Background: Acute asthma exacerbations are a common cause for emergency department (ED) visits and hospitalizations in children. Since the outbreak of COVID-19 and the education system closure/ total lockdown in Israel on March 2020, we have noticed a decrease in pediatric ED visits and an increase in hospitalizations of asthma exacerbations. Objective: to examine the patterns of ED visits for asthma exacerbations during COVID-19 outbreak, in comparison to the previous year. Methods: a retrospective study comparing asthma related ED visits and hospitalizations among children aged 2-18 years at a tertiary center in southern Israel. Three time periods were selected: 2020A (pre- lockdown, 1/2/20-14/3/20), 2020B (lockdown, 15/3/20-15/5/20) and 2020 C (post- lockdown, 16/5/20-30/6/20) and compared to the three parallel time periods in 2019. Data regarding demographics, number of ED visits and clinical severity parameters were collected and analyzed. Results: 512 children visited the ED for asthma exacerbation: 273 children during 2019 and 239 children during 2020, with significantly fewer ED visits per day during the lockdown period (1.8 vs 1.43, p<0.001), compared to the parallel period in 2019. Significantly higher hospitalization rate (47.1% vs 33.7%, p=0.05) and longer length of stay (LOS) (3.15 vs 1.9 days, p= 0.03) were observed during the lockdown. Conclusion: lockdown is associated with fewer ED visits for asthma exacerbation, probably due to; reduced exposure to viral infections and environmental allergens, decreased availability of primary physicians and families’ reluctance to arrive to the ED. ED visits during lockdown were characterized by higher hospitalization rate and longer LOS.

Background: The success of subcutaneous immunotherapy (SCIT) mostly depends on regular injections. Our aim was to investigate adherence to SCIT with aeroallergens during the COVID-19 pandemic and demonstrate clinical consequences of treatment disruptions in real-life. Methods: Visual analogue scale for quality of life (VAS-QoL), VAS for symptom scores (VAS-symptom), medication scores (MSs) and total symptom scores (TSS-6) were recorded during the pandemic in 327 adult allergic rhinitis and/or asthmatic patients receiving maintenance SCIT and these scores were compared with the pre-pandemic data. Patients were grouped according to SCIT administration intervals; no delay (Group 1), <2 months (Group 2), and ≥2 month intervals (Group 3). Results: 104 (31.8%) patients (Group 3) were considered as non-adherent which was mostly related to receiving SCIT with HDMs and using public transportation for reaching the hospital. Median MS, VAS-symptom and TSS-6 scores of Group 3 patients during the pandemic were higher than the pre-pandemic scores (p=0.005, p<0.001, p<0.001, respectively) whereas median VAS-QoL scores of Group 3 during the pandemic were lower than the pre-pandemic scores (p<0.001). Median TSS-6 and VAS-symptom scores were the highest in Group 3 compared to other groups (p<0.001 for each comparison). Median VAS-QoL scores were the lowest in Group 3 compared to Group 1 and Group 2 (p<0.001, p=0.043, respectively). Conclusion: When precautions in allergy clinics are carefully applied, adherence to SCIT can be high during a pandemic. Patients must be warned about adhering to SCIT injections since delays in SCIT administration can deteriorate clinical symptoms.

