Risk-Based Causal Model of Risk Factors for Infection among Medical Personnel Involved in the Care Of Patients with the New COVID-19 Coronavirus Infection

The aim of the study is to develop and apply a mathematical model for assessing the risks of contamination of medical personnel involved in providing medical care to patients with COVID-19 in a "red zone" environment. Materials and methods. Based on the analysis of informative signs and information on working conditions in the infectious disease department of the A.I. Burnazyan Federal Medical Biophysical Center of the Federal Medical and Biological Agency of Russia, a decision-making support system was developed to provide an objective assessment of the risks of infection for medical personnel when providing medical care in the "red zone". Results of the study and their analysis. The influence of various risk factors for infection of medical personnel involved in the provision of medical care to patients with new coronavirus infection COVID-19 was analyzed; the most significant risk factors were identified.

SARS-CoV-2 seroconversions and chains of infection in healthcare professionals in a German maximum care provider (The CoSHeP study)

Introduction The CoSHeP study provides novel data on SARS-CoV-2 seroconversion rates in healthcare professionals (HP) at risk at the University Hospital Bonn, a maximum healthcare provider in a region of 900.000 inhabitants. Methods Single-center, longitudinal observational study investigating rate of SARS-CoV-2 IgG seroconversion in HP at 2 time-points. SARS-CoV-2 IgG was measured with Roche Elecsys Anti-SARS-CoV-2 assay. Results Overall, 150 HP were included. Median age was 35 (range: 19–68). Main operational areas were intensive care unit (53%, n = 80), emergency room (31%, n = 46), and infectious disease department (16%, n = 24). SARS-CoV-2-IgG was detected in 5 participants (3%) at inclusion in May/June 2020, and in another 11 participants at follow-up (December 2020/ January 2021). Of the 16 seropositive participants, 14 had already known their SARS-CoV-2 infection because they had performed a PCR-test previously triggered by symptoms. Trailing chains of infection by self-assessment, 31% (n = 5) of infections were acquired through private contacts, 25% (n = 4) most likely through semi-private contacts during work. 13% (n = 2) were assumed to result through contact with contagious patients, further trailing was unsuccessful in 31% (n = 5). All five participants positive for SARS-CoV-2 IgG at inclusion remained positive with a median of 7 months after infection. Discussion Frontline HP caring for hospitalized patients with COVID-19 are at higher risk of SARS-CoV-2 infections. Noteworthy, based upon identified chains of infection most of the infections were acquired in private environment and semi-private contacts during work. The low rate of infection through infectious patients reveals that professional hygiene standards are effective in preventing SARS-CoV-2 infections in HP. Persisting SARS-CoV-2-IgG might indicate longer lasting immunity supporting prioritization of negative HP for vaccination.

Assessment of physicians’ resilience level during the COVID-19 pandemic

We aim to assess physicians’ level of resilience and define factors that improve or decrease the resilience level during the COVID-19 pandemic. Physicians from hospitals located in areas with different COVID-19 caseload levels, were invited to participate in a national e-survey between April and May 2020. Study participants were mainly emergency physicians, and anaesthesiologists, infectious disease consultants, and intensive care. The survey assessed participant’s characteristics, factors potentially associated with resilience, and resilience using the Connor-Davidson Resilience Scale (RISC-25), with higher scores indicative of greater resilience. Factors associated with the resilience score were assessed using a multivariable linear regression. Of 451 responding physicians involved in the care of COVID-19 patients, 442 were included (98%). Age was 36.1 ± 10.3 years and 51.8% were male; 63% worked in the emergency department (n = 282), 10.4% in anesthesiology (n = 46), 9.9% in infectious disease department (n = 44), 4.8% in intensive care unit (n = 21) or other specialties (n = 49). The median RISC-25 score was at 69 (IQR 62–75). Factors associated with higher RISC scores were anesthesia as a specialty, parenthood, no previous history of anxiety or depression and nor increased anxiety. To conclude, this study is the first to characterize levels of resilience among physicians involved in COVID-19 unit. Our data points to certain protective characteristics and some detrimental factors, such as anxiety or depression, that could be amenable to remediating or preventing strategies to promote resilience and support caregivers in a pandemic.

When Does the Cytokine Storm Begin in COVID-19 Patients? A Quick Score to Recognize It

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that is responsible for coronavirus disease 2019 (COVID-19), which has rapidly spread across the world, becoming a pandemic. The “cytokine storm” (CS) in COVID-19 leads to the worst stage of illness, and its timely control through immunomodulators, corticosteroids, and cytokine antagonists may be the key to reducing mortality. After reviewing published studies, we proposed a Cytokine Storm Score (CSs) to identify patients who were in this hyperinflammation state, and at risk of progression and poorer outcomes. We retrospectively analyzed 31 patients admitted to Infectious Disease Department in “St. Maria” Hospital in Terni with confirmed SARS-CoV-2 infections, and analyzed the “CS score” (CSs) and the severity of COVID-19. Then we conducted a prospective study of COVID-19 patients admitted after the definition of the CSscore. This is the first study that proposes and applies a new score to quickly identify COVID-19 patients who are in a hyperinflammation stage, to rapidly treat them in order to reduce the risk of intubation. CSs can accurately identify COVID-19 patients in the early stages of a CS, to conduct timely, safe, and effect administration of immunomodulators, corticosteroids, and cytokine antagonists, to prevent progression and reduce mortality.

