Management of Nursing Resource during the Covid 19 Pandemic: Lessons on the Ground

During the covid 19 pandemic, management of nursing resource which forms the crux of patient care emerged as one of the major challenges amongst many. The strategies for staff mobilization, redeployment and recruitment, along with laying down standard operating procedures evolved as the pandemic progressed. The safety of the staff has to be a major focus area. Guidelines for covid duty exemption, orientation and training of staff must be drafted, reviewed and revised as required. Issues related to accommodation, psychosocial support and wellbeing have to be addressed. It is very important to adapt to the ever changing needs for nursing resource and be vigilant for emerging issues for an effective response to the pandemic.

Analysis of energy management schemes for renewable-energy-based smart homes against the backdrop of COVID-19

This article reviews energy management schemes for smart homes integrated with renewable energy resources in the context of the COVID-19 pandemic. The incorporation of distributed renewable energy system has initiated an acute transition from the traditional centralized energy management system to independent demand responsive energy systems. Renewable energy-based Smart Home Energy Management Systems (SHEMSs) play a vital role in the residential sector with the increased and dynamic electricity demand during the COVID-19 pandemic to enhance the efficacy, sustainability, economical benefits, and energy conservation for a distribution system. In this regard, the reviews of various energy management schemes for smart homes appliances and associated challenges has been presented. Different energy scheduling controller techniques have also been analyzed and compared in the COVID-19 framework by reviewing several cases from the literature. The utilization and benefits of renewable-based SHEMS have also been discussed. In addition, both micro and macro-level socio-economic implications of COVID-19 on SHEMSs are discussed. A conclusion has been drawn given the strengths and limitations of different energy scheduling controllers and optimization techniques in the context of the COVID-19 pandemic. It is observed that renewable-energy-based SHEMS with improved multi-objective meta-heuristic optimization algorithms employing artificial intelligence are better suited to deal with the dynamic residential energy demand in the pandemic. It is hoped that this review, as a fundamental platform, will facilitate the researchers aiming to investigate the performance of energy management and demand response schemes for further improvement, especially during the pandemic.

A three-stage ensemble boosted convolutional neural network for classification and analysis of COVID-19 chest x-ray images

For the identification and classification of COVID-19, this research presents a three-stage ensemble boosted convolutional neural network model. A conventional segmentation model (ResUNet) is used to increase the model's performance in the initial step of processing the CXR datasets. In the second step, the CNN is used to extract the features from the pictures in the training dataset using machine learning techniques. Using machine learning (ML) techniques, the retrieved characteristics are then combined by voting in the third stage. There are 5178 aberrant CXR photos and 4310 normal CXR images used in this investigation. Models like CNN and ML can't compete with the suggested model. 99.35% of the model's measurements are accurate and precise, and 98% of its recall and F1-score are perfect. It is argued that the suggested model provides a rigorous and trustworthy evaluation of clinical decision-making in the setting of a public health crisis.

Airflow dynamics in an emergency department: A CFD simulation study to analyse COVID-19 dispersion

Emergency departments (EDs) in hospitals are hotspots for highly transmissible infectious diseases and pose the most significant risk of viral infection spreading. With the recent COVID-19 outbreak, it became clear that emergency department design must evolve in order to be adequately prepared to handle the epidemic. The purpose of this research is to examine the design of the emergency department at a university hospital using a computational fluid dynamics (CFD) simulation based on the ANSYS CFX package. Turbulence Kinetic Energy and Velocity profiles were analyzed to determine which areas of the ED were most susceptible to virus spread. The analysis revealed that three critical areas of the emergency department, namely overnight patient beds, operating rooms, and resuscitation rooms, had significantly higher air velocity, dispersion, and mixing levels than the rest of the department's spaces. According to the two scenarios examined, the possibility of air transmission from these locations to neighboring areas becomes apparent, increasing the likelihood of transmitting the virus from these locations and infecting people in the adjacent areas, including patients and health care providers. Using the results of CFD simulations, a solution in the form of instructions for the arrangement of inlets and outlets, the separation of spaces, and the interior design of the spaces and hallways can be presented to the hospital administration. All of which can be implemented in the current design of the emergency department.

Air in the Wrong Place at the Wrong Time: A Case of Pneumomediastinum and Pneumopericardium in the Setting of COVID-19 Disease

Infection with SARS-CoV-2, commonly referred to as COVID-19 disease, has been noted to involve a systemic inflammatory reaction affecting multiple organ systems. Patients present with a spectrum of symptoms from mild to severe respiratory distress requiring supplemental oxygen and, at times, intubation and mechanical intubation. Pulmonary involvement causes diffuse alveolar wall damage leading to destruction and collapse of the alveolar walls causing air leakage and introduction of the air into the mediastinum, pericardium, and interstitial spaces. We present a case of a 71-year-old patient who presented with respiratory distress requiring supplemental oxygen with subsequent rapid decline and decompensation requiring intubation and mechanical ventilation who was found to have pneumomediastinum and pneumopericardium.

Telemedicine in neurology: advances and possibilities

BACKGROUND

Telemedicine develops from technology that offers opportunities for knowledge transfer and information sharing and allows the provision of health services at a distance.

OBJECTIVE

To evaluate the number of publications on teleneurology in the last two decades in PubMed and the available evidence on the use of this technology in neurological clinical conditions.

METHODS

A quantitative assessment of publications related to telemedicine and neurology in the last two decades. A search was performed on the PubMed database for the descriptors ("Telemedicine"[Mesh]) AND "Neurology"[Mesh]). A review of the articles retrieved on the topic was carried out to evaluate the innovation processes used and applications in various clinical conditions involving teleneurology.

RESULTS

The search performed on March 14th 2022 resulted in 229 publications involving the topic of telemedicine and neurology between 1999 and 2022. Since 2000, there has been an increase in publications related to this topic, with a peak of 71 articles published in 2020, the year in which the World Health Organization defined the COVID-19 pandemic status.

CONCLUSION

In the last two decades, teleneurology has been developing through the expansion of technological resources and the COVID-19 pandemic intensified this process. Different modalities of teleneurology are studied in several neurology subfields and include teleconsultation (between healthcare professionals or between healthcare professionals and patients), telerehabilitation, telemonitoring and tele-education. The advances achieved by teleneurology in this period encouraged technological innovations and health processes that developed opportunities to improve the care provided in a mechanism of constant evolution.

Unusual Case of Takotsubo Cardiomyopathy Secondary to COVID-19 Vaccine: Case Report and Literature Review

COVID-19 is a serious disease with high morbidity and mortality around the globe. We present a case of a 45-year-old male who presents with substernal chest pain three days after receiving the second dose of his COVID-19 mRNA (Moderna) vaccine. A transthoracic echo showed reduced left ventricular ejection fraction of 25-30% with akinesis of the mid to distal anterior, anteroseptal, anterolateral, inferolateral, inferoseptal, and inferior walls. Patient symptoms improved significantly during his hospitalization. Repeat trans-thoracic echo four days after his hospitalization showed ejection fraction recovery without segmental wall motion abnormalities. This case demonstrates the importance of recognizing Takotsubo cardiomyopathy as a complication of COVID-19 vaccine.

