Background: In March 2020, in response to the COVID19 outbreak, ENT UK issued guidance recommending that all routine clinics should be cancelled and telephone review should be the first approach for all outpatients who do not need urgent treatment. Our district general hospital department therefore organised telephone reviews for all patients referred with dizziness. It was decided to trial a questionnaire to help clinicians with this new approach to assessing patients with dizziness. Study Design: Prospective Single Centre Randomised Pilot Study. Methods: Local ethics approved was obtained and all 115 patients awaiting otolaryngological assessment for balance were randomised to receive a validated dizziness questionnaire or not. Questionnaires were posted to the patients prior to their appointment. They were then contacted for a planned telephone consultation for dizziness. Data on the outcome and effectiveness of the consultation was collected by the clinicians conducting the consultation. Results were analysed using Microsoft Excel and Fisher’s exact test was used for the statistical analysis. Results: 82/115 patients had consultations with complete data collection, 35 in the questionnaire group (QG) and 47 in the no questionnaire group (NQG). Response rate (returned completed questionnaires) in the QG was 70%. Clinicians were able to make a provisional diagnosis in 77% of QG patients vs 57% of NQG patients. QG patients only required additional investigations 26% of the time compared to 72% in the NQG (p<0.05). Only 17% of QG patients needed additional telephone follow up, compared to 43% of NQG patients (P<0.05). Conclusion: Using an abbreviated dizziness questionnaire can increase clinicians’ ability to come to a diagnosis at the end of a telephone consultation. It may reduce the need for additional investigations and further telephone follow-up, thereby keeping patients away from the hospital and freeing up capacity.

Abstract Objectives: Earlier researches suggested patients should be routinely screened for bacteria and fungi infection after COVID-19 being confirmed. Here, we enrolled 236 patients with COVID-19 to analyze the clinical characteristics, fungal strains, mortality, and laboratory data of different groups. Design: Single center retrospective study Patients: A total of 236 COVID-19 patients from Huoshenshan Hospital were included in this study, consisting of 14(6%) died cases, 222(94%) discharged cases . Results: The result revealed that 5 mortality in positive group were all related to aspergillus infection while candida infection rarely caused death. Aspergillus was most common in non-survivors while candida was most common in survivors. In terms of interleukin-6 (IL6), viral loads, nucleic acid clearance time, etc, fungal serologically positive group had a higher level than negative group. Conclusions: Non-survivors of Covid-19 with fungal infection were almost associated with aspergillus infection. Aspergillus infection, instead of candida infection might be fatal for critical ill patients with COVID-19. There is great significance to carry out routine screening for fungal infection especially for critical patients to enable early treatment to be implemented. Keywords: coronavirus disease 2019 (COVID-19); fungal infection; aspergillus; mortality

Essential to management of pandemics, noninvasive thermometry has been hampered by inaccuracies and inconsistencies, due to measurements on low thermal conductivity (k) surfaces we show here, which have precluded effective assessment of febrile states for centuries. Discovery of brain-eyelid thermal tunnels (BTT) identified undisturbed thermal transmission from brain. We here report a series of integrated anatomic, histologic, thermal emissive, thermal physiologic and thermometric studies designed to identify, characterize and overcome the biophysical limitations of surface thermometry as currently used worldwide to control COVID-19, which primarily relies on non-contact forehead thermometry. However, the forehead has thick and variable dermis (~2000 µm to ~2500 µm) and fat layers (~1100 µm to ~2800 µm) resulting in low-k insulation equivalent to wood. During thermal emission, the highest skin temperature at forehead, present in only ~3.1% of forehead, averaged 1.07±0.49°C (mean±SD) less than over BTT (p=0.008, two-tailed paired t-test). Thermometric studies (without correction factor) revealed 1.97°C higher temperature at BTT site (BTT°) than forehead. Facial fanning caused 3.5°C reduction in forehead temperature, which do not compromise BTT site, attributable to impact on non-BTT surface sites by highly variable surface vasculature. Cerebral hemisphere dominance studies uncovered higher BTT° in the dominant side (P<0.001 for 0.14°C difference). Like BTT, superior palpebral vein region has thin dermis (~900 µm) and is fat-free, however, BTT has higher intensity light emission due to heat transfer from underlying brain tunnel. Findings bring a new dimension for combating COVID-19 that is aligned with physics and biology, and without any cost whatsoever and undue burden, current worldwide suboptimal low-k thermometry can be immediately and conveniently enhanced by brain-enabled thermo-physical based high-k signal conversion, which can be easily implemented by any country, community or individual in the world. 

