Mild Symptomatic Cases Research Articles

Research on demand forecasting and distribution of emergency medical supplies using an agent-based model

The global health crisis caused by SARS-CoV-2 since 2019 has emphasized the critical significance of effective disease detection and treatment in minimizing infection rates and fatalities, as well as halting the spread of pandemics. During an outbreak, individuals suspected of being infected require a significant amount of testing resources, while those confirmed to be infected demand substantial treatment resources. Hence, this paper is dedicated to presenting a new pandemic model that enables joint forecasting and allocation of resources for testing and treatment. The proposed model in this paper is an innovative agent-based epidemic compartmental model, which also incorporates a mixed integer model. It integrates novel features based on crucial disease characteristics, such as self-healing for asymptomatic or mild-symptomatic cases, varying infection risk levels among different groups, and the inclusion of secondary infections. Moreover, the solutions of the joint allocation model are compared with those of the independent allocation model, which entails considering resource interactions rather than allocating each resource independently. Furthermore, the validity of this model was confirmed through real-world data obtained during the SARS-CoV-2 outbreak in China. The findings offer valuable insights into the impact of intervention levels and duration, joint allocation schemes, as well as optimal allocation of test and treatment resources on cross-regional transmission of the pandemic.

Foreign Body Aspiration in Children-Retrospective Study and Management Novelties.

Foreign body aspiration (FBA) is a frequent diagnosis in children. In the absence of other lung conditions, such as asthma or chronic pulmonary infections, this manifests as a sudden onset of cough, dyspnea, and wheezing. The differential diagnosis is based on a scoring system which takes into account the clinical picture as well as the radiologic aspects. The treatment that is considered the gold-standard for FBA in children remains to be rigid fibronchoscopy, however it comes with several potentially crucial local complications such as airway edema, bleeding, and bronchospasm, along inherent issues due to general anesthesia. Material and methods: Our study is a retrospective study analyzing the medical files of the cases from our hospital over the span of 9 years. The study group consisted of 242 patients aged 0-16 years diagnosed with foreign body aspiration in the Emergency Clinical Hospital for Children "Sfânta Maria" Iași, between January 2010-January 2018. Clinical and imaging data were extracted from the patients' observation sheets. Results: In our cohort, the distribution of children with foreign body aspiration was uneven, with the highest incidence being reported in children from rural areas (70% of cases), whereas the most affected age group was 1-3 years, amounting to 79% of all cases. The main symptoms which led to emergency admittance were coughing (33%) and dyspnea (22%). The most important factors that determined the unequal distribution were socio-economic status, which relates to a lack of adequate supervision by parents, as well as the consumption of food inappropriate for their age. Conclusions: Foreign body aspiration is a major medical emergency that may be associated with dramatic clinical manifestations. Several scoring algorithms designed to establish the need for bronchoscopy have been proposed, taking into account both the clinical and radiological results. The issue with asymptomatic or mild symptomatic cases, as well as difficulties managing cases with radiolucent foreign bodies, remains a challenge.

Design of effective outpatient sentinel surveillance for COVID-19 decision-making: a modeling study

BackgroundDecision-makers impose COVID-19 mitigations based on public health indicators such as reported cases, which are sensitive to fluctuations in supply and demand for diagnostic testing, and hospital admissions, which lag infections by up to two weeks. Imposing mitigations too early has unnecessary economic costs while imposing too late leads to uncontrolled epidemics with unnecessary cases and deaths. Sentinel surveillance of recently-symptomatic individuals in outpatient testing sites may overcome biases and lags in conventional indicators, but the minimal outpatient sentinel surveillance system needed for reliable trend estimation remains unknown.MethodsWe used a stochastic, compartmental transmission model to evaluate the performance of various surveillance indicators at reliably triggering an alarm in response to, but not before, a step increase in transmission of SARS-CoV-2. The surveillance indicators included hospital admissions, hospital occupancy, and sentinel cases with varying levels of sampling effort capturing 5, 10, 20, 50, or 100% of incident mild cases. We tested 3 levels of transmission increase, 3 population sizes, and conditions of either simultaneous transmission increase or lagged increase in the older population. We compared the indicators’ performance at triggering alarm soon after, but not prior, to the transmission increase.ResultsCompared to surveillance based on hospital admissions, outpatient sentinel surveillance that captured at least 20% of incident mild cases could trigger an alarm 2 to 5 days earlier for a mild increase in transmission and 6 days earlier for a moderate or strong increase. Sentinel surveillance triggered fewer false alarms and averted more deaths per day spent in mitigation. When transmission increase in older populations lagged the increase in younger populations by 14 days, sentinel surveillance extended its lead time over hospital admissions by an additional 2 days.ConclusionsSentinel surveillance of mild symptomatic cases can provide more timely and reliable information on changes in transmission to inform decision-makers in an epidemic like COVID-19.

