Announcement Effect of COVID-19 on Cryptocurrencies

We performed a meta-analysis comparing the mortality rates after hip and knee joint arthroplasty between the coronavirus 2019 (COVID-19) pandemic and pre-pandemic periods. The purpose of present study was to investigate the impact of the COVID-19 pandemic on mortality rates after hip and knee joint arthroplasty. We systematically searched the MEDLINE, Embase, and Cochrane Library databases for studies published up to 28 March 2022. We included studies which directly compared mortality rates after hip and knee joint arthroplasty between the COVID-19 pandemic and pre-pandemic periods. The methodological quality of the included studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS). We compared the overall mortality rate as the primary outcome. For the subgroup analysis, the mortality rates included were: within 30 days and unrelated to COVID-19; we excluded studies with only elective arthroplasties. Readmission rates following arthroplasties were also compared. We included five studies with 3044 patients, of which 838 patients underwent surgeries during the pandemic period and 2206 patients underwent surgeries in the pre-pandemic period. The mean MINORS score was 15.4/24 (range: 15–16). The overall mortality rate showed no significant differences between the pandemic and pre-pandemic periods (OR, 2.71; 95% CI, 0.78–9.35; p = 0.12; I2 = 19%). No differences were observed in mortality following arthroplasties within 30 days and unrelated to COVID-19 nor in the readmission rates. Mortality, after excluding studies with only elective arthroplasty, presented significant differences between the COVID-19 pandemic and pre-pandemic periods (OR, 3.80; 95% CI, 1.18–12.28; p = 0.03, I2 = 0%). The limitation of the present study was that elective arthroplasty and urgent arthroplasty were not completely differentiated. The overall mortality rate in the COVID-19 pandemic period following hip and knee arthroplasty did not show a significant increase. This finding could help to maintain the practice of elective arthroplasty during a pandemic situation in the future (PROSPERO–CRD42022335471).

IntroductionConflicting reports of increases and decreases in rates of preterm birth (PTB) and stillbirth in the general population during the COVID‐19 pandemic have surfaced. The objective of our study was to conduct a living systematic review and meta‐analyses of studies reporting pregnancy and neonatal outcomes by comparing the pandemic and pre‐pandemic periods.Material and methodsWe searched PubMed and Embase databases, reference lists of articles published up until 14 May 2021 and included English language studies that compared outcomes between the COVID‐19 pandemic time period and pre‐pandemic time periods. Risk of bias was assessed using the Newcastle–Ottawa scale. We conducted random‐effects meta‐analysis using the inverse variance method.ResultsThirty‐seven studies with low‐to‐moderate risk of bias, reporting on 1 677 858 pregnancies during the pandemic period and 21 028 650 pregnancies during the pre‐pandemic period, were included. There was a significant reduction in unadjusted estimates of PTB (28 studies, unadjusted odds ratio [uaOR] 0.94, 95% confidence [CI] 0.91–0.98) but not in adjusted estimates (six studies, adjusted OR [aOR] 0.95, 95% CI 0.80–1.13). The reduction was noted in studies from single centers/health areas (uaOR 0.90, 95% CI 0.86–0.94) but not in regional/national studies (uaOR 0.99, 95% CI 0.95–1.03). There was reduction in spontaneous PTB (five studies, uaOR 0.89, 95% CI 0.82–0.98) and induced PTB (four studies, uaOR 0.90, 95% CI 0.81–1.00). There was no reduction in PTB when stratified by gestational age <34, <32 or <28 weeks. There was no difference in stillbirths between the pandemic and pre‐pandemic time periods (21 studies, uaOR 1.08, 95% CI 0.94–1.23; four studies, aOR 1.06, 95% CI 0.81–1.38). There was an increase in birthweight (six studies, mean difference 17 g, 95% CI 7–28 g) during the pandemic period. There was an increase in maternal mortality (four studies, uaOR 1.15, 95% CI 1.05–1.26), which was mostly influenced by one study from Mexico. There was significant publication bias for the outcome of PTB.ConclusionsThe COVID‐19 pandemic time period may be associated with a reduction in PTB; however, referral bias cannot be excluded. There was no difference in stillbirth between the pandemic and pre‐pandemic period.

Introduction: Many regions around the world have reported declining survival rates from out-of-hospital cardiac arrest (OHCA) during the COVID-19 pandemic. This has been attributed to COVID-19 infection and overwhelmed healthcare services in some regions and imposed social restrictions in others. However, the effect of the pandemic period on CPR quality, which has the potential to impact outcomes, has not yet been described. Methods: A retrospective observational study was performed using data collected in an established OHCA registry in Victoria, Australia. During a pre-pandemic period (11 February 2019-31 January 2020) and the COVID-19 pandemic period (1 February 2020-31 January 2021), 1,111 and 1,349 cases with attempted resuscitation had complete CPR quality data, respectively. The proportion of cases where CPR targets (chest compression fraction [CCF]≥90%, compression depth 5-10cm, compression rate 100-120 per minute, pre-shock pauses &lt;6 seconds, post-shock pauses &lt;5 seconds) were met was compared between the pre-pandemic and pandemic periods. Logistic regression was performed to identify the independent effect of the COVID-19 pandemic on achieving CPR targets. Results: The proportion of arrests where CCF≥90% significantly decreased during the pandemic (57% vs 74% in the pre-pandemic period, p&lt;0.001) as did the proportion with pre-shock pauses &lt;6 seconds (54% vs 62%, p=0.019) and post-shock pauses &lt;5 seconds (68% vs 82%, p&lt;0.001). However, the proportion within target compression rate significantly increased during the pandemic (64% vs 56%, p&lt;0.001). Following multivariable adjustment, the COVID-19 pandemic period was independently associated with a decrease in the odds of achieving a CCF≥90% (adjusted odds ratio [AOR] 0.47 [95% CI 0.40, 0.56]), a decrease in the odds of achieving pre-shock pauses&lt;6 seconds (AOR 0.71 [95% CI 0.52, 0.96]), and a decrease in the odds of achieving post-shock pauses&lt;5 seconds (AOR 0.49 [95% CI 0.34, 0.71]). Conclusion: CPR quality was impacted during the COVID-19 pandemic period which may have contributed to a decrease in OHCA survival previously identified. These findings reinforce the importance of maintaining effective resuscitation practices despite changes to clinical context.

358 The Impact of COVID-19 on Diabetic Ketoacidosis Patients

To verify whether the COVID-19 pandemic has had an impact on the safety climate based on the perception of the multiprofessional team in the operating room and to analyze the domains of the safety climate during the pre-pandemic and pandemic period of COVID-19, demonstrating the intersections of quantitative and qualitative approaches. Mixed-method research using a convergent approach strategy, carried out in the operating room of a university hospital, located in Rio de Janeiro, Brazil. The nature of the quantitative phase was cross-sectional, and the nature of the qualitative phase was descriptive. We used the Pillar Integration Process to integrate the data. This research considered the pre-pandemic period was defined as before March 2020 and for the pandemic period, the 2nd and 3rd global waves. Research was approved by the institution's board management and ethics committee. 145 health professionals participated in the quantitative approach, and 20 in the qualitative approach. The impact of the COVID-19 pandemic was highlighted in the domains 'Perceived stress' (p-value = 0.017); 'Working conditions' (p-value = 0.040). Six categories emerged from the qualitative analysis, namely: Stress and professional performance due to COVID-19; Patient safety protocols in the operating room; Responsibility for patient safety, lack of effective communication and performance feedback; Biosafety of the professional staff in the operating room; Security culture maturity; Fair culture, organizational learning, and reporting mistakes. As a result of the data integration, 6 pillars were identified: Perception of communication in the operating room; Evolution of safety culture; Overview of protocol management and implementation; Fair organizational culture; Perception of stress due to COVID-19; Perception of professional performance due to COVID-19. The impact that COVID-19 had on the safety climate in the operating room is evident. It underlines the need to implement strategies that support the solidification of attitudes aimed at patient safety, even in emergencies.

