weakness median IQR 37 5 25 4 54 5 respectively Other frequently reported symptoms included cardiac dermatologic digestive and ear nose and throat disorders In this systematic review more than half of COVID 19 survivors experienced PASC 6 months after recovery The most common PASC involved functional mobility impairments pulmonary abnormalities and mental health disorders These long term PASC effects occur on a scale that could overwhelm existing health care capacity particularly in low and middle income countries 1 +582 Reporting and methodological quality of COVID 19 systematic reviews needs to be improved an evidence mapping To assess the reporting and methodological quality of COVID 19 systematic reviews and to analyze trends and gaps in the quality clinical topics author countries and populations of the reviews using an evidence mapping approach A structured search for systematic reviews concerning COVID 19 was performed using PubMed Embase Cochrane Library Campbell Library Web of Science CBM WanFang Data CNKI and CQVIP from inception until June 2020 The quality of each review was assessed using the Assessment of Multiple Systematic Reviews 2 AMSTAR 2 checklist and the Preferred Reporting Items for Systematic Reviews and Meta Analyses PRISMA checklist In total 243 systematic reviews met the inclusion criteria over 50 of which 128 52 7 were from 14 developing countries with China contributing the most reviews 76 31 3 In terms of methodological quality of the studies 30 12 3 were of moderate quality 63 25 9 were of low quality and 150 61 7 were of critically low quality In terms of reporting quality the median interquartile range PRISMA score was 14 10 18 Regarding the topics of the reviews 24 9 9 focused on the prevalence of COVID 19 69 28 4 focused on the clinical manifestations 30 12 3 focused on etiology 43 17 7 focused on diagnosis 65 26 7 focused on treatment 104 42 8 focused on prognosis and 25 10 3 focused on prevention These studies mainly focused on general patients with COVID 19 161 66 3 followed by children 22 9 1 and pregnant patients 18 7 4 This study systematically evaluated the methodological and reporting quality of systematic reviews of COVID 19 summarizing and analyzing trends in their clinical topics author countries and study populations 0 +639 Mass Spectrometry based Proteomics and Glycoproteomics in COVID 19 Biomarkers Identification A Mini review The first corona pandemic coronavirus disease 2019 COVID 19 caused a huge health crisis and incalculable damage worldwide Knowledge of how to cure the disease is urgently needed Emerging immune escaping mutants of the virus suggested that it may be potentially persistent in human society as a regular health threat as the flu virus Therefore it is imperative to identify appropriate biomarkers to indicate pathological and physiological states and more importantly clinic outcomes Proteins are the performers of life functions and their abundance and modification status can directly reflect the immune status Protein glycosylation serves a great impact in modulating protein function The use of both unmodified and glycosylated proteins as biomarkers has also been proved feasible in the studies of SARS Zika virus influenza etc In recent years mass spectrometry based glycoproteomics as well as proteomics approaches advanced significantly due to the evolution of mass spectrometry We focus on the current development of the mass spectrometry based strategy for COVID 19 biomarkers investigation Potential application of glycoproteomics approaches and challenges in biomarkers identification are also discussed 0 +284 The Neurological Manifestations of Post Acute Sequelae of SARS CoV 2 infection Coronavirus disease 2019 COVID 19 caused by the severe acute respiratory syndrome coronavirus 2 SARS CoV 2 is a global health challenge This review aims to summarize the incidence risk factors possible pathophysiology and proposed management of neurological manifestations of post acute sequelae of SARS CoV 2 infection PASC or neuro PASC based on the published literature The National Institutes of Health has noted that PASC is a multi organ disorder ranging from mild symptoms to an incapacitating state that can last for weeks or longer following recovery from initial infection with SARS CoV 2 Various pathophysiological mechanisms have been proposed as the culprit for the development of PASC These include but are not limited to direct or indirect invasion of the virus into the brain immune dysregulation hormonal disturbances elevated cytokine levels due to immune reaction leading to chronic inflammation direct tissue damage to other organs and persistent low grade infection A multidisciplinary approach for the treatment of neuro PASC will be required to diagnose and address these symptoms Tailored rehabilitation and novel cognitive therapy protocols are as important as pharmacological treatments to treat neuro PASC effectively With recognizing the growing numbers of COVID 19 patients suffering from neuro PASC there is an urgent need to identify affected individuals early to provide the most appropriate and efficient treatments Awareness among the general population and health care professionals about PASC is rising and more efforts are needed to understand and treat this new emerging challenge In this review we summarize the relevant scientific literature about neuro PASC 1 +2 Longest reported case of symptomatic COVID 19 reporting positive for over 230 days in an immunocompromised patient in the United States Coronavirus 2019 COVID 19 pneumonia was first noted in Wuhan China Since the start of the pandemic there have been millions of cases diagnosed The average time from onset of symptoms to testing negative SARS CoV 2 via reverse transcription polymerase chain reaction is roughly 25 days In patients who continually test positive for COVID 19 it is essential to determine precisely which risk factors contribute to the increase in viral shedding duration We present a case about a 62 year old man who has persistently tested positive for COVID 19 for more than 230 days We followed his treatment course in which he had been hospitalized multiple times since the onset of symptoms back in April 2020 We have determined that patients with immunosuppression especially those taking corticosteroids are at increased risk of prolonged viral shedding It is essential to continually monitor these immunocompromised patients as they required a greater time period in order to have an appropriate immune response in which antibodies are created 1 +197 Post COVID 19 precautions based on lessons learned from past pandemics a review In view of the spread of the contagious coronavirus disease COVID 19 globally the present review focuses on the details of past pandemic diseases along with comparisons and lessons learned A general awareness of COVID 19 infection is addressed and it is compared with the Spanish flu pandemic Based on the successes failures and lessons learned in the past governmental efforts must be undertaken to empower citizens by providing accurate information and implementing post COVID 19 precautions that need to be taken now to stop the spread and recurrence of the virus locally and to restore health and economic normalcy A detailed literature survey of past pandemics is undertaken in order to extract the successes failures and lessons learned from previous breakouts The comparison of past pandemics will enable us to determine post COVID 19 precautions that should be followed Separate tables are prepared to highlight the lessons learned and measures to be taken Both general precautions and preventive measures for pregnant women are compiled The literature shows a continuous struggle of humans with disease outbreaks with the most adverse impact of the Spanish flu killing 20 50 million people Precautions need to be taken including social distancing compulsory mask wearing avoiding public gatherings and washing hands regularly The lessons from earlier pandemics show that they were equally devastating and vaccines were not available at the time of outbreaks Vaccines developed for polio H1N1 measles and other viral diseases have proven to save countless lives Living with COVID 19 and evolving the work culture of protecting oneself and protecting others also has to be adopted COVID 19 has become an everyday topic of discussion throughout the world indicating the increasing number of COVID 19 cases deaths and recoveries The lessons learned from past pandemics such as social distancing wearing masks avoiding public gatherings and adherence to guidelines along with personal hygiene are the key measures that must be taken in order to live with COVID 19 Precautions for the elderly and pregnant women advised by medical authorities are to be strictly adhered to These will help in reducing COVID 19 cases and in turn will reduce the pressure on hospitals to serve those in need India has learned lessons from the past and the present pandemic and will move towards growth through its self reliance 1 +628 Why lockdown and distance learning during the COVID 19 pandemic are likely to increase the social class achievement gap The COVID 19 pandemic has forced teachers and parents to quickly adapt to a new educational context distance learning Teachers developed online academic material while parents taught the exercises and lessons provided by teachers to their children at home Considering that the use of digital tools in education has dramatically increased during this crisis and it is set to continue there is a pressing need to understand the impact of distance learning Taking a multidisciplinary view we argue that by making the learning process rely more than ever on families rather than on teachers and by getting students to work predominantly via digital resources school closures exacerbate social class academic disparities To address this burning issue we propose an agenda for future research and outline recommendations to help parents teachers and policymakers to limit the impact of the lockdown on social class based academic inequality 0 +454 The OM 85 bacterial lysate inhibits SARS CoV 2 infection of epithelial cells by downregulating SARS CoV 2 receptor expression Treatments for coronavirus disease of 2019 COVID 19 which is caused by severe acute respiratory syndrome coronavirus 2 SARS CoV 2 are urgently needed but remain limited SARS CoV 2 infects cells through interactions of its spike S protein with ACE2 and TMPRSS2 on host cells Multiple cells and organs are targeted particularly airway epithelial cells OM 85 a standardized lysate of human airway bacteria with strong immunomodulating properties and an impeccable safety profile is widely used to prevent recurrent respiratory infections We found that airway OM 85 administration inhibits Ace2 and Tmprss2 transcription in the mouse lung suggesting that OM 85 might hinder SARS CoV 2 host cell interactions To investigate whether and how OM 85 treatment protects non human primate and human epithelial cells against SARS CoV 2 ACE2 and TMPRSS2 mRNA and protein expression cell binding of SARS CoV 2 S1 protein cell entry of SARS CoV 2 S protein pseudotyped lentiviral particles and SARS CoV 2 cell infection were measured in kidney lung and intestinal epithelial cell lines primary human bronchial epithelial cells and ACE2 transfected HEK293T cells treated with OM 85 in vitro OM 85 significantly downregulated ACE2 and TMPRSS2 transcription and surface ACE2 protein expression in epithelial cell lines and primary bronchial epithelial cells OM 85 also strongly inhibited SARS CoV 2 S1 protein binding to SARS CoV 2 S protein pseudotyped lentivirus entry into and SARS CoV 2 infection of epithelial cells These effects of OM 85 appeared to depend on SARS CoV 2 receptor downregulation OM 85 inhibits SARS CoV 2 epithelial cell infection in vitro by downregulating SARS CoV 2 receptor expression Further studies are warranted to assess whether OM 85 may prevent and or reduce the severity of COVID 19 0 +245 Long COVID An overview Long COVID is the collective term to denote persistence of symptoms in those who have recovered from SARS CoV 2 infection WE searched the pubmed and scopus databases for original articles and reviews Based on the search result in this review article we are analyzing various aspects of Long COVID Fatigue cough chest tightness breathlessness palpitations myalgia and difficulty to focus are symptoms reported in long COVID It could be related to organ damage post viral syndrome post critical care syndrome and others Clinical evaluation should focus on identifying the pathophysiology followed by appropriate remedial measures In people with symptoms suggestive of long COVID but without known history of previous SARS CoV 2 infection serology may help confirm the diagnosis This review will helps the clinicians to manage various aspects of Long COVID 1 +340 Persistent clinical features in paediatric patients after SARS CoV 2 virological recovery a retrospective population based cohort study from a single centre in Latvia The COVID 19 related state of emergency in Latvia was declared on 12 March 2020 Consequently Childrens Clinical University Hospital in Riga Latvia established a postacute outpatient service for individuals after recovery from COVID 19 Although information regarding the epidemiology and clinical features of COVID 19 in children has accumulated relevant reports about persistent symptoms after recovery are lacking We aimed to determine data on COVID 19 persistent symptoms after recovery in children in Latvia Persistent symptoms have been reported in 9 out of 30 children 1 +615 Suicide prevention and COVID 19 Suicide prevention during Covid 19 has become a global priority because the current pandemic has led to societal difficulties threatening the fabric of our lifestyle with increased morbidity and mortality Modelling studies published since the COVID 19 pandemic was declared in March 2020 estimate that suicide rates will increase by anywhere between 1 to 145 globally in response to the pandemic and action needs to be taken A narrative literature review on high quality evidence sources limited to human studies and publications written in English language only has been used to examine the relationship of COVID 19 and existing mental illness or history of mental illness suicide prevention strategies and changes in overall suicide rates A total of 39 papers are summarised and grouped using the headings aetiological factors proposed interventions to increase access and national policies to provide a framework for suicide prevention during pandemics such as COVID 19 This review indicates that 1 investing in active labour market programmes will result in a decreased suicide rate during times of high unemployment 2 People in low paid and casual jobs require specific support because they are most financially vulnerable during a pandemic related crisis 3 Women require specific support during a pandemic because of the type of employment they have and because they often carry a greater proportion of the domestic burden and are at increased risk of domestic violence during lockdown and crisis 4 Mental health and substance misuse services need to be appropriately funded and prioritised during and post pandemic due to the associated increase in substance misuse during a pandemic causing worsening mental health and increased risk of suicide 5 National Suicide Prevention Strategies should be developed by all countries and should anticipate response to a range of disasters including a pandemic 6 Suicide prevention is everybodys business and National Suicide Prevention Strategies should adopt a whole systems approach including mental health services primary care social care NGOs and other community stakeholders 7 Suicide is preventable 8 It is essential to prioritise suicide prevention strategies in the COVID and post COVID period to ensure that lives are saved Increase in suicide is not inevitable and suicide prevention during pandemics and post COVID 19 pandemics requires a collaborative whole system approach We require real time data to inform dynamic action planning 0 +599 Evidence informed interventions and best practices for supporting women experiencing or at risk of homelessness a scoping review with gender and equity analysis While much of the literature on homelessness is centred on the experience of men women make up over one quarter of Canadas homeless population Research has shown that women experiencing homelessness are often hidden i e provisionally housed and have different pathways into homelessness and different needs as compared to men The objective of this research is to identify evidence based interventions and best practices to better support women experiencing or at risk of homelessness We conducted a scoping review with a gender and equity analysis This involved searching MEDLINE CINAHL PsycINFO and other databases for systematic reviews and randomized trials supplementing our search through reference scanning and grey literature followed by a qualitative synthesis of the evidence that examined gender and equity considerations Of the 4102 articles identified on homelessness interventions only 4 systematic reviews and 9 randomized trials were exclusively conducted on women or published disaggregated data enabling a gender analysis Interventions with the strongest evidence included post shelter advocacy counselling for women experiencing homelessness due to intimate partner violence as well as case management and permanent housing subsidies e g tenant based rental assistance vouchers which were shown to reduce homelessness food insecurity exposure to violence and psychosocial distress as well as promote school stability and child well being Much of the evidence on interventions to better support women experiencing homelessness focusses on those accessing domestic violence or family shelters Since many more women are experiencing or at risk of hidden homelessness population based strategies are also needed to reduce gender inequity and exposure to violence which are among the main structural drivers of homelessness among women 0 +142 Long COVID in children and adolescents To identify the prevalence and also the full spectrum of symptoms complaints of children and adolescents who are suffering from long COVID Furthermore we investigated the risk factors of long COVID in children and adolescents All consecutive children and adolescents who were referred to the hospitals anywhere in Fars province Iran from 19 February 2020 until 20 November 2020 were included All patients had a confirmed diagnosis of COVID 19 In a phone call to patients parents at least 3 months after their discharge from the hospital we obtained their current status and information if their parents agreed to participate In total 58 children and adolescents fulfilled the inclusion criteria Twenty six 44 8 children adolescents reported symptoms complaints of long COVID These symptoms included fatigue in 12 21 shortness of breath in 7 12 exercise intolerance in 7 12 weakness in 6 10 and walking intolerance in 5 9 individuals Older age muscle pain on admission and intensive care unit admission were significantly associated with long COVID Long COVID is a frequent condition in children and adolescents The scientific community should investigate and explore the pathophysiology of long COVID to ensure that these patients receive appropriate treatments for their condition 1 +207 Dermatologic manifestations of COVID 19 associated multisystem inflammatory syndrome in children Multisystem inflammatory syndrome in children MIS C affects a small percentage of pediatric patients infected with COVID 19 and is characterized by fever laboratory evidence of inflammation multisystem involvement and severe illness necessitating hospitalization Skin findings are often present in these patients and when initially compared with Kawasaki disease they likely represent distinct phenomena and overall remain poorly characterized In this retrospective review of 34 case reports and series we identified cutaneous manifestations documented in 417 of 736 patients 57 with MIS C associated with COVID 19 Rash was the sole descriptor of skin findings in nearly half of patients Case reports and smaller case series provided more detail outlining a broad range of lesion morphologies polymorphic maculopapular morbilliform erythrodermic urticarial reticular petechial purpuric in variable anatomic distribution More thorough descriptions of dermatologic manifestations in patients with MIS C are warranted to better characterize this syndrome as they may lend important insight into pathogenic mechanisms of disease 1 +637 Elementary Laboratory Assays as Biomarkers of Ageing Support for Treatment of COVID 19 Youth working age and the elderly On a timeline chronological age CA and biological age BA may dissociate nosological entities manifest themselves at different BAs In determining which disease corresponds to a given age decade statistical registries of causes of death are unreliable and this does not change with SARS CoV 2 infection Beyond adolescence ageing metrics involve estimations of changes in fitness including prediction models to estimate the number of remaining years left to live A substantial disparity in biomarker levels and health status of ageing can be observed the difference in CA and BA in the large cohorts under consideration is glaring Here we focus more closely on ageing and senescence metrics in order to make information available for risk analysis non the least with COVID 19 including the most recent risk factors of ABO blood type and 3p21 31 chromosome cluster impacting on C5a and SC5b 9 plasma levels From the multitude of routine medical laboratory assays a potentially meaningful set of assays aimed to best reflect the stage of individual senescence hence risk factors the observational prospective SENIORLABOR study of 1 467 healthy elderly performed since 2009 and similar approaches since 1958 can be instantiated as a network to combine a set of elementary laboratory assays quantifying senescence 0 +222 Screening of Potential Cardiac Involvement in Competitive Athletes Recovering From COVID 19 An Expert Consensus Statement As our understanding of the complications of