The Death Anxiety Experienced by Cardiac Patients in the Covid-19 Pandemic and Its Affecting Factors

The study was conducted to determine the death anxiety experienced by heart patients and the affecting factors in the COVID-19 pandemic. The study was conducted with 148 patients hospitalized in the cardiology clinic of a university hospital between April and August 2021 in the southeast in Turkey. The data were collected with the personal information form, death anxiety scale, coronavirus anxiety scale and Covid-19 fear scale developed by the researchers. Data analysis was performed by using IBM SPSS Statistics 25. Descriptive statistics were used in the analysis of the data. Correlation and regression analysis were performed to determine the relationship between scales. The mean age of the patients was 64.99+15.56 years and 56.1% were male. 57.4% of them were hospitalized with a diagnosis of coronary artery disease. During the pandemic, it was determined that 74.3% of the patients followed social distance, 71.6% wore masks, 58.8% used disinfectants. The patients had moderate death anxiety, low coronavirus anxiety, and high covid 19 fear. A positive linear correlation was found between anxiety and fear scale and death anxiety total and sub-dimensions. As a result, the fear of COVID-19 may increase the fear of death in individuals with heart disease. Patients who are worried about being infected with Covid 19 during the pandemic process have more fear of death.

Outbreak of delta variant SARS-CoV-2 virus on a psychogeriatric ward in Helsinki, Finland, August 2021; two-dose vaccination reduces mortality and disease severity amongst the elderly

We describe an outbreak of delta variant SARS-CoV-2 on a psychogeriatric ward of elderly patients. Retrospectively collected data was analysed using Fisher's exact test to assess the association between patients’ vaccination status and infection rates, severity of disease and mortality. Vaccination with two doses was shown to reduce severity of disease (5% vs. 75%, p < 0.001) and mortality (5% vs. 50%, p < 0.018) amongst an elderly inpatient population during an outbreak of delta variant SARS-CoV-2. Vaccination should be encouraged in elderly care institutions. Furthermore, adequate vaccination in elderly care institutions is an important consideration in current booster (third/fourth) dose schedules.

Mortality Risk From COVID-19 Among Unvaccinated Subjects With Autoimmune Phenotypes of Interstitial Lung Disease

BACKGROUND

The impact of the severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) virus on patients with interstitial lung disease (ILD) remains poorly understood. As patients with ILD often have severe underlying lung parenchymal involvement, and immunosuppressive therapy is common in this population, they are presumed to be at high risk for severe coronavirus disease 2019 (COVID-19) pneumonitis. Our aim was to explore demographic and clinical differences between those with ILD who tested positive for the SARS-CoV-2 virus compared to those with ILD who did not.

METHODS

In this retrospective cohort study, we identified adult, unvaccinated patients evaluated at the University of Chicago in 2020 who were enrolled in the ILD registry, and stratified by SARS-CoV-2 seropositive status. We then compared baseline clinical characteristics between SARS-CoV-2 seropositive and SARS-CoV-2 seronegative patients and assessed immunosuppressive therapy that the patient may have been on since ILD diagnosis. C-reactive protein and leukocyte subsets were evaluated at COVID diagnosis compared to the time of baseline ILD evaluation as were pulmonary function testing. Variable comparisons were determined by two-sided t-tests or chi-square tests as appropriate, and logistic regression models were fitted to assess the odds of death from COVID-19 using generalized linear models with maximum-likelihood estimation.

RESULTS

Of the 309 individuals with ILD in our cohort, 6.8% (n=21) tested positive for SARS-CoV-2. Those who were SARS-CoV-2 positive were younger (57 years vs 66 years; P=0.002), had baseline higher total lung capacity (81% vs 73%, P=0.045), similar forced vital capacity (71% vs. 67%, P=0.37), and similar diffusion capacity of carbon monoxide (71% vs. 62%, P=0.10) at baseline. Among patients with ILD and COVID-19, 67% had received immunosuppressive therapies compared to 74% of those with ILD without COVID-19. Those with ILD and COVID-19 were also more likely to have had a diagnosis of autoimmune-related ILD (connective tissue disease-ILD or interstitial pneumonia with autoimmune features) (62% vs 38%, P=0.029). Overall, the mortality hazard was highest among unvaccinated subjects with autoimmune-related ILD who had COVID-19 (OR=9.6, 95% CI=1.7-54.0; P=0.01).

DISCUSSION

SARS-CoV-2 is prevalent in ILD, and may put unvaccinated adults who are younger, with autoimmune ILD, and on immunosuppressive therapy at higher risk. This suggests a need for COVID-19 vaccinations and therapy (inpatient and outpatient) for this group of patients at high risk for COVID-19. Larger studies are needed to fully explore the relationship between ILD and immunosuppressive therapy in COVID-19.

Graves' Disease Following COVID-19 Vaccination

Autoimmune endocrine diseases have been reported after influenza and the human papillomavirus vaccine, but there is limited data on autoimmune diseases after coronavirus disease 2019 (COVID-19) vaccination. Our report is about a 42-year-old Caucasian male and a 68-year-old Caucasian female who developed Graves' disease after receiving Moderna (Moderna, Inc., Cambridge, Massachusetts, United States) and Johnson & Johnson (Johnson & Johnson, New Brunswick, New Jersey, United States) vaccines, respectively. Both patients had no previous autoimmune thyroiditis and had normal thyroid function but developed hyperthyroidism characterized by suppressed thyroid-stimulating hormone (TSH), elevated free T4 level, and TSH receptor antibodies after vaccination. COVID-19 vaccines, either mRNA-based (Moderna) or non-mRNA-based (Johnson & Johnson), can cause Graves' disease. The clinical manifestations are similar to Graves' disease but without ocular manifestations.

Remdesivir-Associated Sinus Arrest in COVID-19: A Potential Indication for Close Cardiac Monitoring

Remdesivir is an antiviral, nucleoside analog used extensively during the coronavirus-disease 2019 (COVID-19) pandemic with proven efficacy against COVID-19-induced acute respiratory distress syndrome (ARDS). Our case report details the clinical course of a 50-year-old, COVID-19-positive patient who developed sinus arrest after being treated with remdesivir. Within 24 hours of discontinuing remdesivir therapy, the patient’s sinus arrest resolved to a normal sinus rhythm. The findings from our case report add to a growing body of evidence on the cardiotoxic profile of remdesivir. Remdesivir’s ability to cause bradyarrhythmias, and specifically sinus arrest, should be acknowledged when considering the use of this drug in at-risk patients.