Introduction: Following the Covid-19 pandemic, the face-to-face meetings are delayed to a future date , which is still not clear. However, seminars, meetings, and conferences are necessary for updating our knowledge and skills. The web-based seminars (webinars) are the solutions to this issue. This study aimed to show the participant behavior when webinars present at the Covid-19 pandemic era. Methods: Between December 2017 – July 2020, 58 webinars were broadcasted via the Uropedia, electronic library of SUST. Data of all webinars were collected with the YouTube analytics and application of the Uropedia. Data of streaming webinars included participant behaviors such as content views, engagement time, total unique attendees, average engagement time, and the number of audience to leads. Data were split into two groups; group-1 is webinars before Covid-19 (before March 2020), group-2 is the webinars during Covid-19. Results: Total broadcast time and total page view number were found to be 112.6 hours (6761 min.) and 15919, respectively. The median participant age was 40.1 years. Median content view and median engagement time were found to be 261.0 min., and 12.2 min., respectively. Comparison of two groups revealed a significant increment in the content views (group 1;134.0 range=86.0-87.0 and group 2; 414.0 range=296.0-602.0, p<0.001) and the number of the unique attendees (group 1; 18.0 range=10.0-26.0 and group 2; 57.0 range=27.0-100.0, p<0.001) following Covid-19. However, the median engagement time of the audience did not seem to change with the Covid-19 pandemic (group 1; 11.5 range=10.0-13.3 min. and group 2; 13.2 range=9.4-18.1 min., p=0.12). Conclusion: The webinars are effective ways to share information and have many advantages, including low cost, reaching the high number of audiences. Audience number and page visits seemed to increase following the Covid-19 pandemic. However, The engagement time did not seem to affect a critical attitude of the audience

A document by Ahmad Sharara. Click on the document to view its contents.

Abstract: Background: The 2019 coronavirus disease (COVID-19) pandemic is a public health emergency and constitutes a challenge to psychological health. This study aimed to assess the psychological conditions among university students in Saudi Arabia during the COVID-19 pandemic. Material and Methods: During the period between the 4th and 18th of June 2020, the students at Umm AlQura University in Saudi Arabia were invited to complete an online survey. The survey assessed their sociodemographic characteristics, educational disciplines, and manifestations of depression, anxiety, and stress as determined by the Depression Anxiety Stress Scale-21 (DASS-21). Results: The study included 936 students. Of them, 41.1% had depressive symptoms (31.7% mild to moderate and 9.4% severe to very severe), 26.9% had anxiety symptoms (15.8% mild to moderate and 11.1% severe to very severe), and 22.4% had stress symptoms (15.2% mild to moderate and 7.2% severe to very severe). Students who reported having a friend or relative infected with or died from COVID-19, watching or reading news about the pandemic ≥2 hours/day, and not having emotional support from family, university, and society were more likely to show psychological problems. Conclusion: Symptoms of depression, anxiety, and stress were common among Saudi university students. Psychological counseling and support should be provided to university students in Saudi Arabia. Keywords: Depression; Anxiety; Stress; COVID-19; University students; Saudi Arabia

Background: Covid-19 is an extremely contagious illness caused by the severe acute respiratory syndrome (SARS-CoV-2) virus. Although this disease primarily involves pulmonary tissue, rapidly advancing research has established cardiac involvement in Covid-19 patients. Objective: This systematic review article aimed to compile and illustrate clinical characteristics, diagnostic findings, management, and outcomes manifesting in myocarditis linked with Covid-19. Methods: A literature search was accomplished for published eligible articles with MEDLINE/PubMed and Embase databases. All eligible case reports and case series were included from around the world without any language restrictions. For this review, inclusion criteria were laboratory-confirmed SARS-CoV-2 infection cases reporting a diagnosis of acute myocarditis. Results: Data from 41 studies describing myocarditis in 42 Covid-19 patients was obtained. The median age of these patients was 43.4 years, with 71.4% of them being male. Fever was the most prevalent presenting symptoms seen in 57% of patients. Hypertension was the most pervasive comorbidity accompanying these patients. Cardiac biomarkers troponin and Brain natriuretic peptide (BNP) were raised in almost 90% and 87% of patients, respectively. Electrocardiogram findings were Non-specific and included ST-segment and T-wave changes. The most prevalent histopathological feature appreciated was diffuse lymphocytic inflammatory infiltrates. Antivirals and corticosteroids were the most frequently used medications. About 38% of patients also needed vasopressor assistance. Out of 42 patients, 67% recovered, and eight died. Conclusion: Due to the risk of a sudden worsening of patients conditions and myocarditis association with considerable mortality and morbidity, a knowledge of this cardiac complication of Covid-19 disease is crucial for healthcare professionals.