BackgroundThe optimum management of respiratory failure in COVID-19 patients has been a challenge for physicians across the globe. Many scientific societies have suggested the use of CPAP (continuous positive airway pressure) in severe cases, in an effort to reduce invasive ventilation. We investigated mortality outcomes in patients who needed CPAP but were not suitable for invasive ventilation.MethodsWe retrospectively evaluated the mortality outcomes of all consecutive COVID-19 cases with severe type 1 respiratory failure requiring FiO2 >0.6 who were admitted to our hospital between 12th March and 04th May’20. British Thoracic Society guidelines were followed for identifying patients needing CPAP. Their outcomes were recorded and compared with a similar group of patients who had oxygen as a ceiling of care. Prospectively collected data between 5th May and 7th June’20 in similar but smaller group of patients was also analysed.Results:A total of 104 COVID-19 patients with documented Do Not Attempt Resuscitation (DNAR) decision required high fraction of inspired oxygen (FiO2) >0.6 to maintain peripheral oxygen saturation (SpO2)> 92% (SpO2> 88% in COPD). 24 received CPAP as the ceiling of care with a mortality rate of 92.5%. The remaining 80 patients who were on oxygen as a ceiling of treatment had 91.7% mortality.Conclusion CPAP did not appear to improve survival of patients with severe respiratory failure due to COVID-19 who were not suitable for invasive ventilation. Further studies are warranted to adequately inform appropriate management strategies for this group of patients.KeywordsCPAP; non-invasive ventilation; COVID-19; critically ill; respiratory failure

Background: Infection caused by SARS-CoV-2 virus is a recent disease that is easily spread and has serious complications, such as neuropsychiatric signs and symptoms. Thus, studies are necessary on the clinical manifestations during and/or after the course of the disease. Aims and objectives: To describe the relationship between neuropsychiatric signs and symptoms and SARS-CoV-2 infection. Methods: Systematic review conducted in the Pubmed Portal, Brazilian Virtual Health Library, Cochrane, and Science Direct databases. The descriptors coronavirus, SARS, and neurologic symptoms were used in Pubmed, Cochrane, and Science Direct databases, while the descriptors SARS Virus and Nervous System were used in the Virtual Health Library database. A total of 1024 studies were found and 67 were selected to compose this systematic review. The studies were analyzed qualitatively with the narrative description divided into four thematic categories. Results: There is a pathophysiological relationship between SARS-CoV-2 infection and manifestations involving the Central Nervous System and the Peripheral Nervous System through different pathways and mechanisms. The chances of Nervous System manifestations increase in elderly patients with associated morbidities, such as obesity, diabetes mellitus, chronic obstructive pulmonary disease and/or pre-existing neurological/psychiatric diseases. The most cited neuropsychiatric signs and symptoms were headache, delirium, smell and/or taste disorders, and stroke. The evaluation and monitoring of patients during and after COVID-19 infection is important for the early detection and treatment of neuropsychiatric signs and symptoms. Conclusions: It is recommended that health professionals monitor patients with COVID-19 infection or who had recently had the disease for detecting neuropsychiatric signs and symptoms, especially elderly patients, people with comorbidities such as cardiovascular and pulmonary diseases, diabetes mellitus, and obesity, and patients with pre-existing neurological/psychiatric diseases. Decision-making for the implementation of an early rehabilitation treatment can be reinforced in this groups, minimizing the sequels resulting from COVID-19.

In late 2019, an outbreak of respiratory disease named COVID-19 started in China and rapidly spread to other parts of the world. To date, millions of cases of infection are reported worldwide. Most researches performed on epidemiology and clinical features of COVID-19 and a small part of studies have focused on the genetic characteristics of this virus. Here we performed six months study on D614G mutation in SARS-CoV-2 isolates. Regarding the high price and low availability of sequencing techniques in Iran, we designed the PCR-RFLP method for D614G mutation detection and then evaluated 1440 SARS-CoV-2 positive samples isolated in six months in Northeastern Iran. The first S-G type was detected on 2020 June 10; after that, the number of S-G types increased in our samples, as in the last three weeks, from 2020 September 07 to 2020 September 26, all samples belonged to this type.

