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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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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