coronavirus disease 2019 COVID 19 evolve subclinical cardiac pathology such as myocarditis pericarditis and right ventricular dysfunction in the absence of significant clinical symptoms represents a concern The potential implications of these findings in athletes are significant given the concern that exercise during the acute phase of viral myocarditis may exacerbate myocardial injury and precipitate malignant ventricular arrhythmias Such concerns have led to the development and publication of expert consensus documents aimed at providing guidance for the evaluation of athletes after contracting COVID 19 in order to permit safe return to play Cardiac imaging is at the center of these evaluations This review seeks to evaluate the current evidence regarding COVID 19 associated cardiovascular disease and how multimodality imaging may be useful in the screening and clinical evaluation of athletes with suspected cardiovascular complications of infection Guidance is provided with diagnostic red flags that raise the suspicion of pathology Specific emphasis is placed on the unique challenges posed in distinguishing athletic cardiac remodeling from subclinical cardiac disease The strengths and limitations of different imaging modalities are discussed and an approach to return to play decision making for athletes post COVID 19 as informed by multimodality imaging is provided 1 +481 Clinical review of cerebral venous thrombosis in the context of COVID 19 vaccinations Evaluation management and scientific questions Vaccine induced immune mediated thrombocytopenia or VITT is a recent and rare phenomenon of thrombosis with thrombocytopenia frequently including cerebral venous thromboses CVT that has been described following vaccination with adenovirus vaccines ChAdOx1 nCOV 19 AstraZeneca and Ad26 COV2 S Johnson and Johnson Janssen J J The evaluation and management of suspected cases of CVT post COVID 19 vaccination are critical skills for a broad range of healthcare providers A collaborative comprehensive review of literature was conducted among a global group of expert neurologists and hematologists Strategies for rapid evaluation and treatment of the CVT in the context of possible VITT exist including inflammatory marker measurements PF4 assays and non heparin anticoagulation 0 +292 Post COVID 19 functional status Relation to age smoking hospitalization and previous comorbidities Recently a new Post COVID 19 Functional Status PCFS scale is recommended in the current COVID 19 pandemic It is proposed that it could be used to display direct retrieval and the functional sequelae of COVID 19 The aim of the study was to assess the PCFS and to evaluate if age gender smoking hospitalization and comorbidities have any effect on functional limitations in recovered COVID 19 patients A total of 444 registered confirmed COVID 19 patients were included They were interviewed in our follow up clinics and filled an Arabic translated PCFS scale as well as their demographic and clinical data Eighty percent of COVID 19 recovered cases have diverse degrees of functional restrictions ranging from negligible 63 1 slight 14 4 moderate 2 to severe 0 5 based on PCFS Furthermore there was a substantial variance between the score of PCFS with age i P i 0 003 gender i P i 0 014 the duration since the onset of the symptoms of COVID 19 i P i 0 001 need for oxygen supplementation i P i 0 001 need for intensive care unit ICU admittance i P i 0 003 previous periodic influenza vaccination i P i 0 001 smoking status i P i 0 001 and finally the presence of any comorbid disorder i P i 0 001 Most of the COVID 19 recovered cases have diverse degrees of functional restrictions ranging from negligible to severe based on PCFS These restrictions were affected by age gender periodic influenza vaccination smoking duration since symptoms onset need for oxygen or ICU admittance and finally the presence of coexisting comorbidity 1 +352 Investigations into the efficacy of a novel extubation aerosol shield a cough model study Physicians have had to perform numerous extubation procedures during the prolonged coronavirus disease 2019 COVID 19 pandemic Future pandemics caused by unknown pathogen may also present a risk of exposure to infectious droplets and aerosols This study evaluated the ability of a newly developed aerosol barrier Extubation Aerosol EA Shield to provide maximum protection from aerosol exposure during extubation via an aerosolised particle count and high quality visualisation assessments We employed a cough model having parameters similar to humans and used micron oil aerosol as well as titanium dioxide as aerosol tracers Aerosol barrier techniques employing a face mask group M and EA Shield group H were compared The primary outcome was the difference in the number of particles contacting the physicians face before and after extubation The maximum distances of aerosol dispersal after extubation were measured as the secondary outcomes All aerosolised particles of the two tracers were significantly smaller in group H than in group M p 0 05 In addition the sagittal and axial maximum distances and sagittal areas of aerosol dispersal for 3 5 and 10 s after extubation were significantly smaller in group H than in group M p 0 05 This model indicates that EA Shield could be highly effective in reducing aerosol exposure during extubation Therefore we recommend using it as an aerosol barrier when an infectious aerosol risk is suspected 0 +563 Knowledge awareness and practices of Pakistani professionals amid COVID 19 outbreak End of the year 2019 marks an unprecedented outbreak of a pandemic named COVID 19 caused by the SARS CoV 2 It was first discovered in China and later spread to the whole world currently inflicting almost 200 countries After China few other countries have emerged as potential epicenters of this disease including the US Italy Spain and Pakistan as indicated by the World Health Organization WHO Since proper preventive and curative measures in the form of a vaccine or medication are currently unavailable throughout the world the only remedy devised to stop the spread of this virus is self isolation Such a measure necessitates ample awareness and understanding among people to avoid actions that lead to the spread of this virus Pakistan is the fifth most populous country in the world 212 2 million and has a record of contagious outbreaks in the past Therefore it is key to evaluate the general understanding regarding the cause spread and control of this disease in Pakistani population and acquire data to anticipate the possible spread and persistence of this disease to design relevant preventive measures We have attempted to collect such data from professionals who are susceptible to acquiring the infection due to an unavoidable exposure Keeping in view the current lock down we have relied on an internet based collection of data by filling a self designed questionnaire that is responded to by 1132 Descriptive and Frequency Analysis were performed on the responses received using MS Excel and SPSS software A total of 1132 individuals responded to the questionnaire among which include academic 45 8 non academic 20 8 healthcare 7 8 security 5 9 and other 19 7 professionals The questionnaire addressed the level of basic information regarding the cause spread cure and prevention of this disease among professionals in an attempt to provide directions for awareness campaigns at different levels in Pakistan and provide a model for similar outbreaks in the future To our expectations almost after a month of the coronavirus outbreak in Pakistan above 50 to up to 90 of the recorded responses against every question showed ample understanding regarding the cause spread and control of the disease which is an indicator of effective public awareness campaigns throughout the country largely based on media drive 0 +161 Patient Led Research Collaborative embedding patients in the Long COVID narrative A large subset of patients with coronavirus disease 2019 COVID 19 are experiencing symptoms well beyond the claimed 2 week recovery period for mild cases These long term sequelae have come to be known as Long COVID Originating out of a dedicated online support group a team of patients formed the Patient Led Research Collaborative and conducted the first research on Long COVID experience and symptoms This article discusses the history and value of patient centric and patient led research the formation of Patient Led Research Collaborative as well as key findings to date and calls for the following the acknowledgement of Long COVID as an illness an accurate estimate of the prevalence of Long COVID publicly available basic symptom management care and research to not be limited to those with positive polymerase chain reaction and antibody tests and aggressive research and investigation into the pathophysiology of symptoms 1 +607 Hesitancy Toward a COVID 19 Vaccine The scientific community has come together in a mass mobilization to combat the public health risks of COVID 19 including efforts to develop a vaccine However the success of any vaccine depends on the share of the population that gets vaccinated We designed a survey experiment in which a nationally representative sample of 3 133 adults in the USA stated their intentions to vaccinate themselves and their children for COVID 19 The factors that we varied across treatments were the stated severity and infectiousness of COVID 19 and the stated source of the risk information White House or the Centers for Disease Control We find that 20 of people in the USA intend to decline the vaccine We find no statistically significant effect on vaccine intentions from the severity of COVID 19 In contrast we find that the degree of infectiousness of the coronavirus influences vaccine intentions and that inconsistent risk messages from public health experts and elected officials may reduce vaccine uptake However the most important determinants of COVID 19 vaccine hesitancy seem to be distrust of the vaccine safety including uncertainty due to vaccine novelty as well as general vaccine avoidance as implied by not having had a flu shot in the last two years 0 +632 COVID 19 and violence against children A review of early studies Throughout the course of the COVID 19 pandemic researchers across the globe have attempted to understand how the health and socioeconomic crisis brought about by the coronavirus is affecting childrens exposure to violence Since containment measures have disrupted many data collection and research efforts studies have had to rely on existing data or design new approaches to gathering relevant information This article reviews the literature that has been produced on childrens exposure to violence during the pandemic to understand emerging patterns and critically appraise methodologies to help inform the design of future studies The article concludes with recommendations for future research The study entailed a search of working papers technical reports and journal articles The search used a combination of search terms to identify relevant articles and reports published between March 1 and December 31 2020 The sources were assessed according to scope and study design The review identified 48 recent working papers technical reports and journal articles on the impact of COVID 19 on violence against children In terms of scope and methods the review led to three main findings 1 Studies have focused on physical or psychological violence at home and less attention has been paid to other forms of violence against children 2 most studies have relied on administrative records while other data sources such as surveys or big data were less commonly employed and 3 different definitions and study designs were used to gather data directly resulting in findings that are hardly generalizable With respect to childrens experience of violence the review led to four main findings 1 Studies found a decrease in police reports and referrals to child protective services 2 mixed results were found with respect to the number of calls to police or domestic violence helplines 3 articles showed an increase in child abuse related injuries treated in hospitals and 4 surveys reported an increase in family violence This review underscores the persistent challenges affecting the availability and quality of data on violence against children including the absence of standards for measuring this sensitive issue as well as the limited availability of baseline data Future research on COVID 19 and violence against children should address some of the gaps identified in this review 0 +138 Functional neuroimaging using F 18 FDG PET CT in amnestic mild cognitive impairment A preliminary study People with amnestic mild cognitive impairment aMCI are at a higher risk of developing Alzheimers Dementia AD than their cognitively normal peers Decreased glucose metabolism with F 18 fluorodeoxyglucose FDG positron emission tomography PET is a downstream marker of neuronal injury and neurodegeneration The risk of developing AD is higher in patients with aMCI who have a pattern of AD related glucose metabolic changes on FDG PET than those who do not have these changes We evaluated the utility of visual and statistical parametric mapping SPM supported reading of the FDG PET scans of patients clinically classified as aMCI for identification of predementia patterns and for prediction of their progression to AD PTAD A total of 35 patients diagnosed as aMCI mini mental state examination MMSE score 25 at the cognitive disorders and memory CDM clinic of speciality neurology centers were referred for a resting FDG PET study All patients had a detailed neurological neuropsychological and magnetic resonance imaging MRI evaluation prior to referral Mean age of patients was 67 9 8 7 standard deviation SD years male female M F 26 9 Twenty healthy age matched controls were included in the study for SPM http www fil ion ucl ac uk spm Scans were interpreted visually and using SPM Each scan was classified as high intermediate or low likelihood for PTAD On visual analysis four scans were classified as high likelihood of PTAD and reveled hypometabolism in AD related territories Seven patients had hypometabolism in at least one AD related territory and were classified as intermediate likelihood for PTAD Two patients had hypometabolism in other than AD territories while 22 patients did not show any significant hypometabolism on their FDG PET scans and were classified as low likelihood for PTAD SPM analysis of these cases confirmed the areas hypometabolism in all 13 patients compared to a normal subgroup P 0 05 On follow up of 24 months all four cases with high likelihood scans had progression of cognitive deficits and were confirmed as AD in the CDM clinic while none of the others showed cognitive decline A pattern of AD hypometabolism on the FDG PET study is useful for predicting PTAD A longer follow up of patients with hypometabolism in single AD territories is needed to predict their clinical behavior 1 +571 Asymptomatic COVID 19 infection diagnosis transmission population characteristics A novel coronavirus first discovered in late December 2019 has spread to many countries around the world An increasing number of asymptomatic patients have been reported and their ability to spread the virus has been proven This brings major challenges to the control of the transmission The discovery and control of asymptomatic patients with COVID 19 are the key issues in future epidemic prevention and recovery In this narrative review we summarise the existing knowledge about asymptomatic patients and put forward detection methods that are suitable for finding such patients Besides we compared the characteristics and transmissibility of asymptomatic patients in different populations in order to find the best screening diagnosis and control measures for different populations Comprehensive preventive advice is also provided to prevent the spread of infection from asymptomatic patients 0 +200 A Review of Prolonged Post COVID 19 Symptoms and Their Implications on Dental Management The available data regarding the short and long term consequences of COVID 19 is still insufficient This narrative review aims to provide information on the prolonged COVID 19 symptoms in recovered patients and their implications during dental management Additionally this manuscript highlights the oral manifestations of COVID 19 and its management A systematic search was conducted in PubMed Embase Cochrane Library and Web of Science databases WHO and CDC websites and grey literature was searched through Google Scholar Clinical articles clinical trials case reports cohort and cross sectional studies were included reporting prolonged post COVID 19 symptoms Although COVID 19 is an infectious disease primarily affecting the lungs its multi organ involvement is responsible for several prolonged symptoms including oral implications In recovered patients with prolonged COVID 19 symptoms considerations for providing dental treatment has to be made as they can present with assortment of symptoms These prolonged post COVID 19 symptoms can affect the delivery of the required dental treatment Hence the recommendations proposed in this narrative review can be a useful starting point to aid dental teams providing adequate care for such recovered patients 1 +117 Cellular Tropism of SARS CoV 2 across Human Tissues and Age related Expression of ACE2 and TMPRSS2 in Immune inflammatory Stromal Cells Recently emerging evidence has indicated that COVID 19 represents a major threat to older populations but the underlying mechanisms remain unclear The pathogen causing COVID 19 is acute respiratory syndrome coronavirus 2 SARS CoV 2 SARS CoV 2 infection depends on the key entry factors angiotensin converting enzyme 2 ACE2 and transmembrane serine protease 2 TMPRSS2 Recognizing the importance of ACE2 and TMPRSS2 for the cellular tropism of SARS CoV 2 we analyzed and presented the landscape of cell type identities for ACE2 sup sup TMPRSS2 sup sup cells across different human tissues and the age related alterations in ACE2 and TMPRSS2 expression across different cell types Additionally most of the post acute COVID 19 sequelae could attribute to the ACE2 expressing organ systems Therefore these SARS CoV 2 tropism data should be an essential resource for guiding clinical treatment and pathological studies which should draw attention toward the prioritization of COVID 19 research in the future Notably we discovered the age related expression of ACE2 and TMPRSS2 in the immune inflammatory stromal cells implying the potential interplay between COVID 19 stromal cells and aging In this study we developed a novel and practical analysis framework for mapping the cellular tropism of SARS CoV 2 This approach was built to aid the identification of viral specific cell types and age related alterations of viral tropism highlighting the power of single cell RNA sequencing scRNA seq to address viral pathogenesis systematically With the rapid accumulation of scRNA seq data and the continuously increasing insight into viral entry factors we anticipate that this scRNA seq based approach will attract broader interest in the virus research communities 1 +103 Post infectious and post acute sequelae of critically ill adults with COVID 19 Data on the post acute and post infectious complications of patients who have recovered from severe coronavirus disease 2019 COVID 19 are limited While studies report that approximately 5 15 of COVID 19 hospitalized patients require intensive care and mechanical ventilation a substantially higher number need non invasive ventilation and are subject to prolonged hospitalizations with long periods of immobility and isolation The purpose of this study is to describe the post infectious sequelae of severe viral illness and the post acute complications of intensive care treatments in critically ill patients who have recovered from severe COVID 19 infection We performed a retrospective chart review of adult patients initially hospitalized with confirmed COVID 19 infection who recovered and were transferred to a general medical ward or discharged home between March 15 2020 and May 15 2020 dates inclusive after an intensive care unit ICU or high dependency unit HDU admission in a designated COVID 19 hospital in the United Arab Emirates Demographic data underlying comorbidities treatment complications and outcomes were collected Descriptive statistical analyses were performed Of 71 patients transferred out of ICU n 38 54 and HDU n 33 46 mean age was 48 years SD 9 95 96 men 54 under age 50 Mean ICU stay was 12 4 days SD 5 29 HDU stay was 13 4 days SD 4 53 Pre existing conditions were not significantly associated with developing post acute complications Odds Ratio OR 1 1 95 confidence interval CI 0 41 2 93 p 1 00 Fifty nine percent of patients had complications myopathy swallowing impairments and pressure ulcers were most common Delirium and confusion were diagnosed in 18 n 13 all were admitted to the ICU and required mechanical ventilation Of note of all patients studied 59 2 n 42 71 had at least 1 complication 32 4 n 23 had at least 2 complications and 19 7 n 14 suffered 3 or more sequelae Complications were significantly more common in ICU patients n 33 38 87 compared to HDU patients n 9 33 27 OR 17 6 95 CI 5 23 59 21 p 0 05 In a subset of critically ill patients who recovered from severe COVID 19 infection there was considerable short term post infectious and post acute disability Long term follow up of COVID 19 survivors is warranted 1 +612 Weight Related Behaviors of Children with Obesity during the COVID 19 Pandemic b i Background i b During the coronavirus disease 2019 COVID 19 pandemic children and families have had to adapt their daily lives The purpose of this study was to describe changes in the weight related behaviors of children with obesity after the onset of the COVID 19 pandemic b i Methods i b Semistructured interviews i n i 51 were conducted from April to June 2020 with parents of children with obesity Families were participants in a randomized trial testing a clinic community pediatric obesity treatment model During interviews families described their experience during the COVID 19 pandemic with a particular emphasis on