Background: Neutrophil-to-lymphocyte ratio (NLR) is an accessible and widely used biomarker. NLR may be used as an early marker of poor prognosis in patients with COVID-19. Methods: We conducted a systematic review and meta-analysis. Observational studies that reported the association between baseline NLR values (i.e. at hospital admission) and severity or all-cause mortality in COVID-19 patients were included. The quality of the studies was assessed using the Newcastle-Ottawa scale (NOS). Random effects models and inverse variance method were used for meta-analyses. The effects were expressed as odds ratios (OR) and their 95% confidence intervals (CI). Small study effects were assessed with the Egger’s test. Results: Twenty studies, 19 cohorts and one case-control were included. An increase of one unit of NLR was associated with a higher odds of COVID-19 severity (OR 6.6, 95% CI: 4.71 - 7.19; p<0.001) and higher odds of all-cause mortality (OR 12.7, 95% CI: 1.32, 123.36; p=0.025). No differences were found in subgroup analyses by study design. The subgroup analysis of the studies, by country of origin, showed that the strength of the association between NLR and mortality was greater in Chinese studies (OR 31.1; 95%CI 19.57 to 49.3; p<0.0001) with moderate heterogeneity (I2 =43%). In our sensitivity analysis, we found that 7 studies with low risk of bias maintained strong association between both outcomes and the NLR values (severity: OR 4.7; 95% CI 3.5 to 6.34; p < 0.001 vs mortality: OR 31.1; 95% CI 19.57 to 49.3; p <0.0001), with low (I2 = 37%) and moderate (I2 = 43%) heterogeneity for severity and mortality outcomes, respectively. No publication bias was found for studies that evaluated effects for the severity of disease. Conclusions: Higher values of NLR were associated with severity and all-cause mortality in hospitalized COVID-19 patients.

Aims Delay and false positivity in PCR test results have necessitated accurate chest CT reporting for management of patients with COVID-19 suspected symptoms. Pandemic related workload and level of experience on covid-dedicated chest CT scans might have effected diagnostic performance of on-call radiologists. The aim of this study is to reveal the interpretation errors in chest-CT reports of COVID-19 suspected patients admitted to the ER. Methods COVID-19 dedicated chest-CT scans which were performed between March and June 2020 were re-evaluated and compared with the former reports of these scans and PCR test results. CT scan results were classified into four groups. Parenchymal involvement ratios, radiology departments’ workload, COVID-19 related educational activities have examined. Results Out of 5721 Chest-CT scans, 783 CTs belonging to 664 patients (340 female, 324 male) were included to this study. RT-PCR test was positive in 398; negative in 385 cases. PCR positivity was found to be highest in “normal” and “typical for covid” groups whereas lowest in “atypical for covid” and “not covid” groups. 5-25% parenchymal involvement ratio was found in 84.2% of the cases. Regarding number of chest CT scans performed, radiologists’ workload have found to be increased six-folds compared to the same months of the former year. With the re-evaluation, a total of 145 IEs (18.5%) have been found. IEs were mostly precipitated in the first two months (88.3%) and mostly in “not covid” class (60%) regardless of PCR positivity. COVID-19 and radiology entitled educational activities along with the ER admission rates within the first two months of pandemic have seem to be related with the decline of IEs within time. Conclusion COVID-19 pandemic made a great impact on radiology departments with an inevitable burden of daily chest-CT reporting. This workload and concomitant factors have possible effects on diagnostic challenges in COVID-19 pneumonia.

