Severe COVID-19 disease is associated with an increase in pro-inflammatory markers, such as IL-1, IL-6, and tumor necrosis alpha, less CD4 interferon-gamma expression, and fewer CD4 and CD8 cells, which increase the susceptibility to bacterial and fungal infections. One such opportunistic fungal infection is mucormycosis. Initially, it was debated whether a person taking immunosuppressants, such as corticosteroids, and monoclonal antibodies will be at higher risk for COVID-19 or whether the immunosuppresive state would cause a more severe COVID-19 disease. However, immunosuppressants are currently continued unless the patients are at greater risk of severe COVID-19 infection or are on high-dose corticosteroids therapy. As understood so far, COVID-19 infection may induce significant and persistent lymphopenia, which in turn increases the risk of opportunistic infections. It is also noted that 85% of the COVID-19 patients’ laboratory findings showed lymphopenia. This means that patients with severe COVID-19 have markedly lower absolute number of T lymphocytes, CD4+T and CD8+ T cells and, since the lymphocytes play a major role in maintaining the immune homeostasis, the patients with COVID-19 are highly susceptible to fungal co-infections. This report is intended to raise awareness of the importance of early detection and treatment of mucormycosis and other fungal diseases, such as candidiasis, SARS-CoV-2-associated pulmonary aspergillosis, pneumocystis pneumonia and cryptococcal disease, in COVID-19 patients, to reduce the risk of mortality.

Patient engagement (PE) is a well-known strategy introduced and implemented by pharmaceutical and medical device companies for patient compliance and adherence to treatment protocols during clinical trials and care processes. This can affect a wider range of outcomes such as the quality of treatment decisions and quality of care outcomes. Few studies have paid attention to it. The involvement of patient is one of the crucial stakeholders of health care in their treatment that makes controversial opinions about the potential outcomes of their engagement in various aspects of healthcare. This scoping review was conducted in 2022 to collect the results of PE. The search was performed in the MEDLINE and Web of Sciences databases. The selected documents were categorized and reported by the direct content analysis method. Out of 3974 published documents, 17 articles were selected. Findings are categorized into 4 groups: (1) Health outcome, (2) patient compliance, (3) self-efficiency, and (4) return on investment. PE can improve both treatment outcomes and consequently patient satisfaction and health, as well as the productivity of the service provider. However, increasing self-care and patient adherence are among the positive effects of this engagement on the patient, and return on investment is still a challenge for PE.

First case of COVID-19 was reported in Wuhan, China in December 2019. As of now, May 2021, a total of 164,189,004 people were infected, and 3,401,990 deaths have occurred caused by SARS-CoV-2. As SARS-CoV-2 virus cell entry mainly depends on the ACE2 and TMPRSS2 proteins, the presence of high expression levels of both ACE2 and TMPRSS2 in testes highlights the possible vulnerability of men to the virus. Other RNA viruses frequently induce orchitis and result in male infertility. This review evaluates the decline in male fertility and a total of 48 original articles were included for the analysis. We investigated the effects of COVID-19 on male reproductive health and male fertility. There is a strong association between the high number of ACE2 receptors in the testes and the COVID-19 viral loads. SARS-CoV-2 infection negatively affects the male reproductive tract. Human biological tissues, including body fluids and excretions, tissues, and organs showed positive results tests for SARS-CoV-2. A disruption in the balance of male reproductive system hormones is also observed. Male gonads may be potentially vulnerable to SARS-CoV-2 infection, suggesting caution to follow-up and evaluate infected men that have plans to conceive. Further studies are required to determine if this impairment is temporary or permanent, elucidate SARS-CoV-2’s entrance strategies into the testis and how it can affect the semen quality and quantity. We recommend a post-infection follow-up, especially in male patients of reproductive age already having fertility issues.

Background Pregnancy is an immunocompromised state and, for this reason, a pregnant woman is at a higher risk of getting infected as compared with a healthy individual. There is limited data available regarding the impact of COVD-19 on pregnancy; however, the case of miscarriage due to placental infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in second trimester has already been reported. Methods We searched for all published articles in PubMed, Science Direct, Cochrane, Scopus, and Embase. The literature search produced 167 relevant publications; 67 manuscripts were further excluded because they did not satisfy our inclusion criteria. Out of the remaining 100 articles, 78 were excluded after full text screening. Therefore, a total of 22 articles were eligible for review in our study. Results Overall, these 22 studies included a total of 7,034 participants: 2,689 (38.23%) SARS-CoV-2 positive pregnant women, of which 2,578 (95.87%) were laboratory confirmed and 111 (4.13%) were clinically diagnosed. Among the positive patients, there were 174 (6.47%) cases of abortion, of them 168 (96.55%) were spontaneous abortions and 6 (3.45%) were missed. Most patients either reported mild symptoms of fever, cough, fatigue, and anosmia or they presented asymptomatic. Conclusion Additional investigation and rigorous research are warranted to confirm placental pathology mechanisms concerning COVID-19 to protect maternal and fetal health.

