Cervical lymphadenopathy following COVID-19 vaccine: Clinical characteristics and implications for head and neck cancer servicesRunning title: COVID-19 vaccine-associated lymphadenopathyAhmad K. Abou-Foul1*, Elizabeth Ross1, Mahmoud Abou-Foul2, Ajith P. George1,3

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) still has serious negative effects on health, social life, and economics. Recently, vaccines from various companies have been urgently approved to control SARS-CoV-2 infections. However, any specific antiviral drug has not been confirmed so far for regular treatment. An important target is the main protease (Mpro), which plays a major role in replication of the virus. In this study, Gaussian and residue network models are employed to reveal two distinct potential allosteric sites on Mpro that can be evaluated as drug targets besides the active site. Then, FDA-approved drugs are docked to three distinct sites with flexible docking using AutoDock Vina to identify potential drug candidates. 14 best molecule hits for the active site of Mpro are determined. 6 of these also exhibit high docking scores for the potential allosteric regions. Full-atom molecular dynamics simulations with MM-GBSA method indicate that compounds docked to active and potential allosteric sites form stable interactions with high binding free energy (∆Gbind) values. ∆Gbind values reach -52.06 kcal/mol for the active site, -51.08 kcal/mol for the potential allosteric site 1, and -42.93 kcal/mol for the potential allosteric site 2. Energy decomposition calculations per residue elucidate key binding residues stabilizing the ligands that can further serve to design pharmacophores. This systematic and efficient computational analysis successfully determines ivermectine, diosmin and selinexor currently subjected to clinical trials, and further proposes bromocriptine, elbasvir as Mpro inhibitor candidates to be evaluated against SARS-CoV-2 infection

OBJECTIVE To assess the impact of the surgical delay for localized prostate cancer (PCa) on adverse pathological features and oncological outcomes. MATERIALS AND METHODS Patients who underwent surgery for localized prostate cancer were included from the Turkish Urooncology Association (TUA) Prostate Cancer database. A History of previous treatment or active surveillance (AS) were considered as exclusion criteria from the study. Patients were divided into two groups according the time period between the diagnosis and surgery; less than or equal to 90 days (group 1) or longer than 90 days (group 2). Surgical pathology results and oncological outcomes were compared between the two groups. RESULTS A total of 2454 out of 3646 patients were assessed. Pathological findings of the radical prostatectomy (RP) specimens were similar between two groups. However, there was slightly more seminal vesicle invasion in final surgical pathology in group 1 (12.9% vs. 9.3%, respectively p=0.042). 5-year biochemical recurrence free survival times were similar across all D’Amico risk categories between two groups. The regression analysis demonstrated the seminal vesicle invasion as the only factor affecting time to PSA progression in high-risk patients (p<0.001 HR:2.51 CI: 1,58-4,45). CONCLUSION In conclusion, our results in this large cohort suggest that surgical delay does not cause a deterioration for prostate cancer surgical outcomes even in high-risk group of patients. These findings may be helpful for planning the limited healthcare resources especially in conditions like the Covid-19 pandemic where the availability and optimal use of healthcare system resources is crucial.

One of the hallmarks of COVID-19 is the cytokine storm that provokes primarily pneumonia followed by systemic inflammation. Emerging evidence has identified a potential link between elevated levels of interleukin-17A (IL-17A) and disease severity and progression. Considering that per se IL-17A can activate several inflammatory pathways, it is plausible to hypothesize an involvement of this cytokine in COVID-19 clinical outcomes. Thus, this cytokine can represent a marker of disease progression and/or a target to develop therapeutic strategies. This hypothesis paper aims to propose this “unique” cytokine as a silent amplifier of the COVID-19 immune response and (potentially) related therapy.

A case series of 22 patients with confirmed SARS-CoV-2 infection and Corona Virus Disease 2019 (COVID-19) symptoms was followed in a primary care clinic. We provided quantitative and longitudinal profiling for SARS-CoV-2 IgM and IgG with a point of care device. Half the patients had a history of anosmia or ageusia. IgM and IgG responses were highly heterogeneous quantitatively and temporally. We determined that clinical symptomatology of chemosensory loss correlated with lesser but sustained titers of IgM and IgG whereas normal chemosensation correlated with transiently higher but rapidly declining antibody levels.

