Onset Of Coronavirus Disease 2019 Research Articles

New-onset Adult-onset Still's Disease Following COVID-19 Vaccination: Three Case Reports and a Literature Review.

Since December 2020, coronavirus disease 2019 (COVID-19) vaccines have been distributed in most countries to prevent the onset and aggravation of COVID-19. There is little information regarding the long-term safety of the vaccines. We report three cases and a literature review of new-onset adult-onset Still's disease (AOSD) that occurred following COVID-19 vaccination. Our cases include moderate to severe AOSD, and two were complicated with macrophage activation syndrome. Seventeen cases of new-onset or relapse of AOSD following COVID-19 vaccination, including 14 identified in the literature review and our 3 patients, were all treated successfully with glucocorticoid therapy, immunosuppressive drugs, or biologic agents.

Long-Term Symptoms after Mild Coronavirus Disease in Healthy Healthcare Professionals: A 12-Month Prospective Cohort Study.

The coronavirus disease 2019 (COVID-19) pandemic has changed the course of human history and killed millions of people worldwide. Its long-term consequences remain uncertain. This study aimed to describe the short- and long-term symptoms of COVID-19 among individuals in Goiás, central Brazil, who experienced acute mild or non-symptomatic SARS-CoV-2 infection during the first wave of the pandemic. This prospective cohort study included 110 healthcare workers, 18 safety workers, and 19 administrative support workers, who were followed up for 12 months after the onset of COVID-19. Most participants were healthy adult female healthcare professionals. At the onset of infection, the major symptoms were headache, myalgia, nasal congestion, cough, coryza, anosmia, ageusia, sore throat, fatigue, diarrhea, and dyspnea. Furthermore, 20.3% of the participants had three or more COVID-19 symptoms that persisted for at least 12 months. These included coryza, congestion, hair loss, sore throat, headache, myalgia, cough, memory loss, anosmia, and fatigue. This study revealed a high prevalence of persistent symptoms of COVID-19 in healthy individuals from central Brazil, which may present an additional burden on healthcare services. Further studies are required to investigate the sequelae of COVID-19 over periods greater than 12 months.

Persistent SARS-CoV-2 infectivity for more than four months after onset of COVID-19 in an allogeneic stem cell transplant recipient: A case report

The duration of infectivity associated with severe acute respiratory coronavirus-2 (SARS-CoV-2) is generally approximately 10 days from the onset of symptoms. However, some studies have reported that this period may be longer than 20 days in patients with allogeneic hematopoietic stem cell transplantation (HSCT). Herein, we report a case of persistent viral SARS-CoV-2 shedding for 126 days in an individual with HSCT. When the patient was infected with coronavirus disease 2019 (COVID-19), tacrolimus and prednisolone were administered for graft versus host disease. The viral load, which was monitored regularly by quantitative antigen testing, decreased with the administration of antiviral agents but re-elevated rapidly after discontinuation. Tapering of tacrolimus and prednisolone resulted in a gradual reduction of the viral load and its eventual disappearance. This case report highlights the importance of determining persistent infectivity in patients with allogeneic HSCT using viral testing prior to release from isolation.

Deterioration of Mental Health in Children and Adolescents During the COVID-19 Pandemic

This paper reviews the global effect of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of children and adolescents in South Korea, the U.S., Japan, and China. We reviewed research on deteriorated mental health, including increased suicide, suicidal thoughts, and self-harm. Various studies have shown that students' mental health issues, such as depression and anxiety, have worsened during the COVID-19 pandemic. Furthermore, the number of students who committed suicide has significantly increased in the U.S. and Japan. Factors such as prior mental health status, change in daily routine, reduced physical activity, excessive screen time, overuse of electronic devices, and reduced social support have been reported to have a significant effect. The chain of deteriorating mental health among the youth began at the onset of COVID-19, social distancing, and school closure. As youths began to stay at home instead of going to school, they lost opportunities to connect with their friends or teachers, who could provide support outside of their homes. Young people spent less time on physical activity and more time online, which damaged their sleeping schedule and daily routine. In preparing for the post-pandemic phase, we should thoroughly analyze the long-term effects of the pandemic on youth mental health, while simultaneously tackling current imminent issues.