Neurological Conditions Following COVID-19 Vaccinations: Chance or Association?

Coronavirus disease 2019 (COVID-19) has been labeled a global pandemic with the first reported case of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurring in Wuhan, China in December 2019. To combat the alarming, increasing rate of those affected by the virus, vaccine development ensued. As mass vaccination initiatives against COVID-19 ensued, adverse reactions began emerging. This non-consecutive, population-based case series focuses on four vaccine-associated neurological adverse events across the central and peripheral nervous system detailing the diagnosis, treatment and subsequent follow-up management. These four patients presented to public and private hospitals in Trinidad and Tobago with new-onset neurological diseases soon after their first doses of a COVID-19 vaccine: two after the Pfizer-BioNTech vaccine (one case of new-onset seizures and one case of longitudinally extensive transverse myelitis) and two after the ChAdOx1 nCoV-19 vaccine (one case of Guillain-Barre syndrome and one case of meningitis-retention syndrome). The background incidence rates of neurological conditions in the population and the large numbers of persons being vaccinated means that some of these conditions will appear in the post-vaccination window by chance. Hence, establishing causal links is difficult. The close temporal relationship between vaccination and the presenting symptoms, the biological plausibility, and the extensive diagnostic workup to exclude other causes fulfill criteria provided by the World Health Organization for causality assessment of an adverse event following immunization on an individual level. On this basis, it was determined that these adverse events were likely due to the vaccines. However, establishing causal links on a population level requires large epidemiological studies and cannot be done on individual case reports alone. While physicians should be cognizant of even these rare adverse events of vaccines, it should be reiterated that the overall safety profile of vaccines is well established.

Socioeconomic Determinants of COVID-19 Incidence and Mortality in Florida

A wide variety of social determinants of health have been associated with various risks and impacts on quality of life. Specifically, poverty, lack of insurance coverage, large household sizes, and social vulnerability are all factors implicated in incidence and mortality rates of infectious disease. However, no studies have examined the relationship of these factors to the COVID-19 pandemic on a state-wide level in Florida. Thereby, the objective of this study is to examine the relationship between average household size, poverty, uninsured populations, social vulnerability index (SVI), and rates of COVID-19 cases and deaths in Florida counties. The objective was accomplished by analyzing the cumulative case and death reports from state and local health departments in Florida. The data was compiled into a single dataset by the CDC COVID-19 Task Force. Using US Census Bureau data, all Florida counties were classified into tertiles of the separate categories of poverty rate, average household size, uninsured rates, and SVI (Social Vulnerability Index). The poverty level was classified as low (0-12.3%), moderate (12.3-17.3%), and high (>17.3% below the federal poverty line). The uninsured population proportion was classified as low (0-7.1%), moderate (7.1-11.4%), and high (>11.4% uninsured residents). Average county household size was classified as low (0-2.4), moderate (2.4-2.6), and high (>2.6). The Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) Social Vulnerability Index (SVI) used US census data on 15 social determinants of vulnerability to evaluate and assist disadvantaged communities. SVI tertiles were low (0-0.333), moderate (0.334-0.666), and high (0.667-1) on a range of 0-1, with higher numbers signifying communities with many factors of social vulnerability. The mean cumulative cases and deaths per 100,000 inhabitants were calculated in each tertile for each category. Analysis of the data revealed that case and mortality rates due to COVID-19 in the high poverty counties were markedly higher in Florida than the national average. In contrast, moderate and low poverty rates were below average. Similarly, counties with a high SVI had case and mortality rates greatly above state and national averages. Counties with a high proportion of uninsured displayed the highest case rates. However, mortality rates were the highest in counties with a low proportion of uninsured individuals. No clear correlation was observed between COVID-19 rates and household size. It was concluded that compiled CDC and US census data suggests a significant correlation between poverty, social vulnerability, lack of insurance coverage, and increased incidence and mortality from COVID-19. Future research should statistically analyze the correlations and examine the individual factors of SVI as potential COVID-19 predictors.

Variation in COVID-19 Disease Severity and Clinical Outcomes Between Different ABO Blood Groups

The primary objective of this study was to explore whether coronavirus disease 2019 (COVID-19) severity and outcomes varied between different ABO blood groups. This retrospective study included 363 COVID-19 confirmed patients who had their blood group recorded in the hospital medical records, from March to June 2020. Data representing demographics, clinical features, vital signs, laboratory findings, and COVID-19 outcomes were collected. Multivariate logistic regression was used for analysis and the results were adjusted for sociodemographic, clinical, and laboratory variables. The patients' mean age was 50 ± 17.8 years. Of the 363 patients, 30% were blood group A, 22.3% were blood group B, 8.8% were blood group AB, and 38.8% were blood group O. Bivariate analysis showed that patients with blood group AB were more likely to be free of any medical disease (65.6%) compared to other blood groups (p = 0.007). Fever was the most common presenting complaint (66.7%), and it did not significantly vary with changes in ABO blood groups (p = 0.230). Regarding laboratory characteristics, only C-reactive protein (CRP) levels were significantly associated with the blood groups, with high levels seen in blood groups A, B, and O (p = 0.036). In multivariate analysis, variations in emergency department (ED) disposition, requirement of intensive care unit care, and requirement of mechanical ventilation were not statistically significant among the different ABO blood groups. Furthermore, no correlation was found between hospital death and the different ABO blood groups. In conclusion, COVID-19 is most prevalent among patients with blood group O and least prevalent among those with blood group AB. No particular blood group had worse COVID-19 disease severity and outcomes than other blood groups. Therefore, we believe that ABO blood grouping should not be used as a major assessment tool for COVID-19 disease severity and outcome, and other known risk factors should be investigated.

Preliminary Design and Development of a Mechanical Ventilator Using Industrial Automation Components for Rapid Deployment During the COVID-19 Pandemic

The novel coronavirus disease 2019 (COVID-19) created a shortage of mechanical ventilators in the healthcare sector, resulting in rationed distribution, ethical dilemmas, and high mortalities. This technical report outlines the design and product outcome of a mechanical ventilator based on readily available off-the-shelf components, minimizing the dependence on manufacturing facilities. The ventilator was designed to operate in both hospitals and remote locations, having the ability to operate off various gas pressures and low voltage supplies. Due to the COVID-19 restrictions, the challenges of developing a device in an online setting with minimal manufacturing assistance were explored. Within a 10-day period, the team designed, prototyped, and conducted preliminary feasibility testing on the mechanical ventilator. The proposed design was not intended to replace, or be used as a medically approved ventilator, but demonstrates the ability to exploit off-the-shelf components to enable fast development and assembly. 

A Case of Giant Cell Arteritis Presenting After COVID-19 Vaccination: Is It Just a Coincidence?

