Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Single-Particle Analysis of Atmospheric Aerosols: Applications of Raman Spectroscopy

Atmospheric aerosols, produced as a consequence of different anthropogenic and natural processes, impart significant control over the global energy budget, climate, and human–environmental health. Their size varies across the nano–micrometer scale. Based on their origin, they may be classified into primary or secondary aerosols. Biomass burning, incomplete combustion of fossil fuels, volcanic eruptions, and traffic-related and wind-driven suspensions contribute to primary aerosol emissions. In contrast, gas-to-particle conversion within the atmosphere leads to secondary particle production. The study of atmospheric aerosols is vital to the field of atmospheric research. The dynamic nature (highly variable concentration composition and size with space and time) of aerosols makes them difficult to investigate. Today, aerosol research involves the application of various spectrometric and spectroscopic techniques. The single-particle analysis of aerosols is yet a challenge. In this review, the merits and demerits of various offline and online techniques used for aerosol research are discussed in a nutshell. Mass spectrometric techniques fail in distinguishing certain species. However, Raman spectroscopy’s emergence for the compositional analysis of aerosols resolves most of the present characterization challenges. This review focuses on Raman spectroscopy applications, the merits of this technique, and its immense scope for the measurement of various types of aerosols and their properties. Surface-enhanced Raman spectroscopy (SERS) has an advantage over conventional micro-Raman spectroscopy (MRS). The review depicts the dominance of SERS, specifically in the context of the measurement of ambient atmospheric aerosols. This review discusses two important components, namely laboratory simulation and ambient aerosol studies

Single-Particle Analysis of Atmospheric Aerosols: Applications of Raman Spectroscopy

Atmospheric aerosols, produced as a consequence of different anthropogenic and natural processes, impart significant control over the global energy budget, climate, and human–environmental health. Their size varies across the nano–micrometer scale. Based on their origin, they may be classified into primary or secondary aerosols. Biomass burning, incomplete combustion of fossil fuels, volcanic eruptions, and traffic-related and wind-driven suspensions contribute to primary aerosol emissions. In contrast, gas-to-particle conversion within the atmosphere leads to secondary particle production. The study of atmospheric aerosols is vital to the field of atmospheric research. The dynamic nature (highly variable concentration composition and size with space and time) of aerosols makes them difficult to investigate. Today, aerosol research involves the application of various spectrometric and spectroscopic techniques. The single-particle analysis of aerosols is yet a challenge. In this review, the merits and demerits of various offline and online techniques used for aerosol research are discussed in a nutshell. Mass spectrometric techniques fail in distinguishing certain species. However, Raman spectroscopy’s emergence for the compositional analysis of aerosols resolves most of the present characterization challenges. This review focuses on Raman spectroscopy applications, the merits of this technique, and its immense scope for the measurement of various types of aerosols and their properties. Surface-enhanced Raman spectroscopy (SERS) has an advantage over conventional micro-Raman spectroscopy (MRS). The review depicts the dominance of SERS, specifically in the context of the measurement of ambient atmospheric aerosols. This review discusses two important components, namely laboratory simulation and ambient aerosol studies

Infection and mortality of healthcare workers worldwide from COVID-19:A systematic review

Objectives To estimate COVID-19 infections and deaths in healthcare workers (HCWs) from a global perspective during the early phases of the pandemic. Design Systematic review. Methods Two parallel searches of academic bibliographic databases and grey literature were undertaken until 8 May 2020. Governments were also contacted for further information where possible. There were no restrictions on language, information sources used, publication status and types of sources of evidence. The AACODS checklist or the National Institutes of Health study quality assessment tools were used to appraise each source of evidence. Outcome measures Publication characteristics, country-specific data points, COVID-19-specific data, demographics of affected HCWs and public health measures employed. Results A total of 152 888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%, n=14 058) and nurses (38.6%, n=10 706), but deaths were mainly in men (70.8%, n=550) and doctors (51.4%, n=525). Limited data suggested that general practitioners and mental health nurses were the highest risk specialities for deaths. There were 37.2 deaths reported per 100 infections for HCWs aged over 70 years. Europe had the highest absolute numbers of reported infections (119 628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7). Conclusions COVID-19 infections and deaths among HCWs follow that of the general population around the world. The reasons for gender and specialty differences require further exploration, as do the low rates reported in Africa and India. Although physicians working in certain specialities may be considered high risk due to exposure to oronasal secretions, the risk to other specialities must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine or administrative positions. Our pragmatic approach provides general trends, and highlights the need for universal guidelines for testing and reporting of infections in HCWs. © Author(s) (or their employer(s)) 2020

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality