Prevalence, characteristics, and predictors of Long COVID among diagnosed cases of COVID-19

Background: Long COVID or long-term complication after COVID-19 has the ability to affect health and quality of life. Knowledge about the burden and predictors could aid in their prevention and management. Most of the studies are from high-income countries and focus on severe cases. We did this study to estimate the prevalence and identify the characteristics and predictors of Long COVID among our patients. Methodology: We recruited adult (≥18 years) patients who were diagnosed as Reverse Transcription Polymerase Chain Reaction (RTPCR) confirmed SARS-COV-2 infection and were either hospitalized or tested on outpatient basis. Eligible participants were followed up telephonically after four weeks of diagnosis of SARS-COV-2 infection to collect data on sociodemographic, clinical history, vaccination history, Cycle threshold (Ct) values during diagnosis and other variables. Characteristic of Long COVID were elicited, and multivariable logistic regression was done to find the predictors of Long COVID. Results: We have analyzed 487 individual data with a median follow-up of 44 days (Inter quartile range (IQR): 39,47). Overall, Long COVID was reported by 29.2% (95% Confidence interval (CI): 25.3%,33.4%) participants. Prevalence of Long COVID among patients with mild/moderate disease (n = 415) was 23.4% (95% CI: 19.5%,27.7%) as compared to 62.5% (95% CI: 50.7%,73%) in severe/critical cases(n=72). The most common Long COVID symptom was fatigue (64.8%) followed by cough (32.4%). Statistically significant predictors of Long COVID were - Pre-existing medical conditions (Adjusted Odds ratio (aOR)=2.00, 95% CI: 1.16,3.44), having a more significant number of symptoms during acute phase of COVID-19 disease (aOR=11.24, 95% CI: 4.00,31.51), two doses of COVID-19 vaccination (aOR=2.32, 95% CI: 1.17,4.58), the severity of illness (aOR=5.71, 95% CI: 3.00,10.89) and being admitted to hospital (Odds ratio (OR)=3.89, 95% CI: 2.49,6.08). Conclusion: A considerable proportion of COVID-19 cases reported Long COVID symptoms. More research is needed in Long COVID to objectively assess the symptoms and find the biological and radiological markers.

Preoperative S-1 Therapy for Squamous Cell Carcinoma of The Head and Neck During the Waiting Period Before Surgery

Background: In patients with squamous cell carcinoma of head and neck (SCCHN), delayed surgery can result in poorer postoperative function and prognosis due to the growth of the tumor and the extended surgery. Further, delay may even make the tumor unresectable. To prevent tumor growth during the waiting period before surgery, S-1 has been administrated preoperatively at several facilities in Japan. To date, however, the safety and efficacy of preoperative S-1 remains unclear.Methods: We conducted a retrospective cohort study of 118 patients with SCCHN treated with S-1 before radical surgery at 2 institutions in Japan. We evaluated the safety of S-1 therapy, which was evaluated by the incidence of grade 3 or greater adverse events (AEs). The rate of achievement of the non-growth of tumors was also calculated.Results: Regarding safety, 125 AEs of all grades were recorded in 71 patients (60%). Of these, grade 3 AEs were detected in 3 patients (3%), and no grade 4 or 5 AEs occurred. The non-growth rate of primary lesions and lymph node metastases was 89% and 85%, respectively. Conclusion: Our data showed that preoperative S-1 therapy might be useful with acceptable toxicity on an outpatient basis in patients with SCCHN.