Giant cell arteritis (GCA) is a large vessel vasculitis with variable presentations, including fevers, myalgias, headache, and jaw claudication. A particularly concerning symptom is transient vision loss, which may become irreversible without prompt recognition and treatment. The pathogenesis of GCA is incompletely understood, but it seems that the innate and adaptive immune systems play a key role in vessel inflammation, remodeling, and occlusion. We present a case of a 79-year-old male who developed GCA two days after he received his second dose of a COVID-19 mRNA vaccine. He presented with headaches, fever, and myalgias. Lab workup revealed elevated inflammatory markers, with C-reactive protein (CRP) 272 mg/L (<8.1 mg/L) and erythrocyte sedimentation rate (ESR) 97 mm/hr (0-20mm/hr). Imaging of the head, with CT and MRI, was unremarkable. His headache persisted despite supportive treatment, and he developed new, transient blurred vision, which increased suspicion for GCA. He underwent bilateral temporal artery biopsies, which were consistent with GCA. His symptoms resolved quickly with oral prednisone 60mg daily, and his inflammatory markers returned to normal within a month. A review of the literature revealed several case reports of giant cell arteritis following influenza vaccination. However, no large-scale studies have demonstrated a causal relationship between GCA and immunization. Our case demonstrates the first instance of GCA following a COVID-19 mRNA vaccine. We propose that the upregulated immune response to the vaccine acted as a trigger for GCA in this patient with predisposing factors. While causation cannot be determined based on one case alone, our case demonstrates an opportunity for further research into the relationship between vasculitis and immunizations. Despite this isolated case, the proven benefits of COVID-19 mRNA vaccines significantly outweigh any theoretical risk of immune dysregulation following administration.

Temporal variation analysis, impact of COVID-19 on air pollutant concentrations, and forecasting of air pollutants over the cities of Bangalore and Delhi in India

Indian cities are highly vulnerable to atmospheric pollution in recent years, due to exponential growth in urbanisation and industrialisation, and the increased pollution has been made to focus on the temporal variation analysis and forecasting of air pollutants over major Indian cities like Delhi and Bangalore. PM_2.5 concentrations are nearly 60.5% less than the annual average value during monsoon season while 76.3% more during the winter months. Ozone concentrations increase during the summer months (~ 46.3% more than the annual average) in Delhi, whereas in Bangalore, ozone concentrations are more (~ 75% more than the annual average) during the winter months. Variations of carbon monoxide and nitrogen oxides are significantly less comparatively. COVID-19 lockdown has a substantial positive impact on air pollution. Air pollutant concentrations are reduced during phase I and phase II of the lockdown. Pollutants, especially NOx and PM_2.5 concentrations, are drastically reduced compared to the previous years. NOx concentrations are reduced by ~ 20% in Bangalore, whereas ~ 50% in Delhi. PM_2.5 concentrations are reduced by ~ 41% in Delhi and ~ 55% in Bangalore. Forecasting of pollutants will be helpful in providing the valuable information for the optimal air pollution control strategies. It has been observed that linear model gives better results compared to ARIMA and Exponential Smoothening models. By forecasting, the concentration of NO₂ is 115.288 µg/m³, the ozone is 30.636 µg/m³, SO₂ is 11.798 µg/m³, and CO is 2.758 mg/m³ over Delhi in 2021. All the pollutants during forecasting showed a rising trend except sulphur dioxide.

Phlegmasia Cerulea Dolens Secondary to COVID-19 and May-Thurner Syndrome: A Case Report

Coronavirus disease 2019 (COVID-19) is associated with significant thromboembolic risk. Extensive deep vein thrombosis can infrequently progress to phlegmasia cerulea dolens that carries high morbidity and mortality rates. We report a case of a middle-aged male presenting with phlegmasia cerulea dolens in the context of COVID-19 and underlying May-Thurner syndrome, associated with transiently positive antiphospholipid antibodies.

Generative design of 3D printed hands-free door handles for reduction of contagion risk in public buildings

During the emergency caused by COVID 19 evidence has been provided about the risk of easily getting the virus by touching contaminated surfaces and then by touching eyes, mouth, or nose with infected hands. In view of the restarting of daily activities in presence, it is paramount to put in place any strategy that, in addition to social distancing, is capable to positively impact on the safety levels in public buildings by reducing such risk. The main aim of this paper is to conceive a design methodology, based on a digital, flawless, and sustainable procedure, for producing human-building interfacing solutions that allow anybody to interact in a safer and more comfortable way. Such solutions are focused on the adaptation of existing buildings features and are thought to be an alternative to sensor based touchless technology when this is not applicable due to economic or time constraints. The process is based on the integration of digital technologies such as 3D Scanning, Generative Design and Additive Manufacturing and is optimised to be intuitive and to be adaptive, hence, to be replicable on different kinds of surfaces. The design concept is finalised to generate automatically different products that meet geometry fitting requirements and therefore adapt to the specific geometries of existing handles. A specific case on Hands Free Door Handles is presented and the results of manufacturing and preliminary validation process are provided and discussed.

Post COVID-19 Vaccine Related Cerebral Venous Sinus Thrombosis and Thrombocytopenia

During the height of the COVID-19 pandemic, there was great relief with the global mass rollout of the Covid-19 vaccination programs. While they have proven to be safe and effective, the gradual emergence of side effects to the vaccines has undermined public trust in the vaccination program and, whilst rare, can lead to significant morbidity and mortality. The most serious was the emergence of vaccine-induced immune thrombocytopenia and thrombosis (VITT), also known as thrombosis with thrombocytopenia syndrome (TTS) or vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). VITT is a serious and often fatal complication of some COVID vaccines that seem more prevalent in younger people and women. We present a case of a 48-year-old woman who presented with VITT following COVID vaccination.

Infective endocarditis and COVID -19 coinfection: An updated review

With the rising number of COVID-19 patients, there have been reports of patients presenting with concomitant infective endocarditis.  In this retrospective review, we included all articles from Medline with COVID-19 and infective endocarditis coinfection.  Ten articles were identified from eight different countries over the world over the past 11 months.  All patients reported with the above coinfections were male with a mean age of 53 years.  Clinical features of COVID-19 and the presence of ground-glass opacity in CT thorax were predominant among patients with positive RT-PCR for COVID-19.  New-onset embolic infarct, pulmonary edema was a contributor to the diagnosis of endocarditis in most patients.  Involvement of the aortic valve was most common.  Delayed diagnosis and cardiac surgery were contributors to increased morbidity.

Adult-Onset Still's Disease After the ChAdOx1 nCoV-19 Vaccine

Adult-onset Still's disease (AOSD) is a rare autoimmune disorder without clear etiology. It is known that genetic and infectious causes trigger diseases. AOSD cases have been reported after coronavirus disease 2019 (COVID-19) infection and post influenza vaccine.

