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Coronavirus disease 2019 (COVID-19) has been associated with various neurological and atypical head/eyes/ears/nose/throat (HEENT) manifestations. We sought to review the evidence for these manifestations.
In this systematic review and meta-analysis, we compiled studies published until March 31, 2021 that examined non-respiratory HEENT, central, and peripheral nervous system presentations in COVID-19 patients. We included 477 studies for qualitative synthesis and 59 studies for meta-analyses.
Anosmia, ageusia, and conjunctivitis may precede typical upper/lower respiratory symptoms. Central nervous system (CNS) manifestations include stroke and encephalopathy, potentially with brainstem or cranial nerve involvement. MRI studies support CNS para-/postinfectious etiologies, but direct neuroinvasion seems very rare, with few cases detecting Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the CNS. Peripheral nervous system (PNS) manifestations include muscle damage, Guillain–Barre syndrome (GBS), and its variants. There was moderate-to-high study heterogeneity and risk of bias. In random-effects meta-analyses, anosmia/ageusia was estimated to occur in 56% of COVID-19 patients (95% CI: 0.41–0.71, I2:99.9%), more commonly than in patients without COVID-19 (OR: 14.28, 95% CI: 8.39–24.29, I2: 49.0%). Neurological symptoms were estimated to occur in 36% of hospitalized patients (95% CI: 0.31–0.42, I2: 99.8%); ischemic stroke in 3% (95% CI: 0.03–0.04, I2: 99.2%), and GBS in 0.04% (0.033%–0.047%), more commonly than in patients without COVID-19 (OR[stroke]: 2.53, 95% CI: 1.16–5.50, I2: 76.4%; OR[GBS]: 3.43,1.15–10.25, I2: 89.1%).
Current evidence is mostly from retrospective cohorts or series, largely in hospitalized or critically ill patients, not representative of typical community-dwelling patients. There remains a paucity of systematically gathered prospective data on neurological manifestations. Nevertheless, these findings support a high index of suspicion to identify HEENT/neurological presentations in patients with known COVID-19, and to test for COVID-19 in patients with such presentations at risk of infection.
The hypothesis that coarse grain particles in breads reduce glycaemic response only if the particles remain intact during ingestion was tested. Three breads were formulated: (1) White bread (WB – reference), (2) 75 % of kibbled purple wheat in 25 % white bread matrix (PB) and (3) a 1:1 mixture of 37·5 % kibbled soya beans and 37·5 % of kibble purple wheat in 25 % white bread matrix (SPB). Each bread was ingested in three forms: unchewed (U), as customarily consumed (C) and homogenised (H). Twelve participants ingested 40 g available carbohydrate portions of each bread in each form, with post-prandial blood glucose measured over 120 min. Glycaemic responses to WB were the same regardless of its form when ingested. Unchewed PB had significantly less glycaemic effect than WB, whereas the C and H forms were similar to WB. Based on a glycaemic index (GI) of 70 for WB, the GI values for the C, U and H breads, respectively, were WB: 70·0, 70 and 70, PB: 75, 42 and 61, SPB: 57, 48 and 55 (%) (Least significant difference = 17·43, P < 0·05, bold numbers significantly different from WB). The similar glycaemic response to the H and C forms of the breads, and their difference from the U form, showed that the glycaemia-moderating effect of grain structure on starch digestion was lost during customary ingestion of bread. We conclude that the kibbled-grain structure may not effectively retard starch digestion in breads as normally consumed because it is largely eliminated by ingestive processes including chewing.
To assess whether there is a change in the prevalence of depression and suicidal ideation after the strict lockdown measures due to the first wave of the COVID-19 pandemic in Spain; and to assess which are the factors associated with the incidence of a depressive episode or suicidal ideation during the lockdown.
Data from a longitudinal adult population-based cohort from the provinces of Madrid and Barcelona were analysed (n = 1103). Structured face-to-face home-based interviews (pre-pandemic) and telephone interviews were performed. Both depression and suicidal ideation were assessed through an adaptation of the Composite International Diagnostic Interview (CIDI 3.0). A variety of validated instruments and sociodemographic variables including age, sex, educational level, occupational status, home quietness, screen time, resilience, loneliness, social support, physical activity, disability, economic situation and COVID-19-related information were also considered. Population prevalence estimates and multivariable logistic regressions were computed.