Being Depressed or Having Depression. The biomedical model and the difference between mood and illness

Along with the increase in reported figures of depression in the world's population, organizations such as the WHO have begun to promote screening and pharmacological treatment of mild symptomatic cases. The problem in this context is that the manifestations of 'normal' and 'pathological' depressive mood do not differ much from each other, which creates difficulties at a diagnostic and scientific level. This article explores an approach that could facilitate the clinical and scientific task of differentiating between non-specific affective disturbances (depressive mood) and depression as an illness as such. It is proposed that various causal stressors interact with individual predispositions to trigger a transient change in mood as an adaptive response. In turn, the greater the intensity of the stressors (psychological, social, etc.), the greater the neuroinflammation, which would diminish neuronal plasticity and the possibilities of mood compensation and behavioral change of the subject. The existence of this neurobiological alteration (decreased neuronal plasticity), rather than depressive mood, would help us to categorize depression as a disease.

COVID-19 Pandemic: Assessment of Current Strategies and Socio-economic Impact

The coronavirus disease is a respiratory tract disorder which causes pneumonia-like symptoms in severe patients and mild flu-like symptoms in mild symptomatic cases first noticed in Wuhan, China. DNA sequencing and further analysis shows it to be 79% like the 2002 SARS-CoV and 50% like the 2012 MERS-CoV. It was also observed that the novel coronavirus’s spike protein was larger and very different from its previously known strains. For diagnosis, multiple strategies were developed and real time reverse-transcriptase-polymerase chain reaction (RT-PCR) technique was determined to be the best technique. The CT scan was also found effective majorly for the continuous assessment of the disease. Treatment strategies used in previous outbreaks were looked into and put to trial like convalescent plasma therapy. Vaccine development using various genetic engineering strategies are going on across the world. To contain the spread of the disease, countries with positive cases were put under lockdown to break the chain of spread. These lockdowns forced industries, offices, schools, religious places, stadiums, travel, and many more to close which impacted the economies of all the major countries. Lesser human interaction and more use of social media has impacted the social aspects of human life. Cases of domestic violence and mental stress increased among households. Economic stimulus package was announced by various countries to curb the socio-economic impact of the COVID-19 pandemic.

Obstetrical and Neonatal Outcome of Pregnancies Complicated with SARS-COV-2 Infection

COVID-19 pandemic had an impact without precedent. Pregnant women are part of the vulnerable population and the extent of SARS-CoV-2 infection consequences on obstetrical and neonatal outcome are still studied. It’s been speculated, based on what is known about other pathogenic viruses, SARS-CoV-2 virus can interfere with placental defense mechanisms and increase the miscarriage and preterm birth rate. Often, pregnant women infected with SARS-CoV-2 virus develop mild pneumonia. Severe pneumonia occurs very rarely and is statistically significant related to neonatal death. Our study has been conducted in a multidisciplinary hospital unit and included 184 pregnant women with SARS-COV-2 infection who gave birth in our hospital, diagnosed through polymerase chain reaction. There have been analyzed data regarding the maternal symptomatology, the gestational age, the method of giving birth, complications that have occurred during birth, the newborns weight and neonatal outcome through Apgar score. There have been threecases of severe infection with maternal death and one case with neonatal death. Overall, 20% of patients had mild symptomatology, 2% had severe form and the rest of the patients were asymptomatic. We found a high rate of preterm birth and intrauterine growth restriction and an increase incidence of acute fetal distress followed by caesareansection. SARS-CoV-2 virus affects both the mother and the fetus as a whole and, subsequently, individually. Our results show the adverse obstetrical and neonatal outcome in peripartum period complicated with SARS-CoV-2 infection even in asymptomatic and mild-symptomatic cases.