Introduction: As COVID-19 disease has rapidly spread across the world, its impact has grown with increasing number of cases and mortality rate in Turkey. Aim: The aim of this study is to examine epidemiologic and clinical features of the patients that admitted to the hospital with the pre-diagnosis of coronavirus disease-2019 (COVID-19) in Turkey. Method: In this retrospective study, epidemiologic and clinical features, laboratory findings, radiologic features, therapeutic approaches and survival conditions of the patients with the pre-diagnosis of COVID-19 from March 11th to June 30th, 2020. The all data of the cases were compared in 4 groups: 1st group for the confirmed cases reverse transcriptase polymerase chain reaction (RT-PCR) +, chest computed tomography (CT) +, 2nd group for the clinically diagnosed cases (RT-PCR- CT +), 3rd group for the mild and asymptomatic cases (RT-PCR + CT-), 4th group for the suspected cases (RT-PCR - CT -). Post-hoc analysis was performed to evaluate the differences among the groups. Results: In total, 3334 patients with the pre-diagnosis of COVID-19 admitted to the emergency department. Based on the post-hoc analyses, significant differences were found among the four groups in terms of their test results of leucocytes, hemoglobin, platelets, neutrophils, urea and C-reactive protein (CRP) (p<0.001). Furthermore, the factors of age groups, hospitalization, intensive care follow-up and mortality rate of the four groups showed a significant difference among the groups (p=0.001). Conclusion: Mean of leucocytes, neutrophile and platelet values of the patients with tested positive for the RT-PCR was found lower compared to the ones with tested negative for the RT-PCR. Mean of CRP values was found higher in patients with lung involvement compared to other patient groups.

Objective: SARS-CoV-2 has caused nearly 4 million confirmed cases of COVID-19 worldwide in the approximately 4 months since it emerged in Wuhan, China in December 2019. Comorbidities increase morbidity and mortality in COVID-19, and many laboratory parameters have been associated with mortality. The aim of the present study was to identify the relationship between endogenous carboxyhemoglobin (COHb) level and the clinical course and prognosis of COVID-19. Methods: The study included 48 non-smokers or ex-smokers aged 18 years or older who presented to the emergency department, were diagnosed with COVID-19 by real-time PCR analysis of nasopharyngeal swab sample, and were treated in the pulmonary diseases ward of the Atatürk University hospital after between March 24, 2020 and April 15, 2020. The patients’ laboratory parameters and demographic data were analyzed retrospectively. Results: Prothrombin time and C-reactive protein (CRP), troponin-I, and D-dimer levels decreased in COVID-19 patients during follow-up (p=0.024, p=0.001, p=0.001, p=0.001), while PaO2/FiO2 ratio and COHb increased (p=0.002, p=0.001). COHb level at admission was significantly lower in patients who developed macrophage activation syndrome (MAS), acute respiratory distress syndrome (ARDS), and those who died compared to the other patients (p=0.002, p=0.001). COHb level on day 5 of treatment was significantly higher in patients with ARDS and patients who died (p=0.001, p=0.001).Significant correlations were detected between COHb level and CRP (r=-0.425, p=0.001), ferritin (r=-0.395, p=0.001) and PaO2/FiO2 ratio (r=0.431, p=0.001). Conclusions: COHb level may be an easily accessible biomarker that guides early follow-up and treatment planning to avoid ARDS, MAS, and mortality in COVID-19.

We report mild COVID-19 manifestation in high-risk patient with sufficient plasma 25-OH-Vitamin D3 level. Given the global pandemic of vitamin D deficiency, as well as its likely beneficial effects during SARS-CoV-2 infection, report highlights importance of routine 25-OH-Vitamin D3 measurement, either for clinical course prediction or deciding on supplementation.

BACKGROUND: COVID-19 has significantly impacted the healthcare landscape in the United States in a variety of ways including a nation-wide reduction in operative volume. The impact of COVID-19 on the availability of donor organs and the impact on solid organ transplant remains unclear. We examine the impact of COVID-19 on a single, large-volume heart transplant program. METHODS: A retrospective chart review was performed examining all adult heart transplants performed at a single institution between March 2020 and June 2020. This was compared to the same time frame in 2019. We examined incidence of primary graft dysfunction (PGD), continuous renal replacement therapy (CRRT) and 30-day survival. RESULTS: From March-June 2020, 43 orthotopic heart transplants were performed compared to 31 performed during 2019. Donor and recipient demographics demonstrated no differences. There was no difference in 30-day survival. There was a statistically significant difference in incidence of post-operative CRRT (9/31 v. 3/43; p = .01). There was a statistically significant difference in race (23W/8B/1AA v. 30W/13B; P=.029). CONCLUSION: We demonstrate that a single, large-volume transplant program was able to grow volume with little difference in donor variables and clinical outcomes following transplant. While multiple reasons are possible, most likely the reduction of volume at other programs allowed us to utilize organs to which we would not have previously had access. More significantly, our growth in volume was coupled with no instances of COVID-19 infection or transmission amongst patients or staff due to an aggressive testing and surveillance program.