Infection by SARS CoV-2 in healthcare workers of a second level hospital

Background: From the first Covid-19 case in Playa del Carmen, 370 cases of infection have been reported in our staff until December 31, 2020. Material and Methods: Study in workers of the General Hospital who developed SARCOV-2 infection during the pandemic. A sample of 30 cases of both sexes with laboratory-confirmed infection was obtained. Descriptive statistics were used with measures of central tendency, dispersion and percentages. Results: In a sample of 30 workers there were 13 doctors, 6 nurses and 11 support workers. The age was obtained as a mean of 38.8 years and SD = 10.4. Only four risk factors were found. Of the 30 infected health workers, 27 were treated on an outpatient basis and three required hospitalization. Discussion: The main symptoms in health workers are alterations in the sensation of taste and smell, but unlike our study, was headache, fever and myalgia. Likewise, it has been observed that medical are the most affected, but in this study, it was support and the least affected was nursing personnel. There is no doubt that asymptomatic carriers are a serious disease transmission problem such that transmission between health workers by asymptomatic carriers is possible as was observed in this analysis. Keywords: COVID-19; SARS-CoV-2; Healthcare Workers; Nosocomial Transmission; Asymptomatic Carriers; Diagnostic Testing

A Prospective Study of Clinical, Epidemiological and Serologic Status Features in a Paediatric Pcr Sars-Cov-2 Positive Population

Background:Although most cases of SARS-CoV-2 infection in pediatric population are asymptomatic or mild, severe cases may occur in a small percentage. Unlike other respiratory infections, children usually develop it from infected adults. Percentage of seroconversión and outcome of antibodies after infection anti-SAR-CoV-2 in children are still poorly understood and may be different from adults. The first aim was to describe clinical and epidemiological characteristics of pediatric patients diagnosed of SARS-CoV-2 infection in the second epidemic wave in two tertiary hospitals in Madrid, Spain and to determine the proportion of seronegative by comparing 3 serological techniques. As secondary aim it was proposed to determine the proportion of seronegative by comparing 3 serological techniques, seroconversion associated variables and the way of infection among the family members. Methods:Multicenter prospective observational study in two university hospitals of the Community of Madrid, between September and November 2020, of COVID-19 infection confirmed by PCR in the Emergency Department. A retrospective data collection was performed at 4-8 weeks after diagnosis on an outpatient basis, using a clinical-epidemiological questionnaire. At this time blood samples were collected to analyse the humoral response by 3 different serological assays.The quantitative variables are expressed as medians (interquartile range (IQR) 25-75).Univariate analysis of possible factors associated with seropositivity absence was performed.Results: One hundred and eleven patients (58 girls) were included with a median days of 37 (IQR: 34-44) between diagnosis and serologic test performed.Median age was 88 (IQR: 24-149) months. Parents were from abroad in 62 cases (50% from South and Central America).Ninety eight children were symptomatic, 17 children were diagnosed by epidemiological screening, 4 of whom subsequently developed symptoms.Eight of them needing admission with a median length of stay 2 days (IQR: 2-4), none of them in PICU.Underlying conditions were found in 33 patients, mainly recurrent bronchitis.Most frequent symptoms (70%) were low-grade fever (37-38ºC) or fever (≥ 38ºC), rhinorrhea 44%, cough 31.5%, headache 29.7%, weakness 27%, diarrhea 19.8%, abdominal pain and vomiting 26%, anosmia 16.2% (median 10 days; IQR: 6-30). Infection was interpreted as a secondary case in 56 patients, being a relative the index case in 96.4%. Seronegativity was observed in 19 patients in any of the 3 serological techniques (17.1%; 95% CI: 10.6-25.4), this proportion was higher among children aged 2-to 10-year-old age (16 of 45; 35%, p <0.05).In univariate analysis a lower proportion of seroconversion was found in those children in whom COVID-19 confirmation is not documented among household contacts (15/29; 51.7%; p <0.05). Conclusions: Our results confirm the mild clinical picture in children during the second epidemic wave, and that in most cases, children are not the index case in the family. Likewise, in children the proportion in whom seroconversion is not detected is high, and seems higher than that reported in adults. In our series, an association of seronegativity was seen in the 2 to 10 year-old age group and when there was no documentation of COVID-19 in any household contact.