Isolation of Methicillin-Resistant Staphylococcus aureus from Wound Samples during the COVID-19 Pandemic: A Retrospective Study

Introduction: On March 11th, 2020, the World Health Organisation (WHO) declared the outbreak of the novel coronavirus disease caused by the Severe Acute Respiratory Syndrome Corona Virus 2 (SARSCoV-2) virus as a pandemic. This recently discovered β-coronavirus spread instantaneously across mainland China due to human-tohuman transmission and crossed international borders aided by intercontinental travel. In most nations, the logarithmic growth of the cases very quickly overwhelmed the healthcare system which led to the overcrowding of the hospitals and led to a sudden surge in Hospital-Acquired Infections (HAIs). Implementation of contact precautions was implemented to control cross-infection. Aim: To determine the effect of Coronavirus Disease-2019 (COVID-19) on the prevalence of HAIs with special emphasis on Staphylococcus aureus (S. aureus). Materials and Methods: This three-year retrospective study (September 2018-August 2021) was undertaken at an apex tertiary care institute in Northern India. Wound swabs were collected and processed in the laboratory for the presence of aerobic bacterial isolates. S. aureus was identified using conventional methods and antimicrobial sensitivity was performed by the Kirby-Bauer disc diffusion method. Data was entered in Microsoft Excel and later analysed in International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 22.0. Results: A steady increase in the isolation of MethicillinResistant Staphylococcus aureus (MRSA) was noted during the study period (60.5% in 2018 to 78.1% in 2021). A statistically significant increase was noted in the detection of MRSA after the onset of the COVID-19 pandemic (p=0.018) despite the reduced number of surgeries conducted in the institution and rigorous execution of contact precautions. Conclusion: There was an increase in the rate of MRSA isolation during the study period. The increase was significantly affected by the onset of COVID-19. To contain the spread of MRSA, novel methods including preoperative screening of patients undergoing elective surgeries and periodic screening of hospital staff need to be implemented along with standard infection control precautions at all times.

Identifying Resource Needs and Experiences of the Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning+ Community during the Coronavirus Disease-2019 Pandemic

Introduction Lesbian, gay, bisexual, transgender, queer, and questioning+ (LGBTQ+) people have historically faced disproportionate economic and health-related challenges, which have likely been further exacerbated by coronavirus disease-2019 (COVID-19). To provide support and equitable resources for this community, it is critical to identify resource needs and challenges and understand the experiences of this community during the COVID-19 pandemic. Materials and Methods We administered an online survey to examine the experiences and needs of minority LGBTQ+ people, ages 18-35, who resided in an Ending the Human Immunodeficiency Virus (HIV) Epidemic (EHE) metropolitan jurisdiction in the Southeastern United States (U.S.). Results Since the onset of COVID-19, the majority of survey respondents reported increases in mental health symptomology and substance use, and decreases in economic stability, food security, and medical care access. Conclusion The findings support the need for extended reach of substance use and mental health-related services, linkage to medical/sexual healthcare, and financial assistance.

Ayurvedic Review of Post Covid Anxiety Disorder w.s.r to Chittodvega

The post-COVID-19 situation occurs in people with a record of probably or showed SARS-CoV-2 infection, usually, three months from the onset of COVID-19 with signs that last for at least 2 months and it is not always explained by an alternative diagnosis. The global community is concerned about Post Coronavirus disease 2019 (COVID-19) complications and their impact on mental health. It is going to impact various spheres of life such as the economy, industries, worldwide market, human health, health care etc. It has also induced impairments in work and social functioning which leads to the elevation of mental disorders like stress, anxiety and depression among well-being. Objective: Since anxiety is not described specifically in Ayurveda but is only found as a symptomatic description, this article attempt to study the disease Post COVID Anxiety disorder and its symptomatology and pathogenesis (Samprapti) in Ayurveda. Data source: Charaka Samhita, Sushruta Samhita, Vagabhata Samhita and modern medical textbooks, scientific journals and online databases. Review Methods: The classical textbooks and modern textbooks and various scientific journals and other databases were reviewed manually. Results: Post Covid complications of anxiety can cause serious mental health issues, and has a huge impact on societies. Conclusion: The study intends to study the causes of mental health disorders (Chittodvega) in post covid patients.