Background: Irrational antibiotic use among hospitalized patients can lead to antibiotic resistance. For rational use, the WHO introduced the Access, Watch, and Reserve (AWaRe) classification of antibiotics. We explored antibiotic use according to the AWaRe classification among patients hospitalized with severe acute respiratory infection (SARI) between the prepandemic and COVID-19 pandemic periods in Bangladesh. Methods: From June 2017 to November 2022, we analyzed SARI inpatient data from the hospital-based influenza surveillance platform at 9 tertiary-level hospitals in Bangladesh. We defined June 2017–February 2020 as the prepandemic period and March 2020–November 2022 as the pandemic period. Physicians identified inpatients meeting the WHO SARI case definition and recorded patient demographics, clinical characteristics, and antibiotics received during hospitalization. We used descriptive statistics to summarize the data. Results: We enrolled 20,640 SARI patients (median age, 20 years; IQR, 1.6–50; 63% male); and among them, 18,197 (88%) received antibiotics (26% of those received &gt;1 different course of antibiotics). Compared to the prepandemic period, the proportion of antibiotic use among SARI patients was higher during the pandemic: 93% (9,887 of 10,655) versus 83% (8,310 of 9,985) (P &lt; .001). According to AWaRe classification, Access, Watch, and Reserve groups accounted for 32% (n = 2,623), 86% (n = 7,158), and 0.05% (n = 4), respectively, before the pandemic and 32% (n = 3,194), 90% (n = 8,850), and 0.08% (n = 8), respectively, during the pandemic (Fig.). The most common antibiotic prescribed for children aged &lt;5 years during the prepandemic was ceftriaxone (n = 1,940, 74%), followed by amikacin (n = 325, 13%) and flucloxacillin (n = 300, 12%); similarly, during the pandemic, most common antibiotic prescribed was ceftriaxone (n = 3,097, 79%), followed by amikacin (n = 723, 18%) and flucloxacillin (n = 348, 9%). The most common antibiotic prescribed for patients aged ≥5 years during the prepandemic period was ceftriaxone (n = 3,174, 54%), followed by amoxicillin-clavulanic acid (n = 1,304, 22%) and azithromycin (n = 1,038, 18%). During the pandemic, the most common antibiotic prescribed for patients aged ≥5 years was ceftriaxone (n = 3,793, 64%), followed by amoxicillin-clavulanic acid (n = 1,327, 22%) and clarithromycin (n = 797, 13%). Among children aged &lt;5 years, use of the Watch group of antibiotics during the prepandemic and pandemic periods was similar: 94% (n = 3,688) versus 95% (n = 2,347) (P = .099). However, among patients aged ≥5 years, the use of Watch antibiotics was higher during the pandemic compared to the prepandemic period: 87% (n = 5,163) versus 82% (n = 4,811) (P &lt; .001). Conclusions: Use of antibiotics in the Watch group was predominant among SARI patients both before and during the COVID-19 pandemic, and it increased among SARI patients aged ≥5 years during the pandemic period in Bangladesh. Promoting antibiotic stewardship programs for physicians, including in-service training on antibiotic use, could reduce irrational antibiotic use, which might contribute to mitigating antibiotic resistance in the country.Financial support: This study was funded by the CDC.Disclosures: None

Background and Objectives: Vitamin D is synthesized in the skin upon sunlight exposure, showing variations with season and latitude. We aimed to investigate the influence of age, sex, and season on vitamin D status in a large pediatric cohort during the COVID-19 pandemic period and the corresponding pre-pandemic period. Materials and Methods: Retrospective data concerning subjects aged < 18 years were extracted anonymously from the large database of a reference laboratory hospital (Sassari, Northern Sardinia, Italy). Serum 25-hydroxyvitamin D [25(OH)D] levels measured during the pre-pandemic period (1 March 2018 to 30 September 2019) were compared with those detected during the pandemic period (1 March 2020 to 30 September 2021). Results: A total of 2317 samples from subjects aged < 18 years were included in the analysis, 1303 (47.9% females) of which were collected in the pre-pandemic period and 1014 (51.3% females) in the pandemic period. No significant differences in 25(OH)D levels were found between the two periods, whereas, in children aged < 2 years, levels were higher than those in children aged 11-16 years (p < 0.05). Monthly levels of 25(OH)D between pre-pandemic and pandemic periods did not differ, although significant differences were detected across months (p < 0.0001). Similarly, 25(OH)D values did not differ significantly between males and females in both periods. Marked seasonal variations were observed in males and females across all age groups. Conclusions: Serum vitamin D levels and their season-related variations were not significantly affected by the COVID-19 pandemic and associated restrictions in a large cohort of Italian children and adolescents.

