Objectives Possibility of reinfection with SARS-CoV-2 changes our view on herd immunity and vaccination, and can impact worldwide quarantine policies. We performed RT-PCR follow-up studies on recovered patients to assess possible development of reinfections and re-positivity. Method During a 6-month period, 202 PCR-confirmed recovering COVID-19 patients entered this study. Follow-up RT-PCR tests and symptoms assessment were performed one month after the initial Positive results. patients who tested negative were tested again one and three months later. The Serum IgG and IgM levels were measured in the last follow-up session. Results In the first two follow-up sessions, 82 patients continued their participation, of which four patients tasted positive. In the second follow-up 44 patients participated, three of whom tested positive. None of the patients who tested positive in the first and second follow-up session were symptomatic. In the last session, 32 patients were tested and four patients were positive, three of them were mildly symptomatic and all of them were positive for IgG. Conclusion A positive RT-PCR in a recovering patient may represent reinfection. While we did not have the resources to prove reinfection by genetic sequencing of the infective viruses, we believe presence of mild symptoms in the three patients who tested positive over 100 days after becoming asymptomatic, can be diagnosed as reinfection. The IgG may have abated the symptoms of the reinfection, without providing complete protection.

Since the start of the SARS-CoV-2 pandemic, it has been difficult to differentiate between SARS-CoV-2 re-infection and prolonged RNA shedding. In this report, we identified patients with positive rtPCR results for SARS-CoV-2 ≥70 days apart. Clinical and laboratory data were collected and criteria were applied to discern whether the presentation was consistent with SARS-CoV-2 re-infection or prolonged viral RNA shedding. Eleven individuals met the initial testing criteria, of which, seven met at least one criteria for re-infection and four were consistent with prolonged RNA shedding. These data demonstrate the need for criteria to differentiate SARS-CoV-2 re-infection from prolonged RNA shedding.

A 62-year-old man with rare blood type exhibited severe respiratory failure due to novel coronavirus. Extracorporeal membrane oxygenation was inapplicable, which requires numerous blood products with the same blood type. We thoroughly restricted fluid volumes by sacrificing renal function. He was discharged with complete recovery of respiratory and renal functions.

The entire world is dealing with this pandemic of COVID-19 since December 2019. And several variants of this SARS-COV2 virus have occurred and they have more impact on the increase in the mortality rate and it has now increased to more than 5 percent up till now which is quite an alarming state. But despite this, every day increasing mortality rate the vaccine which is now available for use is not considered to be effective by the general population due to their self-created myths and this leads them to be reluctant to the vaccine. And that's why the vaccination process is still far slow as we know that the number of cases is getting increased day by day the immunization by the vaccine is much important to cope up with this challenging pandemic. There is a need to avoid the psychological considerations for the vaccination because vaccine provision is important to provide the maximum number of individuals with the vaccine so the more complex states of this variant form of viral infection could be deal with in a more sophisticated manner.

Aim: A pandemic is an epidemic of an infectious disease that has spread across a large region of the world and affects many people. In this study, it was aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on ambulance use by pediatric patients in ……………., Turkey. Materials and Methods: This retrospective study was conducted in the spring-summer of 2019 and 2020. The electronic medical records of pediatric patients who were transported to the hospital by ambulance were analyzed. Results: It was determined that 49.6% of the 23,201 patients included in the study were transported during the pandemic period. Male gender was higher in both the pandemic and pre-pandemic periods, there was no difference in terms of average age. The rate of forensic cases and refugee patients increased, while that of emergency patients decreased. Both the arrival at the scene time and intervention time were prolonged. Medical cause was the most common cause of emergency calls in both years, however, it increased significantly in 2020. The decrease in cases of traffic accidents, suicides, and other accidents was statistically significant. In the pandemic period, total rate of COVID-19 infection and suspicion was 29.7%. Most of the patients had been referred to a public hospital. Conclusion: It was found that most of the ambulances were used for transporting patients with minor illnesses that did not require immediate medical attention.