IntroductionThe extent and nature of social pressure and bullying towards healthcare workers (HCWs) during the COVID-19 remains unclear. The following study identifies the effect of social pressure and bullying directed towards HCWs when using biosecurity measures during the COVID-19 pandemic; further, the impact on perceptions, attitudes and job satisfaction level is also explored.MethodologyWe conducted a cross-sectional survey-based study among 684 Ecuadorian HCWs. The survey consisted of 38 questions related to the frequency, attitudes, and perceptions of biosecurity measures during the COVID-19 pandemic. Exploratory factor analysis was performed to assess the validity of the questionnaire. Associations between variables were analysed using χ2 and Fisher’s exact test. Using SPSS V.25, qualitative and quantitative data were analysed.ResultsOf the 684 participants, 175 (25.59%) experienced or felt bullying or social pressure during the COVID-19 pandemic associated with the use of biosecurity measures. Of these, 40.6% believed it was due to an imbalance of power in the workplace. The perception that HCWs wearing personal protective equipment resulting in bullying was noted in 12% of the respondents. Job satisfaction was positive among 73% of the respondents. Gender (female) and type of institution (public) were noted to contribute towards job satisfaction and bullying experiences.ConclusionExposure to social bullying and pressure due to the use of biosecurity measures during the COVID-19 pandemic may result in reduced job satisfaction and thoughts about quitting work.

In the early pandemic, it was brought to attention that individuals with Diabetes Mellitus (DM) are prone to a more severe form of Coronavirus Disease 2019 (COVID-19). With this in mind, healthcare professionals need to be vigilant about their patients’ medical history in these challenging times as this could change the course of treatment and follow-ups for someone with COVID-19 and DM. Moreover, this is of utmost importance as the coronavirus is deemed to thrive in the elevated blood glucose environment. Though there is little known about the best medications for glycemic control in COVID-19, however, there are multiple other factors that can be beneficial in exploring for management in DM patients who are infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and some of these factors are as follow adequate glycemic control, medication dosages adjustment, diet, physical guidelines, thromboembolism prophylaxis, and empirical treatments for the possible co-infections. We conducted a literature review of publicly available information to summarize knowledge about the correlation between Diabetes Mellitus and the COVID-19 infections. The main objective of this manuscript is to provide a brief overview of the potential pathophysiologic correlation of DM and COVID-19, optimal management and prevention.

Background-Acute respiratory failure and Chronic obstructive pulmonary disease, often complicated by acute exacerbation (AECOPD) can result in significant morbidity and mortality. High-flow oxygen through the nasal cannula (HFNC) provides adequate oxygenation and can be used as an initial support strategy for patients with acute respiratory failure (ARF). However, the efficacy and safety of HFNC and Non-invasive ventilation (NIV) when treating ARF of different etiologies in various settings is unknown. Methods-Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception until December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p<0.05. The primary outcome of interest was all-cause mortality at day 30. Secondary outcome was the proportion of patients who required endotracheal intubation. Results-A total of six studies with 709 participants (HFNC= 353, NIV= 356) were included in our analysis. Average follow-up duration was 30 days. A significant reduction in mortality was observed in patients receiving high flow nasal cannula oxygen therapy (OR 0.58 95%CI 0.35-0.95; p=0.03, I 2 =0) However, the proportion of patients requiring intubation was not significantly different between the two groups (OR 0.70 95%CI 0.47-1.03; p=0.07, I 2 =0) Conclusion-Amongst patients with Acute respiratory failure and Acute exacerbation of Chronic obstructive pulmonary disease, treatment with high-flow oxygen and noninvasive ventilation did not result in significantly different intubation rates. However, there was a significant difference in favor of high-flow oxygen therapy in 30-day mortality.

Prolonged intrauterine retention of fetal bones during an abortion procedure can lead to secondary infertility A total of 17 case reports, 7 case series, and one retrospective study were included, with a total of 75 patients. 60% had a termination in the 2nd trimester, while 20% had a pregnancy termination during the 1st trimester. Hysteroscopic resection was used to remove the intrauterine fetal bones in 69% of patients. 59 % of patients could conceivefollowing the procedure, 1% conceived despite the presence of intrauterine bones, 24% could not conceive at the time of the study, and 16% of patients had an unknown outcome. Transvaginal in 41 (55%) and pelvic ultrasound in 21(28%) were used for diagnosis. Secondary infertility is a common occurrence after a D&C procedure partially due to fetal bone retention. The gold standard for an accurate diagnosis and treatment is hysteroscopy.