Periocular capillary hemangioma treated with low dose oral propranolol - presentation and outcome of 30 patients

Purpose: To evaluate the presentation and outcome of periocular capillary hemangioma treated with low-dose oral propranolol. Method: Thirty cases of periocular capillary hemangioma prospectively studied from 1st June 2015 to 31st May 2017 who received oral propranolol on an outpatient basis. Hemangioma causing any threat to vision or disfigurement was included and age below 3 months and multiple lesions were excluded. Starting dose of propranolol was 1 mg/kg and increased to 2 mg/kg after 2 weeks as a maintenance dose. The tapering dose was 1 mg/kg of body weight before discontinuing the medication. Treatment was continued till the child is 1 year of age or no further change in color or size of the lesion in two successive follow-ups. Results: Presenting age was 6.36 ± 3.36 months (ranged 3–24 months) with female predominance (70%). In 86.6% of cases, the vision was Central Steady and Maintained and cycloplegic refraction showed marked astigmatism in 3 children which resolved after treatment. Forty-six percent of children showed color change as an initial response to treatment. Most children (33.3%) responded completely within 5 months after starting the treatment. One third patients (33.3%) showed 100% resolution, 50% showed 90% to 70% resolution. Pretreatment and post-treatment lesion size was1.60 ± 0.86 cm2 and 0.30 ± 0.40 cm2 respectively (p - value < 0.0005). None showed any significant adverse effect of oral propranolol. Conclusion: Low-dose oral propranolol is an effective and cost-effective treatment modality for periocular capillary hemangioma and is safe as an outpatient basis.

Principles of care for adolescent girls with eating disorders and body disturbances disorders: lessons from the COVID-19 pandemic

The pandemic of the new coronavirus infection (COVID-19) has contributed to an increase in problems related to eating behavior and body image in the population. Various risk factors that have become relevant due to changes in the usual lifestyle have significantly affected the frequency of eating disorders in the adolescent population. This necessitated the adapting of new strategies for providing medical care in conditions of limited personal contact.The aim of the work is the methodological substantiation and systematization of modern approaches to the prevention and treatment of eating disorders, body image disorders and risk factors associated with them in adolescents in the conditions of the COVID-19 pandemic.Materials and methods. The methodological basis of the work is a comprehensive analysis of modern medical and social approaches and recommendations on the organization of assistance to adolescents with eating disorders and body image disorders, with a description of personal experience of using various interventions on an outpatient basis during the pandemic.Results: Prevention and treatment of eating disorders and body image disorders in adolescents during the pandemic should be aimed at specific risk factors those have proved to be the most relevant in connection with restrictive measures: involvement in body image-related social media content and active use of the media; reduction of physical activity with simultaneous increase in access to food; social isolation and reduction of social support; restriction of access to qualified care. The most reasonable approaches during the pandemic are the approaches focused on the family of a teenager using, if possible, remote forms of assistance.Conclusions: Currently, there are no norms and standards in the organization of assistance to adolescents with eating disorders and body image disorders in the pandemic context. However, the analysis of the implemented approaches aimed at various risk factors of these disorders will allow the use of the most effective preventive and therapeutic practices in the future.

Management of a patient with viral conjunctivitis on an outpatient basis: a case of acute viral conjunctivitis in a patient with hay fever