During the current COVID-19 pandemic, different methods have been used to evaluate patients suspected with infection of SARS-CoV-2. In this study, we evaluate the longevity of saliva and dry swab samples to retain SARS-CoV-2 for storage and transport at different environmental settings. Our results show that at ambient temperature of 20°C, SARS-CoV-2 RNA remains stable for up to 9 days giving a long span of time for transport and storage without compromising clinical results. Additionally, this study demonstrates that sali­­­va and dry swabs specimens can also be stored at -20°C and +4°C for up to 26 days without affecting RT-qPCR results. Our data is relevant for low-and middle-income countries, which have limited access to rapid refrigerated transport and storage of samples representing an economical alternative. Finally, our study demonstrates that dry swabs provide clear advantages over using transport medium.

Molecular diagnosis is an essential means to detect pathogens. The portable nucleic acid detection chip has excellent prospects in places where medical resources are scarce, and it is also of research interest in the field of microfluidic chips. Here, the paper developed a new type of microfluidic chip for nucleic acid detection where stretching acts as the driving force. The sample entered the chip by applying capillary force. The strain valve was opened under the action of tensile force, and the spring pump generated the power to drive the fluid to flow to the detection chamber in a specific direction. The detection of COVID-19 was realized on the chip. The RT-LAMP amplification system was adopted to observe the liquid color in the detection chamber to decide whether the sample tested positive or negative qualitatively.

COVID-19 is a worldwide crisis with a great impact in health structures. Delay in the management of routine medical conditions has been reported during this pandemic. We describe the case of a spontaneous dissection coronary arteries which has been initially misclassified as a case of COVID-19 infection

Since the beginning of the COVID-19 pandemic, industry and healthcare providers have investigated methodologies to manage infection of SARS-CoV-2. One treatment breakthrough has been the introduction of monoclonal antibodies to prevent worsening SARS-CoV-2 infection in non-hospitalized patients diagnosed with COVID-19. These monoclonal antibodies, like bamlanivimab, bind to the SARS-CoV-2 spike protein and prevent its ability to binding to human ACE2 receptors. This is a case of a 91 year-old man with no prior seizure history who developed new-onset seizures after bamlanivimab infusion.

Objective The Coronavirus pandemic has affected urological practice worldwide. In this study, we aimed to evaluate functional urology practice including outpatient clinic visits, routine examinations, diagnostic procedures and surgical interventions with an online survey. Method We conducted an online survey to evaluate Turkish urologists’ functional urology practices before and during the pandemic. In this survey, we asked questions about the respondents’ place of work, being part of a dedicated pandemic center, involvement with the pandemic and an interest in functional urology. We also examined outpatient clinics, routine examinations, diagnostic methods, and surgical practice before and during the pandemic. Results A total of 152 urologists completed the survey. The majority of the participants, (79.6%) were in tertiary centers. Nearly one-third of respondents (32.2%) stated that more than 50% of their routine practice is related to functional urology. In brief, 80.9% of the participants declared a decrease in the number of outpatient visits for functional urology. 68.4% of the participants declared a decrease in uroflowmetry practice, and 81.3% of had a decrease in urodynamic studies performed. According to respondents, 92.1% stated a decrease in botulinum injections for the bladder, and 93.4% of the participants declared a decrease in anti-incontinence surgery. Eighty-five percent of the participants declared a decrease in prolapse surgery. One-hundred and twenty-eight participants (84.2%) declared a decrease in surgery for benign prostate hyperplasia (BPH). Only 28.9% of the participants responded that they diagnosed their neuro-urology patients as they did prior to the pandemic. Conclusions The daily practice of urology changed, and functional urology was one of the most affected field. The large backlog of functional urology patients is challenging and although conditions, diagnostic tools and surgeries were classed as “benign”, we will have to face the effects of patients’ Quality of life in the near future.

