Impact of Lockdown due to COVID-19 on the Modalities of Intoxicated Patients Presenting to the Emergency Room

Introduction: Coronavirus disease 2019 (COVID-19) pandemic influences health care facilities world-wide. The flow rate, type, and severity of cases presented to emergency departments varied during the pandemic in comparison to the past years. However, this change has not been well-described among the cases of hospital admission due to toxic exposure. Study Objective: Recognition of the pattern of toxic exposure among the cases refereed to Tanta Poison Control Center (TPCC; Tanta, Egypt) during the past five years, and furthermore, exploration of the impact of lockdown due to the COVID-19 pandemic on the pattern of presented cases. Methods: The current study is a five-year retrospective, comparative cross-sectional study carried out among acutely intoxicated patients admitted to TPCC during the spring months (March through May) of 2016-2020. A total of 1,916 patients with complete medical records were recruited. The type and manner of toxic exposure, demographic, clinical data, and outcomes were analyzed. Results: The current study noted that there were delays in time from toxic exposure to emergency services during the lockdown period. This was reflected in significant lower recovery rates (884.8/1,000 population; z = -3.0) and higher death rates (49.4/1,000 population; z = 2.1) despite the marked decrease in the total number of hospital admissions in comparison to the past four years. The lockdown period showed significantly higher phosphides (z = 3.5; χ2 = 34.295; P <.001) and antipsychotics exposure (z = 3.6; χ2 = 21.494; P <.001) than the previous years. However, predominance of female exposure and intentional self-poisoning was maintained over the past five years, including the lockdown. Conclusion: COVID-19-associated lockdown greatly reformed the usual intoxication pattern of the cases admitted to emergency room. Also, it played a role in delaying time of hospital arrival, which was reflected as lower recovery rates and higher death rates.

Are young people with primary social anxiety disorder less likely to recover following generic CBT compared to young people with other primary anxiety disorders? A systematic review and meta-analysis

Background: Social anxiety disorder (SoAD) in youth is often treated with a generic form of cognitive behavioural therapy (CBT). Some studies have suggested that primary SoAD is associated with lower recovery rates following generic CBT compared with other anxiety disorders. Aims: This systematic review and meta-analysis investigated recovery rates following generic CBT for youth with primary SoAD versus other primary anxiety disorders. Method: Five databases (PsycINFO, Web of Science, PubMed, Embase, Medline) were searched for randomised controlled trials of generic CBT for child and/or adolescent anxiety. Results: Ten trials met criteria for inclusion in the systematic review, six of which presented sufficient data for inclusion in the meta-analysis. Sixty-seven did not report data on recovery rates relative to primary diagnosis. While most individual studies included in the systematic review were not sufficiently powered to detect a difference in recovery rates between diagnoses, there was a pattern of lower recovery rates for youth with primary SoAD. Across the trials included in the meta-analysis, the post-CBT recovery rate from primary SoAD (35%) was significantly lower than the recovery rate from other primary anxiety disorders (54%). Conclusions: Recovery from primary SoAD is significantly less likely than recovery from any other primary anxiety disorder following generic CBT in youth. This suggests a need for research to enhance the efficacy of CBT for youth SoAD.

The Younger Age Profile of COVID-19 Deaths in Developing Countries

This paper examines why a larger share of COVID-19 deaths occurs among young and middle-aged adults in developing countries than in high-income countries. Using novel data at the country, city, and patient levels, we investigate the drivers of this gap in terms of the key components of the standard Susceptible-Infected-Recovered framework. We obtain three main results. First, we show that the COVID-19 mortality age gap is not explained by younger susceptible populations in developing countries. Second, we provide indirect evidence that higher infection rates play a role, showing that variables linked to faster COVID-19 spread such as residential crowding and labor informality are correlated with younger mortality age profiles across cities. Third, we show that lower recovery rates in developing countries account for nearly all of the higher death shares among young adults, and for almost half of the higher death shares among middle-aged adults. Our evidence suggests that lower recovery rates in developing countries are driven by a higher prevalence of preexisting conditions that have been linked to more severe COVID-19 complications, and by more limited access to hospitals and intensive care units in some countries.

