Suspicion Of COVID-19 Research Articles

Incidence of Incidental Lung Cancer Detected in Thoracic Computed Tomography During the COVID-19 Pandemic: A Perspective on Lung Cancer Screening in Turkiye

There are risk-based screening programs for lung cancer screening in the world. There is no screening program for lung cancer in Turkiye. The aim of our study was to investigate the incidence of pulmonary nodules and lung cancer detected incidentally with computed tomography scans performed due to the COVID-19 pandemic. Thoracic Computed Tomography (CT) scans performed with suspicion of COVID-19 between 11.03.2020 and 31.03.2022 were analyzed as a single-center and retrospective cohort. Patients with a history of previously diagnosed malignancy or in the follow-up with solitary pulmonary nodules were excluded. A total of 2381 patients were examined, and the mean age was 50.42± 17.03 years. While 267 (11.2%) patients had solitary pulmonary nodules on CT scans, 66 (2.7%) patients were diagnosed with lung cancer. Patients were categorized according to age. The risk of pulmonary nodules increased 1.92-fold between the ages of 51-60, 2.26-fold between the ages of 61-70, and 2.05-fold above the age of 70 compared to age 50 (p< 0.001 for all). Compared to age 50, the risk of developing lung cancer increased 10.3-fold between the ages of 51-60, 33.5-fold between the ages of 61-70, and 34.5-fold above the age of 70 (p< 0.001 for all). In our study, we observed that the risk of incidental detection of pulmonary nodules and lung cancer increased with the age above 50. With this cohort study, we aimed to provide an overview of lung cancer risk prediction models and applications for lung cancer screening. Keywords: Solitary Pulmonary Nodule, COVID-19, Lung Cancer, Screening

Incidental Finding of Subacute DeBakey Type II Aortic Dissection with Circular Intimal Tear in a Patient with Severe Aortic Insufficiency During the COVID-19 Pandemic

We present a case of severe aortic insufficiency diagnosed in the pandemic period with the surgery being postponed due to hygiene concerns and suspicion of COVID-19. One month later the patient’s complaints worsened. Renewed preoperative examinations revealed no difference and no sign of dissection. The suspicion of COVID-19 was eliminated, so immediate aortic valve surgery was performed despite the pandemic. Surprisingly subacute DeBakey type II aortic dissection with complete circular intimal tear came across intraoperatively. Thus, the modified Cabrol procedure was performed successfully. The diagnosis of aortic dissection may be missed, and this rate may increase in natural disasters such as pandemics and earthquakes.

COVID-19 Computed tomography patterns in renal replacement therapy patients.

Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19. ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients. We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12-84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002). In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19.

New initiation of opioids, benzodiazepines and antipsychotics following hospitalization for COVID-19.

Patients newly initiated on opioids (OP), benzodiazepines (BZD), and antipsychotics (AP) during hospitalization are often prescribed these on discharge. Implications of this practice on outcomes remains unexplored. To explore the prevalence and risk factors of new initiation of select OP, BZD and AP among patients requiring in-patient stays. Test the hypothesis that new prescriptions are associated with higher odds of readmission or death within 28 days of discharge. Single center retrospective cohort study. Patients admitted to a tertiary-level medical center with either a primary diagnosis of RT-PCR positive for COVID-19 or high index of clinical suspicion thereof. None. Exposure was the new initiation of select common OP, BZD, and AP which were continued on hospital discharge. Outcome was a composite of 28-day readmission or death following index admission. Multivariable logistic regression was used to assess patient mortality or readmission within 28 days of discharge associated with new prescriptions at discharge. One thousand three hundred and nineteen patients were included in the analysis. 11.3% (149/1319) were discharged with a new prescription of select OP, BZD, or AP either alone or in combination. OP (110/149) were most prescribed followed by BZD (41/149) and AP (22/149). After adjusting for unbalanced confounders, new prescriptions (adjusted odds ratio: 2.44, 95% confidence interval: 1.42-4.12; p = .001) were associated with readmission or death within 28 days of discharge. One in nine patients admitted with a diagnosis of COVID-19 or high clinical suspicion thereof were discharged with a new prescription of either OP, BZD or AP. New prescriptions were associated with higher odds of 28-day readmission or death. Strengthening medication reconciliation processes focused on these classes may reduce avoidable harm.