Objectives As we pass the anniversary of the declaration of a global pandemic by the World Health Organisation, it invites us to reflect upon the inescapable changes that coronavirus has wrought upon ENT and, in particular, rhinological practice. As it remains unclear when we will globally emerge from the shadow of COVID-19, a critical analysis of the evidence base on both the assessment and mitigation of risk is vital for ENT departments worldwide. This article presents a systematic review of the literature examining articles which consider either the quantification of risk or strategies to mitigate risk specifically in the setting of rhinological surgery. Design Systematic literature review. Results The literature search yielded a total of 3406 returns with 24 articles meeting eligibility criteria. A narrative synthesis stratified results into two broad themes: those which made an assessment as to the aerosolisation of droplets during sinus surgery, further subdivided into work which considered macroscopically visible droplets and that which considered smaller particles, and those studies which examined the mitigation of this risk. Conclusion Studies considering the aerosolisation of both droplets and smaller particles suggest endonasal surgery carries significant risk. Whilst results both highlight a range of innovative adjunctive strategies and support suction as an important variable to reduce aerosolisation, appropriate use of personal protective equipment (PPE) should be considered mandatory for all healthcare professionals involved in rhinological surgery given studies have demonstrated that close adherence to PPE use is effective at preventing COVID-19 infection.

Background: Perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA), a subset of ANCA, are associated with a multisystem vasculitis affecting small blood vessels in the body. A handful of adult patients who developed vasculitis post-COVID-19 infection have been reported. Although COVID-19 infection has been shown to drive an exaggerated immune response in the pediatric population, such as MIS-C (multisystem inflammatory syndrome in children), only one case of vasculitis following COVID-19 infection has been reported previously in children. Case presentation: Seventeen-year-old male with a past medical history of COVID-19 pneumonia two months prior presented with acute kidney injury/failure and diffuse alveolar hemorrhage (DAH). Rheumatologic workup revealed P-ANCA and Myeloperoxidase (MPO) positivity. Kidney biopsy showed necrotizing glomerulonephritis with limited immune complex deposition. Subsequently, he was treated with pulse steroids, plasmapheresis, and ultimately started on cyclophosphamide. Conclusions: To our knowledge, this report presents the second reported pediatric case of P-ANCA / MPO vasculitis following COVID-19 infection.

RT-PCR is currently the standard diagnostic method to detect symptomatic and asymptomatic individuals infected with SARS-CoV-2. However, RT-PCR results are not immediate and may falsely be negative before an infected individual sheds viral particle in the upper airway where swabs are collected. Infected individuals emit volatile organic compounds (VOCs) in their breath and sweat that are detectable by trained dogs. Here we evaluate the diagnostic accuracy of dog detection against SARS-CoV-2 infection. Fifteen dogs previously trained at two centres in Australia were presented to axillary sweat specimens collected from known SARS-CoV-2 human cases and non-cases. The true infection status of the cases and non-cases were confirmed based on RT-PCR results as well as clinical presentation. Across dogs, the overall diagnostic sensitivity (DSe) was 95.6% (95%CI: 93.6%-97.6%) and diagnostic specificity (DSp) was 98.1% (95%CI: 96.3%-100.0%). The DSp decreased significantly with non-case specimens sourced from UAE ( P-value < 0.001). The location of evaluation did not impact the detection performances. The accuracy of detection varied across dogs and experienced dogs revealed a marginally better DSp ( P-value = 0.003). The potential and limitations of this alternative detection tool are discussed.