Online teaching and learning: Experiences of students in a nursing college during the onset of COVID-19.

The world has entered the Fourth Industrial Revolution. Utilisation of technology is inevitable. For the past years, the coronavirus disease 2019 (COVID-19) pandemic has halted normal operations, including in the physical classroom for nursing students. Students and facilitators had to move to a remote way of teaching and learning, utilising online teaching and learning. However, students and facilitators were not ready to use online teaching and learning. This not only resulted in numerous challenges, but also became an eye-opener for best practices and intervening strategies. To explore and describe experiences of students in a nursing college with regard to online teaching and learning during the onset of the COVID-19 pandemic. A qualitative, exploratory, descriptive and contextual research design was adopted. A purposive, nonprobability sampling approach was used to select participants from second year, third year and fourth year. First-year student nurses were excluded because they did not commence with classrooms at that time. Seven themes emerged, namely knowledge, confidence, training, equipment, clinical exposure, course extension and flexibility, and all themes had subthemes. It is evident that students had more negative experiences during online teaching and learning than positive experiences.Contribution:The study contributed enormously to teaching and learning of student nurses in nursing colleges as its results can be used to improve nursing colleges with regard to online teaching and learning.

Reduced Risk of Progression from Non-Severe to Severe COVID-19 in Hospitalized Dialysis Patients by Full COVID-19 Vaccination.

Coronavirus disease 2019 (COVID-19) vaccination reduces the risk of progression to severe COVID-19 in the general population. To examine that preventive effect in dialysis patients, the association of vaccination status with severe COVID-19 progression was investigated in this retrospective observational study conducted from December 2020 to May 2022 of 100 such patients hospitalized for non-severe COVID-19 at Inoue Hospital (Suita, Japan). Fifty-seven were fully vaccinated, defined as receiving a COVID-19 vaccine second dose at least 14 days prior to the onset of COVID-19, while 43 were not. Among all patients, 13 (13.0%) progressed to severe COVID-19 with a median (interquartile range) time of 6 (2.5-9.5) days, while 87 (87.0%) were discharged after 11 (8-16) days. Kaplan-Meier analysis showed that fully vaccinated patients had a significantly lower rate of progression to severe COVID-19 (p = 0.001, log-rank test). Cox proportional hazard analysis also indicated that full COVID-19 vaccination was significantly associated with reduced instances of progression to severe COVID-19 (hazard ratio 0.104, 95% confidence interval 0.022 to 0.483; p = 0.004) after balancing patient background characteristics using an inverse probability of treatment weight method. These results suggest that full vaccination status contributes to reducing the risk of progression from non-severe to severe COVID-19 in dialysis patients.

Severity predictors of COVID-19 in SARS-CoV-2 variant, delta and omicron period; single center study.