Clinical and genomic data of sars-cov-2 detected in maternal–fetal interface during the first wave of infection in Brazil

Brazil has the highest SARS-CoV-2 case-fatality rate in pregnant women in the Americas. In this study, clinical and virological findings of five mildly symptomatic pregnant women and their infected fetuses/newborns treated at a referral hospital for COVID19-pregnant women in Midwestern Brazil are reported. Mother and fetal samples were tested by RT-qPCR, ECLIA and Illumina MiSeq sequencing. From the five cases, one resulted in spontaneous abortion, one was stillborn, two were preterm births and one full-term birth. Maternal and fetal placenta, newborn and stillborn secretions were SARS-CoV-2+; one neonate developed ground-glass opacities in his lungs. One neonate's umbilical cord was IgG+ and all were IgM negative upon hospital discharge. Genomes recovered from two placentas belong to the B.1.1.28 and B.1.1.33 lineages and present nonsynonymous mutations associated with virus fitness and infectivity; other not frequently reported mutations (B.1.1.33: NSP3 V2090G, M A2S and ORF3ab S253P and Y264N; B.1.1.28: NSP3 E995D, NSP12 R240K, NSP14H1897Y and in ORF7b V21F) were found in proteins involved in viral replication, viral induction of apoptosis, viral interference on interferon and on NF-Κβ pathways. Phylogeny indicates the south of Brazil as the possible origin of these lineages circulating in Mato Grosso State. These findings contribute to describe SARS-CoV-2 infection and outcomes in pregnant women and their fetuses, at any stage of gestation and even in mild symptomatic cases.

Surveillance Web System and Mouthwash-Saliva qPCR for Labor Ambulatory SARS-CoV-2 Detection and Prevention.

This study provides a safe and low-cost in-house protocol for RT-qPCR-based detection of SARS-CoV-2 using mouthwash–saliva self-collected specimens to achieve clinical and epidemiological surveillance in a real-time web environment applied to ambulatory populations. The in-house protocol comprises a mouthwash–saliva self-collected specimen, heat virus inactivation, and primers to target virus N-gene region and the human RPP30-gene. Aligning with 209 SARS-CoV-2 sequences confirmed specificity including the Alpha variant from the UK. Development, validation, and statistical comparison with official nasopharyngeal swabbing RT-qPCR test were conducted with 115 specimens of ambulatory volunteers. A web–mobile application platform was developed to integrate a real-time epidemiological and clinical core baseline database with mouthwash–saliva RT-qPCR testing. Nine built-in algorithms were generated for decision-making on testing, confining, monitoring, and self-reports to family, social, and work environments. Epidemiological and clinical follow-up and SARS-CoV-2 testing generated a database of 37,351 entries allowing individual decision-making for prevention. Mouthwash–saliva had higher sensitivity than nasopharyngeal swabbing in detecting asymptomatic and mild symptomatic cases with 720 viral copy number (VCN)/mL as the detection limit (Ct = 37.6). Cycling threshold and viral loading were marginally different (p = 0.057) between asymptomatic (35 Ct ± 2.8; 21,767.7 VCN/mL, range 720–77,278) and symptomatic (31.3 Ct ± 4.5; 747,294.3 VCN/mL, range 1433.6–3.08 × 106). We provided proof-of-concept evidence of effective surveillance to target asymptomatic and moderate symptomatic ambulatory individuals based on integrating a bio-safety level II laboratory, self-collected, low-risk, low-cost detection protocol, and a real-time digital monitoring system. Mouthwash–saliva was effective for SARS-CoV-2 sampling for the first time at the community level.