SARS-CoV-2 infections are the most contagious among the three coronavirus infections the world has witnessed till date which have affected almost all parts of the world in millions of population till date since its outbreak in china in Dec. 2019. Moreover, it has severely hit the world economy and therefore there is a dire need to develop the treatment of this deadly disease. Numbers of potential vaccines are in the early or advanced stage of clinical trials. But the development of a vaccine is a very tedious and time consuming task. Therefore, numbers of groups are working on the repurposing of drugs with already known safety and efficacy profile to shorten the time of development of the potential treatment. The main aim of this review article is to summarize the clinical outcomes of the various drugs which have been repurposed for the treatment of COVID-19 associated with SARS-CoV-2.

Hemolytic anemia has been associated with SARS-CoV-2 infection in adult and pediatric patients, we report a case series of preterm newborns with hemolytic anemia whose mothers had a history of SARS-CoV-2 infection. In two of the cases maternal infection occurred early in pregnancy and the newborns had a reactive SARS-CoV-2 antibody test. Hemolysis and coagulopathy improved with the use of washed blood products and prothrombin complex concentrate. Our cases highlight the need for increased awareness of a possible association between hemolysis and exposure to SARS-CoV-2 infection during intrauterine life.

AIM Current guidelines advocate ‘one-stop’ neck lump assessment for cancer referrals. We pilot a novel pre-clinic ultrasound pathway, present the outcomes and discuss strengths and limitations especially in view of the current COVID-19 pandemic. METHODS Patients referred by the GP on a two-week-wait cancer pathway with a ‘neck lump’ were allocated pre-clinic ultrasound scans followed by an ENT clinic appointment. Demographics, patient journey details and outcomes were collected and analysed. RESULTS 99 patients underwent pre-clinic ultrasound assessment by a specialist consultant radiologist an average of 8.02 days after referral with 30 (30.3%) also undergoing biopsy. Patients were followed-up 14.1 days (range 2 – 26 days) after initial referral. In 92.9% of patients, a positive impact was achieved; at the first clinic appointment 45 patients were discharged (45.5%), ten were listed for surgery (10.1%), a cancer diagnosis was made in a further 12 patients (12.1%), 6 patients (6.1%) were referred onwards to another speciality and 19 patients (19.2%) were taken off the cancer pathway and followed up routinely. In four patients, it was retrospectively felt that ultrasound was not indicated as the referral did not accurately reflect the patient’s presenting complaint or examination findings. Repeat ultrasound was inadvertently requested for one patient. Two patients were reviewed prior to biopsy results being available leading to an additional appointment being required. CONCLUSION Pre-clinic ultrasound scanning is an alternative to the current ‘one-stop’ neck lump pathway. Our results demonstrate a reduction in clinic visits, quicker diagnosis and low proportion of unnecessary scans. Our proposed pathway requires minimal service restructuring and has added potential cost savings. We have found it to be effective during the COVID-19 pandemic in minimising the face-to-face consultations and the number of aerosol generating procedures (AGPs). Further refinement is needed to streamline and make the process more robust. A larger study with direct comparison to the ‘one-stop’ clinic is required to assess further strengths and limitations.

Background: Vietnam confirmed its first case of SARS-CoV-2 infection on January 23, 2020 among travelers from Wuhan, China and experienced several clusters of community transmission until September. Vietnam implemented an aggressive testing, isolation, contact tracing, and quarantine strategy in response to all laboratory-confirmed cases. We report the results of SARS-CoV-2 testing during the first half of 2020 in northern Vietnam. Methods: From January through May, 2020, 15,650 upper respiratory specimens were collected from 14,470 suspected cases and contacts in northern Vietnam. All were tested for SARS-CoV-2 by real-time RT-PCR. Individuals with positive specimens were tested every 3 days until negative twice. Positive specimens from 81 individuals were cultured. Results: Among 14,470 tested individuals, 158 (1.1%) cases of SARS-CoV-2 infection were confirmed; 89 were imported and 69 were associated with community transmission. Most patients (122, 77%) became negative after two tests, with 11 and 4 still testing positive when sampled a fourth and fifth time, respectively. Among 81 specimens with Ct values <30, SARS-CoV-2 was isolated from 29 (36%). Seven patients testing positive again after testing negative had Ct values >30 and negative culture. Conclusion: Early and widespread testing for SARS-CoV-2 in northern Vietnam identified very few cases which, when combined with other aggressive strategies, may have dramatically contained the epidemic. We observed rapid viral clearance and very few positive results following clearance. Large scale molecular diagnostic testing is a critical part of early detection and containment of COVID-19 in Vietnam and will remain necessary until a vaccine is widely implemented.