COVID-19: how nuclear medicine can provide a differential diagnosis in very dubious case

Background: We present the case of a 55-year-old woman, admitted to the Infectious Disease Department of Policlinico Umberto I, Rome, in mid-March 2020, with suspicion of COVID-19 infection. Objective: The rRT-PCR was negative and the following CT scan, performed to exclude false-negative results and help diagnosis, was inconclusive. Methods: It was decided to submit the patient to 99mTc-HMPAO-labelled leukocyte scan. Results: This exam led to the diagnosis of infective endocarditis. Conclusion: In the present pandemic scenario, 99mTc-HMPAO-labelled leukocyte scan represents a reliable imaging technique for differential diagnosis with COVID-19 in patients with confusing clinical signs, possible false-negative rRT-PCR results and inconclusive CT scan.

Gastrointestinal Tract Disorders in COVID-19 Infected Children

Objective of the work was to investigate the peculiarities of gastrointestinal tract disorders in children with coronavirus disease caused by SARS-CoV-2 virus.Materials and methods. We have analyzed the frequency, terms of emergence, duration and character of gastrointestinal disorders on the basis of medical records of 36 children receiving the treatment for community-acquired pneumonia of coronavirus etiology (positive for SARS-CoV-2 virus) in the children’s infectious disease department of Moscow State Clinical Hospital, Mytishchi. The majority of patients had moderate form of the disease (97 %), severe cases were not registered. The age range of the children – 8 months to17 years old. All patients were subjected to supplementary examination on Day 1 in accordance with the current recommendations. Children were treated in hospital settings for 8–15 days. Assessment of clinical status was performed at least once a day over the stated period, supplementary survey – at least once in a week, upon indications – more frequently. SARSCoV-2 virus was identified using polymerase chain reaction. All patients received standard therapy in compliance with advanced methodological recommendations, upon indications – other pharmaceutical products.Results and discussion. Gastro-intestinal disorders in 23 children (64 %) emerged on Day 4–5, in 8 children (22 %) – before the start of the treatment; they lasted 3–5 days. In most of the patients diarrhea (64 %) and stomachaches (57 %) were observed. 67 % of the children demonstrated other symptoms indicative of gastrointestinal dysfunction. The disorders were characteristic for most of the children hospitalized with community-acquired pneumonia caused by SARS-CoV-2 virus. The symptoms are contained when the main course of therapy is conducted, indicated for treatment of COVID-19, and additional therapy recommended for management of gastro-intestinal infections is performed.

CLINICO-ETIOLOGICAL CHARACTERISTICS OF ACUTE INTESTINAL INFECTIONS IN HOSPITALIZED CHILDREN OF MOSCOW IN 2015—2017

A retrospective analysis of the etiological structure and clinical manifestations of acute intestinal infections was conducted in 8459 children hospitalized in a specialized infectious disease department at the Children's City Clinical Hospital No.9 in Moscow, in 2015—2017 based on the study of statistical reports of the Children's City Clinical Hospital No.9 for 2015—2017 and 2417 case histories of children aged 1 month to 18 years old.It was found that children with age 1—7 years of age (58.5%) are more likely to have acute intestinal infections and are hospitalized. The etiological interpretation of acute intestinal infections remains at a low level and is 28.6%. The leading causative agents of acute intestinal infections are viruses (83%), mainly rotaviruses (62%), less often noroviruses (18%). Topical diagnosis in the vast majority of patients with acute intestinal infections was gastroenteritis (74.7%), which leads to the development of toxicosis with exsiccosis, especially in young children, which is the reason for hospitalization in the hospital. The share of bacterial diarrhea is small (17%), among them salmonella is significant, and in young children — staphylococcal infection. In recent years, the relevance of identifying campylobacter and clostridium, these pathogens may be the cause of the development of diarrhea with hemoccolitis.

AEFI Reporting Rates in Albania During 2008-2015: A Retrospective Analysis of AEFI Reporting Forms

In Albania, passive AEFI surveillance is conducted by Institute of Public Health, which is under the supervision of Ministry of Health. Reports of suspected adverse events following immunisation (AEFI) are reviewed by the Control of infectious disease department in the Institute of Public Health and recorded in a central database. In this study AEFI database is analysed for individual AEFI reporting forms during 2008-2015. AEFI reporting rates and their patterns were assessed. At 2003 a national standardized AEFI reporting form was introduced to the health-care workers who were obligated to report any observed AEFI. This form was changed and added more requisites in 2008 and nowadays this is the formal AEFI reporting form in Albania. Safe vaccines are essential to preserve high adherence to immunization programs¬ [1]. During the last years the reporting rate increased significantly due to implementation of enhanced vaccine safety reporting strategies but it is still low and underreporting remains one of the limits of passive surveillance. Reporting rates were calculated using as a denominator the administered doses of vaccines.

AEFI Reporting Rates in Albania During 2008-2015: A Retrospective Analysis of AEFI Reporting Forms

In Albania, passive AEFI surveillance is conducted by Institute of Public Health, which is under the supervision of Ministry of Health. Reports of suspected adverse events following immunisation (AEFI) are reviewed by the Control of infectious disease department in the Institute of Public Health and recorded in a central database. In this study AEFI database is analysed for individual AEFI reporting forms during 2008-2015. AEFI reporting rates and their patterns were assessed. At 2003 a national standardized AEFI reporting form was introduced to the health-care workers who were obligated to report any observed AEFI. This form was changed and added more requisites in 2008 and nowadays this is the formal AEFI reporting form in Albania. Safe vaccines are essential to preserve high adherence to immunization programs¬ [1]. During the last years the reporting rate increased significantly due to implementation of enhanced vaccine safety reporting strategies but it is still low and underreporting remains one of the limits of passive surveillance. Reporting rates were calculated using as a denominator the administered doses of vaccines.