childrens diet physical activity sleep and screen time behaviors Rapid qualitative analysis methods were used to identify themes around changes in childrens weight related behaviors b i Results i b The mean child age was 9 7 2 8 years and the majority of children were Black 46 or Hispanic 39 and from low income families 62 Most parent participants were mothers 88 There were differences in the perceived physical activity level of children with some parents attributing increases in activity or maintenance of activity level to increased outdoor time whereas others reported a decline due to lack of outdoor time school and structured activities Key dietary changes included increased snacking and more meals prepared and consumed at home There was a shift in sleep schedules with children going to bed and waking up later and an increase in leisure based screen time Parents played a role in promoting activity and managing childrens screen time b i Conclusions i b The COVID 19 pandemic has created unique lifestyle challenges and opportunities for lifestyle modification Clinical Trials ID NCT03339440 0 +180 COVID and Cardiovascular Disease What We Know in 2021 Coronavirus disease 2019 COVID 19 has been the cause of significant global morbidity and mortality Here we review the literature to date of the short term and long term consequences of Severe Acute Respiratory Syndrome Coronavirus 2 SARS CoV 2 infection on the heart Early case reports described a spectrum of cardiovascular manifestations of COVID 19 including myocarditis stress cardiomyopathy myocardial infarction and arrhythmia However in most cases myocardial injury in COVID 19 appears to be predominantly mediated by the severity of critical illness rather than direct injury to myocardium from viral particles While cardiac magnetic resonance imaging remains a powerful tool for diagnosing acute myocarditis it should be used judiciously in light of low baseline prevalence of myocarditis Guiding an athletic patient through return to play RTP after COVID 19 infection is a challenging process More recent data show RTP has been a safe endeavor using a screening protocol Long COVID or post acute sequelae of SARS CoV 2 infection has also been described The reported symptoms span a large breadth of cardiopulmonary and neurologic complaints including fatigue palpitations chest pain breathlessness brain fog and dysautonomia including postural tachycardia syndrome POTS Management of POTS dysautonomia primarily centers on education exercise and salt and fluid repletion Our understanding of the impact of COVID 19 on the cardiovascular system is constantly evolving As we enter a new age of survivorship additional research is needed to catalogue the burden of persistent cardiopulmonary symptoms Research is also needed to learn how acute management may alter the likelihood and prevalence of this chronic syndrome 1 +485 Connectedness Self Esteem and Prosocial Behaviors Protect Adolescent Mental Health Following Social Isolation A Systematic Review Societal trends and COVID 19 quarantines have increased the number of adolescents experiencing social isolation placing them at heightened risk for mental health issues The aim of this review is to explore protective factors that might mitigate psychological harm in the presence of social isolation A systematic literature review was conducted using Finks step by step process Four library databases were searched and results were reported using PRISMA Of the 246 studies reviewed 12 studies were retained following the quality assessment The sample includes 14 064 participants from USA Australia and Europe ranging from 10 19 years old Social connectedness ie family connectedness school connectedness social support self esteem and prosocial behaviors were the most common protective factors to social isolation Additional factors such as self efficacy optimism and ethnic identity are discussed Implications for future research are recommended including the need to explore spiritual biological and sociocultural factors influencing social connectedness and mental health in adolescents 0 +48 Autonomic dysfunction in long COVID rationale physiology and management strategies The SARS CoV 2 COVID 19 pandemic has caused unprecedented morbidity mortality and global disruption Following the initial surge of infections focus shifted to managing the longer term sequelae of illness in survivors Post acute COVID known colloquially as long COVID is emerging as a prevalent syndrome It encompasses a plethora of debilitating symptoms including breathlessness chest pain palpitations and orthostatic intolerance which can last for weeks or more following mild illness We describe a series of individuals with symptoms of long COVID and we posit that this condition may be related to a virus or immune mediated disruption of the autonomic nervous system resulting in orthostatic intolerance syndromes We suggest that all physicians should be equipped to recognise such cases appreciate the symptom burden and provide supportive management We present our rationale for an underlying impaired autonomic physiology post COVID 19 and suggest means of management 1 +251 Clinical Profile and Short Term Outcome of Children With SARS CoV 2 Related Multisystem Inflammatory Syndrome MIS C Treated With Pulse Methylprednisolone To study the clinical profile and outcome of children with MIS C treated with methylprednisolone pulse therapy and or intravenous immunoglobulin IVIG This prospective observational study included children satisfying CDC MIS C criteria admitted from September to November 2020 Primary outcome was persistence of fever beyond 36 hours after start of immunomodulation therapy Secondary outcomes included duration of ICU stay mortality need for repeat immunomodulation time to normalization of CRP and persistence of coronary abnormalities at 2 weeks Study population included 32 patients with MIS C with median IQR age of 7 5 5 9 5 years The proportion of children with gastrointestinal symptoms was 27 84 cardiac was 29 91 and coronary artery dilatation was 11 34 Pulse methylprednisolone and intravenous immunoglobulin were used as first line therapy in 26 81 and 6 19 patients respec tively Treatment failure was observed in 2 26 patients in methylprednisolone group and 2 6 patients in IVIG group C reactive protein levels less than 60mg L by day 3 was seen in 17 74 in methylprednisolone group and 2 25 in IVIG group P 0 014 There was no mortality At 2 weeks follow up coronary artery dilatation persisted in 4 in methylprednisolone group and 1 in IVIG group In patients with SARS CoV 2 related MIS C methylprednisolone pulse therapy was associated with favorable short term outcomes 1 +471 Physician leaders cross boundary use of social media what are the implications in the current COVID 19 environment The purpose of this study is to better understand social media SM factors that physician leaders need to consider as they adapt their cross boundary practices to engage with colleagues and patients Firstly this study explores why SM is being used by physicians to cross horizontal physician to physician and stakeholder physician to patient boundaries prior to COVID 19 Secondly based on the studies reviewed this study provides insights on the practical SM implications for physician leaders working in the COVID 19 environment to actively enhance their practices reduce public confusion and improve patient care thus informing health care practices A systematic literature review was used to conduct a structured transparent overview of peer reviewed articles that describe physicians use of cross boundary SM across several disciplines e g health information science As a baseline assessment prior to COVID 19 the review synthesized 47 articles identified and selected from six databases and Novanet This study used NVivo 12 to thematical code the articles leading to the emergence of four broad factors that influence SM use A key reason noted in the literature for physicians use of SM to cross horizontal boundaries is to share knowledge Regarding stakeholder boundaries the most cited reasons are to improve patients health and encourage behavioural changes Insights garnered on the practical SM implications include the need for physicians to be stronger leaders in presenting trustworthy and consistent facts about health information to the public and fellow peers As role models for the effective use of SM tools physician leaders can mentor and coach their colleagues and counterparts As this was a literature review the authors did not collect primary data to further explore this rapidly changing and dynamic SM world Next steps could include a survey to determine firstly how physicians currently use SM in this COVID 19 environment and secondly how they could leverage it for their work Findings from this survey will help us better understand the role of physician leaders as health care influencers and how they could better create trust and inform the Canadian public in the health information that is being conveyed Physician leaders can play a key role in positively influencing institutional support for ethical and safe SM use and engagement practices Physicians need to participate in developing regulations and guidelines that are fundamentally to physician leaders SM use Central to this research would be the need to understand how physicians cross boundary practices have changed during and potentially post COVID 19 Physician leaders also need to monitor information sources for credibility and ensure that these sources are protected As role models for the effective use of SM tools physician leaders can mentor and coach their colleagues and counterparts in this area Although there have been studies of how physicians use SM fewer studies explore why physician leaders cross boundaries horizontal and stakeholder using SM Important insights are gained in physician leaders practical use of SM Key themes that emerged included organizational and individual information professional and regulations and guideline factors These factors strengthen physician leaders understanding of areas of foci to enhance their cross boundary interactions There is an urgency to study the complexity of SM and the effectiveness of regulations and guidelines for physicians who are being required at an accelerated rate to strengthen and increase their cross boundary practices 0 +218 Persistent pulmonary pathology after COVID 19 is associated with high viral load weak antibody response and high levels of matrix metalloproteinase 9 The association between pulmonary sequelae and markers of disease severity as well as pro fibrotic mediators were studied in 108 patients 3 months after hospital admission for COVID 19 The COPD assessment test CAT score spirometry diffusion capacity of the lungs DL sub CO sub and chest CT were performed at 23 Norwegian hospitals included in the NOR SOLIDARITY trial an open labelled randomised clinical trial investigating the efficacy of remdesivir and hydroxychloroquine HCQ Thirty eight percent had a CAT score 10 DL sub CO sub was below the lower limit of normal in 29 6 Ground glass opacities were present in 39 8 on chest CT parenchymal bands were found in 41 7 At admission low pO sub 2 sub F sub i sub O sub 2 sub ratio ICU treatment high viral load and low antibody levels were predictors of a poorer pulmonary outcome after 3 months High levels of matrix metalloproteinase MMP 9 during hospitalisation and at 3 months were associated with persistent CT findings Except for a negative effect of remdesivir on CAT score we found no effect of remdesivir or HCQ on long term pulmonary outcomes Three months after hospital admission for COVID 19 a high prevalence of respiratory symptoms reduced DL sub CO sub and persistent CT findings was observed Low pO sub 2 sub F sub i sub O sub 2 sub ratio ICU admission high viral load low antibody levels and high levels of MMP 9 were associated with a worse pulmonary outcome 1 +325 Symptoms complications and management of long COVID a review Globally there are now over 160 million confirmed cases of COVID 19 and more than 3 million deaths While the majority of infected individuals recover a significant proportion continue to experience symptoms and complications after their acute illness Patients with long COVID experience a wide range of physical and mental psychological symptoms Pooled prevalence data showed the 10 most prevalent reported symptoms were fatigue shortness of breath muscle pain joint pain headache cough chest pain altered smell altered taste and diarrhoea Other common symptoms were cognitive impairment memory loss anxiety and sleep disorders Beyond symptoms and complications people with long COVID often reported impaired quality of life mental health and employment issues These individuals may require multidisciplinary care involving the long term monitoring of symptoms to identify potential complications physical rehabilitation mental health and social services support Resilient healthcare systems are needed to ensure efficient and effective responses to future health challenges 1 +357 Thromboprophylaxis in COVID 19 Rationale and considerations The Corona Virus Disease 2019 COVID 19 pandemic is associated with a very high incidence of thrombotic complications The exact mechanisms for this excess risk for clots have not been elucidated although one of the often quoted pathophysiological entity is immunothrombosis Recognition of thrombotic complications early on in this pandemic led to an over explosion of studies which looked at the benefits of anticoagulation to mitigate this risk In this review we examine the rationale for thromboprophylaxis in COVID 19 with particular reference to dosing and discuss what may guide the decision making process to consider anticoagulation In addition we explore the rationale for thrombosis prevention measures in special populations including outpatient setting pregnant females children those with high body mass index and those on extracorporeal membrane oxygenation 0 +684 Detection of N6 methyladenosine in SARS CoV 2 RNA by methylated RNA immunoprecipitation sequencing MeRIP Seq i N i sup i 6 i sup methylation of adenosine m6A is the most abundant internal mRNA modification and is an important post transcriptional regulator of gene expression Here we describe a protocol for methylated RNA immunoprecipitation sequencing MeRIP Seq to detect and quantify m6A modifications in severe acute respiratory syndrome coronavirus 2 SARS CoV 2 RNA The protocol is optimized for low viral RNA levels and is readily adaptable for other applications 0 +264 Long Term Symptoms Among Adults Tested for SARS CoV 2 United States January 2020 April 2021 Long term symptoms often associated with COVID 19 post COVID conditions or long COVID are an emerging public health concern that is not well understood Prevalence of post COVID conditions has been reported among persons who have had COVID 19 range 5 80 with differences possibly related to different study populations case definitions and data sources 1 Few studies of post COVID conditions have comparisons with the general population of adults with negative test results for SARS CoV 2 the virus that causes COVID 19 limiting ability to assess background symptom prevalence 1 CDC used a nonprobability based Internet panel established by Porter Novelli Public Services to administer a survey to a nationwide sample of U S adults aged 18 years to compare the prevalence of long term symptoms those lasting 4 weeks since onset among persons who self reported ever receiving a positive SARS CoV 2 test result with the prevalence of similar symptoms among persons who reported always receiving a negative test result The weighted prevalence of ever testing positive for SARS CoV 2 was 22 2 95 confidence interval CI 20 6 23 8 Approximately two thirds of respondents who had received a positive test result experienced long term symptoms often associated with SARS CoV 2 infection Compared with respondents who received a negative test result those who received a positive test result reported a significantly higher prevalence of any long term symptom 65 9 versus 42 9 fatigue 22 5 versus 12 0 change in sense of smell or taste 17 3 versus 1 7 shortness of breath 15 5 versus 5 2 cough 14 5 versus 4 9 headache 13 8 versus 9 9 and persistence 4 weeks of at least one initially occurring symptom 76 2 versus 69 6 Compared with respondents who received a negative test result a larger proportion of those who received a positive test result reported believing that receiving a COVID 19 vaccine made their long term symptoms better 28 7 versus 15 7 Efforts to address post COVID conditions should include helping health care professionals recognize the most common post COVID conditions and optimize care for patients with persisting symptoms including messaging on potential benefits of COVID 19 vaccination 1 +416 Review Mental health impacts of the COVID 19 pandemic on children and youth a systematic review The COVID 19 pandemic has posed an unprecedented threat to global mental health Children and adolescents may be more susceptible to mental health impacts related to their vulnerable developmental stage fear of infection home confinement suspension of regular school and extracurricular activities physical distancing mandates and larger scale threats such as global financial recessions and associated impacts Our objective was to review existing evidence of the COVID 19 pandemics global impact on the mental health of children and adolescents 19 years of age and to identify personal and contextual factors that may enhance risk or confer protection in relation to mental health outcomes We conducted a search of peer reviewed and preprint research published in English from January 1 2020 to February 22 2021 We included studies collecting primary data on COVID 19 related mental health impacts on children and adolescents We graded the strength of included articles using the Oxford Centre for Evidence Based Medicine rating scheme Our search and review yielded 116 articles presenting data on a total of 127 923 children and adolescents 50 984 child and adolescent proxy reports e g parents healthcare practitioners and 3 000 chart reviews A high prevalence of COVID 19 related fear was noted among children and adolescents as well as more depressive and anxious symptoms compared with prepandemic estimates Older adolescents girls and children and adolescents living with neurodiversities and or chronic physical conditions were more likely to experience negative mental health outcomes Many studies reported mental health deterioration among children and adolescents due to COVID 19 pandemic control measures Physical exercise access to entertainment positive familial relationships and social support were associated with better mental health outcomes This review highlights the urgent need for practitioners and policymakers to attend to and collaborate with children and adolescents especially those in higher risk subgroups to mitigate short and long term pandemic associated mental health effects 0 +617 Applications of CRISPR as a potential therapeutic Genetic disorders and congenital abnormalities are present in 2 5 of births all over the world and can cause up to 50 of all early childhood deaths The establishment of sophisticated and controlled techniques for customizing DNA manipulation is significant for the therapeutic role in such disorders and further research on them One such technique is CRISPR that is significant towards optimizing genome editing and therapies metabolic fluxes as well as artificial genetic systems CRISPR Cas9 is a molecular appliance that is applied in the areas of genetic and protein engineering The CRISPR CAS system is an integral element of prokaryotic adaptive immunity that allows prokaryotic cells to identify and kill any foreign DNA The Gene editing property of CRISPR finds various applications like diagnostics and therapeutics in cancer neurodegenerative disorders genetic diseases blindness etc This review discusses applications of CRISPR as a therapeutic in various disorders including several genetic diseases including sickle cell anemia blindness thalassemia cystic fibrosis hereditary tyrosinemia type I duchenne muscular dystrophy mitochondrial disorders Cancer Huntingtons disease and viral infections like HIV COVID etc along with the prospects concerning them CRISPR based therapy is also being researched and defined for COVID 19 The related mechanism of CRISPR has been discussed alongside highlighting challenges involved in therapeutic applications of CRISPR 0 +341 Sensors for the detection of ammonia as a potential biomarker for health screening The presence of ammonia within the body has long been linked to complications stemming from the liver kidneys and stomach These complications can be the result of serious conditions such as chronic kidney disease CKD peptic ulcers and recently COVID 19 Limited liver and kidney function leads to increased blood urea nitrogen BUN within the body resulting in elevated levels of ammonia in the mouth nose and skin Similarly peptic ulcers commonly from H pylori result in ammonia production from urea within the stomach The presence of these biomarkers enables a potential screening protocol to be considered for frequent non invasive monitoring of these conditions Unfortunately detection of ammonia in these mediums is rather challenging due to relatively small concentrations and an abundance of interferents Currently there are no options available for non invasive screening of these conditions continuously and in real time Here we demonstrate the selective detection of ammonia using a vapor phase thermodynamic sensing platform capable of being employed as part of a health screening protocol The results show that our detection system has the remarkable ability to selectively detect trace levels of ammonia in the vapor phase using a single catalyst Additionally detection was demonstrated in the presence of interferents such as carbon dioxide CO sub 2 sub and acetone common in human breath These results show that our thermodynamic sensors are well suited to selectively detect ammonia at levels that could potentially be useful for health screening applications 1 +505 COVID 19 Pandemic and Water