The effect of current antithrombotic therapy on mortality in nursing home residents with COVID-19: a multicentre retrospective cohort study.

The first wave of COVID led to an alarmingly high mortality rate among nursing home residents (NHRs). In hospitalised patients, the use of anticoagulants may be associated with a favourable prognosis. However, it is unknown whether the use of antithrombotic medication also protected NHRs from COVID-19-related mortality. To investigate the effect of current antithrombotic therapy in NHRs with COVID-19 on 30-day all-cause mortality during the first COVID-19 wave. We performed a retrospective cohort study linking electronic health records and pharmacy data in NHRs with COVID-19. A propensity score was used to match NHRs with current use of therapeutic dose anticoagulants to NHRs not using anticoagulant medication. The primary outcome was 30-day all-cause mortality, which was evaluated using a logistic regression model. In a secondary analysis, multivariable logistic regression was performed in the complete study group to compare NHRs with current use of therapeutic dose anticoagulants and those with current use of antiplatelet therapy to those without such medication. We included 3521 NHRs with COVID-19 based on a positive RT-PCR for SARS-CoV-2 or with a well-defined clinical suspicion of COVID-19. In the matched propensity score analysis, NHRs with current use of therapeutic dose anticoagulants had a significantly lower all-cause mortality (OR = 0.73; 95% CI: 0.58-0.92) compared to NHRs who did not use therapeutic anticoagulants. In the secondary analysis, current use of therapeutic dose anticoagulants (OR: 0.62; 95% CI: 0.48-0.82) and current use of antiplatelet therapy (OR 0.80; 95% CI: 0.64-0.99) were both associated with decreased mortality. During the first COVID-19 wave, therapeutic anticoagulation and antiplatelet use were associated with a reduced risk of all-cause mortality in NHRs. Whether these potentially protective effects are maintained in vaccinated patients or patients with other COVID-19 variants, remains unknown.

Evaluation of congenital rib anomalies with multi-detector computed tomography in the Turkish population.

This study aimed to evaluate the congenital anomalies of ribs in the Turkish population using multi-detector computed tomography (CT) and to reveal the prevalence and distribution of these anomalies according to sexes and body sides. This study included 1120 individuals (592 male, 528 female) over 18 who presented to our hospital with a suspicion of COVID-19 and who had thoracic CT. Anomalies such as a bifid rib, cervical rib, fused rib, Srb anomaly, foramen rib, hypoplastic rib, absent rib, supernumerary rib, pectus carinatum, and pectus excavatum, which were previously defined in the literature, were examined. Descriptive statistics were performed with the distribution of anomalies. Comparisons were made between the sexes and body sides. A prevalence of 18.57% rib variation was observed. Females had 1.3 times more variation than males. Although there was a significant difference in the distribution of anomalies by sex (p = 0.000), there was no difference in terms of body side of anomaly (p > 0.05). The most common anomaly was the hypoplastic rib, followed by the absence of a rib. While the incidence of the hypoplastic rib was similar in females and males, 79.07% of the absent ribs was seen in females (p < 0.05). The study also includes a rare case of bilateral first rib foramen. At the same time, this study includes a rare case of rib spurs extending from the left 11th rib to the 11th intercostal space. This study demonstrates detailed information about congenital rib anomalies in the Turkish population, which may vary between people. Knowing these anomalies is essential for anatomy, radiology, anthropology, and forensic sciences.

ANALİTİK HİYERARŞİ SÜRECİ VE VERİ MADENCİLİĞİ TEKNİKLERİYLE HİBRİT BİR KARAR DESTEK SİSTEMİ UYGULAMASI: TAM KAN SAYIMI DEĞERLERİ İLE KOVİD19 TANISI

