Some patients who recover from COVID-19 have prolonged symptoms such as dyspnea, fatigue, cough, and dysosmia for longer than 120 days after symptom onset. In addition, some patients who recovered from COVID-19 reported hair loss a few months after the onset of the disease. Alopecia is a late-onset symptom of COVID-19. The cause of alopecia is unknown, however, androgenic alopecia and telogen effluvium are possible causes.

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Seasonal abundance and within-plant distribution of Acyrthosiphon spp. and their natural enemies were investigated on alfalfa in Obihiro, Hokkaido, Japan in 2001. Densities of A. pisum and A. kondoi peaked in early June. Coccinellid and syrphid predators appeared to respond to aphid numbers and were synchronized with aphid populations. Two species of braconid (aphidiine) parasitoids (Aphidius ervi and Praon barbatum) were collected. Parasitism rates for each aphid species were variable through the season, but the estimated number of parasitized aphids reached a peak at the same time as overall aphid densities. After the first harvesting of alfalfa (14 June) aphid densities became very low, and coccinellid and syrphid predators were not found. In contrast to the coccinellid and syrphid predators, the heteropteran predators, Nabis stenoferus and Orius spp. became common during summer. Aphids, immature parasitoids (live parasitized aphids and mummies), Coccinella septempunctata and syrphids occurred more on the upper parts of alfalfa stems than on the lower parts, but this trend was not found for Hippodamia tredecimpunctata. The temporal and spatial distributions of members of the aphidphagous guild are likely to influence natural enemy-aphid relationships and intraguild interactions.

BackgroundUnder-diagnosis of pain is a serious problem in cancer care. Accurate pain assessment by physicians may form the basis of effective care. The aim of this study is to examine the association between late referral to a Palliative Care Team (PCT) after admission and the under-diagnosis of pain by primary physicians.MethodsThis retrospective study was performed in the Teikyo University teaching-hospital for a period of 20 months. We investigated triads composed of 213 adult cancer inpatients who had coexisting moderate or severe pain at the initial PCT consultation, 77 primary physicians, and 4 palliative care physicians. The outcome of the present study was the under-diagnosis of pain by primary physicians with routinely self-completed standard format checklists. The checklists included coexisting pain documented independently by primary and palliative care physicians at the time of the initial PCT consultation. Under-diagnosis of pain was defined as existing pain diagnosed by the palliative care physicians only. Late referral to PCTs after admission was defined as a referral to the PCT at ≥20 days after admission. Because the two groups displayed significantly different regarding the distributions of the duration from admission to referral to PCTs, we used 20 days as the cut-off point for “late referral.”ResultsAccurate pain assessment was observed in 192 triads, whereas 21 triads displayed under-diagnosis of pain by primary physicians. Under-diagnosis of pain by primary physicians was associated with a longer duration between admission and initial PCT consultation, compared with accurate pain assessment (25 days versus 4 days, p < 0.0001). After adjusting for potential confounding factors, under-diagnosis of pain by the primary physicians was significantly associated with late (20 or more days) referral to a PCT (adjusted odds ratio, 2.91; 95% confidence interval, 1.27 − 6.71). Other factors significantly associated with under-diagnosis of pain were coexisting delirium and case management by physicians with < 6 years of clinical experience.ConclusionsUnder-diagnosis of pain by primary physicians was associated with late referral to PCTs. Shortening the duration from admission to referral to PCTs, and increasing physicians’ awareness of palliative care may improve pain management for cancer patients.