Objective: To characterize viscoelastic testing profiles of children with multisystem inflammatory syndrome in children (MIS-C). Methods: This single-center retrospective review included 30 patients diagnosed with MIS-C from January 1 to September 1, 2020. Thromboelastography (TEG) with platelet mapping was performed in 19 (63%) patients and compared to age- and gender- matched controls via Student’s t-test and Wilcoxon rank sum test. Pearson’s and Spearman correlation were used to assess relationships between TEG parameters and inflammatory markers. Results: Patients with MIS-C had abnormal TEG results compared to controls, including decreased K time (1.1 vs. 1.7 min, P<0.01), increased alpha angle (75.0 vs. 65.7 degrees, P<0.01), increased maximum amplitude (70.8 vs. 58.3 mm, P<0.01), and decreased Ly-30 (1.1 vs. 3.7%, P=0.03); consistent with increased clot formation rate and strength, and slower fibrinolysis. TEG maximum amplitude was moderately correlated with erythrocyte sedimentation rate (r=0.60, P=0.02), initial platelet count (r=0.67, P<0.01), and peak platelet count (r=0.51, P=0.03). TEG alpha angle was moderately correlated with peak platelet count (r=0.54, P=0.02). 17 (57%) patients received aspirin (ASA) and anticoagulation, 5 (17%) received only ASA, and 3 (10%) received only anticoagulation. No patients had a thrombotic event. 6 (20%) patients had a bleeding event, none of which was major. Conclusions: Patients with MIS-C had evidence of hypercoagulability on TEG. Increased erythrocyte sedimentation rate and platelets were associated with higher clot strength. Treatment with ASA or anticoagulation was well tolerated. Further multi-center study is required to characterize the rate of thrombosis and optimal thromboprophylaxis algorithm in this patient population.

Most but not all observational studies of statin treatment of COVID-19 patients suggest that treatment improves outcomes. However, almost all observational studies fail to consider what cardiovascular investigators have known for 15-20 years: withdrawing statins after hospital admission has detrimental effects on patient outcomes. Continuing (or starting) statin treatment after hospital admission consistently improves COVID-19 patient outcomes, whereas discontinuing treatment does not. Thus, observational studies of the effectiveness of statin treatment of COVID-19 patients must consider the consequences of statin withdrawal.

Actinomycosis is a rare, indolent and invasive infection caused by Actinomyces species. Pulmonary actinomycosis is very rarely seen in the paediatric population. The classic radiological presentation of thoracic involvement of actinomycosis includes lower lobe consolidation, empyema and periostitis of the ribs. We report a case of endobronchial pulmonary actinomycosis in a child diagnosed on endobronchial biopsy and broncho-alveolar lavage taken during bronchoscopy. Bronchoscopy can be dangerous when performed on these cases, as there is a risk of severe bleeding and large airway obstruction, as was the case with this patient.

Methods: Twenty-two French nursing homes were included. COVID-19 had been diagnosed with real-time reverse-transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2. Blood S-protein IgG and nucleocapsid (N) IgG protein (N-protein IgG) were measured 21-24 days after the first jab (1,004 residents) and 6 weeks after the second (820 residents). Results: Among the 735 residents without prior COVID-19, 41.7% remained seronegative for S-protein IgG after the first jab vs 2.1% of the 270 residents with a previous positive RT-PCR (p<0.001). After the second jab, only 3% of the 586 residents without prior COVID-19 remained seronegative. However, 26.5% of them had low S-protein IgG levels (50-1050 UA/mL) vs 6.4% of the 222 residents with prior COVID-19. Residents with old infection (first wave), or seropositive for N-protein IgG at the time of vaccination, had the highest S-protein IgG levels. Residents with a prior COVID-19 infection had higher S-protein IgG levels after one dose than those without two jabs. Interpretation: A single vaccine jab is sufficient to reach immunity in residents with prior COVID-19. Most residents without prior COVID-19 are seropositive for S-protein IgG after the second jab, but around 30% have low levels of S-protein IgG. Whether residents with no or low post-vaccine immunity are at higher risk of symptomatic COVID-19 requires further analysis.

Guillain-Barré syndrome is an immune-mediated neuropathy that was reported following multiple vaccines. We present the case of a gentleman who developed GBS 20 days after the second dose of COVID-19 vaccination. It is important to mention that more research is needed to establish an association between COVID-19 vaccine and GBS.