The rapid global spread of SARS-CoV-2 and the resulting Coronavirus disease (COVID-19) pandemic has led to urgent efforts to contain and mitigate transmission. The use of face masks became a primary measure to limit the spread, which increased the production and consequent waste generation. It is estimated that globally 129 billion single-use face masks are discharged into the environment every month. Besides to add to already great concerns over plastic pollution, contaminated face masks not properly handled also poses a health risk. The health and environmental consequences caused by the inadequate disposal of single-use face masks are treated in this study as an eminent risk to be properly communicated. This study framed the waste generation as a side impact of the COVID-19 pandemic and analysed how the communication has been made regarding the correct disposal of single-use masks, with focus in users of public transport in Stockholm region. National and regional authorities are recognized as the main responsibles for the communication about correct disposal, together with manufacturers and suppliers of single-use face masks. Disclosure and informative material of four government authorities and instruction manuals of eight brands of single-use face masks are analysed according to: i) presence / absence of information (about the disposal); ii) type of communication (visual or written); iii) message transmitted and; ix) availability in other languages. It was found guidance about correct disposal of face mask in two thirds of the existing communication, that is mainly written and with few visual aids. Half of communication is made only in Swedish and with no sufficient focus on the importance of correct disposal neither with reference to trash bins with lid. It suggests that the current communication about how to dispose single-use masks safely may not be enough, which is affecting the perception of risk by the population and worsening the health and environmental consequences caused by the inadequate disposal.

Animals like mink, cats and dogs are susceptible to SARS-CoV-2 infection. In the Netherlands, 69 out of 127 mink farms were infected with SARS-CoV-2 between April and November 2020 and all mink on infected farms were culled after SARS-CoV-2 infection to prevent further spread of the virus. On some farms, (feral) cats and dogs were present. This study provides insight into the prevalence of SARS-CoV-2 positive cats and dogs in ten infected mink farms and their possible role in transmission of the virus. Throat and rectal swabs of 101 cats (12 domestic and 89 feral cats) and 13 dogs of ten farms were tested for SARS-CoV-2 using PCR. Serological assays were performed on serum samples from 62 adult cats and all 13 dogs. Whole Genome Sequencing was performed on one cat sample. Cat-to-mink transmission parameters were estimated using data from all ten farms. This study shows evidence of SARS-CoV-2 infection in twelve feral cats and two dogs. Eleven cats (19%) and two dogs (15%) tested serologically positive. Three feral cats (3%) and one dog (8%) tested PCR-positive. The sequence generated from the cat throat swab clustered with mink sequences from the same farm. The calculated rate of mink-to-cat transmission showed that cats on average had a chance of 12% (95%CI 10% to 18%) of becoming infected by mink, assuming no cat-to-cat transmission. As only feral cats were infected it is most likely that infections in cats were initiated by mink, not by humans. Whether both dogs were infected by mink or humans remains inconclusive. This study presents one of the first reports of interspecies transmission of SARS-CoV-2 that does not involve humans, namely mink-to-cat transmission, which should also be considered as a potential risk for spread of SARS-CoV-2.

Treatment of pediatric oncology patients generally results in significant immunosuppression and when the COVID-19 pandemic arose, there was concern among pediatric oncologists about the implications of this virus. We reviewed the literature and describe all pediatric oncology patients with COVID-19 reported worldwide. Within this review, it is striking that CNS tumors are reported at low numbers (27/466 pediatric oncology patients with COVID-19). This may be related to decreased inpatient care when compared to other pediatric cancers. Additional work is needed to understand the risk of infection in this population and gain insight into the effect on delivery of oncology care.