Overall, prevalence rates of depression and suicidal ideation did not change significantly from before to after the COVID-19 outbreak. However, the rates of depression among individuals aged 50+ years showed a significant decrease compared to before the pandemic (from 8.48 to 6.41%; p = 0.01). Younger individuals (odds ratio (OR) = 0.97 per year older; 95% confidence interval (CI) = 0.95–0.99) and those feeling loneliness (OR = 1.96; 95% CI = 1.42–2.70) during the lockdown were at an increased risk of developing depression during the confinement. Resilience showed a protective effect against the risk of depression (OR = 0.46; 95% CI = 0.32–0.66) and suicidal ideation (OR = 0.33; 95% CI = 0.16–0.68), whereas individuals perceiving social support were at a lower risk of developing suicidal thoughts (OR = 0.35; 95% CI = 0.18–0.69).
Continuous reinforcement of mental health preventive and intervening measures during and in the aftermath of the crisis is of global importance, particularly among vulnerable groups who are experiencing the most distress. Future research should strive to evaluate the long-term effects of the COVID-19 crisis on mental health.
To estimate the cost of metastatic prostate cancer (mPC) treatment using the time-driven activity-based costing (TDABC) method from the perspective of a philanthropic hospital in the Brazilian public health system (PHS) and to identify determinants of costs.
We used data from patients who received docetaxel chemotherapy in the Brazilian PHS from September 2012 to May 2017. Direct medical costs were estimated with the TDABC microcosting method, taking into account the multiple departments and services the patients interacted with during their oncological treatment.
The median overall survival of the forty-three patient sample was 1.8 years (95% CI 1.45–2.30), and the total cost of the sample was BRL 917.005 (USD 250,878). The median monthly cost per patient was BRL 20.201 (USD 5,526). The end-of-life cost per patient using the TDABC method was BRL 5.151 (USD 1,409). Patients who had received previous treatment at the center registered the lowest cost for hospitalizations and exams, suggesting an opportunity to better manage healthcare resources.
This is the first study on the economic burden of mPC in the Brazilian PHS using the TDABC costing evaluation method. Accurate cost information obtained with the TDABC can be helpful in guiding disease management to guarantee better use of ever-scarcer resources.
The Triassic–Jurassic Upper Karoo Group of the Mid-Zambezi Basin (MZB; Zimbabwe) includes a thick succession of terrestrial sediments with high palaeontological potential that has been neglected since the 1970s. Here, we review the Upper Karoo Group stratigraphy, present detailed sedimentological work and identify new vertebrate-bearing sites at several measured sections along the southern shore of Lake Kariba. These fossil-bearing sites fall within the Pebbly Arkose and Forest Sandstone formations, and are the first to be recorded from the region since the discovery of Vulcanodon karibaensis nearly 50 years ago. The unique and diverse assemblage of aquatic and terrestrial fauna reported includes phytosaurs, metoposaurid amphibians, lungfish, non-dinosaurian archosauromorphs and non-sauropod sauropodomorph dinosaurs. This improvement of Upper Karoo Group biostratigraphy is important in refining its temporal resolution, and impacts both regional and global studies. Finally, the new fossil sites demonstrate the palaeontological importance of the MZB and its role in providing a holistic understanding of early Mesozoic ecosystems in southern Gondwana.
