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Purpose: To evaluate the impact of the current pandemic on ophthalmology residency training in Saudi Arabia, focusing on its effects on clinical education, training, and the mental well-being of the trainees Methods: An online self-administered questionnaire was distributed among residents in the Saudi ophthalmology training programs between July 7 and 14, 2020 In this study, we explored residents’ opinions regarding training disruption and virtual education The patient health questionnaire (PHQ-9) was used to assess the COVID-19 pandemic’s impact on their mental health We used descriptive statistics for data analysis Results: Out of 183 registered ophthalmology residents, 142 participated in this study Ninety-six participants (35 4%) were rotated at a specialized eye hospital during the COVID-19 pandemic, while 52 (19 2%) had rotations in the ophthalmology department at general hospitals Those who rotated in both types of hospitals were 123 (45 4%) According to the participants, there was a significant decline in exposure to surgical and office-based procedures compared to emergency eye consultations (Friedman P <0 001) The COVID-19 pandemic’s effect on mental health was reported by 100 (70 5%) participants Eighty-five (55 4%) respondents were satisfied with the virtual method of education Conclusion: COVID-19 pandemic has disrupted residents’ clinical and surgical training in the Saudi ophthalmology training programs Additionally, we believe that COVID-19 may have a negative impact on trainees’ mental health Fortunately, the current pandemic provided an innovative education method that will likely be used even after the pandemic

Abstract Aim The COVID‐19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has put health care workers at risk when exposed to aerosolized viral particles during upper airway mucosal surgery. The objective of this review was to discuss topical preparations that could be utilized preoperatively to help to decrease viral load and potentially reduce the risks of viral transmission. Methods A PubMed/MEDLINE database review of articles was performed querying topical preparations with virucidal activity against coronaviruses. Results Povidone‐iodine (PVP‐I) solutions ranging from 0.23% to 7% have been found to demonstrate highly effective virucidal activity against a broad range of viruses including several coronaviruses responsible for recent epidemics including SARS‐CoV‐1 and MERS‐CoV. Conclusions While specific evidence regarding SARS‐CoV‐2 is lacking, PVP‐I‐based preparations have been successfully demonstrated to reduce viral loads of coronaviruses. They are relatively safe to use in the upper airway and may reduce risk of SARS‐CoV‐2 aerosolization during upper airway mucosal surgery.

COVID-19; Consumo de antimicrobianos; Dosis diarias definidas COVID-19; Consum d'antimicrobians; Dosis diàries definides COVID-19; Antimicrobial consumption; Defined daily doses Background: Antimicrobials have been widely used during the COVID-19 pandemic. This study aimed to analyze the impact of the COVID-19 pandemic on the antimicrobial consumption of 66 hospitals in Catalonia. Methods: Adult antibacterial and antimycotic consumption was calculated as defined daily doses (DDD)/100 bed-days and DDD/100 discharges. Firstly, overall and ICU consumption in 2019 and 2020 were compared. Secondly, observed ICU 2020 consumptions were compared with non-COVID-19 2020 estimated consumptions (based on the trend from 2008–2019). Results: Overall, antibacterial consumption increased by 2.31% and 4.15% DDD/100 bed-days and DDD/100 discharges, respectively. Azithromycin (105.4% and 109.08% DDD/100 bed-days and DDD/100 discharges, respectively) and ceftriaxone (25.72% and 27.97% DDD/100 bed-days and DDD/100 discharges, respectively) mainly accounted for this finding. Likewise, antifungal consumption increased by 10.25% DDD/100 bed-days and 12.22% DDD/100 discharges, mainly due to echinocandins or amphotericin B. ICU antibacterial and antimycotic consumption decreased by 1.28% and 4.35% DDD/100 bed-days, respectively. On the contrary, antibacterial and antifungal use, expressed in DDD/100 discharges, increased by 23.42% and 19.58%. Azithromycin (275.09%), ceftriaxone (55.11%), cefepime (106.35%), vancomycin (29.81%), linezolid (31.28%), amphotericin B (87.98%), and voriconazole (96.17%) use changed the most. Observed consumption of amphotericin B, azithromycin, caspofungin, ceftriaxone, vancomycin, and voriconazole were higher than estimated values. Conclusions: The consumption indicators for most antimicrobials deviated from the expected trend pattern. A worrisome increase in antibacterial and antifungal consumption was observed in ICUs in Catalonia. The present study was carried out as part of our routine work. The VINCat program is supported by public funding from the Catalan Health Service, Department of Health, Generalitat de Catalunya.

Abstract At the time of the COVID-19 pandemic, the impact of lockdown measures highlights changes in terms of sounds and noises present in the everyday life. The present paper deals with this peculiar and unexpected scenario as studied by means of an online survey consisting of 18 questions and distributed to residents in the Italian territory. For studying the unprecedented effect of the pandemic, participants were asked to fill the questionnaire, providing personal data, describing context and characteristics of the house in which they live and making a comparison of the lockdown soundscape with the pre-lockdown one. About four hundred questionnaires have been collected and analysed in order to define correlations between personal and perception variables. Using logistic regression models, changes have been studied during the two abovementioned periods. It has been observed that the perception of traffic noise has increased for people over 35 years old and the noise produced by the neighbourhood has been more statistically significant for employed respondents. Future outlook might provide the spread of the questionnaire in other countries for a global evaluation of the data, to be also acquired with reference to the after-lockdown period.

Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) Main protease (Mpro) is one of the vital drug targets amongst all the coronaviruses, as the protein is indispensable for virus replication. The study aimed to identify promising lead molecules against Mpro enzyme through virtual screening of Malaria Venture (MMV) Malaria Box (MB) comprising of 400 experimentally proven compounds. The binding affinities were studied using virtual screening based molecular docking, which revealed five molecules having the highest affinity scores compared to the reference molecules. Utilizing the established 3D structure of Mpro the binding affinity conformations of the docked complexes were studied by Molecular Dynamics (MD) simulations. The MD simulation trajectories were analysed to monitor protein deviation, relative fluctuation, atomic gyration, compactness covariance, residue-residue map and free energy landscapes. Based on the present study outcome, we propose three Malaria_box (MB) compounds, namely, MB_241, MB_250 and MB_266 to be the best lead compounds against Mpro activity. The compounds may be evaluated for their inhibitory activities using experimental techniques. Graphical abstract Image 1

Objectives During the 2019 Coronavirus disease (COVID-19) outbreak, malnutrition may contribute to COVID-19 adverse outcomes. We conducted a clinical epidemiological analysis to investigate the association of malnutrition with hospitalized duration in patients with COVID-19. Design Retrospective survey study. Setting Taikang Tongji (Wuhan) hospital in Wuhan, China. Participants 139 patients with COVID-19. Methods In total, 139 patients with COVID-19 from patients in the Infection Department of Taikang Tongji (Wuhan) hospital from February 2020 to April 2020 were analyzed retrospectively. We used the “Global leadership Initiative on Malnutrition(GLIM)” assessment standard published in 2019 to assess nutritional status. Prolonged hospitalization was lasting more than the median value of the hospitalized days (17 days) in this population. Results According to the assessment results of GLIM nutrition assessment, the patients were divided into malnutrition group and normal nutrition group. Compared with the patients in the normal nutrition group, the hospitalization time was longer(15.67±6.26 days versus 27.48±5.04 days, P = 0.001). Kaplan-Meier analysis showed patients with malnutrition were more likely to be hospitalized longer compared with those normal nutrition (mean with 95% confidence interval [CI]: 28.91[27.52–30.30] versus 22.78[21.76–23.79], P = 0.001). COX regression analysis showed that malnutrition (hazard ratio [HR] = 3.773, P for trend = 0.001) was proportional associated with being discharged from hospital delayed. Conclusion and implications Present findings suggested that malnutrition contributed to predicting a probability of prolonged hospitalization in patients with COVID-19 infection, to whom extra attentions and precautions should be paid during clinical treatments. Based on the existing results, it is recommended that inpatients with nutritional risk or malnutrition start nutritional support treatment as soon as possible.

Hypertensive disorders are the most common medical complications of pregnancy and a major cause of maternal and perinatal morbidity and death. The detection of elevated blood pressure during pregnancy is one of the cardinal aspects of optimal antenatal care. With the outbreak of novel coronavirus disease 2019 (COVID-19) and the risk for person-to-person spread of the virus, there is a desire to minimize unnecessary visits to health care facilities. Women should be classified as low risk or high risk for hypertensive disorders of pregnancy and adjustments can be accordingly made in the frequency of maternal and fetal surveillance. During this pandemic, all pregnant women should be encouraged to obtain a sphygmomanometer. Patients monitored for hypertension as an outpatient should receive written instructions on the important signs and symptoms of disease progression and provided contact information to report the development of any concern for change in status. As the clinical management of gestational hypertension and preeclampsia is the same, assessment of urinary protein is unnecessary in the management once a diagnosis of a hypertensive disorder of pregnancy is made. Pregnant women with suspected hypertensive disorders of pregnancy and signs and symptoms associated with the severe end of the disease spectrum (e.g., headaches, visual symptoms, epigastric pain, and pulmonary edema) should have an evaluation including complete blood count, serum creatinine level, and liver transaminases (aspartate aminotransferase and alanine aminotransferase). Further, if there is any evidence of disease progression or if acute severe hypertension develops, prompt hospitalization is suggested. Current guidelines from the American College of Obstetricians and Gynecologists (ACOG) and The Society for Maternal-Fetal Medicine (SMFM) for management of preeclampsia with severe features suggest delivery after 34 0/7 weeks of gestation. With the outbreak of COVID-19, however, adjustments to this algorithm should be considered including delivery by 30 0/7 weeks of gestation in the setting of preeclampsia with severe features. Key Points Outbreak of novel coronavirus disease 2019 (COVID-19) warrants fewer office visits. Women should be classified for hypertension risk in pregnancy. Earlier delivery suggested with COVID-19 and hypertensive disorder.