Thrombosis within the microvasculature and medium to large vessels is a serious and common complication among critically ill individuals with COVID-19. While children are markedly less likely to develop severe disease than adults, they remain at risk for thrombosis during acute infection and with the post-acute inflammatory illness termed multisystem inflammatory syndrome in children. Significant knowledge deficits in understanding COVID-19 associated coagulopathy and thrombotic risk pose clinical challenges for pediatric providers who must incorporate expert opinion and personal experience to manage individual patients. We discuss clinical scenarios to provide framework for characterizing thrombosis risk and thromboprophylaxis in children with COVID-19.

COVID-19 vaccines and the role of other potential allergenic components different from PEG. A reply to: “Other excipients than PEG might cause serious hypersensitivity reactions in COVID-19 vaccines”

This study evaluates through modeling the possible individual and combined effect of three populational parameters of pathogens (reproduction rate; rate of novelty emergence; and propagule size) on the colonization of new host species – putatively the most fundamental process leading to the emergence of new infectious diseases. The results are analyzed under the theoretical framework of the Stockholm Paradigm using IBM simulations to better understand the evolutionary dynamics of the pathogen population and the possible role of Ecological Fitting. The simulations suggest that all three parameters positively influence the success of colonization of new hosts by a novel parasite population but contrary to the prevailing belief, the rate of novelty emergence (e.g. mutations) is the least important factor. Maximization of all parameters result in a synergetic facilitation of the colonization and emulates the expected scenario for pathogenic microorganisms. The simulations also provide theoretical support for the retention of the capacity of fast-evolving lineages to retro-colonize their previous host species/lineage by ecological fitting. Capacity is, thus, much larger than we can anticipate. Hence, the results support the empirical observations that opportunity of encounter (i.e. the breakdown in mechanisms for ecological isolation) is an fundamental determinant to the emergence of new associations - in special of Emergent Infectious Diseases - and the dynamics of host exploration, as observed in SARS-CoV-2. Insights on the dynamics of Emergent Infectious Diseases derived from the simulations and from the Stockholm Paradigm are discussed.

An 83 year old female had asymptomatic SARS-CoV-2 infection while taking ruxolitinib. She remained RT-PCR positive for viral RNA for >120 days, Pegylated interferon for 4 weeks led to viral RNA clearance. The observations support combination therapy of ruxolitinib + interferon for COVID-19.

Introduction: COVID-19 emerged in China leading to worldwide morbidity and mortality, including depression and anxiety. As the pandemic spread throughout Italy and Europe, mental health concerns emerged for people with cystic fibrosis (pwCF), who are at increased risk. This led to development of a Telehealth Psychological Support Intervention to help adolescents/young adults with CF and caregivers cope with the stress and emotional challenges of the lockdown which began in Italy in March 2020. Methods: This intervention utilized cognitive behavioral skills (e.g., relaxation training, cognitive reframing). Participants included 16 adolescents/adults and 14 parents, who completed 4 individual video sessions with a psychologist. Stress ratings, PHQ-8 and GAD-7 were completed electronically. Feasibility and Satisfaction were rated. Results: Ratings of stress significantly decreased from pre to post-testing for both pwCF (paired t=-4.06 (14), p<.01) and parents (paired t=-5.2, p< 001). Most participants reported clinically elevated depression and anxiety at the pre-test, with statistically significant reductions in depression for pwCF (pre: M=8.0 to post M=4.7; paired t (14)=2.8, p <.05) but not anxiety (pre: M=6.9 to post: M=5.6, t (14)=1.2, p=NS). Reductions in depression were found for parents (pre: M=6.4 to post: M 5.1, (14) t=-2.5, p<.05) but not anxiety (pre: M=8.1 to post: M=7.9, t (14)=-0.2, p=ns). Positive ratings of Feasibility and Satisfaction were documented. Conclusion: This brief telehealth intervention yielded significant reductions in stress and depression for participants. Anxiety was not reduced, possibly because COVID was ongoing. This intervention was effective for improving mental health and was highly feasible and satisfactory.