Object: Our aim is to evaluate the elevation of pancreatic enzymes in COVID-19 patients and their relationship with severity of COVID-19. Method: In this study, 1378 patients with COVID-19 infection were included. Relation of elevated amylase and lipase levels and co-morbid conditions with the severity of COVID-19 were checked. The effect of hemodynamic parameters and organ failures on pancreatic enzymes and their relations with prognosis were statistically analyzed. Results: There were 678 (%49,2) female patients and 700 (50,8%) male patients. Of all patients, 687 (49,9%) had mild, 691 (50,1%) severe COVID-19 infections. Elevated amylase levels were detected in 23% of patients (n:316). 19% (261) of them had a slight (1-3 times) increase in amylase levels, while 4% (55) had a more than 3 times increase in amylase than normal. Only 6% of patients with elevated amylase leves had the acute pancreatitis according to Atlanta criteria. According to univariate and multivariate analyses, elevated amylase levels was found statistically related with severity of COVID-19 (OR:4,37-p <0,001). And also diabetes mellitus (DM) (OR:1,82-p:0,001), kidney failure (OR:5,18- p< 0,001), liver damage (OR:6,63 p < 0,001), hypotension (OR:6,86-p< 0,001), sepsis (OR:6,20-p:0.008) were found to related to death of COVID-19. Conclusions: Elevated pancreatic enzyme levels in COVID-19 infections is to related to severity of COVID-19 infection and hemodynamic instability. Similar to other organs, the pancreas can be affected by severe COVID-19 infection.

Proning in Pregnancies Complicated by Acute Respiratory Distress Syndrome. A Call to Action During the COVID-19 Pandemic.Authors: L Cojocaru, OM Turan, A Levine, L Sollecito, S Williams, E Elsamadicy, S Crimmins, S Turan.Liviu Cojocaru, MD: Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science. University of Maryland School of Medicine, Baltimore, MD, USA.(lcojocaru@som.umaryland.edu) (ORCID No: 0000-0003-1558-702X).Ozhan M Turan, MD, Ph.D.: Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science. University of Maryland School of Medicine, Baltimore, MD, USA.(oturan@som.umaryland.edu)Andrea Levine, MD: Division of Pulmonary and Critical Care Medicine. Department of Medicine. University of Maryland School of Medicine, Baltimore, MD, USA.(andrea.levine@som.umaryland.edu)Linda Sollecito, BSN, RN, CCRN: Medical Intensive Care Unit. University of Maryland Medical Center, Baltimore, MD, USA.(lsollecito@umm.edu)Susan Williams, MS, RN, CCRN: Medical Intensive Care Unit. University of Maryland Medical Center, Baltimore, MD, USA.(susanwilliams@umm.edu)Emad Elsamadicy, MD: Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science. University of Maryland School of Medicine, Baltimore, MD, USA.(eelsamadicy@som.umaryland.edu)Sarah Crimmins, DO: Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science. University of Maryland School of Medicine, Baltimore, MD, USA.(scrimmins@som.umaryland.edu)Shifa Turan, MD, RDMS: Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science. University of Maryland School of Medicine, Baltimore, MD, USA.(sturan@som.umaryland.edu)Correspondence to: Liviu Cojocaru, MD: Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA.(lcojocaru@som.umaryland.edu)Disclosures: None.Acknowledgments: We are grateful to Bill Seiler, Erin Rummel, Kelly Kennedy, Alexandra Bessent, Chris Wells, McLellan Shelby, Jessica Peterson, and Amanda Sullivan for assistance in creating the proning video instructions.Short title: Proning in pregnancies complicated by ARDS. It’s time!

A document by David Savitz, written on Authorea.