Sanitation and Hygiene Impacts Challenges and Mitigation Strategies In order to protect public health during the outbreaks of infectious diseases including the pandemic COVID 19 provision of Water Sanitation and Hygiene WASH services is important The challenges of inaccessible WASH services along with the pandemic COVID 19 in low income countries can lead to a devastating problem A systematic search of published articles was identified using PubMed Web of Science and Google Scholar on relevant studies of COVID 19 and WASH services Published articles were identified using abstracts and titles of the articles followed by assessed for eligibility and screening of the full text reports of relevant studies Electronic database search identified 798 articles from which 28 full text articles were included in the systematic review A lack of access to WASH services in households schools health care facilities and other public spaces were the main identified COVID 19 related public health risks A lack of adequate data and financial shortages were the challenges for mitigating the problems of COVI 19 and WASH services This systematical review identified the impacts and challenges of COVID 19 in the provision of WASH services The results implied that COVID 19 has significant impacts on WASH services that can affect the health of the public Therefore strengthening and ensuring access to WASH services are important for preventing COVID 19 and realizing human rights Community engagement also can be used to support for prevention and control of COVID 19 Countries need to be expand their investment in WASH services as an important mechanism for mitigating COVID 19 0 +314 Post COVID syndrome A case series and comprehensive review The existence of a variety of symptoms with a duration beyond the acute phase of COVID 19 is referred to as post COVID syndrome PCS We aimed to report a series of patients with PCS attending a Post COVID Unit and offer a comprehensive review on the topic Adult patients with previously confirmed SARS CoV 2 infection and PCS were systematically assessed through a semi structured and validated survey Total IgG IgA and IgM serum antibodies to SARS CoV 2 were evaluated by an electrochemiluminescence immunoassay A systematic review of the literature and meta analysis were conducted following PRISMA guidelines Univariate and multivariate methods were used to analyze data Out of a total of 100 consecutive patients 53 were women the median of age was 49 years IQR 37 8 55 3 the median of post COVID time after the first symptoms was 219 days IQR 143 258 and 65 patients were hospitalized during acute COVID 19 Musculoskeletal digestive i e diarrhea and neurological symptoms including depression by Zung scale were the most frequent observed in PCS patients A previous hospitalization was not associated with PCS manifestation Arthralgia and diarrhea persisted in more than 40 of PCS patients The median of anti SARS CoV 2 antibodies was 866 2 U mL IQR 238 2 1681 Despite this variability 98 patients were seropositive Based on autonomic symptoms by COMPASS 31 two clusters were obtained with different clinical characteristics Levels of anti SARS CoV 2 antibodies were not different between clusters A total of 40 articles 11 196 patients were included in the meta analysis Fatigue muscle weakness dyspnea pain and discomfort anxiety depression and impaired concentration were presented in more than 20 of patients reported In conclusion PCS is mainly characterized by musculoskeletal pulmonary digestive and neurological involvement including depression PCS is independent of severity of acute illness and humoral response Long term antibody responses to SARS CoV 2 infection and a high inter individual variability were confirmed Future studies should evaluate the mechanisms by which SARS CoV 2 may cause PCS and the best therapeutic options 1 +29 Complaints and clinical findings six months after COVID 19 outpatient follow up at the University Medical Center Freiburg Increasing evidence suggests that some patients suffer from persistent symptoms for months after recovery from acute COVID 19 However the clinical phenotype and its pathogenesis remain unclear We here present data on complaints and results of a diagnostic workup of patients presenting to the post COVID clinic at the University Medical Center Freiburg Retrospective data analysis of persistently symptomatic patients presenting to our clinic at least 6 months after onset of acute COVID 19 All patients were assessed by a doctor and routine laboratory analysis was carried out Quality of life was assessed using SF 36 questionnaire In case of specific persisting symptoms further organ specific diagnostic evaluation was performed and patients were referred to respective departments specialists 132 Patients 58 male 74 female mean age 53 8 years presented to our clinic at least 6 months after COVID 19 79 60 had been treated as outpatients and 53 40 as inpatients Most common complaints were persistent fatigue 82 and dyspnea on exertion 61 Further common complaints were impairments of concentration 54 insomnia 43 and impairments of smell or taste 35 Quality of life was reduced in all sections of the SF 36 questionnaire yielding a reduced working capacity Significant pathological findings in laboratory echocardiographic and radiological work up were rare Impairments in lung function tests were more common in previously hospitalized patients Patients presenting 6 months after onset of acute COVID 19 suffer from a diverse spectrum of symptoms with impaired quality of life also referred to as Long COVID or Post Acute Sequelae of SARS CoV 2 infection PASC Further research is needed to determine the frequency of these post COVID syndromes and their pathogenesis natural course and treatment options Evaluation and management should be multi disciplinary 1 +88 Update to post acute sequelae of SARS CoV 2 infection Caring for the long haulers An estimated 10 of COVID 19 survivors continue to experience symptoms several weeks to months after the appearance of initial symptoms a condition termed post acute sequelae of SARS CoV 2 infection PASC These patients also called long haulers most commonly report protracted symptoms of fatigue cough dyspnea chest tightness difficulty concentrating arthralgia olfactory dysfunction and headache While age comorbid medical conditions and COVID 19 severity are suspected risk factors for PASC young and previously healthy individuals with mild COVID 19 are also at risk Recognition of symptoms evaluation supportive treatment and attention to medical comorbidities are the cornerstones of medical management 1 +565 Stop COVID Cohort An Observational Study of 3480 Patients Admitted to the Sechenov University Hospital Network in Moscow City for Suspected Coronavirus Disease 2019 COVID 19 Infection The epidemiology clinical course and outcomes of patients with coronavirus disease 2019 COVID 19 in the Russian population are unknown Information on the differences between laboratory confirmed and clinically diagnosed COVID 19 in real life settings is lacking We extracted data from the medical records of adult patients who were consecutively admitted for suspected COVID 19 infection in Moscow between 8 April and 28 May 2020 Of the 4261 patients hospitalized for suspected COVID 19 outcomes were available for 3480 patients median age 56 years interquartile range 45 66 The most common comorbidities were hypertension obesity chronic cardiovascular disease and diabetes Half of the patients n 1728 had a positive reverse transcriptase polymerase chain reaction RT PCR while 1748 had a negative RT PCR but had clinical symptoms and characteristic computed tomography signs suggestive of COVID 19 No significant differences in frequency of symptoms laboratory test results and risk factors for in hospital mortality were found between those exclusively clinically diagnosed or with positive severe acute respiratory syndrome coronavirus 2 SARS CoV 2 RT PCR In a multivariable logistic regression model the following were associated with in hospital mortality older age per 1 year increase odds ratio 1 05 95 confidence interval 1 03 1 06 male sex 1 71 1 24 2 37 chronic kidney disease 2 99 1 89 4 64 diabetes 2 1 1 46 2 99 chronic cardiovascular disease 1 78 1 24 2 57 and dementia 2 73 1 34 5 47 Age male sex and chronic comorbidities were risk factors for in hospital mortality The combination of clinical features was sufficient to diagnose COVID 19 infection indicating that laboratory testing is not critical in real life clinical practice 0 +553 Long term impact of COVID 19 associated acute respiratory distress syndrome To determine the health status exercise capacity and health related quality of life HRQoL of COVID 19 associated acute respiratory distress syndrome ARDS survivors 8 months after diagnosis All eligible patients were interviewed and underwent a physical examination chest X ray and 6 min walk test 6MWT Scales to evaluate post traumatic stress disorder depression anxiety and HRQoL were applied Of 1295 patients 365 suffered ARDS and 166 survived to hospital discharge Five died after discharge and 48 were lost to follow up Of the 113 remaining patients 81 had persistent symptoms More than 50 of patients completed less than 80 of the theoretical distance on the 6MWT 50 had an abnormal X ray and 93 of patients developed psychiatric disorders Mean SF 36 scores were worse than in the general population After multivariate regression analysis female sex non Caucasian race and Charlson index 2 were independent risk factors for a worse mental health component summary score on the SF 36 and age was associated with a better prognosis Female sex and chronic obstructive pulmonary disease were independently associated with a worse physical component summary score COVID 19 associated ARDS survivors have long term consequences in health status exercise capacity and HRQoL Strategies addressed to prevent these sequelae are needed 0 +442 Non COVID fatalities in the COVID era A paradigm shift in the face of a pandemic lessons learnt or not The rapid spread of the coronavirus pandemic and the associated high morbidity and mortality led to sudden lock down forcing the elderly and others in the high risk group into isolation Elective health care services including diagnostics therapeutics and elective surgical services were put on hold leading to delays seriously affecting cancer and non cancer related services In spite of lessons learnt during the first wave similar issues have persisted during the second wave increasing the pressure on an already fragile infrastructure Information related to surgical patients admitted since lock down March to August 2020 as an emergency was collected on a structured proforma and analysed Data was gathered from prospectively kept patient admission lists and Electronic Discharge summaries All the patients who were directly or indirectly affected with poor outcomes including delayed diagnosis and treatment were identified and included in the analysis A total of 185 patients were admitted as an emergency during this period Of these Eight patients admitted under surgical care were included in the study Four out of eight patients were diagnosed with advanced cancer and the remainder presented with complications of benign pathologies Of the four patients with advanced cancer three patients had advanced colorectal and the fourth had advanced ovarian cancer All four patients either presented late or had delayed access to investigations Three out four patients with benign disease presented with complications due to cancellation of elective and semi urgent services One patient who was COVID positive and presented with bowel perforation died after a prolonged hospital stay There is definite evidence of unfavourable patient outcomes in non COVID patients as a result of the COVID pandemic As COVID is unlikely to whither down in the very near future and highs and lows are expected rapid and safe reintroduction of elective health care services affected by COVID is the call of the hour In addition more efforts should be directed towards increasing awareness amongst patients regarding the importance of reporting red flag symptoms and encouraging them to access health care services 0 +499 Mild SARS CoV 2 Infections and Neutralizing Antibody Titers Recent evidence suggests that neutralizing antibodies nAbs to severe acute respiratory syndrome coronavirus 2 may persist over time however knowledge regarding pediatric subjects is limited A single center prospective observational study was conducted on 57 family clusters of coronavirus disease 2019 including children of neonatal and pediatric age attending the University Hospital of Padua Italy For each patient blood samples were collected for both the quantification of nAbs through a plaque reduction neutralizing test and the detection of antinucleocapsid spike protein immunoglobulin G and or immunoglobulin M We analyzed 283 blood samples collected from 152 confirmed coronavirus disease 2019 cases 82 parents and 70 children or older siblings of median age of 8 years interquartile range 4 13 presenting asymptomatic or with mildly symptomatic disease Despite the decrease of immunoglobulin G over time nAbs were found to persist up to 7 to 8 months in children whereas adults recorded a modest declining trend Interestingly children aged 6 years and in particular those aged 3 years developed higher long lasting levels of nAbs compared with older siblings and or adults Mild and asymptomatic severe acute respiratory syndrome coronavirus 2 infections in family clusters elicited higher nAbs among children 0 +660 SARS CoV 2 The Path of Prevention and Control The 2019 coronavirus pandemic COVID 19 continues to expand worldwide Although the number of cases and the death rate among children and adolescents are reported to be low compared to adults limited data have been reported We urgently need to find the treatment and vaccine to stop the epidemic Vaccine development is in progress but any approved and effective vaccine for COVID 19 will take at least 12 to 18 months The World Health Organization WHO the Center for Disease Control and Prevention CDC and the Food and Agriculture Organization FAO have issued instructions and strategies for controlling COVID 19 outbreak to the general public physicians travelers and injured patients to follow so that the transmission to a healthy population can be prevented In this review we summarize demographic data clinical characteristics complications and outcomes and finally prevention and control strategies for this serious pandemic 0 +460 Longitudinal changes in physical activity during and after the first national lockdown due to the COVID 19 pandemic in England Recent studies have shown reduced physical activity at early stages of the COVID 19 pandemic However there is a lack of investigation on longitudinal changes in physical activity beyond lockdowns and stay at home orders Moreover it is unclear if there is heterogeneity in physical activity growth trajectories This study aimed to explore longitudinal patterns of physical activity and factors associated with them Data were from the UCL COVID 19 Social Study The analytical sample consisted of 35 915 adults in England who were followed up for 22 weeks from 24th March to 23rd August 2020 Data were analysed using growth mixture models Our analyses identified six classes of growth trajectories including three stable classes showing little change over time 62 4 in total two classes showing decreasing physical activity 28 6 and one class showing increasing physical activity over time 9 A range of factors were found to be associated the class membership of physical activity trajectories such as age gender education income employment status and health There is substantial heterogeneity in longitudinal changes in physical activity during the COVID 19 pandemic However a substantial proportion of our sample showed persistent physical inactivity or decreasing physical activity Given the well established link between physical activity and health persistent or increased physical inactivity is likely to have both immediate and long term implications for peoples physical and mental health as well as general wellbeing More efforts are needed to promote physical activity during the pandemic and beyond 0 +548 Role of ACE2 in pregnancy and potential implications for COVID 19 susceptibility In times of coronavirus disease 2019 COVID 19 the impact of severe acute respiratory syndrome SARS coronavirus CoV 2 infection on pregnancy is still unclear The presence of angiotensin converting enzyme ACE 2 ACE2 the main receptor for SARS CoV 2 in human placentas indicates that this organ can be vulnerable for viral infection during pregnancy However for this to happen additional molecular processes are critical to allow viral entry in cells its replication and disease manifestation particularly in the placenta and or feto maternal circulation Beyond the risk of vertical transmission COVID 19 is also proposed to deplete ACE2 protein and its biological actions in the placenta It is postulated that such effects may impair essential processes during placentation and maternal hemodynamic adaptations in COVID 19 pregnancy features also observed in several disorders of pregnancy This review gathers information indicating risks and protective features related to ACE2 changes in COVID 19 pregnancies First we describe the mechanisms of SARS CoV 2 infection having ACE2 as a main entry door and current evidence of viral infection in the placenta Further we discuss the central role of ACE2 in physiological systems such as the renin angiotensin system RAS and the kallikrein kinin system KKS both active during placentation and hemodynamic adaptations of pregnancy Significant knowledge gaps are also identified and should be urgently filled to better understand the fate of ACE2 in COVID 19 pregnancies and the potential associated risks Emerging knowledge will be able to improve the early stratification of high risk pregnancies with COVID 19 exposure as well as to guide better management and follow up of these mothers and their children 0 +638 Redefining the Relationship Palliative Care in Critical Perinatal and Neonatal Cardiac Patients Patients with perinatal and neonatal congenital heart disease CHD represent a unique population with higher morbidity and mortality compared to other neonatal patient groups Despite an overall improvement in long term survival they often require chronic care of complex medical illnesses after hospital discharge placing a high burden of responsibility on their families Emerging literature reflects high levels of depression and anxiety which plague parents starting as early as the time of prenatal diagnosis In the current era of the global COVID 19 pandemic the additive nature of significant stressors for both medical providers and families can have catastrophic consequences on communication and coping Due to the high prognostic uncertainty of CHD data suggests that early pediatric palliative care PC consultation may improve shared decision making communication and coping while minimizing unnecessary medical interventions However barriers to pediatric PC persist largely due to the perception that PC consultation is indicative of giving up This review serves to highlight the evolving landscape of perinatal and neonatal CHD and the need for earlier and longitudinal integration of pediatric PC in order to provide high quality interdisciplinary care to patients and families 0 +348 Current advances in transfusion medicine 2020 A critical review of selected topics by the AABB Clinical Transfusion Medicine Committee The AABB Clinical Transfusion Medicine Committee CTMC compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine TM which has been made available as a manuscript published in Transfusion since 2018 CTMC committee members reviewed original manuscripts including TM related topics published electronically ahead or in print from December 2019 to December 2020 The selection of topics and manuscripts was discussed at committee meetings and chosen based on relevance and originality Next committee members worked in pairs to create a synopsis of each topic which was then reviewed by two additional committee members The first and senior authors of this manuscript assembled the final manuscript Although this synopsis is extensive it is not exhaustive and some papers may have been excluded or missed The following topics are included COVID 19 effects on the blood supply and regulatory landscape COVID convalescent plasma adult transfusion practices whole blood molecular immunohematology pediatric TM cellular therapy and apheresis medicine This synopsis provides easy access to relevant topics and may be useful as an educational tool 0 +588 Rheumatological complications of Covid 19 COVID 19 has caused unprecedented hardships in the 21st century with more than 150 million infections Various immunological phenomena have been described during the course of the infection and this infection has also triggered autoimmunity Rheumatological illnesses have been described following resolution of the acute infection hence we sought to conduct a review of the rheumatological complications of COVID 19 We conducted a literature search for articles relating to sequelae of COVID 19 from Jan 2020 to 30th April 2021 We found a number of reports of inflammatory arthritis after SARS CoV 2 infection SLE and renal disease have been described and vasculitis also appears to be a common complication Rhabdomyolysis and myositis has also been reported in a number of patients We also found some evidence of large vessel vasculitis in long COVID patients This review highlights a number of important complications such as inflammatory arthritis lupus like disease myostis and vasculitis following SARS CoV 2 infection 0 +539 Impact that the COVID 19 pandemic on routine childhood vaccinations and challenges ahead A narrative review To document the decline in vaccination coverage in the first months of 2020 as an indirect effect of the COVID 19 pandemic We performed a literature review in medical databases Overall 143 articles were initially retrieved out of which 48 were selected and included in the review Our