Improving clinical practice in ENT: lessons learnt from the COVID-19 pandemicJames R Tysome, Cambridge University Hospitals, UKEditor-in-Chief, Clinical OtolaryngologyWhile currently in the midst of another wave of COVID-19 infections, putting untold strain on both healthcare systems and healthcare workers around the globe, it is important to reflect on the changes that we have all had to make. All ENT departments, within a very short timeframe, restructured clinical services to prioritise the delivery of patient care to those with the greatest clinical need, while increasing services such as tracheostomy for the high number of patients with COVID-19 in intensive care. We also changed the methods that we use to teach our trainees and share knowledge with colleagues. Many of these changes have been successful and should now be maintained in the future.It has been fascinating to see the how the research community built new research networks and redirected focus to projects related to understanding SARS-CoV-2 infection; surveillance and public health measures, optimising patient management of the disease and understanding the impact of COVID-19 on different healthcare systems. This resulted in over 89,000 peer reviewed publications relating to COVID-19 in 2020 and the development of new research structures such as CovidSurg , a global collaborative platform of studies aiming to explore the impact of COVID-19 on surgical patients.1Two papers in this issue demonstrate how clinical practice in ENT adapted to COVID-19. The first explores the publication of guidance relevant to ENT.2 Both national bodies and specialist societies across the globe published guidance on how services should be reconfigured, patients prioritised, and ENT surgeons protected, particularly with respect to aerosol generating procedures given the potential high risk of infection. It is the speed of publication that was particularly impressive. Of the 175 online publications of COVID guidance related to ENT, 41% were published between the third and fourth week of March 2020.The second study explores the impact of this guidance on clinical care through a prospective audit of the management of tonsillitis and peritonsillar abscess in 86 hospitals across the UK following the publication of guidelines by ENT UK, the professional body representing ENT surgeons in the UK. This provided a pathway that aimed to prevent hospital admission when safe to do so.3 Increased use of single doses of intravenous dexamethasone and antibiotics resulted in return to swallowing in many patients, allowing patients to be discharged safely, without later increases in re-presentation or admission.These studies show the strong clinical leadership has been demonstrated within the ENT community, removing traditional barriers to change. Clinicians have taken the initiative to develop new pathways and new ways of working. An almost overnight change from face-to-face appointments to remote appointments took place in many hospitals, showing how we can adapt when needed. Remote appointments, either by telephone4 or video calls,5 are suitable for many ENT patients, preferred by many and are certainly here to stay.There has been rapid scaling of technology such as digital consultation platforms to enable this remote service delivery. Video conferencing facilitates multidisciplinary team meetings, bringing together clinicians at distant locations to discuss patient management in an efficient manner without the need to spend hours travelling to meet in the same location. Virtual patient consultations can allow sharing of digital information such as imaging without the patient needing to leave their home, reduced footfall in previously over-crowded outpatient departments.New teaching and training opportunities have arisen through the use of digital conferencing platforms, replacing traditional teaching programmes and allowing us to reach larger audiences.6Entire conferences have successfully moved to virtual participation. These opportunities have the potential to significantly enrich training and teaching in the future.We have seen many examples of enhanced local system working. ENT and intensive care teams have needed to work more closely together to manage patients with COVID-19 requiring a tracheostomy.7 It is important that these closer relationships are maintained in the future for patient benefit.The ENT community has demonstrated strong clinical leadership, adaptability to rapid change, enhanced clinical pathways and local networks, widespread use of digital technology for consultation and teaching and redirection of research programmes. These have permanently changed the way we work and, when the current global pandemic improves as COVID-19 infections drop and vaccination programmes are rolled out, we should ensure that the positive changes that have been made are embedded in clinical practice to improve patient care.Globalsurg.org. Covidsurg, NIHR Global Health Research Unit on Global Surgery [Cited 2020 Jan 18]. Available from https://globalsurg.org/covidsurg/Cernei st al. Timing and volume of information produced for the Otolaryngologist during the COVID-19 pandemic in the UK. A review of the volume of online literature. Clin Otolaryngol;46(2):???????Smith M, et al. Admission avoidance in tonsillitis and peritonsillar abscess: a prospective national audit during the initial peak of the COVID-19 pandemic. Clin Otolaryngol;46(2):???????Sharma S and Daniel M. Telepmedicine in paediatric otorhinolaryngology: lessons learnt from remote encounters during the COVID19 pandemic and implications for future practice. Int J Paediatr Otorhinolaryngol. 2020:139:110411.Fieux M, et al. Telemedicine for ENT: effect on quality of care during COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137(4):257-261.Herman A, et al. National, virtual otolaryngology training day in the United Kingdom during the COIVD-19 pandemic: results of a pilot survey. J Surg Educ. 2020; S1931-7204McGrath BA, et al. Multidisciplinary guidance for safe tracheostomy care during the COVID-19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP). Anaesthesia 2020;75(12):1659-1670.