Cook’s Petrel Pterodroma cookii is an endemic New Zealand seabird that has experienced a large range decline since the arrival of humans and now only breeds on two offshore islands (Te Hauturu-o-Toi/Little Barrier Island and Whenua Hou/Codfish Island) at the extreme ends of its former distribution. Morphological, behavioural, and mitochondrial cytochrome oxidase 1 (CO1) sequence data led a previous study to recognise the two extant populations as distinct conservation management units. Here, we further examine the genetic relationship between the extant populations using two nuclear introns (β-fibint7 and PAX). Using one mitochondrial locus (CO1), we also investigate the past distribution of a single nucleotide polymorphism (SNP) that differentiates the modern populations using bone and museum skins sourced from within its former range across New Zealand’s North and South Islands. We found significant population genetic structure between the two extant Cook’s Petrel populations for one of the two nuclear introns (β-fibint7). The mitochondrial DNA CO1 analysis indicated that the SNP variant found in the Codfish Island population was formerly widely distributed across both the North and South Islands, whereas the Little Barrier Island variant was detected only in North Island samples. We argue that these combined data support the recognition of the extant populations as different subspecies. Previous names for these taxa exist, thus Cook’s Petrel from Little Barrier Island becomes Pterodroma cookii cookii and Cook’s Petrel from Codfish Island becomes P. c. orientalis. Furthermore, we suggest that both genetic and non-genetic data should be taken into consideration when planning future mainland translocations. Namely, any translocations on the South Island should be sourced from Codfish Island and future translocations on the North Island should continue to be sourced from Little Barrier Island only.
Associations have been observed between socioeconomic status (SES) and language outcomes from early childhood, but individual variability is high. Exposure to high levels of stress, often associated with low-SES status, might influence how parents and infants interact within the early language environment. Differences in these early language behaviors, and in early neurodevelopment, might underlie SES-based differences in language that emerge later on. Analysis of natural language samples from a predominantly low-/mid-income sample of mother-infant dyads, obtained using the Language Environment Analysis (LENA) system, found that maternal reports of exposure to stressful life events, and perceived stress, were negatively correlated with child vocalizations and conversational turns when infants were 6 and 12 months of age. Greater numbers of vocalizations and conversational turns were also associated with lower relative theta power and higher relative gamma power in 6- and 12-month baseline EEG – a pattern that might support subsequent language development.
Following the continual decline of the Cape vulture Gyps coprotheres since the 1960s, captive breeding and rehabilitation programmes have been established to reinforce populations across southern Africa. This study examines the spatial ecology of captive-bred and rehabilitated vultures following release. Our analysis used 253,671 GPS fixes from 20 captive-bred and 13 rehabilitated birds to calculate home range sizes using kernel density estimation. We found that home range size did not differ significantly between captive-bred and rehabilitated birds. The location of home ranges differed: captive-bred birds showed greater site fidelity, remaining close to their release site, whereas rehabilitated birds dispersed more widely across the species' native range. By remaining close to their release site within a protected area, captive-bred birds had a significantly higher per cent of their GPS fixes within protected areas than did rehabilitated birds. Despite fidelity to their release site, captive-bred birds demonstrated innate capabilities for natural foraging behaviours and the same habitat selection strategy as rehabilitated individuals. These findings suggest that captive breeding and reinforcement of populations at declining colonies could provide localized benefits. Future long-term studies should seek to analyse survivorship and identify the breeding behaviour of these captive-bred birds once they reach sexual maturity.
Presently, evidence guiding clinicians on the optimal approach to safely screen patients for coronavirus disease 2019 (COVID-19) to a nonemergent hospital procedure is scarce. In this report, we describe our experience in screening for SARS-CoV-2 prior to semiurgent and urgent hospital procedures.
Retrospective case series.
A single tertiary-care medical center.
Our study cohort included patients ≥18 years of age who had semiurgent or urgent hospital procedures or surgeries.
Overall, 625 patients were screened for SARS-CoV-2 using a combination of phone questionnaire (7 days prior to the anticipated procedure), RT-PCR and chest computed tomography (CT) between March 1, 2020, and April 30, 2020.
Of the 625 patients, 520 scans (83.2%) were interpreted as normal; 1 (0.16%) had typical features of COVID-19; 18 scans (2.88%) had indeterminate features of COVID-19; and 86 (13.76%) had atypical features of COVID-19. In total, 640 RT-PCRs were performed, with 1 positive result (0.15%) in a patient with a CT scan that yielded an atypical finding. Of the 18 patients with chest CTs categorized as indeterminate, 5 underwent repeat negative RT-PCR nasopharyngeal swab 1 week after their initial swab. Also, 1 patient with a chest CT categorized as typical had a follow-up repeat negative RT-PCR, indicating that the chest CT was likely a false positive. After surgery, none of the patients developed signs or symptoms suspicious of COVID-19 that would indicate the need for a repeated RT-PCR or CT scan.