На долю конъюнктивита приходится 33% всех случаев заболеваний глаз. Конъюнктивит, или воспаление конъюнктивы, относится к ее наиболее частым заболеваниям. Независимо от этиологии клинические проявления примерно одинаковые. На прием в поликлинику приходят пациенты с жалобами на светобоязнь, ощущение инородного тела, покраснение склер, зуд, боль, слезотечение, отек век. Первой целью офтальмолога является дифференциация между вирусным и бактериальным конъюнктивитом. Вторым этапом необходимо провести детальный дифференциальный анализ между нозологиями. Для решения этих задач врачу необходимо провести детальный сбор жалоб и анамнеза, а также биомикроскопию переднего отрезка глаза. Вирусные заболевания глаз представляют собой серьезную медико-социальную проблему. Вирусы – одна из наиболее частых причин инфекционного поражения наружных структур глаза с широким спектром возможных проявлений – от легкого преходящего конъюнктивита до более серьезных состояний, при которых поражение конъюнктивы и роговицы может приводить к рубцеванию, что в некоторых случаях ведет к слепоте. Такие возбудители, как аденовирус, пикорнавирус, вирусы простого герпеса и герпеса зостер, могут вызывать изолированный конъюнктивит, однако нередко они поражают также роговицу и веки. В последние годы отмечается рост распространенности аденовирусных конъюнктивитов. Заболевание отличается высокой частотой встречаемости и поражает все возрастные группы. Рост заболеваемости приходится на осенне-весенний период, когда вирусная контагиозность повышена. В клинической практике для местной терапии таких заболеваний, как вирусные (аденовирусные и герпетические) конъюнктивиты, кератиты, кератоконъюнктивиты, увеиты, с высокой эффективностью используются препараты интерферона. Conjunctivitis accounts for 33% of all eye diseases. Conjunctivitis, or inflammation of the conjunctiva, is one of its most common diseases. Regardless of the etiology, the clinical manifestations are approximately the same. Patients come to the clinics with complaints of photophobia, a feeling of a foreign body, red eye, itching, pain, lacrimation, hyperemia and swelling of the eyelids. The first goal of an ophthalmologist is to differentiate between viral and bacterial conjunctivitis. The second stage is to conduct a detailed differential analysis between nosologies. To solve these problems, the doctor needs to conduct a detailed collection of complaints and anamnesis, conducting a detailed biomicroscopy of the anterior segment of the eye. Viral eye diseases are a serious medical and social problem. Viruses are one of the most common causes of infection of the outer structures of the eye with a wide range of possible manifestations - from mild transient conjunctivitis to more serious conditions in which damage to the conjunctiva and cornea can lead to scarring, which in some cases leads to blindness. Pathogens such as adenovirus, picornavirus, herpes simplex virus and herpes zoster can cause isolated conjunctivitis, but they often also affect the cornea and eyelids. In recent years, there has been an increase in the prevalence of adenoviral conjunctivitis. The disease has a high frequency of occurrence and affects all age groups The increase in morbidity occurs in the autumn-spring period, when viral contagiousness is increased. In clinical practice, for local therapy of diseases such as viral (adenoviral and herpetic) conjunctivitis, keratitis, keratoconjunctivitis, uveitis, interferon preparations are used with high efficiency.

Message of the WHO Representative to the Philippines

Globally, an estimated 2.4 million children died in their first month of life in 2019. This translated to 6,700 newborn deaths every day, and accounted for 47% of all child deaths under the age of 5 years. The world has made substantial progress in child and newborn survival since 1990. However, 75% of newborn deaths continue to occur in the first week of life and about 1 million newborns die within their first 24 hours of life. In the Philippines, an estimated 63,000 of 1.7 million children born in 2019 died before their fifth birthday, with half occurring among newborns. Preterm birth, intrapartum-related complications such as birth asphyxia, infections and birth defects, caused most neonatal deaths in 2019. While child deaths decreased by one-half between 1990 and 2018, newborn mortality declined at half that rate. Along with asphyxia and sepsis, complications of prematurity are the main causes of newborn deaths. Preterm (< 37 weeks gestation) and low birth weight (LBW) (<2500 g) babies have immature immune and organ systems, low fat reserves and reduced muscle mass, placing them at a much higher risk for hypothermia, infection, and death, compared to babies born with normal weight. Kangaroo mother care (KMC) is a technique of caring for preterm and LBW babies which consists of keeping them in skin-to-skin contact (SSC) on the chest of the mother (or other family members), as early and as long as possible, exclusive breastfeeding, and early discharge from the hospital with close monitoring on an outpatient basis. KMC has been demonstrated to reduce mortality in small babies by almost half compared to conventional incubator-based neonatal intensive care. Other benefits include prolonged duration of exclusive breastfeeding and better growth rates. Thus, the World Health Organization (WHO) recommends KMC for babies less than or equal to 2,000 grams. We also support widespread calls to introduce, accelerate, and sustain quality KMC implementation. It is with this note that I congratulate the Kangaroo Mother Care Foundation Philippines, and the research authors for all their original scientific papers on KMC. The publication of these studies, present added evidence that KMC is a cost-efficient, readily available, effective strategy for saving the lives of babies born either prematurely, or with low birth weight for age. Rabindra Abeyasinghe, MD, MSc, DTM&H (Public Health) WHO Representative to the Philippines