Far more intense efforts are needed to identify the characteristics of the long COVID before nourishing the ambition of being able to address the problem effectively. Syndromes are, by definition, heterogeneous and difficult to manage in the absence of a clear understanding of the causal mechanisms. The plethora of symptoms affecting multiple systems exhibited by "long COVID sufferers" suggests several underlying mechanisms1,2,3. In this sense, long COVID is a syndrome par excellence. Being a heterogeneous condition from a pathophysiological point of view requires efforts to improve its understanding, diagnostic accuracy and, above all, establish an effective therapeutic program. The latter cannot be achieved ahead of the antecedent two steps. The National Institute for Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network and the Royal College of General Practitioners have developed a quick guideline for managing the long-term effects of Covid-19. The current guideline lacks essential details, including a comprehensive list of organ complications seen in patients with long COVID, the required investigations, and specific interventions for these complications4,5. It is not clear which speciality could be more suitable for aggregating patients suffering from long COVID. Preliminary to initial referral mandatory exams include FBC, U&E, LFTs, CRP, CK, haematinics, TSH, HbA1c, Calcium, BNP, ECG, CXR, SpO2, RR, HR and temperature. The lack of a specific target underlines the generality of the approach. It leaves us with doubts about what the clinics responsible for managing long COVID are expected to do, at least in the hospital setting. Furthermore, we are moving from the premises of a diagnosis of exclusion. It is even not clear what the overall cost of the initial referral is. Costing should include the charges for the multitude of mandatory tests - often already recently performed, but not within the six weeks antecedent to the referral as per requirement - plus the first hospital consultation charge to the NHS. It also remains to be established what the referring doctor and the patient should expect from the referral, especially in the treatment plan. A cost-benefit analysis – that is, the process used to measure the benefits minus the costs associated - of the long COVID clinics in their current form appears to be lacking. Such analysis should also factor in the opportunity cost in the decision-making process. Opportunity costs are alternative benefits deriving from choosing one alternative over another. In other words, the opportunity cost is the forgone or missed opportunity because of a choice or decision.  The above situation, once again, emphasizes the need for at least more solid diagnostic and pathophysiological premises before proceeding further with clinics and therapeutic programs, other than in a field of scientific research aimed at obtaining more information. In the absence of measures so designed, the long COVID can produce a second crisis of the health system and the job sector in the wake of the pandemic itself. Until we have a better idea of dealing effectively with long COVID, there is a strong case for redirecting any money destined to the Long COVID Clinics to clinical research on long COVID and Primary Care. A golden rule in healthcare is that spending more on prevention, early detection, and better-diagnosing spares patients suffering and leads to less complex and less expensive care later.

The current COVID-19 pandemic highlights the need for zoonotic infectious disease surveillance. Avian influenza virus (AIV) poses a significant threat to animal and public health due to its pandemic potential. Virus-contaminated water has been suggested as an important AIV spread mechanism among multiple species. Nevertheless, few studies have characterized the global AIV subtype diversity and distribution in environmental water. Therefore, this study aims to provide an updated descriptive and phylogenetic analysis of AIVs isolated in water samples from high risk-sites for influenza outbreaks (i.e., live bird markets, poultry farms, and wild bird habitats) on a global scale. A total of 234 hemagglutinin (HA) gene sequences of 21 subtypes were reported from nine countries between 2003 – 2020. Fourteen AIV subtypes were solely reported from Asian countries. Most of the viral sequences were obtained in China and Bangladesh with 47.44% and 23.93%, respectively. Likewise, the greatest global AIV subtype diversity was observed in China with twelve subtypes. Live bird markets represented the main sampling site for AIV detection in water samples (64.10%), mostly from poultry cage water. Nevertheless, the highest subtype diversity was observed in water samples from wild bird habitats, especially from the Izumi plain and the Dongting Lake located in Japan and China, respectively. Water from drinking poultry troughs evidenced the greatest subtype diversity in live bird markets, meanwhile, environmental water used by ducks had the highest number of different subtypes in poultry farms. The maximum-likelihood phylogenetic tree showed that some HA sequences were closely related among different poultry/wild bird-related environments from different geographic origins. Therefore, the results suggest that even though the availability of HA gene sequences in public-access databases varies greatly among countries, environmental AIV surveillance represents a useful tool to elucidate potential viral diversity in wild and domestic bird populations.