Prevalence of Olfactory Dysfunction Among COVID-19 Patients with Self-Reported Smell Loss Versus Objective Olfactory Tests: A Systematic Review and Meta-Analysis

ABSTRACTBackground: Olfactory dysfunction (OD) in COVID-19 presents as a sudden onset smell loss commonly seen in mild symptomatic cases with or without rhinitis but can occur as an isolated symptom. The reported prevalence of OD among COVID-19 patients ranged from 5% to 98%. Although numerous studies have been conducted about their association, these were mainly based on self-reported cases and subjective questionnaires.
 Objective: This study investigates whether there is a significant difference in the prevalence of olfactory dysfunction between self-reported and objective testing using validated objective olfactory tests among RT-PCR confirmed COVID-19 patients.
 Methods: PubMed (MEDLINE), Cochrane, Web of Science, and Google Scholar were searched for studies investigating the prevalence of OD by using objective olfactory tests among patients who self-reported OD (November 1, 2019 to July 31, 2020). All studies were assessed for quality and bias using the Cochrane bias tool. Patient demographics, type of objective olfactory test, and results of self-reported OD and objective testing were reported.
 Results: Nine studies encompassing 673 patients met the inclusion criteria. Validated objective olfactory tests used in the included studies were CCCRC, SST and SIT. Overall prevalence of OD among patients who self-reported was higher after objective testing (71% versus 81%). This was also seen in when we performed subgroup analysis based on the objective tests that were used. However, meta-analysis using random effects model showed no significant difference in the overall prevalence of OD (p value=.479, 95% CI 56.6 to 84.0 versus 71.2 to 89.8) as well as in the subgroups.
 Conclusion: To the best of our knowledge, this is the first meta-analysis that statistically reviewed articles that evaluated the difference between self-reported and objective tests done on the same patients. Results showing that self-reporting OD approximates the results of the objective tests among COVID-19 positive patients may imply that self-reporting can be sufficient in contact tracing and triggering swabbing and self quarantine during the time of COVID-19 and objective tests can be used as an adjunct in the diagnosis particularly in research. However, this study was limited by small sample size and articles done in European countries hence, interpretation and application of the results of this study must be approached with care. Further studies documenting the difference between self-reporting and objective test in large scale setting involving different countries may be helpful in establishing a definitive consensus.

Early and consecutive RT-PCR tests with both oropharyngeal swabs and sputum could improve testing yield for patients with COVID-19: An observation cohort study in China

ObjectiveThe real-time polymerase chain reaction (RT-PCR) test is recommended for the diagnosis of COVID-19 and provides a powerful tool to identify new infections and facilitate contact tracing. In fact, as the prevalence of COVID-19 decreases, this RT-PCR testing remains as the main preventive measure to avoid rebound. However, inconsistent results can lead to misdiagnoses in the clinic. These inconsistencies are due to the variability in (1) the collection times of biological samples post infection, and (2) sampling procedures. MethodsWe applied the Kaplan–Meier method and multivariate logistic regression on RT-PCR results from 258 confirmed patients with COVID-19 to evaluate the factors associated with negative conversion. We also estimated the proportion (%) of negative conversion among patients who had tested twice or more, and compared the proportions arising from oropharyngeal swabs, sputum, and combined double testing, respectively. Main resultsThe proportion of negative conversion was 6.7% on day 4, 16.4% on day 7, 41.0% at 2 weeks, and 61.0% at 3 weeks post-admission. We also found that 34.1% and 60.3% of subjects had at least one negative RT-PCR result on days 7 and 14 after the onset of symptoms, respectively. The proportion of negative conversions following sputum testing was higher than that from oropharyngeal swabs in the early stages but this declined after the onset of symptoms. ConclusionIn the absence of effective treatments or vaccines, efficient testing strategies are critical if we are to control the COVID-19 epidemic. According to this study, early, consecutive and combined double testing, will be the key to identify infected patients, particularly for asymptomatic and mild symptomatic cases. These strategies will minimize misdiagnosis and the ineffective isolation of infected patients.