Scientific research with cancer patients during the COVID-19 pandemic: an experience report

Scientific research brings resolutions to several problems in society, supporting clinical performance in health. Work with cancer patients needs to be even more careful. During the COVID-19 pandemic, cancer patients enter the risk group for exposure to the virus, limiting the monitoring of the disease, impairing treatment. New health technologies and telemedicine have been on the rise in recent years, changing the course of medicine, research and health care. Its implementation and validation have been widely discussed in recent years, and it was greatly encouraged by the COVID-19 pandemic. To report the development, adaptations and the six-month longitudinal follow-up of 20 individuals who underwent thyroidectomy at a university hospital. The research flowchart initially persisted in evaluating symptoms and vocal fatigue in individuals undergoing thyroidectomy due to thyroid cancer at three times: pre-surgical (M1), immediate post-surgical (M2) and late post-surgical (M3) in three to six months. The individuals were submitted to videolaryngoscopy, voice recording, voice acoustic analysis and completion of self-assessment protocols along with the medical consultation. All assessments were performed on an outpatient basis at the three times described. The research began in October 2019, and was interrupted at the beginning of the pandemic. In February 2020 we obtained eight cases with the two initial assessments, and only two cases with M3. Due to the pandemic, the surgeries were suspended and the continuity of the study was impaired, requiring modifications. The initial goal was to last nine months with 30 individuals in the sample. New cases were followed up from October 2020 until May 2021 when there was a reduction in cases. At the end, all data from 20 individuals in this period of the research were collected. The completion time increased from nine months to 20 months. None of the patients were infected by COVID-19 during the research period. Therefore, the treatment of cancer patients encompasses several aspects that have been hampered by its continuity, delaying deadlines and making access difficult by COVID-19. As well as, scientific research in this population has undergone several adaptations to preserve the health of individuals, not unnecessarily exposing them to contamination with the virus. Monitoring by telemedicine proved to be effective for the initial objectives of this study, but it may limit it depending on the type of proposed intervention. Despite the existing pandemic, scientific production should not be stopped because it brings discoveries that aim to improve the health of the population.

Administration and Toxicity Profile of the Capizzi Interim Maintenance—Retrospective Study from a Tertiary Care Cancer Centre

Introduction The Capizzi-style methotrexate (MTX) is an integral part of acute lymphoblastic leukemia (ALL) treatment. The escalating dose of MTX originally used in the United Kingdom and Children’s Oncology Group protocols along with L-asparaginase has been modified in the Indian Childhood Collaborative Leukemia (ICiCLe) group protocol where L-asparaginase has been omitted. The data regarding the incidence of toxicities and ease of administration on the Capizzi-style interim maintenance is not robust. Objectives We have compiled our experience with administration and toxicity profile in children with intermediate-risk ALL. Materials and Methods A retrospective data collection of all children diagnosed with intermediate-risk ALL as per the ICiCLe risk stratification in the year 2019 was included in the analysis. Each cycle of MTX was started after ensuring an absolute neutrophil count of >750/mm3 and transaminases <2 upper limit of normal. As a unit protocol, pre- and post-MTX hydration was administered in all our children. No urine pH or midcycle biochemical parameter monitoring was done. Statistical analysis was done using Microsoft Excel and SPSS version 24 IBM Corp. in Armonk, New York, United States. Results Forty-six children were included in the study. The median age of children in our study was 6 years (range: 1 year 2 months–12 years). Undernutrition was associated with a significant increase in toxicity (p = 0.02). Fifty-two percent of children had evidence of toxicity, elevated transaminases being the most common. There were recurring symptoms resulting in 53 episodes of toxicities overall. Incidence of toxicity was more in the early cycles (<3). Conclusion The pre- and post-MTX hydration is an effective way to reduce toxicities with the Capizzi-style MTX and this course can be administered with ease on outpatient basis with minimal need for monitoring or admission.