In our experience, chest CT scanning did not prove provide valuable information in detecting asymptomatic cases of SARS-CoV-2 (COVID-19) in our low-prevalence population.
Adolescent dieting and disordered eating (DE) are risks for clinical eating disorders. In this five-wave longitudinal study, we tested gender-specific models linking early risk factors to temporal patterns of DE, considering appearance anxiety as a mediator. Participants were 384 Australian students (age 10 to 13; 45% boys) who reported their purging and skipping meals, experience with appearance-related teasing, media pressure, and appearance anxiety. Parents reported pubertal maturation and height/weight was measured. Gender differences in temporal patterns of DE were found and predictive models were tested using latent-variable growth curve and path models. Boys’ DE was generally stable over time; girls showed stability in purging but an average increase in skipping meals. Peer teasing, media pressure, and pubertal maturation were associated with more elevated initial DE in girls, and pubertal maturation was associated with a steeper increase in DE. For boys, body mass index had a direct positive association with DE. Appearance anxiety was associated with more DE, but there was only one significant indirect effect via anxiety, which was for boys’ pubertal maturation. Findings support the dominant role of social interactions and messages, as well as pubertal maturation, for girls’ DE and the prominence of physical risk factors for explaining boys’ DE.
We shall present the development of a cohort of 40 children aged from 6 to 11 who were initially diagnosed with ADHD (T0) and then reassessed after two years of treatment with multimodal treatment in addition to stimulant medication. At the outset of the study (T0) the children underwent a complete assessment which included a child psychiatric examination, a neuropsychological evaluation of attention skills and a psychodynamic psychological assessment using the T.A.T. and Rorschach projective tests interpreted from a psychoanalytic viewpoint. An identical protocol was used for the reassessment of the children two years later (T2).
Clinically, and from a strictly behavioral point of view, it is clear that there was a calming down of the symptoms associated with the ADHD. Can the same be said for the results of the neuro-psychological and projective tests as well as for the overall psychic functioning of the children?
At this point in our research, and taking into account that T 2 just ended, we can affirm that the children who were assessed with neurotic disorders (according to the classification of psychopathological disorders in childhood) were those who showed the clearest signs of improvement. We shall then study in depth the majority of the population who were assessed with borderline personality disorders (BPD). As these children received a multimodal treatment over the two years time of the study which involved either individual, group or family psychotherapy, we shall use brief clinical case studies for a comparative approach to our research results.
Shared decision-making denotes a structured process that encourages full participation by patient and provider in making complex medical decisions. There has been extensive and growing interest in its application to long-term illnesses but surprisingly not in severe psychiatric disorders, such as schizophrenia. However, the great majority of schizophrenics are capable of understanding treatment choices and making rational decisions. Although the main justification for shared decision-making is ethical, several randomized controlled trials support its effectiveness in improving the quality of decisions, but robust evidence in objective health outcomes is needed.
Aims and objectives
Of the study: to demonstrate the effectiveness, measured as treatment adherence and readmissions at 3, 6 and 12 months, of shared decision making in the choice of antipsychotic treatment at discharge.
Of the oral presentation: to present the study design; to make an interim report of the data obtained at the moment of the congress.
Randomized controlled trial, prospective, two parallel groups, not masked, comparing two interventions (shared decision making and treatment as usual). Study population: Inpatients diagnosed of schizophrenia and schizoaffective disorders (ICD-10/DSM-IV-R: F20 y F25) at Adult Acute Hospitalization Unit at Jerez General Hospital.
Currently in the recruiting phase with 55 patients included in the study. An interim analysis of at least half of the target sample size.
We will show the study design and decision tools employed. Conclusions in relation to the effectiveness (adherence and readmissions) and subjective perception.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Effectiveness of shared decision making in treatment planning at discharge of inpatient with schizophrenia: interim analysis.