review retrieved similar data in many countries worldwide and globally preliminary data from the first 4 months of 2020 indicate a decline in diphtheria tetanus pertussis coverage generally considered the marker of vaccination coverage across countries World Health Organization recommends maintaining vaccination services prioritising primary series vaccinations especially for measles rubella or poliomyelitis but it also lets each country decide whether to maintain the immunisation services evaluating the current epidemiology of vaccine preventable diseases and the COVID 19 local transmission scenario Successively recovering of vaccinations should be planned Moreover during the pandemic influenza vaccination should be promoted as a central public health measure Future challenges will be to maintain the vaccination programmes especially in children younger than 2 years old and adolescents to plan the recovery of vaccinations for subjects who postponed them during the lockdown and to early identify any vaccine preventable disease outbreak 0 +459 COVID 19 and the labour market outcomes of disabled people in the UK The economic impact of COVID 19 has exacerbated inequalities in society but disability has been neglected This paper contributes to this knowledge gap by providing a comprehensive analysis of the differential labour market impact of COVID 19 by disability in the UK Using data from the Labour Force Survey before and during the pandemic it estimates disability gaps in pre pandemic risk factors as well as changes in labour market inequality nearly one year on Disabled workers are found to face higher COVID 19 related economic and health risks including being more likely to work in shutdown industries and in occupations with greater proximity to others and exposure to disease However established measures of inequality including the disability employment and pay gap suggest limited impact of COVID 19 in 2020 Nevertheless the increase in the probability of being temporarily away from work even among otherwise comparable workers is 40 higher for disabled workers and consistent with disproportionate use of the governments job retention scheme While the reasons for this are likely to be complex there is a risk that it will contribute to future disability related labour market inequality 0 +381 The use of biological agents in pregnant women affected by autoimmune disorders Why we need more research of this neglected area Women of childbearing age are largely affected by several autoimmune disorders the estimates range between 1 5 and 10 per 10 000 The increasing number of effective biological agents has dramatically revolutionized the treatment of these clinical conditions ameliorating the patients quality of life The use of these agents by women during pregnancy is growing to ensure the disease activity control and avoid adverse health outcomes However for many newer biological agents the degree of information concerning their use in pregnancy is often incomplete to perform a conclusive risk assessment on fetal and maternal health given the exclusion of this specific population from pharmacological clinical trials More recently the COVID 19 pandemic has confirmed the unacceptable inequities of pharmacological research and medical treatment for pregnant and lactating women exacerbating the need for filling the gaps of quantitative and qualitative pharmacology data in this sensitive population ere we summarize i what is already known about safety and effectiveness of biological agents in this understudied population with specific focus on pregnancy related health outcomes and what we are going to learn from the on going studies among pregnant women treated with biological agents ii the methodological and ethical considerations that characterize the pharmacological research in pregnancy also discussing emerging evidence on the use of therapeutic drug monitoring TDM in this clinical setting 0 +143 Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID 19 Fatigue Syndrome Lessons from the Qure Study for Q Fever Fatigue Syndrome An increasing number of young and previously fit and healthy people who did not require hospitalisation continue to have symptoms months after mild cases of COVID 19 Rehabilitation clinics are already offering cognitive behavioural therapy CBT as an effective treatment for long COVID and post COVID 19 fatigue syndrome based on the claims that it is effective for myalgic encephalomyelitis chronic fatigue syndrome ME CFS the most common post infectious syndrome as no study into the efficacy of CBT for post COVID 19 fatigue syndrome has been published Re analyses of these studies however showed that CBT did not lead to objective improvements in heterogeneous groups of ME CFS patients nor did it restore the ability to work The group of patients with long COVID and post COVID 19 fatigue syndrome on the other hand is homogeneous We therefore analysed the Dutch Qure study as it studied the efficacy of CBT in a homogeneous group of patients who developed Q fever fatigue syndrome which affects up to 30 of patients after the largest reported outbreak of Q fever to see if CBT might potentially be an effective treatment for long haulers after COVID 19 infection Our reanalysis found that the Qure study suffered from many serious methodological problems which included relying on one subjective primary outcome in a study without a control group for the non blinded CBT treatment group using a post hoc definition of improvement waiting 2 years before publishing their objective actometer results and ignoring the null effect of said results Moreover only 10 of participants achieved a clinically meaningful subjective improvement in fatigue as a result of CBT according to the studys own figures Consequently CBT has no subjective clinically meaningful effect in nine out of every ten patients that are treated with it Additionally the subjective improvement in fatigue was not matched by an improvement in disability even though the disability was fatigue related according to the researchers On top of this CBT did not lead to an objective improvement in physical performance Therefore it cannot be said that CBT is an effective treatment for Q fever fatigue syndrome either It seems therefore unlikely that CBT will reduce disability or lead to objective improvement in long COVID or in post COVID 19 fatigue syndrome 1 +285 Multisystem inflammatory syndrome in children MIS C and the coronavirus pandemic Current knowledge and implications for public health The coronavirus disease 2019 COVID 19 pandemic has caused widespread mortality and morbidity Though children are largely spared from severe illness a novel childhood hyperinflammatory syndrome presumed to be associated with and subsequent to severe acute respiratory syndrome coronavirus 2 SARS CoV 2 infection has emerged with potentially severe outcomes Multisystem inflammatory disorder in children MIS C most commonly affects young school aged children and is characterized by persistent fever systemic hyperinflammation and multisystem organ dysfunction While uncommon and generally treatable MIS C presents potentially life altering medical sequelae complicated by a dearth of information regarding its etiology pathophysiology and long term outcomes The severity of MIS C may warrant the need for increased awareness and continued COVID 19 mitigation efforts particularly until potential factors conferring a predisposition to MIS C can be clarified through additional research Well informed guidelines will be critical as the school year progresses In this article current knowledge on MIS C is reviewed and the potential implications of this novel syndrome are discussed from a public health perspective 1 +339 A national survey of community rehabilitation service provision for people with long Covid in Scotland b Background b Over 50 million cases of COVID 19 have been confirmed globally as of November 2020 Evidence is rapidly emerging on the epidemiology of COVID 19 and its impact on individuals and potential burden on health services and society Between 10 35 of people with COVID 19 may experience post acute long Covid This currently equates to between 8 129 and 28 453 people in Scotland Some of these people will require rehabilitation to support their recovery Currently we do not know how to optimally configure community rehabilitation services for people with long Covid b Methods b This national survey aimed to provide a detailed description of current community rehabilitation provision for people with long Covid in Scotland We developed piloted and conducted a national electronic survey of current community rehabilitation service provision for people presenting with long Covid symptomatology Our sample were the Allied Health Professions Directors of all 14 territorial NHS Health Boards in Scotland Fixed response and narrative data were analysed descriptively b Results b Responses were received from all respondents 14 14 enabling a national picture to be gained Almost all Health Boards 13 14 currently deliver rehabilitation for people with long Covid within pre existing services Fatigue 11 14 and respiratory conditions 9 14 were the two most common presenting problems of patients Most long Covid community rehabilitation services are delivered through a combination of face to face and digital contact 13 14 b Conclusions b Community rehabilitation for people with long Covid is an emerging reality This survey provides a national picture of current community rehabilitation for people with long Covid We do not know how community rehabilitation can be optimally delivered for this population This is vital as community rehabilitation services were already under pressure prior to the emergence of COVID 19 Further research is urgently required to investigate the implementation outcomes and cost effectiveness of differing models of community rehabilitation for this patient population 1 +441 Image challenge left sided facial swelling in a patient with COVID 19 A 68 year old man with diabetes presented with shortness of breath left sided facial swelling and nasal discharge He had recently returned from India and PCR was positive for SARS CoV 2 Delta variant CT head and diffusion weighted MRI sinuses were performed and the patient underwent endoscopic sinus surgery before being transferred to a specialist skull base centre 0 +122 Comparison of post COVID depression and major depressive disorder During the COVID 19 pandemic rates of depressive symptoms are markedly elevated particularly among survivors of infection Understanding whether such symptoms are distinct among those with prior SARS CoV 2 infection or simply a nonspecific reflection of elevated stress could help target interventions We analyzed data from multiple waves of a 50 state survey that included questions about COVID 19 infection as well as the Patient Health Questionnaire examining depressive and anxious symptoms We utilized multiple logistic regression to examine whether sociodemographic features associated with depression liability differed for those with or without prior COVID 19 and then whether depressive symptoms differed among those with or without prior COVID 19 Among 91 791 respondents in regression models age gender race education and income all exhibited an interaction with prior COVID 19 in risk for moderate or greater depressive symptoms p 0 0001 in all cases indicating differential risk in the two subgroups Among those with such symptoms levels of motoric symptoms and suicidality were significantly greater among those with prior COVID 19 illness Depression risk increased with greater interval following acute infection Our results suggest that major depressive symptoms observed among individuals with prior COVID 19 illness may not reflect typical depressive episodes and merit more focused neurobiological investigation 1 +22 Post COVID 19 Syndrome The Persistent Symptoms at the Post viral Stage of the Disease A Systematic Review of the Current Data Whilst the entire world is battling the second wave of COVID 19 a substantial proportion of patients who have suffered from the condition in the past months are reporting symptoms that last for months after recovery i e long term COVID 19 symptoms We aimed to assess the current evidence on the long term symptoms in COVID 19 patients We did a systematic review on PubMed Web of Science EMBASE and Google Scholar from database inception to February 15 2021 for studies on long term COVID 19 symptoms We included all type of papers that reported at least one long term COVID 19 symptom We screened studies using a standardized data collection form and pooled data from published studies Cohort cross sectional case report cases series case control studies and review were graded using specific quality assessment tools Of 11 361 publications found following our initial search we assessed 218 full text articles of which 145 met all selection criteria We found that 20 70 of reports on long term COVID 19 symptoms were on abnormal lung functions 24 13 on neurologic complaints and olfactory dysfunctions and 55 17 on specific widespread symptoms mainly chronic fatigue and pain Despite the relatively high heterogeneity of the reviewed studies our findings highlighted that a noteworthy proportion of patients who have suffered from SARS CoV 2 infection present a post COVID syndrome The multifaceted understanding of all aspects of the COVID 19 pandemic including these long term symptoms will allow us to respond to all the global health challenges thus paving the way to a stronger public health 1 +64 From frustration to enlightenment experiences of student exchange program awardees in Taiwan b Background b Studying abroad is one of the most exciting experiences for a college student who is running a student exchange program as it creates opportunities to learn work solve problems and ensure a secured life However Indonesians who are into student exchange programs face some difficulties in adjusting to their new environment They experience awkwardness in the use of advanced equipment from technology and cultural aspects This study investigates the experiences of two Indonesian students who participated for a semester at a Taiwanese university It aims to explore the Indonesian student exchange program awardees experiences by examining both the obstacles and benefits of attending the Taiwanese university b Methods b This study used qualitative data analysis Data were collected through a semi structured interview informal participant observations and a set of open and closed ended questions Two Indonesian undergraduate students who belonged to the same major year and university were recruited to act as ambassadors b Results b The two students reported facing some problems but felt more independent and became more adaptable They met with new people and explored new places and learned much in terms of teaching pedagogy and personal development from the 21 sup st sup century classroom pedagogy which was important for their future carrier in education Aside from being able to feel the 21 sup st sup century classroom environment they were able to learn the host language and culture which enriched their insights Five main findings emerged departure and journey difficulties in settling in inability to use technology facilities meeting new people and exploring new places and 21 sup st sup century classroom environment b Conclusions b Despite the challenges that are associated with being a student exchange awardee there are vast opportunities for self development and learning the ropes associated with teaching from the 21st century classroom pedagogy 1 +58 Post COVID pulmonary fibrosis therapeutic efficacy using with mesenchymal stem cells How the lung heals COVID 19 is an acute respiratory infectious disease caused by SARS COV 2 Severe Acute Respiratory Syndrome Coronavirus that has become a global pandemic COVID 19 mainly causes the respiratory complications of Acute Respiratory Distress Syndrome ARDS cytokine storm and severe immune disruptions The assays depict that though people recuperate from COVID 19 there are still symptoms that persists in the body causing discomfort which is the consequence of the viral infection due to severe immune disruptions Upon various difficulties of post COVID 19 the pulmonary fibrosis is the stumbling block in the lungs causing severe damage In this review we have shown the effectiveness and importance of the Hepatocyte Growth Factor HGF secreted by Mesenchymal Stem Cell MSC therapy on selective stoppage of the Transforming Growth Factor Beta TGF β signalling pathway by causing immunomodulatory effects that ameliorate the pulmonary fibrosis through paracrine signalling However more pilot studies have to be carried out to determine the efficacy and outcomes of the re emerging complication 1 +306 Immuno fibrotic drivers of impaired lung function in post acute sequelae of SARS CoV 2 infection PASC Subjects recovering from COVID 19 frequently experience persistent respiratory ailments however little is known about the underlying biological factors that may direct lung recovery and the extent to which these are affected by COVID 19 severity We performed a prospective cohort study of subjects with persistent symptoms after acute COVID 19 collecting clinical data pulmonary function tests and plasma samples used for multiplex profiling of inflammatory metabolic angiogenic and fibrotic factors Sixty one subjects were enrolled across two academic medical centers at a median of 9 weeks interquartile range 6 10 after COVID 19 illness n 13 subjects 21 mild non hospitalized n 30 49 hospitalized non critical and n 18 subjects 30 hospitalized intensive care ICU Fifty three subjects 85 had lingering symptoms most commonly dyspnea 69 and cough 58 Forced vital capacity FVC forced expiratory volume in 1 second FEV1 and diffusing capacity for carbon monoxide DLCO declined as COVID 19 severity increased P 0 05 but did not correlate with respiratory symptoms Partial least squares discriminant analysis of plasma biomarker profiles clustered subjects by past COVID 19 severity Lipocalin 2 LCN2 matrix metalloproteinase 7 MMP 7 and hepatocyte growth factor HGF identified by the model were significantly higher in the ICU group P 0 05 and inversely correlated with FVC and DLCO P 0 05 and were confirmed in a separate validation cohort n 53 Subjective respiratory symptoms are common after acute COVID 19 illness but do not correlate with COVID 19 severity or pulmonary function Host response profiles reflecting neutrophil activation LCN2 fibrosis signaling MMP 7 and alveolar repair HGF track with lung impairment and may be novel therapeutic or prognostic targets The study was funded in part by the NHLBI K08HL130557 to BDK and R01HL142818 to HJC the DeLuca Foundation Award AP a donation from Jack Levin to the Benign Hematology Program at Yale and Divisional Departmental funds from Duke University 1 +272 Pulmonary rehabilitation in long COVID more than just natural recovery b In the light of missing randomised controlled trials some arguments suggest that pulmonary rehabilitation has beneficial effects beyond natural recovery b https bit ly 3ze2xvw 1 +680 Advancements in detection of SARS CoV 2 infection for confronting COVID 19 pandemics As one of the major approaches in combating the COVID 19 pandemics the availability of specific and reliable assays for the SARS CoV 2 viral genome and its proteins is essential to identify the infection in suspected populations make diagnoses in symptomatic or asymptomatic individuals and determine clearance of the virus after the infection For these purposes use of the quantitative reverse transcriptase polymerase chain reaction qRT PCR for detection of the viral nucleic acid remains the most valuable in terms of its specificity fast turn around high throughput capacity and reliability It is critical to update the sequences of primers and probes to ensure the detection of newly emerged variants Various assays for increased levels of IgG or IgM antibodies are available for detecting ongoing or past infection vaccination responses and persistence and for identifying high titers of neutralizing antibodies in recovered individuals Viral genome sequencing is increasingly used for tracing infectious sources monitoring mutations and subtype classification and is less valuable in diagnosis because of its capacity and high cost Nanopore target sequencing with portable options is available for a quick process for sequencing data Emerging CRISPR Cas based assays such as SHERLOCK and AIOD CRISPR for viral genome detection may offer options for prompt and point of care detection Moreover aptamer based probes may be multifaceted for developing portable and high throughput assays with fluorescent or chemiluminescent probes for viral proteins In conclusion assays are available for viral genome and protein detection and the selection of specific assays depends on the purposes of prevention diagnosis and pandemic control or monitoring of vaccination efficacy 0 +544 Cryoglobulins Identification classification and novel biomarkers of mysterious proteins Cryoglobulins consist of serum immunoglobulins that precipitate below 37 C and resolubilize upon warming The clinical triad of cryoglobulinemia usually includes purpura weakness and arthralgia Cryoglobulinemic syndrome clinically defined as a systemic vasculitis is associated with chronic infection with hepatitis C virus HCV and autoimmune disorders and can evolve into B cell malignancies While the current literature about HCV associated cryoglobulinemia is not very limited little is known about the immunologic and serologic profiles of affected patients Therefore comprehension of the pathogenetic mechanisms underlying cryoprecipitation could be very helpful Due to the persistence of viral antigenic stimulation biomarkers to use after the worsening progression of HCV infection to lymphoproliferative and or autoimmune diseases are widely needed Laboratory methods used to detect and characterize low concentrations of cryoprecipitates and immunotyping patterns could improve patient management The most critical factor affecting cryoglobulin testing is that the pre analytical phase is not fully completed at 37 C 0 +583 Covid 19 