Here, we report this challenging case of adult-onset Still's disease in a patient who recently received the ChAdOx1 nCoV-19 vaccine (Oxford-AstraZeneca).

COVID-19-Induced Guillain-Barré Syndrome

This case report involves a 47-year-old male who presented to the emergency department (ED) with a positive coronavirus disease 2019 (COVID-19) test and symptoms of Guillain-Barré syndrome (GBS). Electrodiagnostic (EDX) studies reported an acute inflammatory demyelinating polyradiculoneuropathy (AIDP). The patient underwent intravenous immune globulin (IVIG) treatment and four weeks of acute inpatient rehabilitation with some functional improvement but remained unable to ambulate independently at discharge.

A Unique Presentation of Acute Kidney Injury With COVID-19

Although the respiratory system is the primary target of COVID-19 pneumonia, it can also notably affect the other systemic organs such as renal and cardiac. The incidence and prevalence of SARS CoV-2 associated acute renal failure are emerging day by day. While the pathogenesis is not clearly understood, it is considered multifactorial. Initially, the COVID-19-associated renal dysfunction was limited to acute tubular injury. However, over time a wide spectrum of clinical manifestations has been reported. Therefore, prompt investigation and early initiation of supportive treatment can potentially reduce the mortality and morbidity associated with this systemic disease. In this case report, we present a unique presentation of a COVID-19 with acute kidney injury where the patient was admitted to the intensive care unit with clinical features of acute renal failure with concomitant diagnosis of COVID-19, unlike other reported cases where patients were admitted to the intensive unit with respiratory distress and subsequently developed renal failure.

HIV and COVID-19 Coinfection: A Synergism That Results in More Severe Forms of Reactive Arthritis

Reactive arthritis is defined as arthritis that arises after infection, where pathogens cannot grow in the affected joints. Although the human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2 are not among the most commonly implicated pathogens, there is growing evidence that they have major implications in the genesis of reactive arthritis. However, there are no described cases of coinfection of both entities that cause reactive arthritis at the same time, and the alterations involved in the immune system that could cause the change of certain clinical characteristics to more severe forms of the disease are unknown. The following describes the case of a male patient in his third decade of life who has an unusual and severe presentation of reactive arthritis associated with coinfection by COVID-19 and the human immunodeficiency virus.

COVID-19 Associated Coagulopathy Resulting in Cerebral Venous Thrombosis and Pulmonary Embolism

Venous stroke is an infrequent complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease. Coronavirus disease 2019 (COVID-19) acts as a causative factor for thromboembolic events such as pulmonary embolism (PE), deep vein thrombosis (DVT), stroke (ischemic or hemorrhagic), and myocardial infarction. We report a case of cerebral venous thrombosis (CVT) following severe COVID-19 infection, with co-incidence of pulmonary thromboembolism. A 39-year-old English lady presented with fever and cough; subsequently, she was diagnosed with COVID-19 and was managed in the high dependency unit (HDU) due to the severity of symptoms; she received dexamethasone and tocilizumab. Her condition improved and she was discharged, but presented again after 15 days due to headache and left-sided weakness. Her neurological examination confirmed nystagmus, past pointing, and dysdiadochokinesia positive on the left side. Initial blood investigations showed D-dimer being raised at 1875 ng/ml. Head CT venogram reported evidence of thrombus in the superior sagittal sinus, left transverse sinus, and inferior sagittal sinus consistent with venous sinus thrombosis. She also underwent CT pulmonary angiogram (CTPA) which revealed lingular acute segmental PE and patchy ground-glass shadowing throughout both lung fields, confirming recent infective COVID-19 changes. She was started on a therapeutic dose of dalteparin (low-molecular-weight heparin). Luckily she made a good recovery from her neurological symptoms. Like this case and many other reported cases, COVID-19 acts as an independent risk factor for increased coagulopathy. Clinicians should maintain a high index of suspicion for CVT to aid in timely diagnosis and prompt treatment to save lives.

COVID or Not COVID? A Great Mimicker Behind the Smoke Screen

Vaping is becoming increasingly popular as an alternative to cigarettes. However, vaping does not come without risks; electronic cigarette (e-cigarette) and vaping-associated lung injury (EVALI) is one of the most severe consequences. Coronavirus disease 2019 (COVID-19) and bacterial pneumonia cases often present with almost identical features. We present a case of a young man who presented with pneumonia that was initially thought to be related to COVID-19 infection but later diagnosed as EVALI. Clinicians should have a high suspicion of EVALI in patients who present with hypoxemia and negative infectious workup, particularly during the COVID-19 era. Administration of corticosteroids has shown remarkable efficacy in improving hypoxemia; however, many patients may have chronic lung injury and may require oxygen long-term. Cases of EVALI should continue to be reported and followed up long term for monitoring disease outcomes.

Hemphagocytic Lymphohistiocytosis Secondary to COVID-19: A Case Report

Hemophagocytic lymphohistiocytosis (HLH) is categorized into primary HLH and secondary HLH. Primary or familial HLH is an autosomal recessive disorder due to mutation in immune regulatory genes. Secondary HLH is an uncommon hyperinflammatory disease triggered by a critical illness (malignancies or viral infection) that induces an uncontrollable excessive immune response, which results in multiorgan failure. Due to the rarity of the syndrome, HLH is associated with worse outcomes. Severe coronavirus disease-19 (COVID-19) is identified as a trigger of HLH, and published literature suggests that patients with severe COVID-19 are at high risk of developing HLH. COVID-19-associated HLH is rarely reported in the literature. Herein we present a case of secondary HLH due to COVID-19 presented in the emergency department with prolonged non-resolving fever.

Non-ST Segment Elevation Myocardial Infarction Secondary to Coronary Multi-Vessel Thrombosis in the Setting of COVID-19

Coronavirus disease 2019 (COVID-19) has been shown to impact the cardiovascular system by causing congestive heart failure, arrhythmias, myocarditis, acute coronary syndrome (ACS), or nonischemic cardiomyopathy. The infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) triggers the overproduction of proinflammatory cytokines, generating systemic inflammation and a procoagulant state that can lead to cardiovascular morbidity and mortality. Symptomatology may not be discrete with presentation of chest pain, dyspnea, and fatigue, so careful consideration should be applied to cardiovascular complications. Serial troponin dosage as well as EKG changes serve as viable prognosis markers. Prompt dissolution of the thrombi will minimize the extent of the myocardial injury.