COVID-19 pandemic and associated lockdown measures has deeply modified the natural course of seasonal viral infections, such as respiratory syncytial virus (RSV). Methods We analysed French national data from three networks: emergency departments (ED) of French hospitals, general practitioners (GP), and hospital laboratories. We compared the number of ED visits and GP visits for bronchiolitis in children <2 years of age, and the percentage of RSV positive tests in the 2020-2021 season with those of the two previous seasons (2018-2019 and 2019-2020). We used time series of the previous 5 years to calculate epidemic thresholds. Results During the 2020–2021 season, the epidemic begun in February (week 05) in the Ile de France (Paris and suburbs) region, 12 weeks later compared with the previous seasons and progressively spread across all the French metropolitan regions. The highest number of bronchiolitis cases in 2021 (week 12) occurred 10-12 weeks after the previous seasonal peaks of previous seasons, but the number of cases remained lower than in the previous seasonal peaks. Conclusion We identified a delayed RSV epidemic in the period that usually corresponds at the end of the epidemic season, raising concerns for the burden of RSV in the already strained healthcare systems during the COVID-19 pandemic

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Backround: The ongoing pandemic of Coronavirus Disease 2019 (COVID-19) infection has declared as a global emergency. Although the most people had mild illness due to the infection, some patients were seriously affected associated with complications especially including respiratory and cardiovascular systems. In despite of the respiratory system involvement is in the foreground, cardiovascular complications result in worse clinical outcomes. The purpose of this study is to compare the levels of the N-terminal pro-brain natriuretic peptide, neutrophil-to-lymphocyte, lymphocyte-to-monocyte and platelet-to-lymphocyte ratios -which are accepted as a marker of negative outcomes in cardiovascular diseases- of the patients with COVID-19 and healthy subjects and reveal the increased risk of cardiovascular disease in patients with COVID-19. Methods: This prospective study was designed in a single center and included 33 patients with COVID-19 (Group 1) and 33 healthy subjects consisted of health care professionals (Group 2). N-terminal pro-brain natriuretic peptide levels, neutrophil-to-lymphocyte, lymphocyte-to-monocyte and platelet-to-lymphocyte ratios were compared between the groups. Results: N-terminal pro-brain natriuretic peptide levels, neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios were statistically significantly higher in the patients with COVID-19 (p<0,0001) and lymphocyte-to-monocyte ratio was statistically significantly lower in the same group (p<0,0001). Conclusion: Cardiovascular manifestations result in worse outcomes in patients with COVID-19 although the disease primarily affects the respiratory system. Early detection of this clinical situation and taking precautions have vital importance in the progress of the disease. NT-proBNP levels, neutrophil-to-lymphocyte, lymphocyte-to-monocyte and platelet-to-lymphocyte ratios are inexpensive, easy, fast and reproducible parameters that can be used in determination of probabl cardiovascular events that may develop during COVID-19 and enables early optimal treatment strategies for patients.

Background and Aim:The novel coronavirus (SARS-CoV-2) that causes novel coronavirus pneumonia (COVID-19) is the third fatal coronavirus. The prognosis of disease varies depending on patient’s specialties. The aim of this study was to evaluate the correlation of CBC parameters and ferritin levels at the time of diagnosis with the prognosis of patients hospitalized due to COVID 19. Materials and Methods: In this retrospective study, 1320 patients hospitalized at the Aksaray University Training and Research Hospital between July 2020 and December 2020 were evaluated. Results: All of the patients were hospitalized because of symptoms associated with COVID 19. There were 688 males and 632 females with a median age of 70 (19-98) at the time of hospitalization with COVID 19 symptoms. The median follow-up time was 7 (range, 1-57) days in hospital for all patients. Median age was significantly higher in patients who do not respond to treatment and have mortality (p<0.001). Most of the patients with mortality were males (p=0.001). There was a statistically significant difference in the parameters other than monocyte and basophil among the hemogram parameters checked at the time of presentation. Neutrophil / lymphocyte ratio was significantly higher in patients with mortality (p<0.001). Conclusion: In conclusion, this study indicates that by using the most simple and routine hematological tests at the time of COVID-19 diagnosis, it may be possible to predict a patient’s prognosis. This will help patients receive early clinical care, reducing patient mortality and aiding in the control and prevention of the outbreak.

The aim of this research is to investigate the relationship between the counts of cases with Covid-19 and the deaths due to it in seven countries that are severely affected by the pandemic. First, the Pearson's correlation is used to determine the relationships among these countries. Then, the factor analysis is applied to categorize these countries based on their relationships.