A retrospective analysis of Ayurvedic clinical management of mild COVID-19 patients

BACKGROUND: The COVID-19 virus is a new contagious pathogen which has made a huge impact on health, economic and societal perspectives of our country. Early detection, rapid isolation, and adoption of effective infection prevention and control (IPC) measures are key to preventing and controlling COVID-19 infection. Patients are now receiving symptomatic treatment. This retrospective study aims to assess and comprehend the effectiveness of Ayurvedic interventions in the treatment of mild symptomatic COVID-19 patients. OBJECTIVE: The objective of this study is to analyze the outcome of Ayurvedic interventions in managing mild symptomatic COVID-19-infected cases. MATERIALS AND METHODS: COVID-19 patients (diagnosed through RT-PCR test) admitted at Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh were treated with Ayurvedic interventions. The data were collected and have been analyzed retrospectively. Data collected were systematically analyzed and presented using appropriate software (SPSS version 21). RESULTS: The treatment given in this particular study were aimed at dissipating the pathogenesis based on Ayurvedic principles of management. Relief in major clinical symptoms such as fever, cough, and throat pain has been observed in studied cases of COVID-19. The clinical recovery rate observed in this study was 94.3%, which is comparatively high with reference to the current clinical recovery rate, i.e., 69.5% in Chandigarh (India). CONCLUSION: The Ayurvedic interventions, AYUSH-64, Agasthya Hareetaki Rasayana, and Anu Taila Nasya, may play a major role in managing mild symptomatic cases of COVID-19. IEC number: 8-55/2020-CARIRD/TECH/COVID/149

A prospective, open label clinical study to evaluate the safety, efficacy and tolerability of azadvir herbal steam inhaler in asymptomatic, mildly symptomatic COVID-19 patients and health care workers posted to covid wards

Background: COVID-19 patients experience cytokine storm which cause pulmonary and extra-pulmonary complications even with currently available of standard of care. Additional antiviral and immune boosters are the need of hour to treat COVID-19 and to prevent post covid complications.Methods: In this study we enrolled 40 asymptomatic to mild COVID-19 patients to receive azadvir herbal steam inhaler along with standard of care. We evaluated the benefits of azadvir herbal steam inhaler by assessing RT-PCR conversion, clinical outcomes and improvement in immune markers (LDH, CRP, D-DIMER).Results: At the end of the study the immune markers improved significantly in study patients. In mild symptomatic cases IL-6 was 23.2 pg/ml on day 0 and 21.8 pg/ml on day 14. Reduction in IL-6 in mild symptomatic patients was statistically highly significant (p=0.0056). Mean IL-6 in asymptomatic patients was 22.3 pg/ml on day 0 and 21.1 pg/ml on day 14. Reduction in IL-6 in asymptomatic patients was statistically highly significant (p=0.0035). Mean D-dimer was showing decreasing trend from day 0 to day 14 in mild symptomatic patients. In asymptomatic patients D dimer was 0.8 µg/ml on day 0 and 0.6 µg/ml on day 14. D-dimer decreased significantly from day 0 to day 14 (p value =0.0013). Mean LDH values on day 0 in mild symptomatic patients was 319.4 U/l and 219.3 on day 14. The reduction in LDH values in mild symptomatic patients is statistically significant (p value <0.0122). In asymptomatic patients mean LDH values on day 0 was 237 U/l and 194 U/l on day 14. The reduction in LDH values in asymptomatic group was statistically significant. Mean CRP values in mild symptomatic patients on day 0 was 12.2 mg/l and 3.8 mg/l on day 14. There was significant reduction in CRP values in mild symptomatic group which was statistically significant (p value =0.0546). Mean CRP values in asymptomatic patients on day 0 was 4.9 mg/l and 2.8 mg/l on day 14. There was significant reduction in mean CRP in asymptomatic patients which was statistically significant (p value =0.0446). In the present study all 40 patients (100%) cleared the virus and became negative for RT PCR test within 6 days. None of the patients progressed to severe COVID-19 and none of the patients succumbed to the disease.Conclusions: Azadvir accelerated recovery of COVID-19 patients by RT-PCR conversion, early improvement in clinical symptoms and immune markers in this study. This study results clearly indicates that azadvir has antiviral, immune booster activity and has definitive role in the management of asymptomatic to mild COVID-19 patients along with standard of care (CTRI no. CTRI/2020/06/026181).