The outcomes of coronavirus disease 2019 (COVID-19) treatment have improved due to vaccination and the establishment of better treatment regimens. However, the emergence of variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, and the corresponding changes in the characteristics of the disease present new challenges in patient management. This study aimed to analyze predictors of COVID-19 severity caused by the delta and omicron variants of SARS-CoV-2. We retrospectively analyzed the data of patients who were admitted for COVID-19 at Yokohama City University Hospital from August 2021 to March 2022. A total of 141 patients were included in this study. Of these, 91 had moderate COVID-19, whereas 50 had severe COVID-19. There were significant differences in sex, vaccination status, dyspnea, sore throat symptoms, and body mass index (BMI) (p <0.0001, p <0.001, p <0.001, p = 0.02, p< 0.0001, respectively) between the moderate and severe COVID-19 groups. Regarding comorbidities, smoking habit and renal dysfunction were significantly different between the two groups (p = 0.007 and p = 0.01, respectively). Regarding laboratory data, only LDH level on the first day of hospitalization was significantly different between the two groups (p<0.001). Multiple logistic regression analysis revealed that time from the onset of COVID-19 to hospitalization, BMI, smoking habit, and LDH level were significantly different between the two groups (p<0.03, p = 0.039, p = 0.008, p<0.001, respectively). The cut-off value for the time from onset of COVID-19 to hospitalization was four days (sensitivity, 0.73; specificity, 0.70). Time from the onset of COVID-19 to hospitalization is the most important factor in the prevention of the aggravation of COVID-19 caused by the delta and omicron SARS-CoV-2 variants. Appropriate medical management within four days after the onset of COVID-19 is essential for preventing the progression of COVID-19, especially in patients with smoking habits.

Liver resection in a patient with persistent positive PCR test for coronavirus disease 2019 (COVID-19): a case report

BackgroundThe perioperative mortality rate is high in patients with coronavirus disease 2019 (COVID-19), and infection control measures for medical care providers must be considered. Therefore, the timing for surgery in patients recovering from COVID-19 is difficult.Case presentationA 65-year-old man was admitted to a hospital with a diagnosis of moderate COVID-19. He was transferred to our hospital because of risk factors, including heavy smoking history, type 2 diabetes mellitus, and obesity (BMI 34). Vital signs on admission were a temperature of 36.1 °C, oxygen saturation > 95% at rest, and 94% on exertion with 3 L/min of oxygen. Chest computed tomography (CT) showed bilateral ground-glass opacities, predominantly in the lower lungs. Contrast-enhanced abdominal CT incidentally revealed a liver tumor with a diameter of 80 mm adjacent to the middle hepatic vein, which was diagnosed as hepatocellular carcinoma (HCC). After being administered baricitinib, remdesivir, dexamethasone, and heparin, the patient’s COVID-19 pneumonia improved, his oxygen demand resolved, and he was discharged on day 13. Furthermore, the patient was initially scheduled for hepatectomy 8 weeks after the onset of COVID-19 following a discussion with the infection control team. However, 8 weeks after the onset of illness, a polymerase chain reaction (PCR) test was performed on nasopharyngeal swab fluid, which was observed to be positive. The positive results persisted till 10 and 11 weeks after onset. Both Ct values were high (≥ 31) out of 45 cycles, with no subjective symptoms. Since we determined that he was no longer contagious, surgery was performed 12 weeks after the onset of COVID-19. Notably, medical staff wearing personal protective equipment performed extended anatomical resection of the liver segment 8 ventral area in a negative-pressure room. The patient had a good postoperative course, with no major complications, including respiratory complications, and was discharged on postoperative day 14. Finally, none of the staff members was infected with COVID-19.ConclusionsWe reported a case regarding the timing of surgery on a patient with persistently positive PCR test results after COVID-19, along with a literature review.

A comparative analysis of anti-vax discourse on twitter before and after COVID-19 onset.

This study aimed to identify and assess the prevalence of vaccine-hesitancy-related topics on Twitter in the periods before and after the Coronavirus Disease 2019 (COVID-19) outbreak. Using a search query, 272,780 tweets associated with anti-vaccine topics and posted between 1 January 2011, and 15 January 2021, were collected. The tweets were classified into a list of 11 topics and analyzed for trends during the periods before and after the onset of COVID-19. Since the beginning of COVID-19, the percentage of anti-vaccine tweets has increased for two topics, "government and politics" and "conspiracy theories," and decreased for "developmental disabilities." Compared to tweets regarding flu and measles, mumps, and rubella vaccines, those concerning COVID-19 vaccines showed larger percentages for the topics of conspiracy theories and alternative treatments, and a lower percentage for developmental disabilities. The results support existing anti-vaccine literature and the assertion that anti-vaccine sentiments are an important public-health issue.