Objective: Data mining techniques have a significant impact on enhancing the precision of diagnostics based on artificial intelligence. In this research, it was aimed to develop a web-based decision support that predicts the status of a person who comes to the hospital with Covid-19 suspicion by using complete blood count results until the imaging and PCR test results are obtained.&#x0D; Method: In this study, firstly data pre-processing techniques on the data set were applied, then feature selection was made using data mining approaches. After reducing the number of variables, the analytical hierarchy process method (AHP), a prominent multi-criteria decision-making approach, was utilized. Through the AHP method combined with expert opinions, the priorities of the variables determined by machine learning were ascertained, leading to the development of a decision model using publicly accessible data. A web-based application of this decision model was subsequently crafted to provide the decision support system to the end-users. Furthermore, an evaluation was conducted to gauge the usability of the decision support system and the satisfaction of its users.&#x0D; Results: RFE-SVM feature selection algorithm identified seven pivotal variables: Basophil, Eosinophil, Lymphocyte, Leukocyte, Neutrophil, Platelet, and Monocyte. Consultations were held with six expert physicians spanning diverse specialties relevant to COVID-19 diagnosis decision-making with the AHP method. Out of the 42 expert users (57.1% were male, with an average age of 37.30±10.56) were evaluated the system. The System Usability Scale (SUS) score averaged 81.43±15.64, indicating high usability.&#x0D; Conclusion: Consequently, this system might enable faster isolation of the patient and the commencement of preliminary treatment.

Long COVID is not a uniform syndrome: Evidence from person-level symptom clusters using latent class analysis

BackgroundThe current study aims to enhance insight into the heterogeneity of long COVID by identifying symptom clusters and associated socio-demographic and health determinants. MethodsA total of 458 participants (Mage 36.0 ± 11.9; 46.5% male) with persistent symptoms after COVID-19 completed an online self-report questionnaire including a 114-item symptom list. First, a k-means clustering analysis was performed to investigate overall clustering patterns and identify symptoms that provided meaningful distinctions between clusters. Next, a step-three latent class analysis (LCA) was performed based on these distinctive symptoms to analyze person-centered clusters. Finally, multinominal logistic models were used to identify determinants associated with the symptom clusters. ResultsFrom a 5-cluster solution obtained from k-means clustering, 30 distinctive symptoms were selected. Using LCA, six symptom classes were identified: moderate (20.7%) and high (20.7%) inflammatory symptoms, moderate malaise-neurocognitive symptoms (18.3%), high malaise-neurocognitive-psychosocial symptoms (17.0%), low-overall symptoms (13.3%) and high overall symptoms (9.8%). Sex, age, employment, COVID-19 suspicion, COVID-19 severity, number of acute COVID-19 symptoms, long COVID symptom duration, long COVID diagnosis, and impact of long COVID were associated with the different symptom clusters. ConclusionsThe current study’s findings characterize the heterogeneity in long COVID symptoms and underscore the importance of identifying determinants of different symptom clusters.

SARS-CoV-2-Related Persistent Pulmonary Affection Case in A 55-Year-Old Gastric MALT Lymphoma Patient on Rituximab

Following a mild symptomatic SARS-CoV-2 infection, a 55-year-old patient with gastric MALT lymphoma, currently treated with rituximab, experienced persistent symptoms. Over subsequent months, the patient exhibited low-grade fever, dyspnea, and progressive desaturation, leading to respiratory failure necessitating home oxygen therapy. A PCR test confirmed SARS-CoV-2 infection, prompting suspicion of persistent COVID-19. Imaging and biopsy results were consistent with cryptogenic organizing pneumonia (COP), but the patient showed no response to treatment, including corticosteroids and immunosuppressants. Remdesivir treatment yielded partial improvement but failed to achieve full resolution. Plitidepsin (2.5 mg/day for 3 days) under compassionate use led to negative PCR tests and normal respiratory function restoration within 3 days after treatment. SARS-CoV-2's impact on immunocompromised patients is concerning due to unique clinical features, challenges in viral clearance and immunization, and varied responses to approved treatments. A phase II clinical trial is underway to assess plitidepsin's efficacy in immunocompromised COVID-19 adults requiring hospital care.

Detection of subsolid nodules on chest CT scans during the COVID-19 pandemic.