Assessing the Impact of Retailer Disclosure on the Effectiveness of U.S. Meat and Poultry Recalls

ABSTRACT In August 2008, the Food Safety and Inspection Service of the U.S. Department of Agriculture (USDA) launched a new policy that required publication of a list of retail consignees for the meat and poultry products part of class I recalls, those with the greatest potential impact on public health. In this study, two recall effectiveness measures (recovery rate and completion time) and a difference-in-difference method were used to examine the effects of retailer disclosures. When controlling for factors previously determined to impact recall effectiveness, including product type, reasons for recall, the amount of food recalled, plant size, and the way the problem was discovered, no significant impact on recall effectiveness was discerned under the current disclosure policy. Recalls for bacterial contamination had higher recovery rates. Larger recalls had lower recovery rates and longer completion times. Recalls issued by very small plants had lower recovery rates. Compared with other stakeholders, government agency discovery of the problem was associated with lower recovery rates. As the U.S. Food and Drug Administration considers a similar retailer disclosure policy for foods regulated under the Food Safety Modernization Act, such lessons from the USDA experience should inform the policy debate. HIGHLIGHTS

Neurological recovery following traumatic spinal cord injury: a systematic review and meta-analysis

OBJECTIVEPredicting neurological recovery following traumatic spinal cord injury (TSCI) is a complex task considering the heterogeneous nature of injury and the inconsistency of individual studies. This study aims to summarize the current evidence on neurological recovery following TSCI by use of a meta-analytical approach, and to identify injury, treatment, and study variables with prognostic significance.METHODSA literature search in MEDLINE and EMBASE was performed, and studies reporting follow-up changes in American Spinal Injury Association (ASIA) Impairment Scale (AIS) or Frankel or ASIA motor score (AMS) scales were included in the meta-analysis. The proportion of patients with at least 1 grade of AIS/Frankel improvement, and point changes in AMS were calculated using random pooled effect analysis. The potential effect of severity, level and mechanism of injury, type of treatment, time and country of study, and follow-up duration were evaluated using meta-regression analysis.RESULTSA total of 114 studies were included, reporting AIS/Frankel changes in 19,913 patients and AMS changes in 6920 patients. Overall, the quality of evidence was poor. The AIS/Frankel conversion rate was 19.3% (95% CI 16.2–22.6) for patients with grade A, 73.8% (95% CI 69.0–78.4) for those with grade B, 87.3% (95% CI 77.9–94.8) for those with grade C, and 46.5% (95% CI 38.2–54.9) for those with grade D. Neurological recovery was significantly different between all grades of SCI severity in the following order: C > B > D > A. Level of injury was a significant predictor of recovery; recovery rates followed this pattern: lumbar > cervical and thoracolumbar > thoracic. Thoracic SCI and penetrating SCI were significantly more likely to result in complete injury. Penetrating TSCI had a significantly lower recovery rate compared to blunt injury (OR 0.76, 95% CI 0.62–0.92; p = 0.006). Recovery rate was positively correlated with longer follow-up duration (p = 0.001). Studies with follow-up durations of approximately 6 months or less reported significantly lower recovery rates for incomplete SCI compared to studies with long-term (3–5 years) follow-ups.CONCLUSIONSThe authors’ meta-analysis provides an overall quantitative description of neurological outcomes associated with TSCI. Moreover, they demonstrated how neurological recovery after TSCI is significantly dependent on injury factors (i.e., severity, level, and mechanism of injury), but is not associated with type of treatment or country of origin. Based on these results, a minimum follow-up of 12 months is recommended for TSCI studies that include patients with neurologically incomplete injury.

Influence of Hyperglycemia Associated with Enteral Nutrition on Mortality in Patients with Stroke

Objectives: To evaluate in patients admitted for stroke: (1) The frequency of hyperglycaemia associated with enteral nutrition (EN). (2) The risk of morbidity and mortality associated with the development of this type of hyperglycaemia. Methods: A longitudinal observational study was conducted in 115 non-diabetic patients admitted for stroke with EN. Age, functional capacity (Rankin scale), and blood plasma glucose (BPG) were recorded. Hyperglycaemia was considered as: a value higher than 126 mg/dL before the EN and/or a value higher than 150 mg/dL after a week of enteral nutrition. According to this, three groups were differentiated: HyperES: Those who had hyperglycemia before the beginning of the EN (33% patients); NoHyper: those who did not have hyperglycemia before or after (47.8% patients); and HyperEN: Those who did not have hyperglycemia before but suffered it after the beginning of the EN (19.1% patients). Results: The age was 72.72 (15.32) years. A higher rate of mortality was observed in the HyperEN group 45.50%, than HyperES 15.80% or NoHyper: 10.90%). A lower recovery of the oral feeding was observed in those patients of the HyperEN group 27.30%, than HyperES: 42.10% or NoHyper: 61.80%). In the multivariate analysis adjusting for age, sex, and Rankin scale the development of hyperglycemia in those who did not have it at the beginning (HyperEN) was an independent risk factor for non-recovery of the oral feeding (OR: 4.21 (1.20–14.79), p = 0.02); and mortality adjusted for age, sex and Rankin scale (OR: 6.83 (1.76–26.47), p < 0.01). Conclusions: In non-diabetic patients admitted for stroke with EN, the development of hyperglycaemia in relation to enteral nutrition supposes an independent risk factor for mortality and for the non-recovery of the oral feeding.