Pandemic Resumption of Orthopedic Care and Medical Education Covid 19 is a respiratory disease caused by coronavirus 2 SARS CoV 2 first identified in Wuhan China December 2019 The disease rapidly crossed the barrier of countries continents and spread globally Non pharmaceutical measures such as social distancing face mask frequent hand washing and use of sanitizer remained the best available option to prevent the spread of disease OPD IPD admissions elective O Ts were curtailed Orthopedic care was only limited to emergency and semi urgent procedures like necrotizing fasciitis open fracture and compartment syndrome These measures were taken to preserve infrastructure and manpower to manage covid 19 pandemic The children were thought to have a low susceptibility to covid 19 as compared to an adult Deferring the patient during pandemic has led to high orthopedic disease burden morbidity and disease related sequelae hence elective care must be resumed with modified hospital infrastructure Resumption of elective emergent orthopedic care should be slow phasic and strategic much similar to unlocking Cases must be stratified depending on covid status and severity Dedicated O Ts with neutral negative pressure and HEPA filter for covid positive and suspected patients are to be used All symptomatic and suspected patients should be investigated for covid 19 by RT PCR blood counts and CT scan Regional anaesthesia should be preferred to General anaesthesia Power drill saw burr pulse lavage should be minimized to avoid aerosol generation Postoperatively continuous surveillance and monitoring to be done for covid related symptoms Medical institutes rapidly shifted to the online mode of education Blended learning virtual physical and imparting skills have to be continued in post covid phase with equitable distribution of teaching hours to students of different years 0 +343 Post acute sequelae of SARS CoV 2 infection Caring for the long haulers An estimated 10 of COVID 19 survivors continue to experience symptoms several weeks to months after the appearance of initial symptoms a condition termed post acute sequelae of SARS CoV 2 infection PASC These patients also called long haulers most commonly report protracted symptoms of fatigue cough dyspnea chest tightness difficulty concentrating arthralgia olfactory dysfunction and headache While age comorbid medical conditions and COVID 19 severity are risk factors young and previously healthy individuals with mild COVID 19 are also at risk Recognition of symptoms evaluation supportive treatment and attention to medical comorbidities are the cornerstones of medical management 1 +595 Association of Blood Groups with the Severity and Outcome of COVID 19 Infection in Children The objective of this study was to find out the association of ABO blood groups with the severity and outcome of corona virus disease 2019 COVID 19 in children It included all laboratory confirmed cases of COVID 19 and post COVID multisystem inflammatory syndrome in children MIS C Kawasaki disease KD like illness admitted from March to September 2020 to The Childrens Hospital Lahore Out of 66 children 45 68 2 were COVID 19 and 21 31 8 MIS C KD temporally associated with SARS C0V 2 The mean age was 7 9 4 2 years Majority of children had mild to moderate illness 38 57 6 while 23 34 8 had severe or critical disease Among all patients 24 36 4 had some underlying comorbidity Blood group A was significantly associated with severe and critical disease p 0 030 COVID 19 in children had generally a good outcome but children with blood group A were more susceptible to severe critical disease Key Words Coronavirus disease 2019 ABO blood groups Children Severity Outcome 0 +100 Is there a post COVID syndrome For critically ill COVID 19 patients surviving the acute phase of the disease could possibly only mean having overcome the first stage of a long and challenging path Physical cognitive and psychological consequences seem to be realistic however do residual symptoms in patients who have returned to microbiological normalization constitute a post COVID syndrome and which symptoms are principally possible in this context and are able to cause such a syndrome It is no novelty that critically ill patients often still sustain functional limitations over a long period after discharge from hospital in many cases even over many years In most cases of COVID 19 it is too early for the diagnosis of a post COVID syndrome For this the symptoms would have to have lasted over a period of at least 6 months therefore only a post infection fatigue can currently be spoken of On top of this even if patients recover physically they could be at particular risk of suffering from long term mental health problems or perceive a reduced quality of life Such findings exist not only after ARDS as many intensive care unit patients sustain long term disorders which is also known as post intensive care syndrome PICS To sum up there is sufficient evidence for the possible existence of a post COVID syndrome or for the justification to correspondingly designate these possible sequelae with persisting symptoms in this way In any case all efforts that enable a complete functional recovery and a return to a life after corona are justified 1 +661 Mental health among healthcare workers and other vulnerable groups during the COVID 19 pandemic and other coronavirus outbreaks A rapid systematic review Although most countries and healthcare systems worldwide have been affected by the COVID 19 pandemic some groups of the population may be more vulnerable to detrimental effects of the pandemic on mental health than others The aim of this systematic review was to synthesise evidence currently available from systematic reviews on the impact of COVID 19 and other coronavirus outbreaks on mental health for groups of the population thought to be at increased risk of detrimental mental health impacts We conducted a systematic review of reviews on adults and children residing in a country affected by a coronavirus outbreak and belonging to a group considered to be at risk of experiencing mental health inequalities Data were collected on symptoms or diagnoses of any mental health condition quality of life suicide or attempted suicide The protocol for this systematic review was registered in the online PROSPERO database prior to commencing the review https www crd york ac uk prospero display_record php RecordID 194264 We included 25 systematic reviews Most reviews included primary studies of hospital workers from multiple countries Reviews reported variable estimates for the burden of symptoms of mental health problems among acute healthcare workers COVID 19 patients with physical comorbidities and children and adolescents No evaluations of interventions were identified Risk and protective factors mostly for healthcare workers showed the importance of personal factors the work environment and social networks for mental health This review of reviews based on primary studies conducted in the early months of the COVID 19 pandemic shows a lack of evidence on mental health interventions and mental health impacts on vulnerable groups in the population 0 +487 The long term consequences of Corona Virus Disease 2019 patients receiving Chinese herbal medicine treatments in acute phase A protocol for systematic review and meta analysis In December 2019 the first case of Corona Virus Disease 2019 COVID 19 associated with severe acute respiratory syndrome coronavirus 2 viral infection was described in Wuhan Similar to SARS in 2003 COVID 19 also had a lasting impact Approximately 76 of patients discharged after hospitalization for COVID 19 had neurological manifestations which could persist for 6 months and some long term consequences such as the gradual loss of lung function due to pulmonary interstitial fibrosis could have comprehensive effects on daily quality of life for people who were initially believed to have recovered from COVID 19 Our comprehensive search strategy developed in consultation with a research librarian We will search these following electronic databases PubMed Cochrane Library Web of Science ScienceDirect Scopus Google Scholar Embase ProQuest China Science and Technology Journal Database VIP China National Knowledge Infrastructure WANFANG DATA WHO covid 19 website and Centers for Disease Control and the Prevention COVID 19 websites of the United States and China The bias of publication will be confirmed via the P value of Egger test The quality of studies will be evaluated by the Newcastle Ottawa Scale There are no ethical considerations associated with this study protocol for this systematic review which mainly focuses on the examination of secondary data On completion of this analysis we will prepare a manuscript for publication in a peer reviewed medical journal CRD42021258711 0 +480 Translating known drivers of COVID 19 disease severity to design better SARS CoV 2 vaccines The SARS CoV 2 pandemic has highlighted how an emergent disease can spread globally and how vaccines are once again the most important public health policy to combat infectious disease Despite promising initial protection the rise of new viral variants calls into question how effective current SARS CoV 2 vaccines will be moving forward Improving on vaccine platforms represents an opportunity to stay ahead of SARS CoV 2 and keep the human population protected Many researchers focus on modifying delivery platforms or altering the antigen s presented to improve the efficacy of the vaccines Identifying mechanisms of natural immunity that result in the control of infection and prevent poor clinical outcomes provides an alternative approach to the development of efficacious vaccines Early and current evidence shows that SARS CoV 2 infection is marked by potent lung inflammation and relatively diminished antiviral signaling which leads to impaired immune recognition and viral clearance essentially making SARS CoV 2 too hot to handle 0 +132 The microvascular hypothesis underlying neurologic manifestations of long COVID 19 and possible therapeutic strategies With the ongoing distribution of the coronavirus disease COVID vaccines the pandemic of our age is ending leaving the world to deal with its well documented aftereffects Long COVID comprises a variety of symptoms of which the neurological component prevails The most permeating theory on the genesis of these symptoms builds upon the development of microvascular dysfunction similar to that seen in numerous vascular diseases such as diabetes This can occur through the peripheral activation of angiotensin converting enzyme 2 receptors or through exacerbations of pro inflammatory cytokines that can remain in circulation even after the infection diminishes Several drugs have been identified to act on the neurovascular unit to promote repair such as gliptins and others They also succeeded in improving neurologic outcome in diabetic patients The repurposing of such drugs for treatment of long COVID 19 can possibly shorten the time to recovery of long COVID 19 syndrome 1 +203 Multiorgan impairment in low risk individuals with post COVID 19 syndrome a prospective community based study To assess medium term organ impairment in symptomatic individuals following recovery from acute SARS CoV 2 infection Baseline findings from a prospective observational cohort study Community based individuals from two UK centres between 1 April and 14 September 2020 Individuals 18 years with persistent symptoms following recovery from acute SARS CoV 2 infection and age matched healthy controls Assessment of symptoms by standardised questionnaires EQ 5D 5L Dyspnoea 12 and organ specific metrics by biochemical assessment and quantitative MRI Severe post COVID 19 syndrome defined as ongoing respiratory symptoms and or moderate functional impairment in activities of daily living single organ and multiorgan impairment heart lungs kidneys liver pancreas spleen by consensus definitions at baseline investigation 201 individuals mean age 45 range 21 71 years 71 female 88 white 32 healthcare workers completed the baseline assessment median of 141 days following SARS CoV 2 infection IQR 110 162 The study population was at low risk of COVID 19 mortality obesity 20 hypertension 7 type 2 diabetes 2 heart disease 5 with only 19 hospitalised with COVID 19 42 of individuals had 10 or more symptoms and 60 had severe post COVID 19 syndrome Fatigue 98 muscle aches 87 breathlessness 88 and headaches 83 were most frequently reported Mild organ impairment was present in the heart 26 lungs 11 kidneys 4 liver 28 pancreas 40 and spleen 4 with single organ and multiorgan impairment in 70 and 29 respectively Hospitalisation was associated with older age p 0 001 non white ethnicity p 0 016 increased liver volume p 0 0001 pancreatic inflammation p 0 01 and fat accumulation in the liver p 0 05 and pancreas p 0 01 Severe post COVID 19 syndrome was associated with radiological evidence of cardiac damage myocarditis p 0 05 In individuals at low risk of COVID 19 mortality with ongoing symptoms 70 have impairment in one or more organs 4 months after initial COVID 19 symptoms with implications for healthcare and public health which have assumed low risk in young people with no comorbidities NCT04369807 Pre results 1 +65 Similar patterns of sup 18 sup F FDG brain PET hypometabolism in paediatric and adult patients with long COVID a paediatric case series Several weeks after COVID 19 infection some children report the persistence or recurrence of functional complaints This clinical presentation has been referred as long COVID in the adult population and an sup 18 sup F FDG brain PET hypometabolic pattern has recently been suggested as a biomarker Herein we present a retrospective analysis of 7 paediatric patients with suspected long COVID who were explored by sup 18 sup F FDG brain PET exam Metabolic brain findings were confronted to those obtained in adult patients with long COVID in comparison to their respective age matched control groups Review of clinical examination and whole brain voxel based analysis of sup 18 sup F FDG PET metabolism of the 7 children in comparison to 21 paediatric controls 35 adult patients with long COVID and 44 healthy adult subjects Despite lower initial severity at the acute stage of the infection paediatric patients demonstrated on average 5 months later a similar brain hypometabolic pattern as that found in adult long COVID patients involving bilateral medial temporal lobes brainstem and cerebellum p voxel 0 001 p cluster 0 05 FWE corrected and also the right olfactory gyrus after small volume correction p voxel 0 010 FWE corrected with partial PET recovery in two children at follow up These results provide arguments in favour of possible long COVID in children with a similar functional brain involvement to those found in adults regardless of age and initial severity 1 +16 Headache as an acute and post COVID 19 symptom in COVID 19 survivors A meta analysis of the current literature Headache is identified as a common post COVID sequela experienced by COVID 19 survivors The aim of this pooled analysis was to synthesize the prevalence of post COVID headache in hospitalized and non hospitalized patients recovering from SARS CoV 2 infection MEDLINE CINAHL PubMed EMBASE and Web of Science databases as well as medRxiv and bioRxiv preprint servers were searched up to 31 May 2021 Studies or preprints providing data on post COVID headache were included The methodological quality of the studies was assessed using the Newcastle Ottawa Scale Random effects models were used for meta analytical pooled prevalence of post COVID headache Data synthesis was categorized at hospital admission symptoms onset and at 30 60 90 and 180 days afterwards From 9573 studies identified 28 peer reviewed studies and 7 preprints were included The sample was 28 438 COVID 19 survivors 12 307 females mean age 46 6 SD 17 45 years The methodological quality was high in 45 of the studies The overall prevalence of post COVID headache was 47 1 95 CI 35 8 58 6 at onset or hospital admission 10 2 95 CI 5 4 18 5 at 30 days 16 5 95 CI 5 6 39 7 at 60 days 10 6 95 CI 4 7 22 3 at 90 days and 8 4 95 CI 4 6 14 8 at 180 days after onset hospital discharge Headache as a symptom at the acute phase was more prevalent in non hospitalized 57 97 than in hospitalized 31 11 patients Time trend analysis showed a decreased prevalence from the acute symptoms onset to all post COVID follow up periods which was maintained afterwards This meta analysis found that the prevalence of post COVID headache ranged from 8 to 15 during the first 6 months after SARS CoV 2 infection 1 +626 Care of Pediatric Patients with Diabetes During the Coronavirus Disease 2019 COVID 19 Pandemic This article summarizes clinical observations and management strategies in pediatric type 1 diabetes T1D during the coronavirus disease 2019 COVID 19 pandemic Despite initial fears that children with diabetes would similar to adults with diabetes be at risk for severe COVID 19 most pediatric patients with a history of T1D who developed COVID 19 had mild disease or were asymptomatic similar to their peers without diabetes The article also summarizes the use of telemedicine to provide ongoing care for pediatric patients with T1D during the COVID 19 pandemic Finally the article highlights important lessons learned about management of pediatric diabetes during the COVID 19 pandemic 0 +47 The occurrence of long COVID a rapid review The long term effects of the severe acute respiratory syndrome SARS coronavirus 2 SARS CoV 2 are not well understood This rapid review was aimed at synthesizing evidence on the long term effects of the SARS CoV 2 infection among survivors We considered both randomised controlled trials and non randomised studies eligible for inclusion in this review The following databases were searched PubMed Scopus Cochrane library Google Scholar and the World Health Organization WHO COVID 19 database The reference lists of all the included studies were also searched Two authors independently screened the search outputs and reviewed full texts of potentially eligible articles Data extraction was done by one author and checked by a second author A meta analysis was not conducted due to heterogeneity among the included studies Results are presented narratively Eleven studies met our inclusion criteria All these studies were conducted in high income countries Study findings demonstrate that COVID 19 survivors can experience persistent symptoms after recovering from their initial illness especially among previously hospitalized persons The majority of symptoms reported were fatigue shortness of breath cough and sleep disorders Mental conditions such as depression and anxiety disorders were also reported In conclusion this study showed that COVID 19 survivors can experience persistent symptoms after recovering from their initial illness Therefore there is a need for a long term follow up of COVID 19 patients and rehabilitation services for survivors More research is needed in this area especially in Africa 1 +233 Duration of post COVID 19 symptoms is associated with sustained SARS CoV 2 specific immune responses A subset of COVID 19 patients exhibit post acute sequelae of COVID 19 PASC but little is known about the immune signatures associated with these syndromes We investigated longitudinal peripheral blood samples in 50 individuals with previously confirmed SARS CoV 2 infection including 20 who experienced prolonged duration of COVID 19 symptoms lasting more than 30 days median 74 days compared with 30 who had symptom resolution within 20 days Individuals with prolonged symptom duration maintained antigen specific T cell response magnitudes to SARS CoV 2 spike protein in CD4 and circulating T follicular helper cell populations during late convalescence while those without persistent symptoms demonstrated an expected decline The prolonged group also displayed increased IgG avidity to SARS CoV 2 spike protein Significant correlations between symptom duration and both SARS CoV 2 specific T cells and antibodies were observed Activation and exhaustion markers were evaluated in multiple immune cell types revealing few phenotypic differences between prolonged and recovered groups suggesting that prolonged symptom duration is not due to persistent systemic inflammation These findings demonstrate that SARS CoV 2 specific immune responses are maintained in patients suffering from prolonged post COVID 19 symptom duration in contrast to those with resolved symptoms and may suggest the persistence of viral antigens as an underlying etiology 1 +652 Obesity and immune status in children Childhood obesity with persistent chronic inflammation is a worldwide epidemic Obesity causes dysregulation throughout the immune system affecting the balance and levels of cytokines adipokines and innate and adaptive immune cells The present review focuses on the impact of obesity on immune function in children altering the baseline activation state of immune cells and affecting the ability of the host to combat pathogens and malignancy and respond appropriately to vaccination Obesity causes dysregulation of the immune system Single cell RNA sequencing of adipose tissue and resident immune cells is quantifying the impact of obesity on the frequency of immune cell subsets and their states The system wide alterations in immune function in obesity are most evident upon perturbation including the response to infection e g increased risk of severe COVID 19 in the ongoing pandemic vaccination and malignancy However mechanistic research in pediatric obesity is limited and this impacts our ability to care for these children We must better understand baseline and perturbed immune health in obese children to determine how to account for altered frequency and function of humoral and cellular immune components in acute infection during vaccine design and when considering therapeutic options for this complex medically vulnerable group 0 +642 Development and optimization of heavy metal lead biosensors in biomedical and environmental applications The detrimental impact of the heavy metal lead Pb on human health has been studied for years The fact that Pb impairs human body has been established from countless