Unilateral vocal cord paralysis (UVCP) is a known complication of thyroid surgery, due to iatrogenic recurrent laryngeal nerve injury, with reported rates of 2-5% in children. The gold standard for assessing vocal cord function in flexible nasendoscopy (FNE) examination, which is considered high-risk for contraction of the COVID-19 virus. Intraoperative ultrasonographic assessment (IUA) of vocal cord function is a non-invasive and relatively simple procedure, performed in a supine position under general anesthesia. Objectives: To evaluate the validity of IUA modality in children undergoing thyroidectomy, and to compare it to the standard FNE. Design: A prospective double-blind study covering 24 months (March 2019-March 2021). Twenty thyroid lobectomies were performed, during 15 surgeries. Vocal cord function was assessed three times: Preoperatively by FNE, intraoperative (IUA) following extubation, and a second FNE on the first post-operative day. Settings: A tertiary pediatric hospital. Results: The overall accuracy of IUA results in our study was 92%. IUA sensitivity, specificity, positive and negative predictive values were 100%, 89%, 33%, and 100% respectively. Patient’s age demonstrated borderline significance (p= 0.08). The resident’s experience was associated with a better correlation between IUA and FNE results (p<0.05). Conclusions: IUA of vocal cord motion has a high accuracy rate for detection of iatrogenic vocal cord paralysis, similar to FNE. It is easily learned by residents, well tolerated by children, and it provides a safe and valid alternative modality while ensuring the safety of the medical staff in treating patients, especially in times of COVID-19 pandemic.

Background: The present study aimed to determine the duration of hospital admission of the panic diagnosed patients, examine the factors that may influence hospital admission time, and identify the impact of the COVID-19 pandemic on hospital admission time. Materials and methods: In this study, the panic diagnosed patients between January 2018 and January 2021 were determined. These patients’ demographic, clinical, and panic diagnosis form data were documented. The duration of hospital admission of patients during and pre-COVID-19 pandemic period was determined. Results: There were 65 panic diagnosed cases, of which one One patient had leukocytoclastic vasculitis, 10 patients had uterine contents without villi or trophoblasts, and 54 patients had unexpected malignancy. The mean time of admission to the hospital of verbally informed and not verbally informed cases were five days and 156 days, respectively in the pre-COVID group. All cases in the COVID pandemic group were verbally informed about panic diagnosis by phone call. The mean time (day) of admission to the hospital was 18.3 days (1-40). Admission times were on mean about 13.3 days longer in verbally informed cases in the COVID pandemic group compared to verbally informed cases in the pre-COVID group. Conclusion: We determined a dramatic decrease in the number of panic diagnosed cases during the COVID pandemic and patients who are verbally informed admitted to the hospital in a shorter time. Integrations of hospital panic diagnosis notification systems to health application programs and primary responsible family physician’s systems may be useful for preventing unwanted delays.

In December 2019, the novel coronavirus disease 2019 (COVID-19) emerged in China and spread rapidly around the world, resulting in a pandemic declared by the World Health Organization in March 2020. The disease has affected more than 11 million people in Brazil, with more than 265.000 deaths to date, as we are now facing a second wave of infections. Regarding medical assistance and training, it turned out to be a great challenge, since - among other things - many residents were relocated to respiratory units to treat patients with COVID-19. Even though the residency programs situation has become chaotic all around the world and the activities in almost all specialties nearly stopped (especially in surgical specialties), the need to reinvent the way of teaching was the best concern. Worldwide the “webinars fever” was an impulse to try new strategies to fulfill the gaps of knowledge of these future specialists. It is crucial to call to the responsibility put on medical training institutions to prepare these new professionals according the principles of evidence-based medicine, surgical proficiency and patient safety.