Unusual Presentation of a Rare Pneumothorax in a Patient With COVID-19 Pneumonia: A Case Report

Coronavirus disease 2019 (COVID-19) is a respiratory and systemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Since the start of the COVID-19 pandemic, pneumothorax (PTX) has only been reported as a complication of the virus-induced pneumonia in less than 1% of cases. The majority of them developed symptoms in the setting of either an underlying history of lung disease or being placed on a mechanical ventilator during admission. The authors report a unique case of PTX in a patient with a recent COVID pneumonia that did not fit the aforementioned clinical picture - a 41-year-old male with a complete collapse of his right lung who was previously admitted for COVID pneumonia with no known pulmonary history and was not intubated. A chest tube was placed with the resolution of the PTX and the patient is being monitored on the medicine floor.

Sentiments Evoked by WHO Public Health Posts During the COVID-19 Pandemic: A Neural Network-Based Machine Learning Analysis

Introduction

The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. Established on April 7, 1948, it has since played a pivotal role in several public health achievements and has had considerable success. But never since the establishment of the WHO has it faced a pandemic of such a huge scale. The spread of the coronavirus and the inability of the WHO to contain it has raised many questions about its efficiency and role. The present study explores the range of emotions and sentiments evoked by public health information posts of WHO over the course of the pandemic.

Methods

This study uses Bidirectional Encoder Representations from Transformers (BERT), which is a neural network-based technique for natural language processing. Three timeframes of five months each, starting from March 2020, were defined. A total of six posts, two posts from each timeframe, were then analysed. Comments were classified as positive, neutral and negative. The broader positive and negative classes were further subclassified into two classes each. Natural language processing was further applied to obtain results.

Results

The general trend of the sentiments over the period of pandemic showed a significant and dominant proportion of negative comments that overshadowed the neutral, positive and irrelevant comments over all timeframes. Specifically, the negative sentiments peaked during the second timeframe. The negativity was directed more towards the WHO, governments and people not complying with coronavirus disease 2019-appropriate norms. Positive comments were mostly expressed towards health workers.

Conclusion

An unusually high proportion of negative sentiment was observed in response to relatively innocuous public health posts. This may be a result of heightened anxiety, questionable credibility of the sources of information and geopolitical power play maligning the image of the WHO.

ST Depression in the Setting of Subarachnoid Hemorrhage

We present a case report of a patient presenting with subarachnoid hemorrhage whose electrocardiogram (ECG) mimicked non-ST-elevation myocardial infarction. A 36-year-old male with a past medical history of resistant hypertension, previous severe acute respiratory syndrome coronavirus 2 infection, and alcohol abuse presented to the hospital after cardiac arrest. He was taken to the catheterization lab upon arrival and was found to have an unremarkable coronary angiogram. After angiography, computerized tomography (CT) head was performed revealing an acute, large-volume, subarachnoid hemorrhage. Subsequent CT angiogram of the head confirmed this with source noted to be a ruptured aneurysm of the anterior communicating artery. ST depression on ECG has been reported in patients who have suffered a subarachnoid hemorrhage. Although the most common etiology of cardiac arrest is an acute coronary syndrome, other etiologies based on a patient's past medical history need to remain in the differential. Recognition of ECG changes may lead to earlier diagnosis and decreased mortality in subarachnoid patients.

Post-COVID-19 Acute Transverse Myelitis: A Case Report and Literature Review

Acute transverse myelitis (ATM) following coronavirus disease 19 (COVID-19) is rarely reported in the literature. We report a case of ATM after COVID-19 infection in a female who presented with sudden onset bilateral lower limb weakness, paresthesia, and urinary retention. She developed fever, cough, dyspnea two weeks ago, and her COVID-19 test was positive one week later. After a complete physical examination and detailed investigations, including cerebrospinal fluid analysis, autoimmune screening, and infectious workup, a diagnosis of ATM due to COVID-19 was made. Magnetic resonance imaging of the whole spine confirmed the diagnosis of ATM. She was managed with intravenous methylprednisolone, physical therapy, and bladder training and her condition improved gradually.

A Case of Idiopathic Thrombocytopenic Purpura After Booster Dose of BNT162b2 (Pfizer-Biontech) COVID-19 Vaccine

Vaccination is now considered the best measure in minimizing the morbidity and mortality from the Covid-19 pandemic. Almost all the vaccines are considered safe except for minor and occasional side effects. Some of the commonly reported complications from the COVID-19 vaccines are vaccine-induced thrombotic thrombocytopenia (VITT)/thrombosis with thrombocytopenia syndrome/vaccine-induced pro-thrombotic immune thrombocytopenia syndrome.

In this case report, we present a case of a 75-year-old female who had an uncomplicated first and second vaccine dose but developed VITT after the booster dose of the vaccine. The patient was treated with dexamethasone and platelet transfusions. So far no such cases have been reported after the third (booster) dose of the Pfizer-Biontech vaccine.

With this case report, we present the case of the patient and discuss the literature related to vaccine-induced thrombocytopenia.

C4. Acute Limb Ischemia in Covid-19 Patient : A Rare Case Report from Rural to Tertiary Hospital

Background

Acute limb ischemia is defined as a decrease in blood perfusion to the limbs caused by blockages in peripheral arteries. Coronavirus disease 19 (COVID 19), declared as a pandemic by WHO, affects not only respiratory system but also other organs including cardiovascular system. Patients mainly manifests as venous thromboembolism, while peripheral arteries blockages is less common.

Case Summary

A 53 years old man came to emergency room complaining of pain in his left leg. It was felt since the third day of treatment at the previous hospital, in Tuban, as a covid patient one month ago. The first and third of his left toes were also blackish. There was no history of hypertension, diabetes or smoking. On laboratory result, D-dimer level was elevated by 745 ng/ml (normal range <500 ng/ml), while the others within normal limit. CT Angiography examination showed bilateral legs arterial thrombus which the left side was worse. A thrombectomy was performed, then heparin therapy intravenously was given. During observation at the 4^th day after surgery, the sign of necrotic border in the 1^st dan 3^rd toes were seen clearer and we decided to do mutilation.

Discussion

The pathophysiology of acute limb ischemia in Covid-19 patients is known multifactorial, including endothelial damage, immobilization and hypercoagulable states that have a role in the occurrence of blockages. They may also have an acute thrombosis of non atherosclerotic native arteries. An immediate anticoagulants and vascular interventions are needed to reduce its morbidities.

C53. Infection of Coronavirus Disease 2019 Reveals Brugada Pattern

Background

Coronavirus Disease 2019 (COVID-19) resulted considerable morbidity and mortality worldwide since December 2019. In the other hand, Brugada syndrome had higher risk of sudden cardiac death. Although it was manifested with an electrocardiographic (EGC) abnormalities, the patients with Brugada syndrome were often healthy and unaware of their genetic predisposition.