Finding the real COVID-19 case-fatality rates for SAARC countries

The crude case fatality rate (CFR), because of the calculation method, is the most accurate when the pandemic is over since there is a possibility of the delay between disease onset and outcomes. Adjusted crude CFR measures can better explain the pandemic situation by improving the CFR estimation. However, no study has thoroughly investigated the COVID-19 adjusted CFR of the South Asian Association For Regional Cooperation (SAARC) countries. This study estimated both survival interval and underreporting adjusted CFR of COVID-19 for these countries. Moreover, we assessed the crude CFR between genders and across age groups and observed the CFR changes due to the imposition of fees on COVID-19 tests in Bangladesh. Using the daily records up to October 9, we implemented a statistical method to remove the delay between disease onset and outcome bias, and due to asymptomatic or mild symptomatic cases, reporting rates lower than 50% (95% CI: 10%–50%) bias in crude CFR. We found that Afghanistan had the highest CFR, followed by Pakistan, India, Bangladesh, Nepal, Maldives, and Sri Lanka. Our estimated crude CFR varied from 3.708% to 0.290%, survival interval adjusted CFR varied from 3.767% to 0.296% and further underreporting adjusted CFR varied from 1.096% to 0.083%. Furthermore, the crude CFRs for men were significantly higher than that of women in Afghanistan (4.034% vs. 2.992%) and Bangladesh (1.739% vs. 1.337%) whereas the opposite was observed in Maldives (0.284% vs. 0.390%), Nepal (0.006% vs. 0.007%), and Pakistan (2.057% vs. 2.080%). Besides, older age groups had higher risks of death. Moreover, crude CFR increased from 1.261% to 1.572% after imposing the COVID-19 test fees in Bangladesh. Therefore, the authorities of countries with higher CFR should be looking for strategic counsel from the countries with lower CFR to equip themselves with the necessary knowledge to combat the pandemic. Moreover, caution is needed to report the CFR.

Obstetrical and neonatal outcome of pregnancies complicated with SARS-CoV-2 infection

The COVID-19 pandemic has an impact without precedent. Pregnant women are part of the vulnerable population and the extent of SARS-CoV-2 infection consequences on pregnancy outcome and on neonatal prognosis are still studied. It has been speculated, based on what is known about other pathogenic viruses, that SARS-CoV-2 can interfere with placental defense mechanisms and increase the abortion and preterm birth rate. Often, pregnant women infected with SARS-CoV-2 develop mild pneumonia; however, severe pneumonia occurs very rarely and is statistically significantly related to neonatal death. Our study was conducted in a multidisciplinary hospital unit and included 90 pregnant women with SARS-CoV-2 infection, diagnosed through polymerase chain reaction. Data regarding the maternal symptomatology, the gestational age, the way of giving birth, complications that have occurred during birth, the weight at birth and neonatal outcome have been analyzed. No cases of infection with severe clinical impact has been included in the study, only 20% of patients presenting a mild symptomatology. We found an increased rate of preterm birth and intrauterine growth restriction and a high incidence of acute fetal distress followed by caesarean section. SARS-CoV-2 has a chain effects on both the mother and the fetus, as a whole and, subsequently, individually. Our results revealed the adverse obstetrical and neonatal outcome in the prenatal period complicated with SARS-CoV-2 infection, even in asymptomatic and mild-symptomatic cases.

Feasibility of the home isolation programme for adults and children with COVID-19

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused an upsurge of cases in many countries leading to inadequate quarantine facilities and hospital beds. Studies on the feasibility of home isolation for COVID-19 patients are the need of the hour. This is the first study from India on the feasibility of home isolation to the best of the author's knowledge.Methods: This methodical study was conducted at a designated COVID-19 tertiary care hospital in India, which included all patients enrolled for the home isolation programme from the 4 July to 3 August 2020. Laboratory confirmed COVID-19 patients were assessed during the enrolment for their eligibility for home isolation. The enrolled patients were followed up once daily over a telephonic call with objective parameters like temperature, pulse and oxygen saturation.Results: There were a total of 447 adults and 67 children. Amongst adults, hypertension was the most common co-morbid condition seen in 23 (5.15%) followed by diabetes in 18 (4.03%) patients. Only 24 (5.37%) patients were hospitalised during the duration of home isolation due to reasons like persistent fever, decreased SpO2, and non-medical ones like anxiety regarding the disease. Age and the presence of co-morbidities were directly related to the requirement of hospitalisation. No children required hospitalisation. There were no deaths.Conclusions: Home isolation is effective for COVID-19 patients in resource limited settings. We provide strong evidence for adapting it for asymptomatic and mild symptomatic cases with judicious use of resources and without compromising the risk to patients.