Strategies to Mitigate the Pandemic Aftermath on Perioperative Professionalism

Turnaround time is an integral component of primary healthcare and is a key performance indicator of healthcare delivery. It is defined as the time patients spend during a healthcare facility visit. In this study, turnaround time is defined as the time elapsed from registration to the end of consultation. This study aimed to determine the turnaround time of consults in the primary care system in a rural site in the Philippines, and compare turnaround time during the pre-pandemic and COVID-19 pandemic periods. This is a retrospective cohort study of patients seen at the primary care facility under the Philippine Primary Care Studies (PPCS) rural site from April 2019 to March 2021. Patients included in this study were chosen through random sampling. Electronic medical records (EMR) of these patients were reviewed. Turnaround time was computed electronically from time of registration to end of consultation. Descriptive statistics was used to summarize data and report turnaround time. The turnaround time before and during the pandemic was compared using an independent sample t-test (if normally distributed) or Mann Whitney U test (if not normally distributed). A p-value of <0.05 was considered statistically significant. A random sample of 342 patients out of the total 45,501 patient consults seen at the rural primary healthcare facility from April 2019 to March 2021 were included in this study. The median turnaround time was 29.0 minutes (interquartile range [IQR] 68.3), with range of 0.9 to 437.2 minutes. During the pre-pandemic period, the median turnaround time of consults is 29.3 minutes (IQR 70.4) which is 1.8 minutes longer than the pandemic period which showed median turnaround time of 27.5 minutes (IQR 72.7). The difference between the two time periods was not statistically significant (P = 0.39). The study showed that the median turnaround time of medical consults was 29.0 minutes, which was shorter by 80 minutes compared to other published Philippine studies. The turnaround time did not differ significantly in the pandemic and pre-pandemic period, despite new policies and systems that were implemented during the pandemic.

BackgroundSevere acute respiratory infection (SARI) is a leading cause of mortality globally, peaking during the COVID-19 pandemic. We analyzed SARI-associated deaths during the pre-and-pandemic periods in Bangladesh to identify the contributing factors.MethodsWe analyzed data from hospital-based influenza surveillance at nine tertiary-level hospitals in Bangladesh. We considered March 2018–February 2020 as the pre-pandemic period and March 2020–February 2022 as the pandemic period and included adult (≥ 18 years) participants in our study. Surveillance physicians identified WHO-SARI case definition meeting inpatients and collected demographics, clinical characteristics, and outcomes at hospital discharge and 30 days post-discharge. We performed rRT-PCR for influenza and SARS-CoV-2 viruses on collected nasopharyngeal and oropharyngeal swabs. We used multivariable Cox's regression models to calculate the hazard ratio (HR) for factors associated with SARI deaths in these adult patients.ResultsWe enrolled 4392 SARI patients during the pre-pandemic and 3824 SARI patients during the pandemic period. Case fatality ratio was higher during the pandemic: 13.62% (521) [in-hospital: 6.45% (247); post-discharge: 7.17% (274)] compared to pre-pandemic, 6.01% (264) [in-hospital: 2.01% (89), post-discharge: 4% (175)] (p < 0.001). Pre-pandemic, influenza was detected in 14% (37/264) of SARI deaths. Influenza was detected during the pandemic in 2.3% (12/521), SARS-CoV-2 in 41.8% (218/521), and both viruses in only one SARI death. History of smoking and the presence of 1 or more co-morbid conditions independently attributed to SARI deaths in adults in the pre-pandemic period. SARI deaths in such patients were also associated with respiratory difficulties on admission in both pre-pandemic (aHR 2.36; 95% CI:1.65–3.36) and pandemic period (aHR 2.30; 95% CI: 1.57–3.35) after accounting for age, sex, smoking status, presence of 1 or more co-morbid conditions, and detection of influenza and SARS-CoV-2 viruses.ConclusionsDuring the pandemic, SARI mortality increased; influenza-associated mortality declined, and SARS-CoV-2 caused over a third of SARI deaths. Post-discharge mortality was higher than in-hospital mortality during both periods. Limiting premature discharge and strengthening post-discharge monitoring and nursing services could reduce unexpected deaths. Formative research to better understand post-discharge mortality is essential to reduce SARI deaths.