To investigate the detection of subsolid nodules (SSNs) on chest CT scans of outpatients before and during the COVID-19 pandemic, as well as to correlate the imaging findings with epidemiological data. We hypothesized that (pre)malignant nonsolid nodules were underdiagnosed during the COVID-19 pandemic because of an overlap of imaging findings between SSNs and COVID-19 pneumonia. This was a retrospective study including all chest CT scans performed in adult outpatients (> 18 years of age) in September of 2019 (i.e., before the COVID-19 pandemic) and in September of 2020 (i.e., during the COVID-19 pandemic). The images were reviewed by a thoracic radiologist, and epidemiological data were collected from patient-filled questionnaires and clinical referrals. Regression models were used in order to control for confounding factors. A total of 650 and 760 chest CT scans were reviewed for the 2019 and 2020 samples, respectively. SSNs were found in 10.6% of the patients in the 2019 sample and in 7.9% of those in the 2020 sample (p = 0.10). Multiple SSNs were found in 23 and 11 of the patients in the 2019 and 2020 samples, respectively. Women constituted the majority of the study population. The mean age was 62.8 ± 14.8 years in the 2019 sample and 59.5 ± 15.1 years in the 2020 sample (p < 0.01). COVID-19 accounted for 24% of all referrals for CT examination in 2020. Fewer SSNs were detected on chest CT scans of outpatients during the COVID-19 pandemic than before the pandemic, although the difference was not significant. In addition to COVID-19, the major difference between the 2019 and 2020 samples was the younger age in the 2020 sample. We can assume that fewer SSNs will be detected in a population with a higher proportion of COVID-19 suspicion or diagnosis.

Correlation between Chest Computed Tomography Severity Scores and Age of Adult Patients with Suspected Covid-19 Pneumonia Admitted in Intensive Care Unit of a Tertiary Care Hospital, Bangladesh

In Bangladesh, the second wave of Covid-19 was devastating. Mostly RT-PCR is used to determine the Covid-19 infection. But when test results are delayed, or when there is a clinical suspicion of Covid-19 despite initial negative RT-PCR testing, CT scan of chest was used to detect Covid-19 and Covid-19 severity. This observational cross-sectional study was carried out at Corona dedicated ICU of Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur during February to June, 2021 to observe the HRCT severity score of the patient and its correlation with different ages. A total of 50 patients with clinically suspected Covid-19 cases who were admitted to the Corona dedicated ICU were included in the study. The chest HRCT images of study participants was gathered, CT severity score was calculated by a particular assignment radiologist. Based on this score; Severe disease was mainly seen in the &gt;60 year age group (50%). A significant moderate positive correlation was observed between age and CT chest severity score. With the increasing age the patients were suffering more and being male may increase the risk and put the patient to get admitted in the ICU, and as an alternative of the RT-PCR, CT scan of chest could be useful. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(2):77-82

A machine learning tool for the diagnosis of SARS-CoV-2 infection from hemogram parameters.

Monocytes and neutrophils play key roles in the cytokine storm triggered by SARS-CoV-2 infection, which changes their conformation and function. These changes are detectable at the cellular and molecular level and may be different to what is observed in other respiratory infections. Here, we applied machine learning (ML) to develop and validate an algorithm to diagnose COVID-19 using blood parameters. In this retrospective single-center study, 49 hemogram parameters from 12,321 patients with clinical suspicion of COVID-19 and tested by RT-PCR (4239 positive and 8082 negative) were analysed. The dataset was randomly divided into training and validation sets. Blood cell parameters and patient age were used to construct the predictive model with the support vector machine (SVM) tool. The model constructed from the training set (5936 patients) achieved an accuracy for diagnosis of SARS-CoV-2 infection of 0.952 (95% CI: 0.875-0.892). Test sensitivity and specificity was 0.868 and 0.899, respectively, with a positive (PPV) and negative (NPV) predictive value of 0.896 and 0.872, respectively (prevalence 0.50). The validation set model (4964 patients) achieved an accuracy of 0.894 (95% CI: 0.883-0.903). Test sensitivity and specificity was 0.8922 and 0.8951, respectively, with a positive (PPV) and negative (NPV) predictive value of 0.817 and 0.94, respectively (prevalence 0.34). The area under the receiver operating characteristic curve was 0.952 for the algorithm performance. This algorithm may allow to rule out COVID-19 diagnosis with 94% of probability. This represents a great advance for early diagnostic orientation and guiding clinical decisions.