Degenerative Cervical Myelopathy: Natural History, clinical presentation, current diagnosis and treatment update.

Degenerative cervical myelopathy is a chronic, nontraumatic compression and progressive disease of the cervical spinal cord. Osteoarthritic degeneration (spondylosis, facet hypertrophy, degenerative disc disease), ligament changes (ossification of the posterior longitudinal ligament, hypertrophy of the ligamentum flavum) and ischemia (secondary ischemic injury) may lead to spinal cord compression and result in neurological deficits. Clinically, the appendicular function is mainly affected, as well as gait and urinary function. Duration and degrees of compression are negatively correlated with prognosis. Non-operative treatment can be performed in mild symptomatic cases; however, surgical treatment may possibly improve the natural course of cervical myelopathy disease by stopping progression or avoiding deterioration and, in some cases, restoring some neurological function.

Global Lessons and Potential Strategies in Combating COVID-19 Pandemic in Ethiopia: Systematic Review

Background: Coronavirus disease 2019 (CoVID-19) is a rapidly emerging disease that has been classified a pandemic by the World Health Organization (WHO). In the absence of treatment for this virus, there is an urgent need to find alternative public health strategies to control the spread. Here, we have conducted an online search and summarize the global COVID-19 pandemic situation and recommend potential mitigation strategies in the context of Ethiopia. Result: The most common global COVID-19 mitigation strategies include, whole of government approach including individual, community and environmental measures, detecting and isolating cases, contact tracing and quarantine, social and physical distancing measures including for mass gatherings and international travel measures. Social and physical distancing alone could prevent the pandemic from 60-95%. Moreover, detecting and isolation of cases were found to be crucial while access to testing was found to the global challenge. Individual measures including proper hand washing were also reported to be effective measures in preventing the pandemic. Asymptomatic cases of COVID-19 ranged from 25% to 80% and as a result, countries are revising the case definition for early detection of mild symptomatic cases of COVID-19 with inclusion of Chills, Muscle pain and new loss of taste or smell in addition to Cough, Shortness of breath, Fever and Sore throat. Ethiopia is also unique in the aspects of sociocultural prospects while more than 99.3% of the population has a religion. Moreover, 69% of the population is under the age of 29 years old and the health policy in the country focused on prevention and primary health care. Conclusion: While recommendations may change depending on the level of outbreak, we conclude that in most countries have benefited from early interventions and in setups like Africa including Ethiopia where health system capability is limited, community engagement supported by local evidence with strict implementation of social and physical distancing measures is mandatory. Community level case detection could enhance early identification of cases. Validation and use of rapid test kits could be vital to increase access for testing. Revision of case definitions for COVID-19 could be important for early detection of cases.

Confinement Time Required to Avoid a Quick Rebound of COVID-19: Predictions From a Monte Carlo Stochastic Model

How long should we self-isolate at home to diminish the threat of COVID-19? This is a question that billions of people are wondering early 2020 due to the outbreak of the novel coronavirus SARS-CoV-2. This virus can produce a severe pneumonia that has killed over 160,000 people so far, was detected for the first time late 2019 in Wuhan (China), and has spread all over the world due, in part, to the difficulty of detecting and isolating asymptomatic or mild-symptomatic cases. In this paper, we explore how long suppression strategies (i.e., home confinement and social distancing) must be put into practice in highly populated cities to reduce the chances that a quick rebound of COVID-19 cases occur again over the next months. This is explored, using New York City (USA), San Francisco (USA), and Madrid (Spain) as case studies, through a simple but realistic Monte Carlo stochastic model that takes into account that part of the undetected infected individuals remain in circulation propagating the virus. Our simulations reflect that, if suppression strategies are not properly applied, they can be counterproductive because there are high chances that the confinement time has to be lengthened without reducing the total number of infections. We also estimate that, in the most conservative scenario and under the model assumptions, home confinement is effective if applied at least ~110 days in New York City, ~80 days in San Francisco, and ~70 days in Madrid, i.e., until mid-July 2020, early June 2020, and late May 2020, respectively.