Evidence suggests growing opioid-related toxicity deaths within shelters that has been exacerbated by the COVID-19 pandemic. We sought to characterise opioid-related toxicity deaths within Ontario shelters before and during the pandemic. A descriptive cross-sectional study of people who died of an accidental opioid toxicity, where the location of the incident (ie, toxicity) was within a shelter in Ontario, Canada, was conducted. The primary analysis was restricted to conventional shelter spaces as classified by the coroner (ie, excluding temporary COVID-19 emergency shelters in hotels). Characteristics, circumstances surrounding death and patterns of healthcare use preceding death in the pre-pandemic period (1 January 2018-16 March 2020) and the COVID-19 pandemic period (17 March 2020-31 May 2022) were summarised. Overall, opioid-related toxicity deaths within Ontario shelters more than tripled when comparing the pre-pandemic (n=48) with the pandemic period (n=162). Fentanyl directly contributed to the majority of these deaths, and its role as a direct contributor to death rose during the pandemic (from 85.4% to 94.4%; p=0.04), as did those of any stimulants (from 43.8% to 71.0%; p< 0.001). Moreover, benzodiazepine detection in opioid-related toxicity deaths increased during the pandemic (from 27.1% to 56.8%; p<0.001). In both the pre-pandemic and pandemic periods, more than half of the recorded deaths occurred among people with a diagnosis of an opioid use disorder (59.6% vs 53.5%; p=0.46), and a large percentage of people had a healthcare encounter in the week before death (46.8% vs 43.9%; p=0.73). Opioid-related toxicity deaths within Ontario's shelters have increased rapidly over the study period, with notable changes in the circumstances of death and patterns of non-pharmaceutical opioid involvement during the COVID-19 pandemic period. This study demonstrates the urgent need to expand programme and policy interventions tailored toward harm reduction within Ontario's shelter system.

The objective of this study was to analyze the temporal and spatial trends of accidents involving venomous animals in Brazil during the pre- and COVID-19 pandemic periods. We conducted a population-based ecological study using comprehensive data from the Notifiable Diseases Information System, covering all accidents involving venomous animals in Brazil from January 2013 to December 2022. We did a temporospatial analysis to compare the incidence rates of accidents involving venomous animals per Brazilian municipality in the pre-pandemic period (January 2013 to February 2020) and the pandemic period (March 2020 to December 2022). To analyze the trend, the seasonal-trend model was used based on the classic additive decomposition model. For spatial distribution analysis, the Global Moran's Index was used. A total of 2,202,842 cases of accidents involving venomous animals were recorded. Brazil showed an increasing trend from 2017 to 2019 (annual percentage change [APC]: 0.98, p<0.001) and a stable trend from 2020 to 2022 (APC: 0.42, p<0.080). The North (APC: 0.19, p<0.330), South (APC: 0.04, p<0.953), and Southeast (APC: 0.26, p<0.312) regions presented a stable trend from 2020 to 2022. Spatial dependence of smoothed rates was observed in both the pre-pandemic (Moran's I: 0.47; p=0.000) and COVID-19 pandemic periods (Moran's I: 0.50; p=0.000). There was a stable trend in accidents involving venomous animals from 2020 to 2022 in Brazil. The spatial distribution of cases was heterogeneous for both periods studied.

The COVID-19 pandemic burdens hospitals, but consequences for quality of care outcomes such as healthcare-associated infections are largely unknown. This cohort included all adult hospital episodes (n=186 945) at an...