Background: COVID-19, as a contagious infectious disease, can affect many systems and cause changes in inflammatory and hematological parameters. This study aims to research the effects of hematological and inflammatory parameters on prognosis of the disease and the duration of hospitalization. Methods: 186 patients aged 15-92 with positive COVID-19 PCR test results and a control group consisting of 187 healthy individuals with similar characteristics in terms of age and gender are included in the study. Age, gender, hematological variables, and inflammatory parameters of the patients on the 1st and 5th days of hospitalization were recorded retrospectively. Results: The mean age of the patient’s group was 47.0 ± 18.4 years and 54.3% were male. WBC, lymphocyte count, and platelet count were statistically lower in the patient group compared to the control group, while MPV, NLR, and PLR levels were higher. On the 5th day of the patient follow-up compared to admission day, it was observed that the neutrophil count and MPV level were lower; However, the platelet count and ferritin level were statistically higher. While there was a significantly positive correlation between the duration of hospitalization and the 5th day D-dimer (r = 0546, p < 0.001) and ferritin (r = 0.568, p < 0.001); there was a negative correlation between the duration of hospitalization and admission day lymphocyte count (r = 0.256, p = 0.006) and the 5th day lymphocyte count (r = 0.325, p < 0.001). Conclusion: Increased levels of ferritin and D-dimer and decreased count of lymphocyte are among important factors affecting the duration of hospitalization for COVID-19 patients. Furthermore, we think that neutrophil count and MPV levels are low and platelet count and ferritin levels are high during the course of the disease, so these parameters can be used as prognostic indicators of the disease.

The coronavirus disease 19 (COVID-19) pandemic has resulted in widespread economic, health and social disruptions. The delivery of cardiovascular care has been stifled during the pandemic in order to adhere to infection control measures as a way of protecting patients and the workforce at large. This cautious approach has been protective since individuals with COVID-19 and cardiovascular disease are anticipated to have poorer outcomes and an increased risk of death. The combination of postponing elective cardiovascular surgeries, reduced acute care and long-term cardiac damage directly resulting from COVID-19 will likely have increased the demand for cardiac care, particularly from patients presenting with more severe symptoms. The combination of increased demand and inhibited supply will likely result in huge backlog of unmet patients’ needs. The novelty, virulence and infectivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused substantial morbidity and mortality which have necessitated modifications to the UK government’s healthcare strategy. Without improving cost efficiency, the UK’s ageing population will likely need an increasing spend on cardiac surgery simply to maintain the same level of service. However, the government’s short-term increase in spending is unsustainable especially in the face of ongoing economic uncertainty. This means that the long-term impact of COVID-19 will only increase the need to find innovative ways of delivering equivalent or superior cardiac care at a reduced unit cost.

Background: We aimed to determine the clinical, laboratory and echocardiographic parameters associated with an increased high-sensitivity cTnI (hs-cTnI) levels in COVID-19 pneumonia who admitted to the emergency department. Methods: This cross-sectional study included 70 COVID-19 patients with and without pneumonia. In addition to medical history, physical examination and laboratory tests, echocardiography and lung computed tomography was performed. The hs-cTnI value of the patients’ ≥14ng/L for men and ≥18ng/L for women was considered as an increased hs-cTnI. The patients were compared in two groups, with and without pneumonia. Results: Tricuspid regurgitation pressure gradient (TRPG) were higher in patients with COVID-19 pneumonia (p<0.05). Tricuspid annular plane systolic excursion (TAPSE) were lower in patients with COVID-19 pneumonia (p<0.05). In regression analysis; HR, NT-proBNP and TRPG was found to be related to hs-cTnI (p<0.01). Discussion: The most important determinants of increased hs-cTnI level in these patients are; increased NT-proBNP and TRPG. Therefore, it is necessary to follow-up the RV functions and TRPG by echocardiography in patients with increased hs-cTnI and COVID-19 pneumonia.