Objective: The novel coronavirus SARS-CoV-2 (COVID-19) rapidly escalated from its origin in an animal market in Wuhan, China in December 2019 to a global pandemic, and the lungs are the most frequently affected organ. The aim of this study was to investigate the relationship between pulmonary function test parameters and laboratory parameters in COVID-19. Method: A total of 60 patients who were admitted to the chest diseases department and intensive care unit of our hospital and were diagnosed with COVID-19 by real-time PCR analysis of nasopharyngeal swabs were evaluated. Pulmonary function tests and laboratory parameters at admission and on day 7 of treatment were analyzed. Results: On day 7 of treatment, white blood cell count, CRP, and fibrinogen level were significantly lower than at admission (p=0.002, 0.001, and 0.001, respectively), while forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) values were significantly higher compared to admitting values (p=0.001 for both). Correlation analysis of the changes in respiratory function values and laboratory parameters during follow-up (day 1 to day 7 of treatment) revealed that CRP level was positively correlated with FEV1 (r=0.616, p=0.01) and FVC values (r=0.51, p=0.01). Fibrinogen level was also positively correlated with FEV1 (r=0.345, p=0.01) and FVC (r=0.357, p=0.01). Conclusion: Fibrinogen and CRP levels are easily accessible parameters that may help identify improvement or deterioration in pulmonary function in COVID-19 patients during follow-up and discharge while reducing the risk of transmission.

Aim: In this feasibility study, we aimed to implement a pilot telemedicine service at our healthcare facility in Faisalabad, Pakistan, and describe our experience. Methods: Telemedicine service was established by Faisalabad Medical University at two of its affiliated locations: 1) A 24-hour COVID-19 Telephone Helpline was established at Director Emergency Office, Allied Hospital and District Headquarter (DHQ) Hospital. 2) A Telemedicine Clinic comprising consultants and postgraduate residents from different specialties was established at Chief Office, Allied Hospital. The data related to the number and categories of calls and advice provided was collected from 27th March 2020 till 31st July 2020. Results: A total of 4582 calls were received, at both locations, during the study period, out of which 2325 callers (51%) were male, and 2257 (49%) were females. At Allied Hospital, 172 patients were advised accordingly for their complaints, whereas, at DHQ Hospital, 320 patients were advised accordingly for their complaints. At the telemedicine clinic only, a total of 2436 calls were received during the study period, 1474 (60%) callers were male, and 962 (40%) were female. The majority of the calls were received by medicine (43%), dermatology (21%), and pediatrics (11%) specialties, respectively. Conclusion: Despite some limitations, the benefits of telemedicine in this COVID-19 era are enormous and it is feasible to implement telemedicine services in developing countries. The developing countries must invest in the internet and technology access to facilitate telemedicine and other e-health services for not only curbing this pandemic but also to promote a more efficient healthcare system after the pandemic.