Globally diarrheal illness is the second leading reason behind death in kids underneath 5 years accounting for 525 000 kids death annually, which can be treated and prevented if timely interventions are applied as well as can be prevented through safe drinking-water with adequate sanitation and hygiene. Global prevalence of childhood diarrhoea is about 1.7 billion cases per annum. SARS-CoV utilize the Angiotensin-converting enzyme 2 (ACE2) with the serine protease TMPRSS2 for S protein priming. ACE2 and TMPRSS2 are expressed in lung, as well as small intestinal epithelia, added to this the ACE2 is expressed in the oesophagus, liver, and colon; SARS-CoV-2 binds strongly with ACE2 (10–20 times) compared with other SARS-CoV. The purpose of this research is to examine the epidemiology of childhood diarrheal events during COVID-19-period and comparing it with the pre-pandemic period of 2018-2019 as well as monthly-seasonal-temperature variations during different months of pre-pandemic and pandemic period associated diarrhoea to identify any changes in the usual seasonal pattern of childhood diarrheal events. A total of 11171113 eligible childhood diarrhoea (0-5 years) and 1704819 Childhood diarrhoea treated in Inpatients (0-5 years) were analyzed during the 41 month study period. A total of 11171113 (mean-272466.2; [95% Conf. Interval means] 250375.4-294556.9) childhood diarrhoea (mean-; [95% Conf. Interval means]) (0-5 years), 1704819 (mean 41580.95-; [95% Conf. Interval means 36458.75-46703.15])childhood diarrhoea treated in Inpatients (0-5 years), 7603860 (mean 185460-; [95% Conf. Interval means 159578.8-211341.2])were included in this study on an all-India basis. The 41 months of study when grouped into two groups as pre-pandemic era and pandemic era shows that the Monthly /seasonally Prevalence of Childhood diarrhoea (0-5 years) were MAX in July 2019 monsoon season during pre-pandemic period with 418722 cases ([95% CONF. INTERVAL] 299758.7-338763.3; STD. ERR.-9427.519; MEAN-319261; STD. DEV-46185.22; and MIN-261319 in December 2019, post monsoon season, See table- 1, 3, and 4; figure-5 and 6. During the COVID-19 pandemic period Monthly /seasonally Prevalence of Childhood diarrhoea (0-5 years) were MAX in February 2020 winter season during pre-pandemic period with 284075 cases ([95% CONF. INTERVAL] 188170.3 - 224635.3; STD. ERR.- 8600.616; MEAN206402.8; STD. DEV- 35461.25; and MIN-158007 in April 2020.

<b>Objective:</b> To analyse whether the COVID-19 pandemic (2020) resulted in differences in the characteristics of hospital admissions for a respiratory infection in adults with bronchiectasis compared to the pre-COVID-19 period. <b>Methods:</b> An observational, retrospective study enrolling all adults admitted to the hospital between Jan 2009 and Dec 2020 for a respiratory infection with a computed-tomography-confirmed bronchiectasis. Admissions for COVID-19 were excluded. Sociodemographic data, clinical data and admission characteristics were compared between pre-pandemic (2019) and pandemic (2020) period. <b>Results:</b> In 2019, 35 patients were admitted with a mean age of 77y (11), classified the 60% of them as severe according to the Bronchiectasis Severity Index (BSI). Three of these patients had to be readmitted in the same year. During this period, the proportion of admissions tested for viral infection was 28% and for bacterial infection was 72% of hospitalizations. A total of 25 patients were admitted in 2020, with a mean age of 74y (12), being the 76% severe. Readmissions in the same period were observed in four of these patients. Of the admissions, 57% were tested for viral infection and 73% for bacterial infection. The only difference observed for admission characteristics between both periods was the number of test for virus detection (11 (28%) in 2019 <i>vs.</i> 19 (57%) in 2020; p=0.02) (table 1). <b>Conclusions:</b> The number of viral infection test seems to increase during the pandemic period in comparison with pre-pandemic period during admissions for an exacerbation in adult patients with bronchiectasis.