painful and sad historical events Nowadays World Health Organization and many developmental countries have established regulations concerning the use of Pb Measuring the blood lead level BLL is so far the only way to officially evaluate the degree of Pb exposure but the so called safety value 10 μg dL in adults and 5 μg dL in children seems unreliable to represent the security checkpoint for children through daily intake of drinking water or physical contact with a lower contaminated level of Pb contents In general unsolved mysteries about the Pb toxicological mechanisms still remain In this review article we report on the methods to prevent Pb poison for further Pb toxicological research We establish high sensitivity Pb monitoring and also report on the use of fluorescent biosensors such as genetically encoded fluorescence resonance energy transfer based biosensors built for various large demands such as the detection of severe acute respiratory syndrome coronavirus 2 We also contribute to the development and optimization of the FRET based Pb biosensors Our well performed version of Met lead 1 44 M1 has achieved a limit of detection of 10 nM 2 ppb 0 2 μg dL and almost 5 fold in dynamic range DR supported for the real practical applications that is the in cell Pb sensing device for blood and blood related samples and the Pb environmental detections in vitro The perspective of our powerful Pb biosensor incorporated with a highly sensitive bio chip of the portable device for quick Pb measurements will be addressed for further manipulation 0 +113 Clinical features and follow up of pediatric patients hospitalized for COVID 19 This report summarizes the clinical features and 1 month follow up observations for pediatric patients who were hospitalized with coronavirus disease 2019 COVID 19 in Wuhan Women and Childrens Hospital The 1 month follow up data included clinical manifestations and results from serum severe acute respiratory syndrome coronavirus 2 SARS CoV 2 IgG and IgM tests reverse transcription polymerase chain reaction RT PCR for SARS CoV 2 lung computed tomography CT scans and laboratory tests Between January 20 and March 15 2020 127 patients aged 0 15 years were hospitalized for COVID 19 treatment including 3 severe cases and 124 mild or moderate cases The main therapies included inhalation of aerosolized interferon α 122 127 and additional antiviral drugs 28 127 Among the 81 patients who had pneumonia at admission 35 with right lobe pneumonia had the longest hospital stay mean 14 5 7 days 17 with left lobe pneumonia had the highest creatine kinase 154 106 U L and creatine kinase myocardial band CK MB 43 48 U L levels and 29 with bilateral pneumonia had the highest white blood cell counts 8 3 4 10 sup 9 sup L Among the 46 patients who were successfully followed up 1 month after discharge two notable findings were right lobe pneumonia in 22 95 confidence interval CI 11 37 of patients and persistently elevated serum creatine kinase and CK MB levels The median duration of elevated CK MB was 45 days The mean concentrations of serum SARS CoV 2 IgG and IgM in 41 patients were 8 0 7 5 and 98 40 ng ml respectively At follow up four patients retested positive for SARS CoV 2 The involvement of different lung lobes in patients with COVID 19 was associated with variations in the persistence of pneumonia and elevation of CK MB levels and body temperature 1 +616 How does COVID 19 affect intestinal microbiota There is a bidirectional interaction between the intestines and lungs the so called lung intestinal axis The review article reports on studies that deal with a possible influence of the intestinal microbiota on the immune response to a SARS CoV 2 infection Studies have shown that COVID 19 is accompanied by dysbiosis that persists even after successful virus conversion negative PCR One study found that the severity of COVID 19 is associated with the intestinal microbiota A dysbiosis could thus favor the so called cytokine storm There is indication that pre and probiotics could boost the immune response in both the guts and lungs 0 +152 Role of the Renin Angiotensin Aldosterone and Kinin Kallikrein Systems in the Cardiovascular Complications of COVID 19 and Long COVID Severe Acute Respiratory Syndrome Coronavirus 2 SARS CoV 2 is the virus responsible for the COVID 19 pandemic Patients may present as asymptomatic or demonstrate mild to severe and life threatening symptoms Although COVID 19 has a respiratory focus there are major cardiovascular complications CVCs associated with infection The reported CVCs include myocarditis heart failure arrhythmias thromboembolism and blood pressure abnormalities These occur in part because of dysregulation of the Renin Angiotensin Aldosterone System RAAS and Kinin Kallikrein System KKS A major route by which SARS CoV 2 gains cellular entry is via the docking of the viral spike S protein to the membrane bound angiotensin converting enzyme 2 ACE2 The roles of ACE2 within the cardiovascular and immune systems are vital to ensure homeostasis The key routes for the development of CVCs and the recently described long COVID have been hypothesised as the direct consequences of the viral S protein ACE2 axis downregulation of ACE2 and the resulting damage inflicted by the immune response Here we review the impact of COVID 19 on the cardiovascular system the mechanisms by which dysregulation of the RAAS and KKS can occur following virus infection and the future implications for pharmacological therapies 1 +73 Brain imaging before and after COVID 19 in UK Biobank There is strong evidence for brain related pathologies in COVID 19 some of which could be a consequence of viral neurotropism The vast majority of brain imaging studies so far have focused on qualitative gross pathology of moderate to severe cases often carried out on hospitalised patients It remains unknown however whether the impact of COVID 19 can be detected in milder cases in a quantitative and automated manner and whether this can reveal a possible mechanism for the spread of the disease UK Biobank scanned over 40 000 participants before the start of the COVID 19 pandemic making it possible to invite back in 2021 hundreds of previously imaged participants for a second imaging visit Here we studied the effects of the disease in the brain using multimodal data from 782 participants from the UK Biobank COVID 19 re imaging study with 394 participants having tested positive for SARS CoV 2 infection between their two scans We used structural and functional brain scans from before and after infection to compare longitudinal brain changes between these 394 COVID 19 patients and 388 controls who were matched for age sex ethnicity and interval between scans We identified significant effects of COVID 19 in the brain with a loss of grey matter in the left parahippocampal gyrus the left lateral orbitofrontal cortex and the left insula When looking over the entire cortical surface these results extended to the anterior cingulate cortex supramarginal gyrus and temporal pole We further compared COVID 19 patients who had been hospitalised n 15 with those who had not n 379 and while results were not significant we found comparatively similar findings to the COVID 19 vs control group comparison with in addition a greater loss of grey matter in the cingulate cortex central nucleus of the amygdala and hippocampal cornu ammonis all Z 3 Our findings thus consistently relate to loss of grey matter in limbic cortical areas directly linked to the primary olfactory and gustatory system Unlike in i post hoc i disease studies the availability of pre infection imaging data helps avoid the danger of pre existing risk factors or clinical conditions being mis interpreted as disease effects Since a possible entry point of the virus to the central nervous system might be via the olfactory mucosa and the olfactory bulb these brain imaging results might be the i in vivo i hallmark of the spread of the disease or the virus itself via olfactory and gustatory pathways 1 +125 Epidemiologic and clinical characteristics of multisystem inflammatory syndrome in adults a rapid review Multisystem inflammatory disease in children MIS C is one of the severe presentations of the coronavirus disease 2019 COVID 19 that has been described in the literature since the beginning of the pandemic Although MIS C refers to children cases with similar clinical characteristics have been recently described in adults A description of the epidemiologic and clinical characteristics of multisystem inflammatory disease in adults MIS A is a starting point for better knowledge and understanding of this emerging disease We identified nine case reports of MIS A in the literature five from the United States two from France and two from the United Kingdom The case descriptions revealed similarities in clinical features including occurrence during post acute disease phase fever digestive symptoms cardiac involvement and elevated inflammatory markers All the patients were hospitalized three required admission to the intensive care unit and one died The most common treatments were intravenous immunoglobulin prednisolone and aspirin These findings suggest that MIS A is a severe complication of COVID 19 disease that can lead to death Further studies to improve our understanding of the pathogenesis of MIS A which will help improve treatment decisions and prevent sequelae or death 1 +432 Adenoviral Vector DNA and SARS CoV 2 mRNA Based Covid 19 Vaccines Possible Integration into the Human Genome Are Adenoviral Genes Expressed in Vector based Vaccines Vigorous vaccination programs against SARS CoV 2 causing Covid 19 are the major chance to fight this dreadful pandemic The currently administered vaccines depend on adenovirus DNA vectors or on SARS CoV 2 mRNA that might become reverse transcribed into DNA however infrequently In some societies people have become sensitized against the potential short or long term side effects of foreign DNA being injected into humans In my laboratory the fate of foreign DNA in mammalian human cells and organisms has been investigated for many years In this review a summary of the results obtained will be presented This synopsis has been put in the evolutionary context of retrotransposon insertions into pre human genomes millions of years ago In addition studies on adenovirus vector based DNA on the fate of food ingested DNA as well as the long term persistence of SARS CoV 2 RNA DNA will be described Actual integration of viral DNA molecules and of adenovirus vector DNA will likely be chance events whose frequency and epigenetic consequences cannot with certainty be assessed The review also addresses problems of remaining adenoviral gene expression in adenoviral based vectors and their role in side effects of vaccines Eventually it will come down to weighing the possible risks of genomic insertions of vaccine associated foreign DNA and unknown levels of vector carried adenoviral gene expression versus protection against the dangers of Covid 19 A decision in favor of vaccination against life threatening disease appears prudent Informing the public about the complexities of biology will be a reliable guide when having to reach personal decisions about vaccinations 0 +631 Exercise Is Medicine for Immune Function Implication for COVID 19 This review supports that physical activity improves immunosurveillance and has the potential to counter COVID 19 infection and symptomatology at three prevention levels At the primary prevention level several lines of evidence support that physical activity is an immune system adjuvant in combating infectious diseases Recent epidemiological studies indicate that regular physical activity is associated with a reduced risk for COVID 19 similar to what has been reported for other respiratory infections Although specific COVID 19 related studies are needed data from investigations with other types of infectious agents such as influenza support the potential role of physical activity in augmenting COVID 19 vaccine efficacy secondary prevention level There is a growing awareness that COVID 19 can cause sustained morbidity in some patients and physical training and rehabilitation tertiary prevention level can be directed toward improvement in physical fitness quality of life and immune health 0 +372 Remote evaluations of violence against women and girls interventions a rapid scoping review of tools ethics and safety Although programmes and policies targeting violence against women and girls VAWG have increased in the past decade there is a paucity of evidence on the effectiveness of these interventions To expand this evidence base researchers increasingly employ remote data collection RDC including online surveys mobile applications and telephone interviews in their evaluations Although RDC allows for evaluations without in person interactions which are restricted during crises such as the COVID 19 pandemic information about these methods is necessary to understand their potential usefulness and limitations This scoping review examines remote evaluations of VAWG interventions to describe the landscape of RDC methods reflect on safety and ethical considerations and offer best practices for RDC in VAWG research Fourteen studies met eligibility criteria with seven five and two studies employing telephone interviews online surveys and mobile applications respectively Studies commonly stated that participants were asked to use a safe email or device but the method for verifying such safety was rarely specified Best practices around safety included creating a quick escape button for online data collection to use when another individual was present explaining to participants how to erase browsing history and application purchases and asking participants to specify a safe time for researchers to call Only eight studies established referral pathways for respondents as per best practice None of the eligible studies took place in low middle income countries LMICs or humanitarian settings likely reflecting the additional challenges to using RDC methods in lower resource settings Findings were used to create a best practice checklist for programme evaluators and Institutional Review Boards using RDC for VAWG interventions The authors found that opportunities exist for researchers to safely and effectively use RDC methodologies to gather VAWG data but that further study is needed to gauge the feasibility of these methods in LMICs and humanitarian settings 0 +410 COVID 19 Disease Womens Predominant Non Heparin Vaccine Induced Thrombotic Thrombocytopenia and Kounis Syndrome A Passepartout Cytokine Storm Interplay Coronavirus disease 2019 COVID 19 and severe acute respiratory syndrome coronavirus 2 SARS CoV 2 constitute one of the deadliest pandemics in modern history demonstrating cardiovascular gastrointestinal hematologic mucocutaneous respiratory neurological renal and testicular manifestations and further complications COVID 19 induced excessive immune response accompanied with uncontrolled release of cytokines culminating in cytokine storm seem to be the common pathogenetic mechanism of these complications The aim of this narrative review is to elucidate the relation between anaphylaxis associated with profound hypotension or hypoxemia with pro inflammatory cytokine release COVID 19 relation with Kounis syndrome and post COVID 19 vaccination correlation with heparin induced thrombocytopenia with thrombosis HITT especially serious cerebral venous sinus thrombosis were also reviewed A current literature search in PubMed Embase and Google databases was performed to reveal the pathophysiology prevalence clinical manifestation correlation and treatment of COVID 19 anaphylaxis with profuse hypotension Kounis acute coronary syndrome and thrombotic events post vaccination The same key immunological pathophysiology mechanisms and cells seem to underlie COVID 19 cardiovascular complications and the anaphylaxis associated Kounis syndrome The myocardial injury in patients with COVID 19 has been attributed to coronary spasm plaque rupture and microthrombi formation hypoxic injury or cytokine storm disposing the same pathophysiology with the three clinical variants of Kounis syndrome COVID 19 interrelated vaccine excipients as polysorbate polyethelene glycol PEG and trometamol constitute potential allergenic substances Better acknowledgement of the pathophysiological mechanisms clinical similarities multiorgan complications of COVID 19 or other viral infections as dengue and human immunodeficiency viruses along with the action of inflammatory cells inducing the Kounis syndrome could identify better immunological approaches for prevention treatment of the COVID 19 pandemic as well as post COVID 19 vaccine adverse reactions 0 +133 Evolving Phenotypes of non hospitalized Patients that Indicate Long Covid For some SARS CoV 2 survivors recovery from the acute phase of the infection has been grueling with lingering effects Many of the symptoms characterized as the post acute sequelae of COVID 19 PASC could have multiple causes or are similarly seen in non COVID patients Accurate identification of phenotypes will be important to guide future research and help the healthcare system focus its efforts and resources on adequately controlled age and gender specific sequelae of a COVID 19 infection In this retrospective electronic health records EHR cohort study we applied a computational framework for knowledge discovery from clinical data MLHO to identify phenotypes that positively associate with a past positive reverse transcription polymerase chain reaction RT PCR test for COVID 19 We evaluated the post test phenotypes in two temporal windows at 3 6 and 6 9 months after the test and by age and gender Data from longitudinal diagnosis records stored in EHRs from Mass General Brigham in the Boston metropolitan area was used for the analyses Statistical analyses were performed on data from March 2020 to June 2021 Study participants included over 96 thousand patients who had tested positive or negative for COVID 19 and were not hospitalized We identified 33 phenotypes among different age gender cohorts or time windows that were positively associated with past SARS CoV 2 infection All identified phenotypes were newly recorded in patientsâ medical records two months or longer after a COVID 19 RT PCR test in non hospitalized patients regardless of the test result Among these phenotypes a new diagnosis record for anosmia and dysgeusia OR 2 60 95 CI 1 94 3 46 alopecia OR 3 09 95 CI 2 53 3 76 chest pain OR 1 27 95 CI 1 09 1 48 chronic fatigue syndrome OR 2 60 95 CI 1 22 2 10 shortness of breath OR 1 41 95 CI 1 22 1 64 pneumonia OR 1 66 95 CI 1 28 2 16 and type 2 diabetes mellitus OR 1 41 95 CI 1 22 1 64 are some of the most significant indicators of a past COVID 19 infection Additionally more new phenotypes were found with increased confidence among the cohorts who were younger than 65 Our approach avoids a flood of false positive discoveries while offering a more robust probabilistic approach compared to the standard linear phenome wide association study PheWAS The findings of this study confirm many of the post COVID symptoms and suggest that a variety of new diagnoses including new diabetes mellitus and neurological disorder diagnoses are more common among those with a history of COVID 19 than those without the infection Additionally more than 63 percent of PASC phenotypes were observed in patients under 65 years of age pointing out the importance of vaccination to minimize the risk of debilitating post acute sequelae of COVID 19 among younger adults 1 +581 Imaging Evaluation of Pulmonary and Non Ischaemic Cardiovascular Manifestations of COVID 19 Coronavirus Disease 2019 COVID 19 has been a pandemic challenge for the last year Cardiovascular disease is the most described comorbidity in COVID 19 patients and it is related to the disease severity and progression COVID 19 induces direct damage on cardiovascular system leading to arrhythmias and myocarditis and indirect damage due to endothelial dysfunction and systemic inflammation with a high inflammatory burden Indirect damage leads to myocarditis coagulation abnormalities and venous thromboembolism Takotsubo cardiomyopathy Kawasaki like disease and multisystem inflammatory syndrome in children Imaging can support the management assessment and prognostic evaluation of these patients Ultrasound is the most reliable and easy to use in emergency setting and in the ICU as a first approach The focused approach is useful in management of these patients due its ability to obtain quick and focused results This tool is useful to evaluate cardiovascular disease and its interplay with lungs However a detailed echocardiography evaluation is necessary in a complete assessment of cardiovascular involvement Computerized tomography is highly sensitive but it might not always be available Cardiovascular magnetic resonance and nuclear imaging may be helpful to evaluate COVID 19 related myocardial injury but further studies are needed This review deals with different modalities of imaging evaluation in the management of cardiovascular non ischaemic manifestations of COVID 19 comparing their use in emergency and in intensive care 0 +250 A Clinic Blueprint for Post Coronavirus Disease 2019 RECOVERY Learning From the Past Looking to the Future The severe acute respiratory syndrome coronavirus 2 pandemic poses extraordinary challenges The tremendous number of coronavirus disease 2019 COVID 19 cases in the United States has resulted in a large population of survivors with prolonged postinfection symptoms The creation of multidisciplinary post COVID 19 clinics to address both persistent symptoms and potential long term complications requires an understanding of the acute disease and the emerging data regarding COVID 19 outcomes Experience with severe acute respiratory syndrome and Middle East respiratory syndrome post acute respiratory distress syndrome complications and post intensive care syndrome also informs anticipated sequelae and clinical program design Post COVID 19 clinical programs should be prepared to care for individuals previously hospitalized with COVID 19 including those who required critical care support nonhospitalized individuals with