The Impact of COVID-19 on Blood Transfusion Services: A Systematic Review and Meta-Analysis

IntroductionWhile SARS-CoV-2''s main transmission route is through respiratory droplets, research has found that viral RNA could be detected in blood samples, causing concerns over the safety of blood donations and blood products. This paper therefore aims to systematically search for studies that have addressed their country''s lack of donations and analyse the risk of blood transfusion-transmission. As such, it will answer the question “should blood services focus more on donation vigilance or worry more about the risks of transmission through blood products?”Methods38 articles were identified through a systematic review adopting the PRISMA and STROBE guidelines. Meta-analysis was conducted using OpenMeta software.ResultsThe average decrease in blood donations was found to be 38%, with some regions showing up to 67% decrease. To assess the risk of actual blood transfusion-transmission, three datasets were analysed. Firstly, the viral load in COVID-19 patients was studied and found to have less than 1% detection rate (ARD = −0.831, 95% −0.963, −0.699). Secondly, the prevalence of finding viral RNA in a pool of donations was nearly −1.503 (ARD = −1.538, −1.468). Lastly, recipients who were given blood products of positive donors were found to be −0.911 (ARD 95% = −1.247, −0.575).Discussion/ConclusionBlood centres should focus more on launching initiatives and policies that would increase their countries'' blood supply as the virus has no direct threat to blood safety.     

Acute Cerebellar Ataxia in COVID-19 Infection: A Case Report

BackgroundThe outbreak of coronavirus disease 2019 (COVID-19) has been widely reported to cause symptoms such as fever, cough, sore throat, fatigue, and shortness of breath. Neurologic complications have not been widely reported without associated respiratory symptoms. These neurologic manifestations have been found mostly in the elderly. There has been no report of ataxia or COVID-19 cerebellitis in the young adult population without associated respiratory symptoms.Case ReportHere we report the case of a 30-year-old patient who presented with isolated cerebellar symptoms and was diagnosed with COVID-19 cerebellitis.Why Should an Emergency Physician Be Aware of This?It is important for emergency physicians to know that COVID-19 can have many clinical manifestations and to have a high level of suspicion with acute neurologic symptoms.     

Efficacy and Safety of Blood Derivative Therapy for Patients with COVID-19: A Systematic Review and Meta-Analysis

BackgroundThe outbreak of COVID-19 has resulted in more than 200 million infections and 4 million deaths. The blood derivative therapy represented by intravenous immunoglobulin (IVIG) and convalescent plasma (CP) therapy may be the promising therapeutics for COVID-19.MethodsA systematic article search was performed for eligible studies published up to August 3, 2021, through the PubMed, Embase, Cochrane Library. The included articles were screened by using rigorous inclusion and exclusion criteria. All analyses were conducted using Review Manager 5.4. Quality of studies and risk of bias were evaluated.ResultsA total of 5 IVIG therapy and 13 CP therapy randomized controlled trials were included with a sample size of 13,696 subjects diagnosed with COVID-19. IVIG could reduce the mortality compared with the control group (RR 0.65, 95% CI: 0.46–0.93, p = 0.02). The use of CP did not effectively reduce the mortality (RR 0.97, 95% CI: 0.91–1.03, p = 0.38), the length of hospital stay (MD −0.47, 95% CI: −4.13 to 3.20, p = 0.80), and the mechanical ventilation use (RR = 0.98, 95% CI: 0.89–1.07, p = 0.62) of the patients with COVID-19. Treatment with IVIG or CP was not significantly associated with an increase in reported adverse events (RR 1.07, 95% CI: 0.94–1.22, p = 0.28).ConclusionsTreatment with IVIG could be effective and safe to improve survival for patients with COVID-19. But the benefit of CP in the treatment of COVID-19 is limited. The certainty of the evidence was moderate for all outcomes.     

Recognizing the Clinical Sequelae of COVID-19 in Adults: COVID-19 Long-Haulers

As the numbers of acute severe acute respiratory syndrome coronavirus 2 infections continue to rise, we are learning that symptoms do not resolve quickly in all patients. Although why some patients experience persistent symptoms is not clear, these individuals suffer. Long-hauler is the term that is associated with these persistent symptoms, and this review of the literature provides information to nurse practitioners working in primary care about symptoms, risk factors, and resources for disease management.     