Objective: To investigate prevalence and epidemiological and clinical factors associated with OD and GD in COVID-19 patients according to the disease severity. Study design: Cross-sectional study. Methods: A total of 2,579 patients with a positive diagnosis of COVID-19 were identified between March 22 and June 3, 2020 from 18 European hospitals. Epidemiological and clinical data were extracted. Otolaryngological symptoms, including OD and GD were collected through patient-reported outcome questionnaire and sniffin-sticks tests were carried out in a subset of patients. Results: A total of 2,579 patients were included, including 2,166 mild (84.0%), 144 moderate (5.6%) and 269 severe-to-critical (10.4%) patients. Mild patients presented an otolaryngological picture of the disease with OD, GD, nasal obstruction, rhinorrhea and sore throat as the most prevalent symptoms. The prevalence of subjective OD, GD were 73.7 and 46.8% and decrease with the severity of the disease. Females had higher prevalence of subjective OD and GD compared with males. Diabetes was associated with a higher risk to develop GD. Among the subset of patients who benefited from psychophysical olfactory evaluations, there were 75 anosmic, 43 hyposmic and 113 normosmic patients. The prevalence of anosmia significantly decreased with the severity of the disease. Anosmia or hyposmia were not associated with any nasal disorder, according to SNOT-22. Conclusion: OD and GD are more prevalent in patients with mild COVID-19 compared with individuals with moderate, severe or critical diseases. Females might have a higher risk of developing OD and GD compared with males.

The recent COVID-19 pandemic has created havoc across the globe. Although there are several controversies regarding its origin, the worldwide scientific fraternity currently indulges in developing various therapeutic strategies to combat this threat. Consequently, we aimed to provide a comprehensive evaluation of this pandemic’s global transmission landscape to get an insight into its imminent fate on global populations. For this, we have analyzed the data on daily reported COVID-19 cases for 294 days since inception, i.e., from 31 December 2019 to 19 October 2020, in 210 countries across the five continents available in the ECDC database. Additionally, we have summarised an up-to-date list of currently available/under trial 23 drugs and vaccines to provide a consolidated reference to those who have a growing interest in knowing the status of related repurposed drugs and vaccines and to become acquainted with their mechanism of actions for preventing the pathogenesis of SARS-CoV-2 into the human host. We performed an extensive literature review to justify our findings and get the latest know-how on the COVID-19 pathogenesis. Our findings show that India is presently in the most critical condition, where the maximum COVID-19 cases (19.37%) are reported globally in the last 14 days, which has turned into a major concern. So the government should give priority to deal with this pandemic. Besides, American and European countries are also in a risky position, as they harbor 33.31% and 34.52% of total COVID-19 cases in the last 14 days, respectively. The sudden spurt in the number of COVID-19 cases in Europe due to the beginning of extensive testing probably reflects the relaxation in policies for controlling this pandemic. Nevertheless, we should make predictions on how this virus would evolve further, which might help us design a ‘magic compound’ that can prevent any likely situation.

To the Editor,We appreciate the interest and comments of Soriano and Ancochea1 regarding our papers 2. Further to the suggestion that “it would be of interest to repeat their statistics conducted during the first wave of COVID-19, again with the current estimates during the ongoing second wave, or later ones”, we would like to emphasize that our geographical observation was a type of anecdotal evidence that contributed to formulating a hypothesis. In a previous paper, we found that after adjusting for potentially relevant country-level confounders, there was a negative ecological association between COVID-19 mortality and the consumption of cabbage and cucumber in European countries 3. In this study, we acknowledged that “As in any ecological study, any inference from the observed association should be made at the country level, as the possibility of ecological fallacy precludes inferences at the individual level; and that further testing in properly designed individual studies would be of interest”. Indeed, what would be useful is testing the hypothesis in robust observational studies and/or clinical trials.Regarding our observation that COVID-19 could be considered as a disease of the Anthropocene 4 , other authors have recently provided a more complete description of the links between the disruption of the natural ecosystems that characterize the Anthropocene and the occurrence of zoonosis 5 6.1. Soriano J and Ancochea J. Saved by cabbage, killed by cabbage, and COVID-19. Allergy 2020; in press.2. Bousquet J, Anto JM, Czarlewski W, et al. Cabbage and fermented vegetables: from death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19. Allergy 2020. DOI: 10.1111/all.14549.3. Fonseca S, Rivas I, Romaguera D, et al. Association between consumption of vegetables and COVID-19 mortality at a country level in Europe. MedRix 2020; 10.1101/2020.07.17.201558464. O’Callaghan C and Anto J. COVID-19: The Disease of the Anthropocene.Env Res 2020; 187: 109683.doi: 109610.101016/j.envres.102020.109683. Epub 102020 May 109615.5. Morens DM and Fauci AS. Emerging Pandemic Diseases: How We Got to COVID-19. Cell 2020; 182: 1077-1092. 2020/08/28. DOI: 10.1016/j.cell.2020.08.021.6. Roche B, Garchitorena A, Guegan JF, et al. Was the COVID-19 pandemic avoidable? A call for a ”solution-oriented” approach in pathogen evolutionary ecology to prevent future outbreaks. Ecol Lett 2020 2020/09/02. DOI: 10.1111/ele.13586.JM AntoISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. IMIM (Hospital del Mar Research Institute), Barcelona, Spain. Universitat Pompeu Fabra (UPF), Barcelona, Spain. CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.J BousquetCharité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany. MACVIA-France, Montpellier, France.