Background-The SARS-CoV-2/ Covid-19 pandemic is still going on and globally healthcare

Background. This paper presents, for the first time, the Epidemic Volatility Index (EVI), a conceptually simple, early warning tool for emerging epidemic waves.  Methods. EVI is based on the volatility of the newly reported cases per unit of time, ideally per day, and issues an early warning when the rate of the volatility change exceeds a threshold.Results. Results from the COVID-19 epidemic in Italy and New York are presented here, while daily updated predictions for all world countries and each of the United States are available online.Interpretation. EVI's application to data from the current COVID-19 pandemic revealed a consistent and stable performance in terms of detecting oncoming waves. The application of EVI to other epidemics and syndromic surveillance tasks in combination with existing early warning systems will enhance our ability to act fast and optimize containment of outbreaks.

A 42-year-old male patient was diagnosed with coronavirus disease 2019. His symptoms improved 2 weeks after lopinavir therapy (400 mg every 12 hours). However, he was subsequently diagnosed with complete anosmia. Magnetic resonance brain imaging showed no abnormalities. We prescribed B-complex vitamins and olfactory training. Forty days later, he recovered.

IntroductionSince the outbreak of COVID-19 there has been an unprecedented effort from the scientific community to develop tools to help tackle this crisis. According to the Foundation for Innovative New Diagnostics (FIND; 18 March 2021) there are 1025 commercialized SARS-CoV-2 assays currently available and an additional 98 in development, including 655 immunoassays and 437 molecular assays.1 Early in the pandemic, molecular testing using nucleic acid amplification tests (NAATs) became the pillar of COVID-19 diagnostics. Since then, the development of antigen tests, immunoassays, point-of-care, and centralized options means there are now choices to be made as to how, when, and where to deploy these technologies and many guidelines have been developed, often based on Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) guidance.2-4 However, with the rapid emergence of new technologies and new scientific data, these guidelines are very fluid and subject to change. Furthermore, while NAATs are the most sensitive diagnostic tool for COVID-19 infection,3-5 the global demand for diagnostic testing is still such that the use of labour-intensive, specialist techniques needs to be carefully considered.The aim of this review is to provide an international evaluation of real-world testing needs and to define: settings where the ‘next best’ alternatives to NAATs are appropriate; settings where NAATs may not be the best option; how to manage antigen test results; and how to manage negative NAAT results where there is still a strong clinical suspicion of COVID-19. We will further aim to set out the key considerations for defining a testing strategy. Table 1 demonstrates that each testing strategy provides different information on infection status and has different performance metrics, so the right option for the right setting needs to be carefully assessed. Here we also discuss the common challenges facing clinicians and laboratorians when interpreting and supplying COVID-19 diagnostics and provide insights into what will be needed next.Table 1. A summary of the diagnostic testing methodologies for COVID-19.

Background Some drugs used in the treatment of coronavirus disease 2019 (COVID-19) are likely to increase the risk of QT interval prolongation and related arrhythmias or death. Due to the low sensitivity of the reverse transcriptase-polymerase chain reaction (RT-PCR) test, chest computed tomography (CT) imaging is being used for COVID-19 diagnostic correlation and to evaluate whether there is pneumonic involvement in the lung. Objective In this study, we aimed to compare whether there was a difference in terms of QT interval prolongation and effect on heart rate in COVID-19 patients based on their chest CT findings and drug treatment regimes. Methods This was a single-center retrospective cohort study of non-intensive care unit (ICU) patients hospitalized . A total of 344 patients with a mean age of 46.34 ± 17.68 years were included in the study (56.1% men). Patients were divided into four groups according to their chest CT results as having typical, atypical, indeterminate, or no finding of pneumonic involvement. Mean QTc intervals and heart rates calculated from electrocardiograms at admission and after treatment were compared. Results There were no significant differences between groups with regards to age, gender, and body mass index (BMI). There were also no significant differences between the groups in terms of mean QTc interval values upon admission (p:0.127) or after treatment (p:0.205). Heart rate values were similar among the groups as well, with no significant differences in mean heart rate on admission (p:0.648) and post-treatment (p:0.229) ECGs. Conclusion This study has demonstrated finding of COVID-19 infection based on chest CT does not affect QT interval prolongation and bradycardia in non-ICU COVID-19 patients. There is a need for additional larger studies investigating the effect of chest CT findings on QT interval prolongation and bradycardia in COVID-19 patients.