The Effect of Stress Ball Use Applied by Emergency Nurses During Swabbing Procedure on the Pain and Fear Levels of Children Admitted to the Pediatric Emergency Service With the Suspicion of COVID-19: A Randomized Controlled Trial

IntroductionThis study aimed to determine the effect of stress ball use during the swabbing procedure on the pain and fear levels of children admitted to the pediatric emergency department with the suspicion of coronavirus disease 2019. Children with suspected coronavirus disease 2019 were recruited by convenience sampling from the pediatric emergency department of a university hospital in a city in Turkey. MethodsThis study used a random controlled experimental design and had a calculated sample size of 60. There were 30 participants in both the control and experimental groups. The stress ball intervention was applied to the children in the experimental group during the swabbing process, and no intervention was made to the children in the control group during the procedure. The pain and fear levels of the children in the control and experimental groups were measured during the swabbing process. “Descriptive Characteristics Form for Parents and Children,” “Wong-Baker Faces Pain Rating Scale,” “Children’s Fear Scale,” and “Stress Ball” were used in data collection. Chi-square, Mann-Whitney U, and Friedman tests were used in the analysis. ResultsAlthough there was no statistically significant difference between the groups in terms of pain and fear level mean scores before the procedure, a statistically significant difference was found between the groups during and after the procedures (P < .05). DiscussionGiving a stress ball to children aged 4 to 10 years during the swabbing procedure was determined to reduce the pain and fear levels during and after the procedures. It is recommended that stress ball use be applied during the swabbing procedure for children.

A comparative study of diagnostic performance of COVID-19 Reporting and Data System and computed tomography severity score in clinically suspected COVID-19 patients

Purpose: The aim of this study was to compare the diagnostic performance of COVID-19 Reporting and Data System (CO-RADS) and computed tomography (CT) severity score (CT-SS) in patients with clinically suspected coronavirus disease. Methods: A cross-sectional study was done. Patients presenting to the emergency department with symptoms suspicious for COVID-19 were participated. Patients referred with a positive reverse transcription polymerase chain reaction (RT-PCR) had chest CT evaluation done by CO-RADS and CT-SS, respectively, by an independent investigator. A binomial logistic regression analysis was performed to calculate the sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the two scoring systems in diagnosing COVID infection, considering RT-PCR as the reference standard. Results: A total of 400 cases were evaluated. Two hundred sixty-eight patients with a clinical suspicion of COVID-19 had a positive RT-PCR. The mean duration of symptoms was 5.5 ± 3.4 (range, 1–21 days). The mean CO-RADS and CT-SS scores were 3.7 ± 1.4 (range, 1–5) and 9.1 ± 7.5 (range, 0–28), respectively. Air leaks, including pneumothorax, pneumomediastinum, and surgical emphysema, were observed in six cases. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of CO-RADS was 93.8, 80, 90.7, 92.1, and 90%, respectively. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of CT-SS were 95, 76, 86, 89, and 85%, respectively. The area under the curve (AUC) for CO-RADS was 0.943 [95% confidence interval (CI), 0.909–0.976, P &lt; 0.001] and AUC for CT-SS was 0.877 (95% CI, 0.821–0.933, P &lt; 0.001), respectively. The cut-off values of CT-SS and CO-RADS were 7.1 and 4.2, respectively. Conclusion: Both scoring systems had good sensitivity, specificity, and diagnostic accuracy in comparison to RT-PCR test to diagnose COVID-19 infection.

Active cancer as the main predictor of mortality for COVID-19 in oncology patients in a specialized center.