We systematically assessed the evidence comparing surgical facemasks to respirators in the prevention of COVID-19 in HCW providing non AGP care in a hospital setting. We identified only one relevant study which reported no significant difference in COVID-19 infection rates amongst HCWs wearing surgical facemasks or FFP1 face-covers as compared to FFP2 respirators. This was an observational study with substantial methodological deficiencies and highlights the need for high quality evidence. However, until this evidence is available, and given that inadequate mask use may increase the risk of nosocomial infection amongst patients and HCWs, we would recommend respirators for non-AGP care.

Background: Many variants detected after Wuhan-Hu-1 reference which were able to develop the resistance against the neutralizing antibodies induced by vaccine and may cause false negative results in diagnostic tests targeting the S gene. The Covid-19 cases are increasing rapidly in India and the government authorized a new vaccine for restricted use in emergency situation. Aims: This review discusses about the efficacy, safety, and economical aspects of vaccines authorized in India. Materials and methods: Wide-ranging assessment and analysis of accessible resources on online database. Results: The rAd26-s & rAd5-s (Gamaleya Research Institute of Epidemiology and Microbiology) demonstrate high efficacy as well as safety, followed by BBV152 (Bharat Biotech) and AZD1222 (Oxford AstraZeneca); AZD1222 is more economical than other two. Conclusion: The main goal of vaccination is to reduce deaths, protect the health care system and finally disease control, this is only be possible if more population is vaccinated with locally available Covid-19 vaccine and self-awareness about the prevention of disease transmission. Key Words: Covid-19, SARS-CoV-2, Immunization, Vaccine, Efficacy.

Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection with clinical features of Kawasaki-like disease was reported in various pediatric centers in late April 2020. Currently, cases have increased throughout the world with a range of manifestations from less to greater severity. However, hemophagocytosis has not been described in patients with MIS-C. We describe two infants diagnosed with MIS-C who presented Macrophage Activation Syndrome (MAS) with hemophagocytosis documented in the bone marrow. MIS-C can be complicated with MAS, the key features for diagnosis are splenomegaly, hypofibrinogenemia, hypertriglyceridemia and bone marrow hemophagocytosis. Cytokine storm and MAS in MIS-C may represent part of the spectrum of the disease and HScore could be of value in order to give timely and aggressive treatment.

Background: This longitudinal cohort study aimed to examine the impact of the first wave of the COVID-19 pandemic in Ireland on parents of children with externalising difficulties, in comparison to parents of children without such difficulties. Method: Parents of 159 children completed online self-report measures at three time points during the first wave of the COVID-19 pandemic; 1) Delay and Mitigation Phase (March 2020 - May 2020), 2) Reopening of Society Phase (June 2020 – July 2020), and 3) Wave 2 Case Acceleration Phase (September 2020 - October 2020). Participants were allocated to the Clinical group if they met the clinical cut off point on the Conduct or Hyperactivity/Inattention subscales of the Strengths and Difficulties Questionnaire at Time 1. Results: Parents of children with externalising difficulties experienced significantly higher levels of stress, lower levels of wellbeing, and engaged in higher levels of avoidant-focused coping strategies longitudinally. There was a significant difference between outcomes at the different phases of the COVID-19 pandemic, for stress related to parenting, personal/family stress related to the impact of the COVID-19, and type of coping strategies employed. Children with externalising difficulties, in comparison to children without externalising difficulties, showed significantly greater adjustment over time for behavioural and emotional difficulties. Conclusions: Results provide important information regarding the trajectory of psychological outcomes in parents of children with externalising difficulties over the first wave of the COVID-19 pandemic, highlighting the need for increased parental supports during, and after, the COVID-19 pandemic.