Case Summary

A 59 years old man without significant medical history was reported a day of fever, productive cough, and shortness of breath. He did not complain any chest pain, palpitation, and episode of syncope. The patient had no family history of sudden cardiac death. On presentation, he was febrile (39,5°C), tachycardia (110 beats/ min), and tachypnea (28 breath/ min). Laboratory findings of the patient were elevated High-sensitivity C-reactive protein (hs-CRP), with normal electrolyte level, and troponin. The Polymerase chain reaction (PCR) test for COVID-19 performed with the positive result. The chest radiograph showed multifocal bilateral interstitial with a normal cardiac silhouette. The ECG revealed Brugada type 2 ECG pattern. A bedside echocardiogram demonstrated with the normal result. His condition continued to improve and the ECG demonstrated complete resolution of the initial Brugada ECG pattern.

Discussion

COVID-19 infection has been described as unmasking Brugada pattern. The most frequently reported symptoms of COVID-19 was fever. Brugada syndrome was a genetic disorder, that was most commonly involving SCN5A gene, which encoded the cardiac sodium channel. Fever caused blockade of sodium channel was being well described provocative trigger that might incite arrhythmia in patient with Brugada syndrome.

COVID-19 Collateral Damage: Management of Periprosthetic Joint Infection in Malaysia

Background and objective

Periprosthetic joint infection (PJI) is one of the dreaded complications in patients after arthroplasty surgeries, owing to the risk of morbidity and arduous investigations and management associated with it. Nevertheless, as Malaysia is currently battling against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) pandemic head-on, the treatment for other non-life-threatening diseases including PJI has taken a backseat. In this study, we present a case series of 11 patients with PJI who were managed surgically at the largest tertiary hospital in Malaysia and we hope to shed some light on the difficulties we have encountered during this trying period.

Patients and methods

Patients with PJIs who underwent surgical intervention during the ongoing COVID-19 pandemic (March 1, 2020, to June 30, 2021) were reviewed and included in this study. The demographic profile of the patients, presenting complaints, prosthesis topography, biochemical investigative findings, surgical interventions, and short-term outcomes were summarized.

Results

A total of 11 patients were treated surgically at Hospital Kuala Lumpur for PJI. Among them, five patients are still awaiting their second-stage surgeries despite the completion of their antibiotic regimes, and they are fit for the procedure.

Conclusion

The COVID-19 pandemic has wreaked havoc on the treatment of patients with PJI. In a setting with scarce resources, surgeons should strongly consider single-stage revision surgeries for the treatment of patients with PJI.

Evolving Practice in Management of Pelvic-Acetabular Trauma: COVID-19 Experience From a Tertiary Referral Centre in the UK

Introduction

The United Kingdom was one of the hardest-hit countries during the COVID-19 Pandemic. The UK government announced three national lockdowns to control the spread of the coronavirus and prevent the NHS from getting overburdened with COVID-19 related attendances. Two of the most significant peaks in terms of COVID-19 related hospitalizations and COVID-19 related deaths were in Summer 2020 (corresponding to lockdown 1, which was in effect from 26th March to 26th May 2020) and early 2021 (corresponding to lockdown 3, which was in effect 6th January to 8th March 2021).

During this time, a significant proportion of NHS resources was being diverted towards the treatment of COVID-19 patients. Measures were being taken to prevent unnecessary hospitalizations and reduce patient contact. These included but were not limited to measures to reduce attendances to Emergency departments, introducing telemedicine clinics, and pausing elective services. 

Our hospital is a Major Trauma Centre providing Tertiary Pelvic trauma service to the Greater Manchester area and the North West of England. We conducted this retrospective comparative study to compare the trends in presentation and Management of Pelvic trauma and identify trends in how these changed throughout the pandemic. We want to share these insights with our readers.

Methodology

We conducted a retrospective comparative study by comparing two cohorts of patients, patients presenting to the Pelvic Trauma service during Lockdown 1 and Lockdown 3 in the UK, named Group A and Group B, respectively. Data on patient demographics, injuries, and their management was identified from the Electronic Patient Record System. The data analysis was carried out with the aid of Stata/IC version 16.1. using descriptive Statistics.

Results

Group A contained 19 patients, with a mean age of 66.9 years. Group B contained 23 patients with a mean age of 67.4 years. There was no statistically significant difference in these patients' population demographics, injury patterns, and management (operative vs conservative). However, there was an absolute reduction in the complication rate from Group A to Group B of 17.2% (26.3% vs 9.1%). The higher complication rate during Lockdown 1 can be explained by conservatively managing Pelvic and Acetabular Fractures that would have been eligible for fixation, had COVID-19 not been a factor.

Conclusions

Within the limitations of our study, it appears that operatively managing a carefully selected cohort of acute Pelvic Trauma patients with proper precautions was safe and effective. It is unclear whether there was an added benefit to having a higher threshold to operate and adopting the watch-and-wait policy in Lockdown 1. We recommend continuing to follow the current evidence and fix these fractures early.

The Associations of COVID-19 Induced Anxiety, Related Knowledge and Protective Behavior

On the last day of 2019, 44 pneumonia cases with unknown etiology were reported to the World Health Organization (WHO) Country Office of China. This was the first cluster of what would be defined later as coronavirus disease (COVID-19). A self-administered questionnaire with multiple-choice items was created in Microsoft Forms (Microsoft Corp. Redmond, WA. 2020). A 5-point Likert scale with ten items, where "1" refers to "Totally disagree" and "5" refers to "Totally agree," was developed to evaluate the anxiety induced by the COVID-19 outbreak highlighting the suggested sources of stress and anxious emotions, e.g., "When I or any family member go outside home during this COVID-19 outbreak I feel anxious". A 5-point Likert scale with 14 items, where "1" refers to "Not at all like me" and "5" refers to "Just like me," was developed to evaluate people's protective behaviors against coronavirus infection from 3 dimensions: Routine Protective Behaviors (RPB), Post-exposure Protective Behaviors (PPB), and Post-exposure Risky Behaviors (PRB). Items in RPB are aimed to measure individuals' protective behaviors in daily life when facing the epidemic. A multiple-choice scale of 12 items was developed to assess public awareness of COVID-19 as an emerging infectious disease. The primary objective of this work was to develop psychometrically sound scales to assess COVID-19 induced anxiety (CIAS), protective behaviors towards COVID-19 (PBCS), and COVID-19 related knowledge. The results indicated that COVID-19 induced the 6-item version of the CIAS can adequately measure anxiety level. Infectious disease outbreaks represent specific health-related crises that may impact people's emotions in different patterns according to their emerging nature. Therefore, the CIAS was designed to cover the potential anxiety sources for the general population during the COVID-19 outbreak.