Opportunities and Challenges of Telehealth in Disease Management during COVID-19 Pandemic: A Scoping Review

Objective  The novel coronavirus disease 2019 (COVID-19) pandemic is an unexpected universal problem that has changed health care access across the world. Telehealth is an effective solution for health care delivery during disasters and public health emergencies. This study was conducted to summarize the opportunities and challenges of using telehealth in health care delivery during the COVID-19 pandemic. Methods  A structured search was performed in the Web of Science, PubMed, Science Direct, and Scopus databases, as well as the Google Scholar search engine, for studies published until November 4, 2020. The reviewers analyzed 112 studies and identified opportunities and challenges. This review followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis. Results  A total of 112 unique opportunities of telehealth application during the pandemic were categorized into 4 key themes, such as (1) clinical, (2) organizational, (3) technical, and (4) social, which were further divided into 11 initial themes and 26 unique concepts. Furthermore, 106 unique challenges were categorized into 6 key themes, such as (1) legal, (2) clinical, (3) organizational, (40 technical, (5) socioeconomic, and (6) data quality, which were divided into 16 initial themes and 37 unique concepts altogether. The clinical opportunities and legal challenges were the most frequent opportunities and challenges, respectively. Conclusion  The COVID-19 pandemic significantly accelerated the use of telehealth. This study could offer useful information to policymakers about the opportunities and challenges of implementing telehealth for providing accessible, safe, and efficient health care delivery to the patient population during and after COVID-19. Furthermore, it can assist policymakers to make informed decisions on implementing telehealth in response to the COVID-19 pandemic by addressing the obstacles ahead.     

Quality of Life of People with Cancer in the Era of the COVID-19 Pandemic in India: A Systematic Review

Background:The recent pandemic of COVID-19 caused havoc on the health system globally and raised a lot of questions and issues. Treatment for cancer is an emergency that cannot be taken back, particularly in an era of global pandemics. Cancer treatment mainly includes chemotherapy, surgery, radiotherapy, and palliative care, and because of the pandemic, all of these treatments are affected. The COVID-19 pandemic also had a potential effect on the quality of life and mental health of patients as well as health workers.Objective:This systematic review was intended to discuss the quality of life of people with cancer in the era of the COVID-19 pandemic in India in the light of the best available facts.Methods:An extensive literature search was done on PubMed, Medline, Embase, Clinical Key and Google Scholar databases till 3rd Feb 2021. Out of 1455 research articles, 06 research articles were included in this systematic review.Results:The results showed that cancer treatment delivery was as per standard safety protocol and the best treatment decisions were made by scheduling and setting priority. Till data, no direct research was conducted on the Indian continent to assess the quality of life of cancer patients in the COVID-19 era. The effect on the quality of life of cancer patients is very large and needs to be explored more by further research. Issues to be discussed with health care administrators and policy makers further. The tele-oncology method of cancer care delivery to patients is another rational option which is applicable as well.Conclusion:This systematic review demonstrated up-to-date evidence regarding the quality of life of cancer patients in the COVID-19 era in India. No research has been done to assess the quality of life of cancer patients. Still, the area is unrevealed, but evidence from other global studies indicates an altered quality of life for cancer patients. To maintain quality of life, cancer physicians should make evidence-based decisions and incorporate multidisciplinary management into decision making.     

Nasal Foreign Body,an Unanticipated Complication of COVID-19 Care: A Case Report

BackgroundCoronavirus disease 2019 (COVID-19) has changed the way we practice medicine. Standards of care are evolving in an effort to diagnose, manage, and treat the cause of this global pandemic, as well as to protect the health care workforce. These practices can have unexpected and potentially dangerous consequences, particularly for patient populations with confounding factors that put them at increased risk for complications and poor outcomes.Case ReportA 52-year-old previously healthy woman presented with 4 days of nasal pain and discharge after using a home collection kit in an attempt to obtain a nasopharyngeal viral sample for COVID-19 testing.Why Should an Emergency Physician Be Aware of This?With treatments, policies, and procedures that are rapidly evolving and often deviating from established, evidence-based, usual care in response to the COVID-19 pandemic, emergency physicians must be cognizant of and monitor for poor outcomes and potential downstream complications, especially in underserved patient populations.     

老年危重型新冠肺炎患者救治病例报告

2020年2月8日,阳光融和医院收治1例重型新冠肺炎感染患者,病情进展迅速,短期内转为新冠肺炎危重型患者,后经精心治疗与护理,该患者2次咽拭子核酸检测阴性,解除隔离,转入隔离观察区继续治疗基础疾病,且参与本次救治的重症组所有医护人员无感染发生。本文回顾了该新冠肺炎危重型患者救治过程中的工作情景及细节,以病例讨论的形式,还原诊疗过程、护理记录,针对该患者护理中的重点、疑点、难点进行讨论分析,旨在总结新冠肺炎的护理要点,提高对危重型新冠肺炎患者在不同时期的护理管理,推广医护人员避免感染的防护措施,为临床救治新冠肺炎危重型患者提供医疗及护理经验,为医护人员职业防护提供依据。     