Aim: The aim of this study was to investigate the ABO and Rh blood group distribution and clinical characteristics in patients with Covid-19. Materials and Methods: The clinical characteristics and blood groups of 1667 patients who were hospitalized due to Covid-19 (with a positive PCR test) between 16 March and 10 July were reviewed cross-sectionally.. Results: When blood groups of patients diagnosed with Covid-19 and control group were compared, it was observed that there was increase in the number of Covid-19 patients with blood groups A and AB, decrease in the number of Covid-19 patients with blood group O, a statistically significant increase in the number of individuals with blood group A in Covid-19 patients compared to healthy individuals, and almost significant increase in the number of Covid-19 patients with blood group AB and a very significant decrease in the number of Covid-19 patients with blood group O. Conclusion: Our study has found that having blood group O may be protective, that blood group A may have greater susceptibility to the disease, but this does not affect the course of the disease and is not associated with mortality.

A document by William Jones, written on Authorea.

Background: A novel coronavirus, led to a rapidly spreading outbreak of COVID¬19 which caused morbidity and mortality worldwide. Appropriate case definitions can help in diagnosing COVID¬19. The aim of this study was to evaluate the existing and potential syndromic case definitions of COVID¬19 using latent class analyses (LCA) among hospitalized patients of North Iran. Methods. The data of this cross-sectional study was collected from hospitalized patients tested for COVID-¬19 by RT-PCR between February 20 and August 20, 2020. The sensitivity, specificity, positive, and negative predictive values, and the area under the ROC curve (AUC) of each syndromic pattern (standard case definitions and alternative case definition patterns from Latent Class Analysis (LCA)) were compared and plotted. Results. Among 7,784 hospitalized patients tested for COVID¬19 and included in the analyses, 2,233 (28, 7%) had RT-PCR confirmed COVID-19. The symptoms of fever & chills, cough, breathing difficulty, myalgia, sore throat, headache; and the signs of body temperature >37.8, pharyngeal exudate, and abnormal chest radiography were informative in all syndromic patterns. Among latent classes, symptom-class 3 that was comprised of fever & chills, cough, and breathing difficulty had the greatest AUC. While, among standard syndromic patterns, the WHO-acute respiratory infection (ARI), suspected-COVID-19 and probable-COVID-19 definitions had the greatest sensitivity and AUC. Conclusion. The WHO ARI, suspected-COVID-19, and probable-COVID-19 patterns were the most sensitive for detecting COVID-19 infection among hospitalized patients. However, alternative syndromic patterns can be used in case high specificity is required.