Introduction: The role of the type, stage and status of cancer in the outcome of COVID-19 remains unclear. Moreover, the characteristic pathological changes of severe COVID-19 reveled by laboratory and radiological findings are similar to those due to the development of cancer itself and antineoplastic therapies. Objective: To identify potential predictors of mortality of COVID-19 in cancer patients. Materials and methods: A retrospective and cross-sectional study was carried out in patients with clinical suspicion of COVID-19 who were confirmed for COVID-19 diagnosis by RT-PCR testing at the National Institute of Neoplastic Diseases between April and December 2020. Demographic, clinical, laboratory and radiological data were analyzed. Statistical analyses included area under the curve and univariate and multivariate logistic regression analyses. Results: A total of 226 patients had clinical suspicion of COVID-19, the diagnosis was confirmed in 177 (78.3%), and 70/177 (39.5%) died. Age, active cancer, leukocyte count ≥12.8 × 109/L, urea ≥7.4mmol/L, ferritin ≥1,640, lactate ≥2.0mmol/L, and lung involvement ≥35% were found to be independent predictors of COVID-19 mortality. Conclusion: Active cancer represents the main prognosis factor of death, while the role of cancer stage and type is unclear. Chest CT is a useful tool in the prognosis of death from COVID-19 in cancer patients. It is a challenge to establish the prognostic utility of laboratory markers as their altered values it could have either oncological or pandemic origins.

VEGF-A plasma levels are associated with impaired DLCO and radiological sequelae in long COVID patients.

Long COVID, also known as post-acute sequelae of COVID-19 (PASC), is characterized by persistent clinical symptoms following COVID-19. To correlate biomarkers of endothelial dysfunction with persistent clinical symptoms and pulmonary function defects at distance from COVID-19. Consecutive patients with long COVID-19 suspicion were enrolled. A panel of endothelial biomarkers was measured in each patient during clinical evaluation and pulmonary function test (PFT). The study included 137 PASC patients, mostly male (68%), with a median age of 55years. A total of 194 PFTs were performed between months 3 and 24 after an episode of SARS-CoV-2 infection. We compared biomarkers evaluated in PASC patients with 20 healthy volunteers (HVs) and acute hospitalized COVID-19 patients (n = 88). The study found that angiogenesis-related biomarkers and von Willebrand factor (VWF) levels were increased in PASC patients compared to HVs without increased inflammatory or platelet activation markers. Moreover, VEGF-A and VWF were associated with persistent lung CT scan lesions and impaired diffusing capacity of the lungs for carbon monoxide (DLCO) measurement. By employing a Cox proportional hazards model adjusted for age, sex, and body mass index, we further confirmed the accuracy of VEGF-A and VWF. Following adjustment, VEGF-A emerged as the most significant predictive factor associated with persistent lung CT scan lesions and impaired DLCO measurement. VEGF-A is a relevant predictive factor for DLCO impairment and radiological sequelae in PASC. Beyond being a biomarker, we hypothesize that the persistence of angiogenic disorders may contribute to long COVID symptoms.

Generalized anxiety disorder in Brazilian undergraduate dental students during the COVID-19 pandemic: A cross-sectional study.

Explore the prevalence of generalized anxiety disorder (GAD) and associated factors in undergraduate dental students during the first wave of the COVID-19 pandemic in Brazil. Cross-sectional study. A semi-structured questionnaire addressing the variables of interest was shared with dental students between July 8 and 27 2020. The outcome was determined using the seven-item generalized anxiety disorder (GAD-7) scale. A 'positive' diagnosis was defined as a total of ≥10 points on the scale. Statistical analysis involved descriptive, bivariate and multivariate analyses, with the significance level set at 5%. Among the 1050 students evaluated, 53.8% had a positive diagnosis for GAD. The multivariate analysis revealed that the prevalence of symptoms was higher among individuals who resided with more than three people, those enrolled at teaching institutions that suspended all clinical and laboratory activities, those who did not have an adequate home situation to maintain distance learning, those who had been diagnosed with COVID-19, those who felt anxious about having to see patients with a suspicion or diagnosis of COVID-19 and those who preferred to interrupt in-person academic activities until the population is vaccinated for the COVID-19 virus. The prevalence of GAD was high. Aspects related to the composition and organization of the home, the suspension of academic activities, a history of COVID-19 contamination, feelings of anxiety in providing dental care to patients with symptoms/suspected of COVID-19 infection and the preference to interrupt in-person academic activities until the population is vaccinated for COVID-19 were factors predisposing the students to anxiety during the first wave of the pandemic.