Shared decision-making denotes a structured process that encourages full participation by patient and provider in making complex medical decisions. Hamann et al. conducted a few years ago a randomized controlled trial with schizophrenic inpatients and found increased knowledge and perceived involvement in decisions about antipsychotic treatment at discharge by the experimental group, but not clear beneficial effects on long term outcomes. The present communication introduces the DECIDE study.
Aims and objectives
Of the study: to demonstrate the effectiveness, measured as treatment adherence and readmissions at 3, 6 and 12 months, of shared decision making in the choice of antipsychotic treatment at discharge in a simple of schizophrenics hospitalized after an acute episode of their disorder. Of the oral presentation: to present preliminary conclusions with more of the half of the sample.
Randomized controlled trial, prospective, two parallel groups, not masked, comparing two interventions (shared decision making and treatment as usual). Study population: inpatients diagnosed of schizophrenia and schizoaffective disorders (ICD-10/DSM-IV-R: F20 y F25) at Adult Acute Hospitalization Unit at Jerez General Hospital.
At discharge, increased scale score COMRADE, both subscales (Satisfacción in communication and trust in the decision) statistically significant. At 3 months follow-up, intensification of these differences in effect size and statistical significance and shows trends in health outcomes. We will present results for 6 and 12 months.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Translocations are used to mitigate human–wildlife conflict, secure population viability of isolated populations and introduce or reintroduce populations in former or new range. With wild species increasingly confined to small patches of habitat embedded in human-dominated landscapes, the use of translocations is likely to increase. The cheetah Acinonyx jubatus is a large carnivore species with a long history of translocations. As for other species, evaluation of the success of cheetah translocations is complicated by a scarcity of published results, especially of failed attempts. Yet, such information is crucial to improve future translocations. A relatively well documented case is the translocation of alleged problem cheetahs into Matusadona National Park, Zimbabwe, in the early 1990s. In this study we used a combination of survey methods to reassess the status of Matusadona's cheetah population and model current occupancy in relation to densities of competing carnivores and altitude. Our findings indicate this cheetah population has effectively been extirpated, highlighting the importance of thorough planning and standardized long-term monitoring of translocated populations for the understanding of the factors that affect translocation success.
With prevalence of obesity increasing worldwide, understanding body image in individuals with excessive weight is important, as unawareness of weight excess can prevent weight loss attempts. We explored the associations among measured and self-reported body mass index (BMI), body image and body satisfaction among Spanish females and males with overweight or obesity, with a special focus in discriminating individuals who are and are not satisfied with their body and wish or not to change their appearance. Just unifying all individuals with excessive weight may lead to uncover or deny different realities and to develop unfitted clinical management options. Updating findings for the Spanish population, we found that most participants correctly estimated their weight, but 3 in 10 underestimated it. Similarly, their body images corresponded to adults with overweight or obesity who desired to be thinner, but in average they reported a perceived body just slightly overweight and a moderate satisfaction with their body. Complementing the existing evidence, BMI and sex-gender interacted for influencing body weight estimation and desired weight change. In addition, three different subgroups were found for desired change of weight and size, depending on their BMI and body satisfaction. Discovering and considering different subjective realities and corporeal experiences among individuals with weight excess will help professionals to develop appropriate therapeutic interventions. Thus, the personal experiences that individuals have with obesity, instead of obesity itself, should be considered for disentangling management efforts.
Loyalty cards programs have been used by retailers to increase customer retention. Loyality cards provide means to identify a particular customer and to collect customer-specific data, thus enabling individualized marketing; however, operating a loyalty program is complicated for retailers since they require to manage balances, collections, and transfers of customers. This is exactly the same problem the retailers were facing before credit cards were readily available. A new problem is that customers now have too many cards, customers may forget, or even deliberately decide to carry only a selection of their cards. This paper proposes a loyalty program based on a blockchain that does not require a physical card for identifying customers as it associates customers to their phone numbers, since nowadays people always carry their phone. In this perspective, companies can reduce overhead costs associated to managing the loyalty program. This paper reviews the technology required and describes the implementation of a loyalty program based on blockchains. Finally, it also enumerates the reasons for choosing the blockchain technology for this application.