Herpes Zoster Following COVID-19 Vaccination in Long-Term Breast Cancer Survivors

Mortality from coronavirus disease 2019 (COVID-19) is higher among patients with cancer. Vaccination represents a cornerstone in overcoming the disease, and vaccine safety needs to be closely assessed. This article discusses two cases of herpes zoster (HZ) following the administration of the BNT162b2 mRNA vaccine in patients who are long-term survivors of breast disease. HZ developed 24 days and two days after the second dose of the vaccine in women aged 81 and 61, respectively. These two patients were breast cancer operated respectively nine and 16 years before; interestingly HZ developed in the same site of previous surgical resection. The patients did not show lymphocytopenia or other signs of immunosuppression and were treated with acyclovir, resulting in the complete resolution of HZ. To our knowledge, these two patients are the first described cases of HZ reactivation following COVID-19 vaccination in cancer survivors.

Severe Dengue With Multisystem Inflammatory Syndrome in Children Due to COVID-19: A Co-infection Case Series

Severe dengue with the multisystem inflammatory syndrome in children (MIS-C) can be difficult to diagnose as both diseases have similar symptoms and laboratory findings. Bangladesh is currently facing a double burden of severe dengue and SARS-CoV-2 infection. Co-infection with these viruses can result in severe morbidity. Worldwide this co-infection is rare. However, we present five cases of severe dengue with possible MIS-C due to SARS-CoV-2 infection in children. All the children presented with shock with variable degrees of plasma leakage. Mucocutaneous and gastrointestinal involvement were common. All tested positive for dengue nonstructural protein 1 antigen on the second to the third day of fever and tested positive for anti-SARS-CoV-2 IgG by enzyme-linked immunosorbent assay. Echocardiographic evaluation in all patients showed coronary arterial abnormalities. Cardiac enzymes were abnormal, and there were raised inflammatory markers and abnormal coagulation profiles. One patient had neurological involvement and needed mechanical ventilatory support. All cases were successfully managed according to dengue shock syndrome guidelines and required intravenous immunoglobulin with prednisolone, aspirin, and in some cases, enoxaparin for the management of coronary arterial involvements, which is not a documented feature for severe dengue infection, but typically found in MIS-C due to SARS-CoV-2 infection or Kawasaki disease. This case series aims to describe the possibility of co-infection of severe dengue with MIS-C due to SARS-CoV-2 infection in a dengue-endemic region during the coronavirus disease 2019 (COVID-19) pandemic, and alternatively, dengue virus as an unusual etiology for Kawasaki disease was also entertained. Severe dengue in endemic regions can coexist with COVID-19 during an outbreak, making it hard to diagnose. It can be fatal without early, appropriate management.

Working at Home: The Impacts of COVID 19 on Health, Family-Work-Life Conflict, Gender, and Parental Responsibilities

OBJECTIVE

To examine the impact of working at home on general health, pain, stress, and work-family and family-work conflict, and differences based on gender and parental responsibilities.

METHODS

A convenience sample of 658 adults completed an online questionnaire. Regression modeling examined the effects and interactions of gender and parental responsibility on general health, musculoskeletal discomfort/pain frequency and severity, stress, and work-family and family-work conflict.

RESULTS

Women reported more pain and discomfort, regardless of the presence of children, than men with children. Women with children experienced increased stress compared with men with children. Women without children experienced less work-family conflict, and those without children experienced less family-work conflict than men with children.

CONCLUSIONS

The impact on pain, stress, and work-family and family-work conflict, due to mandated working at home, is gendered and influenced by parental responsibilities.

Warm and Cold Autoimmune Hemolytic Anemia in the Setting of COVID-19 Disease

Known associations with autoimmune hemolytic anemia (AIHA) include lymphoproliferative neoplasms, autoimmune conditions, and viral infections. There are a few case reports that implicate a potential relationship between COVID-19 and either warm or cold AIHA. We present the case of combined warm and cold AIHA in the setting of COVID-19. A 51-year-old male with no known past medical history presented with weakness and jaundice. Initial workup revealed white blood cells 41.4, hemoglobin 3.1, platelets 343, total bilirubin 5.3, direct bilirubin 1.6, and COVID-19 positive. Direct antiglobulin test (DAT) found IgG and C3 antibodies and pathology revealed cold agglutinins, consistent with both warm and cold AIHA. He received a total of five blood transfusions and was started on prednisone 1 mg/kg daily with a gradual taper over months. Hemolysis labs normalized within two weeks after discharge although antibodies remained positive 70 days after admission. Our patient presented with IgG and C3 antibodies as well as cold agglutinins, consistent with both warm and cold AIHA. To our knowledge, this is the first case of both warm and cold AIHA presenting simultaneously in COVID-19 infection. Unlike most cases in the existing literature, this patient had no history of underlying hematologic malignancy and both warm and cold AIHA.

Asymptomatic Rhabdomyolysis in a Young Adult With COVID-19

The novel coronavirus disease 2019 (COVID-19) is an ongoing pandemic. Although COVID-19 is frequently associated with respiratory symptoms and complications, multiple extrapulmonary manifestations have been identified since the beginning of the pandemic. Rhabdomyolysis has been described in the literature as one of the extrapulmonary manifestations of COVID-19. Herein, we describe a 21-year-old male patient who presented with cough and fever secondary to COVID-19 confirmed by positive reverse-transcription polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patient presented with an extremely elevated creatinine kinase (CK) of 53,886 U/L (normal 10-170) without any classical symptoms of rhabdomyolysis or deterioration in his kidney function. He was successfully managed with aggressive intravenous fluids. The aim of reporting this case is to highlight the importance of including total CK in the initial evaluation of COVID-19 patients.

COVID-19 Rekindling Herpes Zoster in an Immunocompetent Patient

During the coronavirus 2019 (COVID-19) pandemic, sundry dermatological conditions related to COVID-19 pneumonia have been published. COVID-19 primarily affects the respiratory system, but secondarily it also affects the heart, kidney, brain, skin, spinal cord, etc. Herpes Zoster (HZ) is considerably important morbidity associated with COVID-19 pneumonia. Recrudescence of HZ occurs because of the latent varicella-zoster virus (VZV) predominantly because of the decline in cell-mediated immunity (CMI). Abating CMI is due to the increasing age, but could also occur if the patient is suffering from an immunosuppressive disease or is using immunosuppressive drugs. In our case, the patient had no lymphopenia unlike the other cases, yet still, he developed HZ. HZ is associated with post-herpetic neuralgia (PHN), HZ ophthalmicus (HZO), and cerebral arteritis increasing morbidity and mortality, especially in elderly people and those who are immunocompromised.

Acute Mesenteric Ischemia as an Early Complication of COVID-19

We herein report a case of a 44-year old male patient with coronavirus disease 2019 (COVID-19) who presented with acute mesenteric ischemia. Acute mesenteric ischemia presents with severe abdominal pain, vomiting, and constipation. The case consisted of features typical of acute mesenteric ischemia. The patient underwent laparotomy with resection of a gangrenous segment of the bowel. The radiological features of the injury along with the pathophysiology and management have been discussed.