The National Institute for Health and Care Excellence (NICE) describe “ post COVID-19 syndrome” or “Long COVID” as a set of persistent physical, cognitive and/or psychological symptoms that continue for more than 12 weeks after illness and which are not explained by an alternative diagnosis. These symptoms are experienced not only by patients discharged from hospital but also those in the community who did not require inpatient care. To support the recovery of this group of people, a unique integrated rehabilitation pathway was developed following extensive service evaluations by Leeds Primary Care Services, Leeds Community Healthcare NHS Trust and Leeds Teaching Hospital NHS Trust. The pathway aligns itself to the NHS England “Five-point plan” to embed post-COVID-19 syndrome assessment clinics across England, supporting the comprehensive medical assessment and rehabilitation intervention for patients in the community. The pathway was first of its kind to be set up in the UK and comprises of a three-tier service model (level 1: specialist MDT service, level 2: community therapy teams and level 3: self-management). The MDT service brings together various disciplines with specialist skill sets to provide targeted individualized interventions using a specific core set of outcome measures including C19-YRS (Yorkshire Rehabilitation Scale). Community and primary care teams worldwide need such an integrated multidisciplinary comprehensive model of care to deal with the growing number of cases of post-COVID-19 syndrome effectively and in a timely manner.

Absztrakt: A WHO által 2020. március 11-én hivatalosan is pandémiának nyilvánított COVID–19-járvány ismét felhívja a figyelmet a telemedicina lehetőségeire. Az új koronavírus-fertőzés megfékezése érdekében, az ellátórendszer működtetése során, a fertőződés kockázatának maximális csökkentése mellett új utakat, módszereket, platformokat kell találnunk. Célunk, hogy szakirodalmi összegzéssel és gyakorlati szempontú útmutatók révén, valamint a hazai telefogászat különleges példáján keresztül bemutassuk, milyen kísérletek történtek a COVID–19-járvány kapcsán a telemedicinának az ellátásba való bevonására mind a nemzetközi, mind pedig a hazai ellátórendszerek különböző szintjein. Mind a nemzetközi, mind a hazai adatok azt mutatják, hogy a telemedicina kiemelt szerepű lehet a triázs folyamatában, a fertőzöttek korai kiemelésében, diagnosztizálásában, ellátásában, betegútjának menedzselésében úgy, hogy a szakszemélyzet nem érintkezik a potenciálisan fertőzött páciensekkel. Ugyancsak fontos szerepe van a gondozott, krónikus betegséggel élő páciensek állapotának távoli monitorozásában, ellátásában és a veszélyeztetett egészségügyi dolgozói csoport ellátásba való visszakapcsolásában. A potenciális előnyök mellett nem szabad megfeledkeznünk a telemedicinális ellátás korlátairól, ugyanakkor fontos kiemelni, hogy széles hozzáférhetősége miatt a veszélyhelyzet kapcsán kellő rugalmasságot adhat mind az alapellátás, mind a szakellátás számára. Éppen ezért mielőbb szükséges a hazai szakmai irányelveket, a jogi és a finanszírozási lehetőségeket e területen hosszú távon fenntartható módon is meghatározni.* Orv Hetil. 2020; 161(24): 983–992. *Megjegyzés: A jelen cikk írását 2020. április 30-án zártuk le. A COVID–19-pandémia és az ezzel kapcsolatos kutatások, vizsgálatok dinamikusan változnak azóta is.

ObjectivesWe aim to estimate the impact of various mitigation strategies on COVID-19 transmission in a US jail beyond those offered in national guidelines.DesignWe developed a stochastic dynamic transmission model of COVID-19.SettingOne anonymous large urban US jail.ParticipantsSeveral thousand staff and incarcerated individuals.InterventionsThere were four intervention phases during the outbreak: the start of the outbreak, depopulation of the jail, increased proportion of people in single cells and asymptomatic testing. These interventions were implemented incrementally and in concert with one another.Primary and secondary outcome measuresThe basic reproduction ratio, R0, in each phase, as estimated using the next generation method. The fraction of new cases, hospitalisations and deaths averted by these interventions (along with the standard measures of sanitisation, masking and social distancing interventions).ResultsFor the first outbreak phase, the estimated R0 was 8.44 (95% credible interval (CrI): 5.00 to 13.10), and for the subsequent phases, R0,phase 2=3.64 (95% CrI: 2.43 to 5.11), R0,phase 3=1.72 (95% CrI: 1.40 to 2.12) and R0,phase 4=0.58 (95% CrI: 0.43 to 0.75). In total, the jail’s interventions prevented approximately 83% of projected cases, hospitalisations and deaths over 83 days.ConclusionsDepopulation, single celling and asymptomatic testing within jails can be effective strategies to mitigate COVID-19 transmission in addition to standard public health measures. Decision makers should prioritise reductions in the jail population, single celling and testing asymptomatic populations as additional measures to manage COVID-19 within correctional settings.