Background Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has resulted in profound health challenges across the globe. Objective This study aims to examine community pharmacists’ views on their work environment, policies, and preparedness for safe retail patronage to prevent the transmission of COVID-19. Setting An online survey of pharmacists practicing in community pharmacy setting in Malaysia. Method A questionnaire-based, cross-sectional study was conducted in Malaysia to evaluate coping strategies of community pharmacists and pharmaceutical services provided during COVID-19 pandemic. Between May 1 and July 31, 2020, the questionnaire was distributed to pharmacists working in community setting nationwide utilizing a snowball sampling method. Main outcome measure Community pharmacists’ perceptions on safety, resilience, organizational support, and pharmaceutical services offered during COVID-19 pandemic. Results A total of 217 pharmacists participated in the study. Most community pharmacists had reported a positive outlook and were able to balance working with self-care during this period. Most had reported to have access to personal protective equipment such as gloves and hand sanitizers. A large proportion of community pharmacies also installed physical barriers in doorways or in front of the counter, put markings on the ground to section areas to ensure physical distancing, and controlled the number of customers who could access the pharmacy during this period. Innovations reported to be implemented included teleconsultations and providing curb-side or drive-through delivery and pickups. Conclusion The findings suggest the front-line and essential roles of community pharmacists in delivering pandemic responses, creating the opportunity to determine areas where community pharmacy services can be incorporated to strengthen the public health system and improve patient health outcomes.

Cryptococcus neoformans infection is a known cause of meningoencephalitis in immunocompromised patients. However, it is less frequent in immunocompetent individuals. Here we report a case of a 60 years old COVID-19 patient with a history of several co-morbidities who received tocilizumab and corticosteroids, which lead to Cryptococcemia.

In a pandemic, where it is impossible to distinguish a pauci-symptomatic/asymptomatic patient, all must be regarded as potentially infected. The symptoms of COVID-19 are non-specific and cannot alone be used for screening. On detecting significant positive women in Non-covid suspect obstetric population led to change in strategies. Application of Truenat test for Covid screening in these asymptomatic obstetric patients on admission led to appropriate segregation of infective patients and avoided extra burden on RT-PCR lab. Our experience may be informative in re-adjusting the existing policies for other healthcare systems while setting up a mixed Covid- obstetric setting.

Aim: To investigate the difference in both numbers and acuity of presentations to the Paediatric Emergency Department (PED) during the peak time period of the current global SARS-CoV-2 pandemic. Design: This single centre retrospective observational study used routinely collected electronic health data to compare patient presentation characteristics between 21st March and 26th April 2020 compared to the equivalent time period in 2019. Results: There was a 90% decrease in attendances to PED, with a 10.23% reduction re-attendance rate. Children presenting were younger during the pandemic, with a median age difference of 2 years. They were more likely to present in an ambulance (9.63%), be admitted to hospital (5.75%) and be assigned the highest two Manchester triage categories (6.26%). There was a non-significant trend towards longer lengths of stay. The top 10 presenting complaints remained constant (although the order changed) between time periods. There was no difference in mortality or admission to PICU. Implications: Our data demonstrates that there has been a significant decrease in numbers of children seeking emergency department care. It suggests that presenting patients were proportionally sicker during the pandemic; however, we would argue that this is more in keeping with appropriate acuity for PED presentations, as there were no differences in PICU admission rate or mortality. We explore some of the possible reasons behind the decrease in presentations and the implications for service planning ahead of the winter months.

In this study, psychosocial impact of coronavirus lockdown on Nigerians was assessed through a cross-sectional descriptive survey across the 36 States and Federal Capital Territory in Nigeria. The survey comprised a sample of 740 adults (54.32% male and 45.68% female). The 3 psychosocial metrics investigated were depression, stress and anxiety. Data obtained in the survey were analysed using the descriptive (percentages and frequency) and inferential (test for association using chi-square trend test-Cochran-Armitage trend) statistics. Findings showed that coronavirus lockdown had a psychosocial impact on Nigerians, particularly on mental wellbeing as agreed upon by 50% of respondents. While the lockdown was established to have ushered in symptoms of anxiety and depression, educational level and religion were statistically significant in association with depression at χ 2 = 11.510, p-value = 0.0007 and χ 2 =8.3419, p-value = 0.0039 respectively. Cases of domestic violence with emphasis on rape increased due to frustration, idleness and inaccessibility to sex commercial workers. Based on these findings, it is concluded that coronavirus lockdown had a psychosocial impact on Nigerians. Therefore, it is recommended that Nigerian governments should put more stringent measures aimed at containing these social vices, by proactively engaging law enforcement agencies to prosecute those that violate curfew hours. Again, the government should devise other measures of involving citizens in proactive activities that could disengage them from inexplicable behavioural patterns; this would enable them develop the right attitude for positive mental wellbeing.