The hypercoagulable state observed in COVID-19 could be responsible for morbidity and mortality. In this retrospective study we investigated whether therapeutic anticoagulation prior to infection has a beneficial effect in hospitalized COVID-19 patients. 1154 COVID-19 patients admitted to 6 hospitals in the Netherlands between March and May 2020 were included. We applied 1:3 propensity score matching to evaluate the association between prior therapeutic anticoagulation use and clinical outcome, with in hospital mortality as primary endpoint. 190 (16%) patients used therapeutic anticoagulation prior to admission. In the propensity score matched analyses, we observed no associations between prior use of therapeutic anticoagulation and overall mortality (RR 1.02 (95% CI; 0.80-1.30) or length of hospital stay (7.0 [4-12] vs 7.0 {4-12] days, p=0.69), although we observed a lower risk of pulmonary embolism (RR 0.19 (95% CI; 0.05-0.80). This study shows that prior use of therapeutic anticoagulation is not associated with improved clinical outcome in hospitalized COVID-19 patients.

Global influenza virus circulation declined and has been below traditional seasonal levels during the COVID-19 pandemic.1-3 We reviewed WHO influenza surveillance outputs from May 1-December 31, 2020 (epidemiologic weeks 18-53) from tropical Asian countries. For each country we report influenza surveillance specimens tested, and the percentage positive for influenza, by type and subtype. We compared current data to historical data from 2015-2019 in order to place the current season in historical context. Twelve included countries tested 17,407 surveillance specimens, with 592 (3.4%) testing positive for influenza viruses. From April 27-July 26, 2020 (epidemiologic weeks 18-30), specimens tested decreased from an average of 14,102 per year in 2015-2019 to 3,969 (71.9% decrease) and influenza positivity from 22% to <1%. During weeks 31-53, specimens tested decreased from an average of 24,782 per year in 2015-2019 to 13,438 (45.8% decrease) and influenza positivity from 18% to 4%. In six countries that maintained testing of surveillance specimens for >90% of weeks, influenza circulation was unseasonably low, or absent, during weeks 18-30, 2020. However, during weeks 31-53, the percentage of surveillance specimens testing positive for influenza approached or reached positivity rates of 2015-2019 in Bangladesh and Cambodia; and increased but remained lower than historical positivity in Lao PDR and Viet Nam. The data presented here are a reminder that the low levels of influenza circulation in the northern hemisphere in summer 2020 may not necessarily persist into the upcoming influenza season, and influenza surveillance and prevention strategies should continue as planned and not be delayed.

A document by Kefei Rao. Click on the document to view its contents.

COVID-19 is a complex disease and many difficulties are faced today especially in the proper choice of pharmacological treatments. The role of antiviral agents for COVID-19 is still being investigated. The evidence for immunomodulatory and anti-inflammatory drugs is quite conflicting, while the use of corticosteroids is supported by robust evidence. The use of heparins in hospitalized critically ill patients is preferred over other anticoagulants. Lastly, conflicting data were found regarding to the use of convalescent plasma and vitamin D. According to data shared by the WHO, many vaccines are under phase 3 clinical trials and some of them already received the marketing approval in EU countries and in the US. In conclusion, drugs repurposing has represented the main approach recently used in the treatment of patients with COVID-19. At this moment, the analysis of efficacy and safety data of drugs and vaccines used in real life context is strongly needed.