A fatal case of COVID-19-associated invasive pulmonary aspergillosis

A 79-year-old Japanese man with polymyalgia rheumatica was admitted to hospital with coronavirus disease (COVID-19). On admission, he was treated with ciclesonide inhalation, ivermectin, and meropenem. He was intubated 6 days after admission, and methylprednisolone therapy was initiated (1000 mg/day). Hypoxemia and chest radiographic findings temporarily improved. However, chest computed tomography showed bilateral ground-glass attenuations, multiple nodules, and consolidation. Aspergillus fumigatus was cultured from the tracheal aspirate and he was diagnosed with COVID-19-associated invasive pulmonary aspergillosis (CAPA) and treated with liposomal amphotericin B. However, he died 28 days after admission.     

Salt Toxicity: A Systematic Review and Case Reports

IntroductionSalt toxicity is a rare form of hypernatremia that typically occurs after a single massive ingestion of salt over a short period of time (minutes/hours). It is a dangerous imbalance capable of causing significant neurological injury; quick recognition of salt toxicity is crucial to allow treatment before permanent brain injury occurs. The purpose of this review is to assist emergency nurses in gaining knowledge on the causes, pathophysiology, symptoms, and treatment of salt toxicity.MethodsA systematic search for case reports of hypernatremia due to salt toxicity was conducted in the PubMed and Scopus electronic databases. The search terms used were salt, sodium, hypernatremia, toxicity, poisoning, case reports, case series, and cases. The following were the inclusion criteria: publication dates between January 1, 2000, and September 30, 2019; evidence of an acute large oral or gastric tube ingestion of salt over a short period of time (minutes/hours); admission for treatment within hours of the event; laboratory verification of hypernatremia; and full-text article available electronically in English. The following were the exclusion criteria: an unclear history, high salt consumption over a period of days, high sodium intake via the intravenous route, and breast feeding.ResultsOnly 15 cases met the inclusion criteria for the review. Patients described in the case reports ranged in age from 5 days to 73 years. Forty percent of the patients were children less than 15 years old. Of the 14 cases with known outcomes, 50% were fatal. The most frequent causes of salt toxicity were salt water emetics, intentional administration of large quantities of salt to a child by a caregiver, and suicide attempts. Among the other causes were unintentional salt overload in infant formula, an exorcism ritual, and a college prank.DiscussionFindings from this review of 15 case reports in which a large salt load was ingested over a short period of time suggest that salt toxicity is a rare condition associated with high mortality. In addition, salt toxicity can occur in patients of all ages for a variety of reasons; the most frequently identified reasons in this review were use of salt water as an emetic and child abuse by the intentional administration of a high salt load by a caregiver. For patients whose massive exposure to salt is recent (such as minutes to hours), rapidly reducing the serum sodium concentration may prevent irreversible neurological injury.     

Factors associated with COVID-19 vaccination hesitancy in South Korea: A cross-sectional study

Vaccination against COVID-19 has been promoted as a way to protect oneself and others from infection. To ensure the comprehensive acceptance of COVID-19 vaccines, the factors that affect COVID-19 vaccination hesitancy should be examined. This study aimed to identify the factors that affect COVID-19 vaccination hesitancy among Korean adults, focusing on COVID-19 knowledge and attitudes toward vaccination. This was a cross-sectional study conducted with 2286 Korean adults aged 20–64 years. Demographic characteristics, knowledge regarding COVID-19, and attitudes toward vaccination were assessed. A generalized linear model with Poisson regression was used to identify factors associated with COVID-19 vaccination hesitancy. Approximately 67% of the COVID-19 knowledge-related questions were correctly answered. A neutral attitude toward vaccination and relatively low vaccination hesitancy were found. COVID-19 vaccination hesitancy was affected by individuals' attitudes toward vaccination, as well as their gender and age, but not by their knowledge. Interventions or policies considering gender and age could be helpful in reducing COVID-19 vaccination hesitancy. Strategies to disseminate more accurate and novel information related to the COVID-19 vaccines should be implemented.     

Manifestations and risk factors of COVID-19 and mucormycosis: A mini-review

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has become a pandemic disease. It also increases the risk of co-infections. Mucormycosis is a severe fungal infectious disease and its causative agent, mucormycetes, belongs to an opportunist fungus Mucoraceae family. Mucormycosis in COVID-19 patients with mucormycosis presents an additional challenge worldwide. Mucormycosis shares certain risk factors and signs and symptoms with COVID-19. In this review, we summarize manifestations and risk factors of mucormycosis and COVID-19.     