persistent respiratory symptoms following COVID 19 and individuals with preexisting lung disease complicated by COVID 19 Effective multidisciplinary collaboration models leverage lessons learned during the early phases of the pandemic to overcome the unique logistical challenges posed by pandemic circumstances Collaboration between physicians and researchers across disciplines will provide insight into survivorship that may shape the treatment of both acute disease and chronic complications In this review we discuss the aims general principles elements of design and challenges of a successful multidisciplinary model to address the needs of COVID 19 survivors 1 +0 Role of senescence in the chronic health consequences of COVID 19 While the full impact of COVID 19 is not yet clear early studies have indicated that upwards of 10 of patients experience COVID 19 symptoms longer than 3 weeks known as Long Haulers Syndrome or PACS postacute sequelae of SARS CoV 2 infection There is little known about risk factors or predictors of susceptibility for Long Haulers Syndrome but older adults are at greater risk for severe outcomes and mortality from COVID 19 The pillars of aging including cellular senescence telomere dysfunction impaired proteostasis mitochondrial dysfunction deregulated nutrient sensing genomic instability progenitor cell exhaustion altered intercellular communication and epigenetic alterations that contribute to age related dysfunction and chronic diseases the Geroscience Hypothesis may interfere with defenses against viral infection and consequences of these infections Heightening of the low grade inflammation that is associated with aging may generate an exaggerated response to an acute COVID 19 infection Innate immune system dysfunction that leads to decreased senescent cell removal and or increased senescent cell formation could contribute to accumulation of senescent cells with both aging and viral infections These processes may contribute to increased risk for long term COVID 19 sequelae in older or chronically ill patients Hence senolytics and other geroscience interventions that may prolong healthspan and alleviate chronic diseases and multimorbidity linked to fundamental aging processes might be an option for delaying preventing or alleviating Long Haulers Syndrome 1 +28 Emerging potential mechanisms and predispositions to the neurological manifestations of COVID 19 A spectrum of neurological disease associated with COVID 19 is becoming increasingly apparent However the mechanisms behind these manifestations remain poorly understood significantly hindering their management The present review subsequently attempts to address the evolving molecular cellular and systemic mechanisms of NeuroCOVID which we have classified as the acute and long term neurological effects of COVID 19 We place particular emphasis on cerebrovascular demyelinating and encephalitic presentations which have been reported Several mechanisms are presented especially the involvement of a cytokine storm We explore the genetic and demographic factors that may predispose individuals to NeuroCOVID The increasingly evident long term neurological effects are also presented including the impact of the virus on cognition autonomic function and mental wellbeing which represent an impending burden on already stretched healthcare services We subsequently reinforce the need for cautious surveillance especially for those with predisposing factors with effective clinical phenotyping appropriate investigation and if possible prompt treatment This will be imperative to prevent downstream neurological sequelae including those related to the long COVID phenotypes that are being increasingly recognised 1 +523 Being the Father of a Preterm Born Child Contemporary Research and Recommendations for NICU Staff b Background b Most studies on parental reactions to a preterm birth and to hospitalization of the newborn in Neonatal Intensive Care Units NICUs have involved mothers However emotional responses and behaviors of fathers are equally important Usually the father is the first to meet the preterm newborn to find out information about babys condition and to communicate to the mother and other family members In this context he is often left alone and can show psychological difficulties including affective disorders such as depression or anxiety This paper describes the role of fathers in the NICU the best practices to support fathers and to explain the role of a psychologist in the NICU staff Considerations and suggestions are provided on the difficulties encountered to support parents with a focus on the role of fathers during the COVID 19 pandemic b Methods and Discussion b Considering contemporary research data and following an attachment perspective we analyze the role of the father of a preterm born child in the relation with the partner and in newborn caring Research has shown that involving fathers in newborn care in NICU and at home is essential not only because it promotes the father son attachment relationship and has positive effects on the psychological and somatic development of the newborn but also for the health of the mother and whole family b Conclusion b Recommendations are provided to enhance the functions of fathers in the NICU promote their involvement in the care of their infant and interventions to prevent the manifestation of psychological suffering and or perinatal affective disorders The commitments of a psychologist in a NICU team are presented and require not only clinical skills but also the ability to manage the emotional and relational difficulties of fathers family and NICU staff Considerations and suggestions are provided on the difficulties encountered by parents in the NICU during the COVID 19 pandemic 0 +646 Strategies for drug repurposing against coronavirus targets Repurposing regulatory agency approved drugs and investigational compounds with known safety profiles can significantly fast track the drug development timeline over i de novo i drug discovery with lower investment requirements and improved attrition rate These advantages are vital in any epidemic or pandemic situation where hospital beds are occupied by patients for whom there is no known treatment Here we examine drug repurposing in the context of human coronaviruses SARS CoV MERS CoV and in particular SARS CoV 2 the virus currently causing a continued widespread pandemic with substantial impacts on public health and economy The key druggable targets explored were those involved in viral entry viral replication and viral induced ARDS as well as viral proteases with a focus on the strategy by which the drugs were repurposed 0 +422 Favipiravir exposure and pregnancy outcome of COVID 19 patients COVID 19 is a rapidly spreading disease and many people have been infected in a short time Favipiravir is under investigation for the treatment of COVID 19 and given to patients in many countries following emergency use approval Based on data from animal studies favipiravir use is contraindicated during pregnancy Currently there is no human data except for a single case report on use of favipiravir in pregnancy This article includes the outcomes of 29 pregnancies reported to the Clinical Pharmacology and Toxicology Unit regarding favipiravir use in pregnancy For drug risk assessment maternal characteristics were obtained at first contact After the expected day of delivery follow up is conducted by phone call and all relevant data regarding pregnancy and newborn outcome were documented Of the 29 pregnancies exposed to favipiravir 5 were electively terminated and 24 resulted in live birth There were no miscarriages or no stillbirths There were 25 live births including one pair of twins Three children were born premature and one infant had patent foramen ovale Birth weights lengths and head circumferences of all infants were within normal range The results of the study indicate that favipiravir is unlikely to be a major human teratogen but experience is still limited for a well grounded risk assessment Although these findings may be useful for the physicians and patients larger studies are needed due to small number of cases 0 +349 Impact of COVID 19 pandemic on sleep in children and adolescents a systematic review and meta analysis This systematic review and meta analysis were conducted to study the prevalence and pattern of sleep disturbances in children and adolescents during the COVID 19 pandemic MEDLINE EMBASE and Web of Science were searched for original studies describing sleep abnormalities in children and adolescents with or without pre existing neurobehavioral disorders during the COVID 19 pandemic The pooled estimates for various sleep abnormalities were calculated using a random effect model Of 371 articles screened 16 studies were included Among these five studies were in preschool children two were in children with pre existing neurobehavioral disorders and the remaining were in school going children and adolescents The outcome measures used for sleep were markedly heterogeneous across the studies The pooled prevalence of any sleep disturbance in children during the pandemic was 54 95 CI 50 57 Interestingly the prevalence in pre school children was lower than pre pandemic times RR 0 87 95 CI 0 58 1 30 but this was not statistically significant The pooled prevalence of children not meeting sleep recommendation was 49 95 CI 39 58 The prevalence of sleep problems in children and adolescents during the COVID 19 pandemic is alarming Pre school children had a trend towards relatively fewer sleep disturbances due to home confinement measures in comparison with pre pandemic times Sleep duration recommendations were not met in nearly half of healthy children However these conclusions need to be seen in light of limited literature on the topic few included studies done in heterogenous populations and dubious quality of inferences drawn from these studies which were predominantly online surveys CRD42020213788 0 +445 COVID 19 and BRD4 a stormy and cardiotoxic bromo romance Severe systemic inflammation in COVID 19 patients can lead to dysfunction of multiple organs including the heart Using an ex vivo cardiac organoid system Mills et al discovered that inhibitors of the chromatin reader protein bromodomain containing protein 4 protect cardiomyocytes from COVID associated cytokine storm We briefly review these important findings and highlight the translational significance of the work 0 +385 SARS CoV 2 related ARDS and Invasive Fungal Infections in Intensive Care Patients SARS CoV 2 infection can potentially necessitate intensive care management An increasing number of case reports are found in the literature indicating patients admitted in an intensive care setting with COVID 19 pneumonitis being complicated with invasive fungal infections In a retrospective assessment of a three month period at the national hospital of Malta examining patients who were suffering from SARS CoV 2 acute respiratory distress syndrome 6 out of 63 patients 9 5 were found to have confirmation or high probability of invasive fungal infection The consensus definition for invasive fungal disease developed by the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium was utilised to aid in the identification of these patients In total 15 patients received treatment with an anti fungal agent in this three month period the decision being led by both clinical suspicion and the use of fungal markers obtained from the serum and bronchoalveolar lavage Although several risk factors are attributed for the development of invasive fungal disease the main factors identified in our cohort of patients is the SARS CoV 2 ARDS in itself along with the use of high dose corticosteroids The average period of time between admission in intensive care and diagnosis of invasive fungal infection was noted to be 10 5 days This high incidence of invasive fungal disease in mechanically ventilated patients suffering from SARS CoV 2 ARDS relatively early in their course of disease should guide the clinician to investigate further with fungal biomarkers and cultures in those patients who are clinically deteriorating despite optimal medical treatment as well as possibly considering empirical anti fungal treatment if suspicion remains high 0 +392 Rhino orbital cerebral mucormycosis in COVID 19 A systematic review Since the onset of COVID 19 pandemic parallel opportunistic infections have also been emerging as another disease spectrum Among all these opportunistic infection mucormycosis has become a matter of concern with its rapid increase of cases with rapid spread as compared to pre COVID 19 era Cases have been reported in post COVID 19 related immune suppression along with the presence of comorbidity which adds on the deadly outcome There is no systematic review addressing the issue of COVID 19 associated mucormycosis This is the first systematic review of published studies of mucormycosis associated with COVID 19 The aim was to analyze the real scenario of the disease statement including all the published studies from first November 2019 to 30th June to analyze the contemporary epidemiology clinical manifestations risk factor prognosis and treatment outcome of COVID 19 associated rhino orbito cerebral mucormycosis A comprehensive literature search was done in following databases namely PubMed Google Scholar Scopus and EMBASE using keywords mucormycosis rhino orbital cerebral mucormycosis COVID 19 and SARS CoV 2 from November 01 2019 to June 30 2021 Our study shows that while corticosteroids have proved to be lifesaving in severe to critical COVID 19 patients its indiscriminate use has come with its price of rhino orbito cerebral mucormycosis epidemic especially in India especially in patients with preexisting diabetes mellitus with higher mortality Corticosteroid use should be monitored and all COVID 19 patients should be closely evaluated monitored for sequelae of immunosuppression following treatment 0 +664 What will we do if we get infected a qualitative interview based study of the COVID 19 pandemic and its effects on the health and safety of sex workers in the United States Emerging evidence suggests that sex workers face unique and profound risks arising from the COVID 19 pandemic To illuminate the pandemics effects on sex worker health and safety and identify intervention opportunities from May August 2018 in depth interviews were conducted with a purposive sample of 15 sex workers four service providers and two individuals who were both Sampled sex workers included eight people of color eight cisgender women five cisgender men three non binary people and one transgender woman Using Conservation of Resources Theory to define impacts on sex worker resources and resulting health and safety implications a deductive thematic analysis was conducted Seven resources were threatened due to the pandemic work opportunity sex work venues social support health services money food and housing The loss of these resources was exacerbated by stigma notably sex work criminalization and significantly undermined health and safety by increasing food and housing instability increasing risks of violence and diminishing safer sex negotiation Six resources were activated in response social support digital skills health knowledge non sex work employment money and resilience While social support had numerous benefits investing digital skills and non sex work employment were generally of limited impact The pandemics negative health and safety effects were most profound at the intersections of race gender class and migration status These findings suggest sex workers need urgent and ongoing support with investments in social support and sex work decriminalization likely to have the greatest effects on health and safety relative to and beyond the COVID 19 pandemic 0 +380 Anxiety and Depression in Chinese Students During the COVID 19 Pandemic A Meta Analysis b Background b The novel 2019 coronavirus disease COVID 19 pandemic has spread rapidly worldwide and poses a global health threat b Aims b This study assessed the prevalence of anxiety and depression symptoms in Chinese students during the COVID 19 pandemic and explored potential moderating factors b Methods b We searched English and Chinese databases using pertinent keywords for articles published and unpublished up until November 2020 The estimate of the overall prevalence of anxiety and depression was conducted through a random effects model b Results b A total of 31 cross sectional studies were included The overall prevalence of anxiety and depression symptoms in Chinese students during the COVID 19 pandemic was 24 0 95 CI 20 0 29 0 and 22 0 95 CI 18 0 27 0 respectively Subgroup analyses revealed that Chinese middle school students were at heightened risk of anxiety while university students were at heightened risk of depression Students who lived in higher risk areas presented severe anxiety and depression especially during the late period of the COVID 19 epidemic b Conclusions b Overall during the COVID 19 pandemic there was a high prevalence of anxiety in Chinese students and a high prevalence of depression among Chinese students in high risk areas Therefore comprehensive and targeted psychological interventions should be developed to address the mental health of students in different grades especially in high risk areas and during the late period of the COVID 19 pandemic 0 +77 Olfactory dysfunction amongst children and adolescents with laboratory confirmed coronavirus disease 2019 a systematic review Despite the rapidly emerging reports of olfactory dysfunction amongst adult patients with coronavirus disease 2019 cases involving children and adolescents are scarcely reported The literature was reviewed to elucidate olfactory dysfunction amongst children and adolescents with coronavirus disease 2019 A search of the literature published from 1 December 2019 to 30 April 2021 was conducted using four databases based on Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions The search was performed over one month May 2021 Only 9 articles were identified with a total of 316 laboratory confirmed coronavirus disease 2019 positive children and adolescents of whom 156 reported olfactory dysfunction Four studies reported olfactory dysfunction based on subjective tests four studies carried out objective assessment Most studies reported on olfaction recovery The literature review revealed an olfactory dysfunction rate of 49 per cent amongst children and adolescents with coronavirus disease 2019 Persistence of olfactory dysfunction was reported in 7 1 per cent of the patients Further studies involving objective measures need to be carried out in children and adolescents with coronavirus disease 2019 1 +30 Epidemiology and organ specific sequelae of post acute COVID19 A narrative review Long COVID a term coined by COVID 19 survivors describes persistent or new symptoms in a subset of patients who have recovered from acute illness Globally the population of people infected with SARS CoV 2 continues to expand rapidly necessitating the need for a more thorough understanding of the array of potential sequelae of COVID 19 The multisystemic aspects of acute COVID 19 have been the subject of intense investigation but the long term complications remain poorly understood Emerging data from lay press social media commentaries and emerging scientific reports suggest that some COVID 19 survivors experience organ impairment and or debilitating chronic symptoms at times protean in nature which impact their quality of life In this review by addressing separately each body system we describe the pleiotropic manifestations reported post COVID 19 their putative pathophysiology and risk factors and attempt to offer guidance regarding work up follow up and management strategies Long term sequelae involve all systems with a negative impact on mental health well being and quality of life while a subset of patients report debilitating chronic fatigue with or without other fluctuating or persistent symptoms such as pain or cognitive dysfunction Although the pathogenesis is unclear residual damage from acute infection persistent immune activation mental factors or unmasking of underlying co morbidities are considered as drivers Comparing long COVID with other post viral chronic syndromes may help to contextualize the complex somatic and emotional sequalae of acute COVID 19 The pace of recovery of different aspects of the syndrome remains unclear as the pandemic began only a year ago Early recognition of long term effects and thorough follow up through dedicated multidisciplinary outpatient clinics with a carefully integrated research agenda are essential for treating COVID 19 survivors holistically 1 +550 Computational Method Based Optimization of Carbon Nanotube Thin Film Immunosensor for Rapid Detection of SARS CoV 2 Virus The recent global spread of COVID 19 stresses the importance of developing diagnostic testing that is rapid and does not require specialized laboratories In this regard nanomaterial thin film based immunosensors fabricated via solution processing are promising potentially due to their mass manufacturability on site detection and high sensitivity that enable direct detection of virus without the need for molecular amplification However thus far thin film based biosensors have been fabricated without properly analyzing how the thin film properties are correlated with the biosensor performance limiting the understanding of property performance relationships and the optimization process Herein the correlations between various thin film properties and the sensitivity of carbon nanotube thin film based immunosensors are systematically analyzed through which optimal sensitivity is attained Sensitivities toward SARS CoV 2 nucleocapsid protein in buffer solution and in the lysed virus are 0 024 fg mL sup 1 sup and 0 048 copies mL sup 1 sup respectively which are sufficient for diagnosing patients in the early stages of COVID 19 The technique therefore can potentially elucidate complex relationships between properties and performance of biosensors thereby enabling systematic optimization to further advance the applicability of biosensors for accurate and rapid point of care POC diagnosis 0