Human Semen Samples with High Antioxidant Reservoir May Exhibit Lower Post-Cryopreservation Recovery of Sperm Motility

Cryopreservation-thawing of human semen was found to reduce the level of antioxidant activity surrounding the sperm, which may negatively affect post-cryopreservation (post-thaw) recovery of sperm motility. Therefore, the current manufactured cryoprotectant media have been supplemented with certain antioxidants to preserve the loss in seminal antioxidant activity. In this study, we aimed to explore the correlation between total antioxidant capacity (TAC) of human semen samples before cryopreservation and the post-thaw recovery of sperm motility. Normal semen specimens (n = 77) were recruited in this study. Sperm motility was measured for each semen sample before and after cryopreservation and the post-thaw recovery of sperm motility was calculated. Seminal TAC was measured spectrophotometrically before cryopreservation for each semen sample using the sensitive cupric ion-reducing antioxidant capacity (CUPRAC) method. The results from this study showed that the post-thaw recovery of sperm motility is negatively correlated (p = 0.0404, p = 0.0402) with the absorbance at 450 nm and the values of seminal TAC in terms of µM Trolox equivalents, as evaluated by CUPRAC, respectively. In conclusion, the total antioxidant reservoir in each ejaculated semen specimen could be a factor in determining the post-thaw recovery of sperm motility toward lower recovery for semen specimens of high antioxidant content.

Shifted baselines and the policy placebo effect in conservation

Coastal ecosystems have been degraded by human activity over centuries, with loss of memory about past states resulting in shifted baselines. More recently conservation efforts have resulted in localized recoveries of species and ecosystems. Given the dynamism of ecosystem degradation and recovery, understanding how communities perceive long-term and recent changes is important for developing and implementing conservation measures. We interviewed stakeholders on three Caribbean islands and identified a shifted baseline with respect to the extent and degree of long-term declines in marine animal populations; stakeholders with more experience identified more species as depleted and key species as less abundant than those with less experience. Notably, the average respondent with < 15 years of experience listed no species as depleted despite clear evidence of declines. We also identified a phenomenon we call the policy placebo effect, in which interviewees perceived some animal populations as recently recovering following passage of new conservation legislation but in the absence of evidence for actual recovery. Although shifted baselines have a negative effect on conservation as they can lower recovery goals, the outcomes of a policy placebo effect are unclear. If the public prematurely perceives recovery, motivation for continued conservation could decline. Alternatively, perception of rapid success could lead communities to set more ambitious conservation goals.

Paediatric tuberculosis in Singapore: a retrospective review

BackgroundTuberculosis (TB) is a major cause of mortality and morbidity in the world. Each case represents ongoing transmission and has a significant public health burden. We aim to examine the clinical profile of paediatric TB and compare pulmonary TB (PTB) with extrapulmonary TB (EPTB) in Singapore.MethodsA retrospective study of patients admitted to KK Women’s and Children’s Hospital, Singapore from January 2008 to September 2017 with active TB was undertaken. The clinical characteristics and outcomes of patients with PTB and EPTB were compared.ResultsSeventy-five patients were diagnosed as having active TB (49 (65%) with PTB and 26 (35%) with EPTB). Patients with EPTB were more likely than those with PTB to be younger (median age 5.1 (IQR 1.2–10.2) years vs 10.1 (IQR 3.5–13.5) years), immunodeficient (35% vs 6%), with a lower haemoglobin count (median 11.2 (IQR 10.2–11.9) g/dL vs 12.0 (IQR 10.5–13.9) g/dL), lower recovery rate (27% vs 57%) and required longer duration of treatment (median 12 (IQR 9–12) months vs 6 (IQR 6–9) months). Common clinical presentations of both PTB and EPTB were significant fever (27%), cough (33%) and weight loss (32%). Overall mortality was 8% with septic shock responsible for three of the six deaths.ConclusionEPTB is more common in the younger age group and is associated with a lower recovery rate.