The effect of a video-based COVID-19 paediatric patient education on state anxiety in children with suspected COVID-19 admitted to hospital

BackgroundAnxiety causes the long-term psychological impacts on children during the pandemic. ObjectiveThe aim of this study is to reduce anxiety in paediatric patients and increase their adherence to treatment through a video-based COVID-19 paediatric patient education. MethodsThis quasi-experimental study with pretest–posttest single group was carried out in a research hospital’s COVID-19 Paediatric Emergency Area in Turkey between May and August 2020. The sample consisted of 128 children aged between 4 and 12 years. ResultsIn the study, it was found that 50.8% of the children who came to the COVID- 19 Paediatric Emergency Area due to suspicion of COVID-19 were boys and their mean age was 8.54 ± 2.62. 21.1% of the children were hospitalised before and 73.4% were afraid of the hospital. State stress scores of the participants before the patient education were higher in those, who didn’t attend school between ages of 4–10, than those who went to school. State stress mean scores of the children from all age groups decreased significantly after the education. ConclusionsThe video-based paediatric patient education decreases the children’s hospital-related anxiety during the pandemic and increased their adherence to treatment.

Cardiac injury in children with COVID-19.

There is little known about the spectrum of cardiac injury in acute COVID-19 infection in children. A single-centre, retrospective chart analysis was performed. The protocol was deemed IRB exempt. All patients under the age of 21 years admitted from 20 March, 2020 to 22 June, 2021 for acute symptomatic COVID-19 infection or clinical suspicion of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 were included. Past medical history, lab findings, echocardiogram and electrocardiogram/telemetry findings, and clinical outcomes were reviewed. Sixty-six patients with MIS-C and 178 with acute COVID-19 were reviewed. Patients with MIS-C had more cardiac testing than those with acute COVID-19. Inflammatory markers were more likely elevated, and function was more likely abnormal on echocardiogram in those with MIS-C with testing performed. Among patients with MIS-C, 17% had evidence of coronary dilation versus 0% in the acute COVID-19 group. One (0.6%) patient with acute COVID-19 had clinically significant electrocardiogram or telemetry findings, and this was in the setting of prior arrhythmias and CHD. Four (6%) patients with MIS-C had clinically significant findings on electrocardiogram or telemetry. Among patients with acute COVID-19, extracorporeal membrane oxygenation support was required in 0.6% of patients with acute COVID-19, and there was a 2.8% mortality. There were no deaths in the setting of MIS-C. Patients with acute COVID-19 and clinical suspicion of cardiac injury had a lower incidence of abnormal laboratory findings, ventricular dysfunction, or significant arrhythmia than those with MIS-C.

COVID-19-related hyperglycemia is associated with infection of hepatocytes and stimulation of gluconeogenesis

Occurrence of hyperglycemia upon infection is associated with worse clinical outcome in COVID-19 patients. However, it is still unknown whether SARS-CoV-2 directly triggers hyperglycemia. Herein, we interrogated whether and how SARS-CoV-2 causes hyperglycemia by infecting hepatocytes and increasing glucose production. We performed a retrospective cohort study including patients that were admitted at a hospital with suspicion of COVID-19. Clinical and laboratory data were collected from the chart records and daily blood glucose values were analyzed to test the hypothesis on whether COVID-19 was independently associated with hyperglycemia. Blood glucose was collected from a subgroup of nondiabetic patients to assess pancreatic hormones. Postmortem liver biopsies were collected to assess the presence of SARS-CoV-2 and its transporters in hepatocytes. In human hepatocytes, we studied the mechanistic bases of SARS-CoV-2 entrance and its gluconeogenic effect. SARS-CoV-2 infection was independently associated with hyperglycemia, regardless of diabetic history and beta cell function. We detected replicating viruses in human hepatocytes from postmortem liver biopsies and in primary hepatocytes. We found that SARS-CoV-2 variants infected human hepatocytesin vitrowith different susceptibility. SARS-CoV-2 infection in hepatocytes yields the release of new infectious viral particles, though not causing cell damage. We showed that infected hepatocytes increase glucose production and this is associated with induction of PEPCK activity. Furthermore, our results demonstrate that SARS-CoV-2 entry in hepatocytes occurs partially through ACE2- and GRP78-dependent mechanisms. SARS-CoV-2 infects and replicates in hepatocytes and exerts a PEPCK-dependent gluconeogenic effect in these cells that potentially is a key cause of hyperglycemia in infected patients.