Association of SARS-CoV-2 RNA Copy Number with the COVID-19 Mortality Rate and Its Effect on the Predictive Performance of Mortality in Severe Cases.

Factors associated with mortality are important in the treatment of coronavirus disease 2019 (COVID-19). Polymerase chain reaction (PCR) is the gold standard for diagnosing COVID-19, which reflects the viral load in the upper respiratory tract. In total, 523 patients were enrolled in this study; of them, 441 and 75 patients underwent PCR testing of nasopharyngeal swabs and sputum samples, respectively, within 20 days from onset of COVID-19. We investigated the association between RNA copy number and the COVID-19 severity and mortality rate and its effect on the predictive performance for severity and mortality. RNA copy numbers in nasopharyngeal swabs were higher in the non-survivor group than in the survivor group. Multivariate logistic regression analysis identified that the high RNA copy number (≥9 log10 /swab) in nasopharyngeal swabs was a factor associated with mortality (odds ratio, 4.50; 95% confidence interval, 1.510-13.100; P = 0.008). Furthermore, adding RNA copy number (≥9 log10 /swab) in severe cases, adjusted by duration from onset to PCR, improved mortality predictive performance based on known factors. The RNA copy number is a factor associated with the mortality of patients with COVID-19 and can improve the predictive performance of mortality in severe cases.

Meta-analysis of the prevalence of anxiety and depression among frontline healthcare workers during the COVID-19 pandemic.

ObjectiveTo systematically review the prevalence of anxiety and depression among frontline healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic.MethodsComputers were used to search CNKI, VIP, WanFang Data, PubMed, and other Chinese and English databases. The search period was limited to December 2019 to April 2022. Cross-sectional studies collected data on the prevalence of anxiety and depression among frontline healthcare workers since the onset of COVID-19. The STATA 15.1 software was used for the meta-analysis of the included literature.ResultsA total of 30 studies were included, with a sample size of 18,382 people. The meta-analysis results showed that during the COVID-19 pandemic, the total prevalence of anxiety among frontline healthcare workers was 43.00%, with a 95% confidence interval (CI) of 0.36–0.50, and the total prevalence of depression was 45.00%, with a 95% CI of 0.37–0.52. The results of the subgroup analysis showed that prevalence of anxiety and depression in women, married individuals, those with children, and nurses was relatively high. Frontline healthcare workers with a bachelor's degree or lower had a higher prevalence of anxiety. The prevalence of depression was higher among frontline healthcare workers with intermediate or higher professional titles.ConclusionDuring the COVID-19 pandemic, the prevalence of anxiety and depression among frontline healthcare workers was high. In the context of public health emergencies, the mental health status of frontline healthcare workers should be given full attention, screening should be actively carried out, and targeted measures should be taken to reduce the risk of COVID-19 infection among frontline healthcare workers.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022344706.

Korean Fashion and Beauty Livestreaming Commerce before and after COVID-19

From the perspective of live commerce consumers in South Korea, this study aimed to investigate the changes in consumer interest since the onset of the coronavirus disease 2019 (COVID-19) pandemic. To this end, a consumer perception survey on live commerce was conducted. Further, this study utilized social big data analytics, which involved collecting posts and articles from Korean portal sites for the 2019–2020 period and then analyzing them through text mining. The results revealed that, before the outbreak of COVID-19, the keyword “mobile” showed high appearance frequency and high connection centrality. “Fashion” and “beauty,” which are classified as subcategories of live commerce in Korea, also appeared as top keywords, both before and after the onset of COVID-19. Considering the social environment and characteristics of live commerce, providing services that enable consumers to participate in the streaming platform more actively is necessary. Additionally, providing services that encourage customers to respond would also be desirable. This study’s findings can serve as baseline data for the development of an extension plan for the Korean fashion and beauty industry through live commerce and can provide insight into the consumption patterns of consumers of live commerce.