A randomized double-blind controlled trial of convalescent plasma in adults with severe COVID-19

BACKGROUNDAlthough convalescent plasma has been widely used to treat severe coronavirus disease 2019 (COVID-19), data from randomized controlled trials that support its efficacy are limited.METHODSWe conducted a randomized, double-blind, controlled trial among adults hospitalized with severe and critical COVID-19 at 5 sites in New York City (USA) and Rio de Janeiro (Brazil). Patients were randomized 2:1 to receive a single transfusion of either convalescent plasma or normal control plasma. The primary outcome was clinical status at 28 days following randomization, measured using an ordinal scale and analyzed using a proportional odds model in the intention-to-treat population.RESULTSOf 223 participants enrolled, 150 were randomized to receive convalescent plasma and 73 to receive normal control plasma. At 28 days, no significant improvement in the clinical scale was observed in participants randomized to convalescent plasma (OR 1.50, 95% confidence interval [CI] 0.83–2.68, P = 0.180). However, 28-day mortality was significantly lower in participants randomized to convalescent plasma versus control plasma (19/150 [12.6%] versus 18/73 [24.6%], OR 0.44, 95% CI 0.22–0.91, P = 0.034). The median titer of anti–SARS-CoV-2 neutralizing antibody in infused convalescent plasma units was 1:160 (IQR 1:80–1:320). In a subset of nasopharyngeal swab samples from Brazil that underwent genomic sequencing, no evidence of neutralization-escape mutants was detected.CONCLUSIONIn adults hospitalized with severe COVID-19, use of convalescent plasma was not associated with significant improvement in day 28 clinical status. However, convalescent plasma was associated with significantly improved survival. A possible explanation is that survivors remained hospitalized at their baseline clinical status.TRIAL REGISTRATIONClinicalTrials.gov, {"type":"clinical-trial","attrs":{"text":"NCT04359810","term_id":"NCT04359810"}}NCT04359810.FUNDINGAmazon Foundation, Skoll Foundation.     

Acquired Tracheomegaly in Critically Ill Patients With COVID-19: A Literature Review

Tracheomegaly is defined as an abnormally dilated trachea and is seen in patients requiring long-standing mechanical ventilation and/or significant hyperinflation of their endotracheal or tracheostomy tube cuffs can occur in adults with severe COVID-19. Tracheomegaly is linked with inadequate nutrition, pneumonia, diabetes, hypotension, steroids, and protracted mechanical ventilation, which are common in COVID-19 patients. Findings include cuff leaks that necessitate cuff overinflation to maintain adequate tidal volumes. Tracheomegaly can be diagnosed with chest radiographs, chest computed tomography, bronchoscopy, or diagnostic laryngoscopy or tracheoscopy. This condition leads to a concern for obstruction, airway collapse, aspiration pneumonia, and iatrogenic tracheal injuries.     

COVID-19 mortality and its risk factors: A single-center observational study

Objectives: To determine COVID-19 mortality and its risk factors in hospitalized patients at of a tertiary care center in north India. Methods: A retrospective observational study was conducted of patients who were hospitalized from May 2020 to January 2021. The in-hospital mortality was assessed, and demographic variables and comorbidities between COVID-19 deaths and survivors were compared. Results: A total of 24000 patients were admitted during the study period, among which 17000 had shown positive results of the RT-PCR test for COVID-19. The total mortality was 329 patients (1.37％), among which 232 (70.52％) succumbed due to COVID-19, and 97 (29.48％) died due to other illnesses. The mean age of the patients was (64.09±16.99) years. The mean age was significantly higher in COVID-19 related deaths [(67.63±13.78) years] as compared to that of the survivors [(60.52±19.5) years] (P<0.001). Compared to COVID-19 survivors, there were more males (72.41％ v.s. 61.5％) and less females (27.59％ v.s. 38.5％) in COVID-19 related deaths (P=0.001). Comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease showed a significant correlation with COVID-19 mortality with an adjusted odds ratio of 2.389 (95％ CI: 1.465-2.982), 3.891 (95％ CI: 2.059-5.392), and 6.358 (95％ CI: 5.675-10.564), respectively. Conclusions: Elderly males with comorbidities have higher risk for mortality related to COVID-19. Ongoing vaccination drive is rightfully prioritised to serve the high-risk category first.     

COVID-19 and psychiatry training: A cross-national trainee perspective

The coronavirus disease 2019 pandemic has significantly altered many aspects of our professional lives, including how psychiatry as a medical discipline is taught and learnt. Training in psychiatry relies on developing competencies through observing and interacting with patients, developing empathic consultation skills and seeking feedback from colleagues derived from cognitive and constructivist theories of learning, in a time-bound manner. The pandemic has drawn attention to the dual role of psychiatry residents as both trainees and physicians, with a pressing identity crisis at an inopportune time. This paper aims to illustrate some of the emerging themes in psychiatry training during the pandemic and some solutions for the same.