INTRODUCTION: Countries are mandating the use of face masks to stem the spread of coronavirus disease 2019 (COVID-19). Face mask use has been associated with discomfort due to its effects on thermoregulation, breathing and oxygenation. We evaluated the prevalence and severity of self-reported cardiovascular symptoms before and during face mask use. METHODS: This was a cross-sectional study of 1,001 participants residing in Singapore, who participated in a self-administered questionnaire between 25 April 2020 and 4 May 2020. Symptom severity before and during mask use, and health-seeking behaviour information were collected. The study outcome was self-reported worsening of cardiovascular symptoms and its association with the type of mask worn, duration of mask worn per day, and intensity of physical activities during mask use. RESULTS: The most common symptom reported during mask use was dyspnoea. Independent predictors for self-reported cardiovascular symptoms during mask use were moderate-high physical activity during mask use (odds ratio [OR] 1.634, 95% confidence interval [CI] 1.176-2.270, P = 0.003), duration of mask use for ≥3 h (OR 1.672, 95% CI 1.189-2.352, P = 0.003) and type of mask used, after adjusting for age, sex, healthcare-based worker status and presence of comorbidities. N95 mask was associated with worse symptoms when compared to surgical mask. Participants with ≥3 worsening symptoms or worsening dyspnoea, palpitations, fatigue and dizziness were more likely to seek medical help. CONCLUSION Face mask use has been proven to be an effective way in curbing COVID-19 transmission. However, participants in this study had concerns regarding its use and these concerns should be urgently addressed to enable mask use policies to be enacted.
Humans ; COVID-19/epidemiology* ; Pandemics ; Masks/adverse effects* ; Self Report ; Cross-Sectional Studies ; Dyspnea/etiology*

Amyloidosis/diagnostic imaging* ; Cardiomyopathies/diagnostic imaging* ; Diagnostic Imaging ; Humans ; Prealbumin/genetics*

Twin reversed arterial perfusion (TRAP) sequence is a rare, unique complication of monochorionic twin pregnancy in which one of the twins with an absent or a non-functioning heart (acardiac twin) is per- fused by its own co-twin (pump twin) via placental arterial anastomosis. The anomalous twin may ap- pear as a heterogenous mass simulating a teratoma or intrauterine foetal demise and has poorly devel- oped heart, upper body and head. The normal twin faces the excess burden of having to send and re- ceive blood from the acardiac mass as well as its own growing tissue and is at risk of heart failure and preterm birth. Left untreated, in up to 50% of cases, this otherwise normal twin may die in utero or shortly after birth. We report the case of a TRAP sequence in a monochorionic twin pregnancy. Unfortu- nately, the pump twin died because mother went into premature labour that was complicated by ab- ruptio placenta at 26 weeks of gestation.