Clinical and epidemiological features of healthcare workers after a coronavirus disease 2019 cluster infection in Japan and the effects of Kampo formulas-Hochuekkito and Kakkonto: A retrospective cohort study.

It is expected that a low-toxicity natural compound like Kampo formulas would exhibit a preventive effect on COVID-19, in a global outbreak of coronavirus disease 2019 (COVID-19). Although the biological properties and safety of the representative Kampo, Hochuekkito (HET), and Kakkonto (KKT) have been confirmed in various animal model experiments and clinical studies, and in a few human studies to induce biological effects on various infectious diseases without significant toxicity, it is unclear whether HET and KKT are safe and effective for COVID-19 prevention. We summarized the clinical characteristics of HCWs and the preventive effects of HET and KKT. We performed a retrospective, single-center, cohort study that included 175 HCWs (aged 21-77 years) from a total number of 217 in a hospital with a history of COVID-19 cluster infection. In total, 175 HCWs were tested for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies. We identified 27 patients (median age: 49 ± 10.7 years) who were diagnosed with COVID-19. The patients in the group that had a body mass index ≥ 25 had a high COVID-19 infection risk, while those in the group with a Kampo formula adherence rate ≥ 40% had a low COVID-19 risk. Patients in the group with an adherence rate ≥ 40%, as well as those in the current alcohol consumption group, were at a low risk of developing severe COVID-19. In conclusion, HET and KKT may have prevented the onset or worsening of COVID-19, which could be clinically used. Obesity might have increased the patients' susceptibility to COVID-19 and the disease severity.

Low COVID-19–related knowledge and access to adequate handwashing among patients with chronic diseases in rural Rwanda: a cross-sectional survey

Background The coronavirus disease 2019 (COVID-19) misinformation and inadequate access to hygiene and sanitation amenities could hamper efforts to contain COVID-19 spread in resource-limited settings. In this study, we describe knowledge of COVID-19 symptoms and preventive measures, sources of information, and access to adequate handwashing among patients with chronic diseases in three Rwandan rural districts during the onset of COVID-19 in Rwanda. Methods This was a cross-sectional survey conducted among patients who were enrolled in the HIV/AIDS, non-communicable diseases, mental health, oncology, and pediatric development programs at health facilities in Kayonza, Kirehe and Burera districts. The study sample was randomly selected and stratified by district and clinical program. Telephone-based data collection occurred between 23 April and 11 May 2020. Primary caregivers responded to the survey when the selected patient was a child under age 18 or severely ill. We defined good knowledge of COVID-19 symptoms and preventive measures as knowing that a dry cough and fever were common symptoms and social distancing or staying home and regular handwashing could prevent COVID-19 infection. Access to adequate handwashing was defined as living in a household with a handwashing station and regular access to clean water and soap. We used Fisher’s exact tests and logistic regression to measure associations between the source of information and good knowledge about COVID-19 and between socio-economic characteristics and access to adequate handwashing. Results In total, 150 patients and 70 caregivers responded to the survey. Forty-eight (22.3%) respondents had no formal education. Sources of COVID-19 information included mass media (86.8%), local government leaders (27.3%), healthcare workers (15.9%) and social media (6.8%). Twenty-seven percent (n=59) of respondents had good knowledge of COVID-19 symptoms and preventive measures. In the adjusted analysis, getting information from news media was associated with having good knowledge about COVID-19 (adjusted odds ratio, aOR: 5.46; 95% CI: 1.43-20.75]. Seventy-nine (35.9%) respondents reported access to adequate handwashing at home, with access varying significantly by the district in favour of Kayonza (61.3%). Conclusions COVID-19-related knowledge and access to adequate handwashing were low among patients with chronic diseases at the beginning of the pandemic in Rwanda. Efforts to mitigate COVID-19 spread among chronic care populations may include investment in targeted COVID-19-related education and access to adequate handwashing.

CO132 Duration of COVID-19 and Long COVID - a US Healthcare Database Analysis

Continued morbidity following Coronavirus disease 2019 (COVID-19) (long COVID (LC)) is defined by the World Health Organization (WHO) as conditions lasting > 2 months and identified ∼ 3 months after onset of COVID-19. The prevalence of LC is still unknown. Our study is designed to evaluate duration of COVID-19-related care, and prevalence of LC, in patients with mild, moderate and severe disease.

Impact of previous cardiac function status assessed by echocardiography on the outcome of COVID-19

More than 91,000 fatalities due to Coronavirus Disease 2019 (COVID-19) have occurred in Spain. Several factors are associated with increased mortality in this disease, including cardiovascular risk factors (CVRF). However, information on the cardiac function of patients prior to the onset of COVID-19 is scarce and the potential impact it may have is uncertain. The aim of the EchoVID study was to describe the potential association between CVRF and cardiac function status prior to SARS-CoV-2 infection and in-hospital mortality. We studied clinical characteristics and cardiac function of patients admitted during the first wave of COVID-19. All patients had a transthoracic echocardiogram performed in the previous 12 months prior to diagnosis; conventional systolic and diastolic function parameters were analyzed. Logistic regression analysis was performed to identify predictors of in-hospital mortality. We included 296 individuals. Median age was higher in the group of patients who died (81.0 vs 76.1 years; p = 0.007). No significant differences were found in CVRF. Survivors were more frequently receiving anticoagulation therapy (52.9% vs 70.8%; p = 0.003). LVEF, although preserved on average in both groups, was significantly lower in the group of deceased patients (56.9% vs 61.1%; p = 0.017). Average E/e′ ratio was higher in the deceased group (11.1 vs 10.1; p = 0.049). Five variables were found to be independently associated with in-hospital mortality due to COVID-19: Age, male gender, LVEF, E/e′ ratio and anticoagulation therapy. A model including these variables had an area under the ROC curve of 0.756 (CI 0.669–0.843). The echocardiographic variables included in the model significantly improved the discriminative power, compared to a model including only demographic data. Left ventricular ejection fraction and E/e′ ratio prior to SARS-CoV-2 infection are two easily-obtained echocardiographic parameters that provide additional prognostic information over clinical factors when assessing patients admitted for SARS-CoV-2 infection.

Prevalence of Vitamin D Deficiency in Children with Fractures: Before and during the COVID-19 Outbreak.

Background Although it is generally agreed that vitamin D is important for bone health, the role of vitamin D in preventing fractures in children and adolescents remains unclear. Therefore, this study aimed to investigate the prevalence of vitamin D deficiency and insufficiency in healthy Korean children with fractures. Our secondary aim was to compare serum vitamin D levels before and during the coronavirus disease 2019 (COVID-19) outbreak. Methods We evaluated 334 patients with fractures who were surgically treated at our institution between 2018 and 2019 before the onset of COVID-19 (group I). In addition, we collected data on the serum 25(OH)D levels of 210 patients who visited our pediatric department for evaluation of short stature (group II) and the serum 25(OH)D levels of the patients with fractures during the COVID-19 pandemic period (group III). A serum 25(OH)D level of <20 ng/mL was considered deficient, between 20 and 32 ng/mL was insufficient, and ≥32 ng/mL was considered sufficient. Results The mean age was 8.1 ± 3.5 years in group I, 8.2 ± 3.7 years in group II, and 8.6 ± 3.5 years in group III. The prevalence of vitamin D deficiency was 53.0% in group I and 32.9% in group II. The mean serum 25(OH)D level was lower in group I than in group II (20.0 ± 7.3 ng/ml vs. 23.2 ± 6.9 ng/ml, p < 0.001). The mean serum 25(OH)D level of younger patients (<10 years) in group III was lower than that of the younger patients in the prepandemic period (21.4 ± 7.2 ng/mL vs. 19.2 ± 6.8 ng/mL, p=0.037). Conclusions We observed a high prevalence of vitamin D deficiency/insufficiency in children with fractures who required surgical treatment. During the COVID-19 pandemic, the serum vitamin D levels became even lower, especially in younger children.