Periodic Granulocyte Count Measuring Is Useful for Detecting Asymptomatic Agranulocytosis in Antithyroid Drug-Treated Patients with Graves' Disease

Objective: Finding agranulocytosis (AG) at an early stage is important to improve outcome, but periodic granulocyte count monitoring is not generally recommended for patients with Graves' disease, because AG develops suddenly. Method: At the Kuma Hospital, Graves' patients under antithyroid drug (ATD) treatment in an outpatient clinic have a granulocyte count examination during each visit, and if it is <1,000/μl, a warning is immediately sent to the patient's physician. We evaluated the usefulness of this system. Results: We investigated 25 AG and 33 granulocytopenia (GP) cases over a recent 5-year period, excluding patients who developed AG or GP at another hospital and were referred to us for treatment. Among the 25 AG patients, 16 patients (64%; 9 asymptomatic and 7 very mild symptomatic cases) were discovered by the periodic granulocyte count examination at an outpatient clinic. The remaining 9 patients visited the Kuma Hospital or other hospitals because of infection symptoms. Most of the AG patients were given granulocyte colony-stimulating factor injections immediately and were admitted if a prompt increase in granulocytes could not be obtained. The final treatments for Graves' disease were ¹³¹I-radioisotope therapy (19 patients), thyroidectomy (2 patients), inorganic iodine (1 patient), or another ATD (1 patient). Among the 33 GP patients, 31 (94%), including 20 asymptomatic cases, were discovered during periodic granulocyte count monitoring. Most of them stopped ATD, and other treatments for Graves' disease were selected. Conclusion: Periodic monitoring of granulocyte counts is useful for identifying AG and GP patients with no or minimum infection symptoms.

脳梗塞ＳＴＡ‐ＭＣＡバイパス術後の過灌流症候群について―急性期バイパス術の安全性の観点から―

When we treat a patient with progressing stroke, STA-MCA bypasses in the acute stage may be effective to minimize the lesion size. However, there was no evidence to support this hypothesis. The aim in this study is to investigate the potential risk and safety of acute stage bypass surgery to determine whether this treatment would be reasonable or not. Over a 4-year period, from April 1 2002 to August 1 2006, we performed 55 STA-MCA bypasses, 23 in the acute stage and 32 in the chronic stage. The chronic stage patients were based on the selection standards of JET study (Japanese EC-IC bypass Trial). Each case was examined by IMP or Xe SPECT within 2 weeks of bypass surgery. Where hyperperfusion was evident, cases were divided into one of 2 groups, according to the location of the hyperperfusion: Group A demonstrating it locally, and Group B demonstrating it hemispherically. Symptomatic cases were also divided into 2 groups according to the degree of severity, with the mild group exhibiting such symptoms as headaches or transient psychological disturbance, and the severe group reporting convulsions or conscious disturbance, etc. We examined the frequency of hyperperfusion syndrome and the safety of STA-MCA bypasses performed in the acute stages. Of the 23 acute stage bypasses, 7 cases (30.4%) were classified as Group A and 2 cases (8.7%) as Group B, affecting 9/23 cases, or 39.1% of the acute total. Of these, there were 3 mild symptomatic cases (13.0%), and 1 severe case (4.3%). Of the 32 chronic stage bypasses, 4 cases (12.5%) were classified as Group A and 1 case (3.1%) as Group B, affecting 5/32 cases, or 15.6% of the chronic total. Of these, there was 1 mild symptomatic case (3.1%), and 2 severe cases (6.3%). There were no hemorrhagic transformations. According to these results, acute stage bypasses did not differ significantly from chronic ones with regard to the occurrence of symptomatic cases. (p=0.435; Fisher exact method) STA-MCA bypass surgery might be feasible in the acute stage for a little symptomatic hyperperfusion syndrome. More cases would be necessary to clarify the safety of acute stage bypass surgery.