Clinical expression of symptomatic Familiar Mediterranean Fever (FMF) in Lebanese patients: a real-life survey study

Background: Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease characterized by recurrent fever and serositis attacks. We aimed to explore clinical aspects of FMF including knowledge, diagnosis, symptoms, and medication in a Lebanese cohort enrolled by ad-hoc questionnaire. Methods: During November 2021-March 2022 we conducted an online survey by a google form questionnaire (33 items) advertised across Lebanese communities, hospitals, internists, and specialists. Patients and children's parents voluntarily provided information about FMF knowledge, diagnosis, presence, and severity of symptoms before and after medication. Since COVID-19 and FMF may share some common symptoms due to activation of the inflammasome pathway, we further investigated this aspect in the FMF cohort with symptomatic COVID-19. Results: A total of 123 FMF patients participated in this survey (75 females, age range 1-67 years;10 subjects from Armenia, Persia, and Turkey). The most frequent MEFV variants were M694V, M694I, E148Q, V726A, R202Q, and A744S. Before the diagnosis 70% of the subjects had no knowledge about FMF. The diagnosis was late in 40% of subjects (at age ≥20 years). A misdiagnosis occurred in 21% of subjects and was associated with unnecessary procedures such as heavy antibiotic prescription, appendectomy, and abdominal surgery. Prior to the diagnosis and targeted FMF therapy, subjects described typical febrile periodical attacks of systemic serositis with a frequency of more than attack once per month (48%) with intensity ranging from moderate to severe (95%). Following therapy with colchicine, 65% of the subjects reported mild symptoms. In addition, 60% of subjects had COVID-19 infection which was symptomatic in 80% of the cases. Concerning COVID-19, 63% of symptomatic COVID-19 subjects reported that FMF symptoms were higher compared to COVID-19, 23% reported that COVID-19 symptoms were higher than FMF symptoms, and 14% reported no difference between the two diseases. Additionally, 12% reported consequences of FMF-COVID- 19 combined symptoms, mainly joint pain due to persisting arthralgias. Conclusion: In Lebanon, an endemic region for FMF with a mixture of the ethnic communities from the Mediterranean area, FMF diagnosis can be missed, delayed, or initially erroneously classified. Nevertheless, the diagnostic ability is improving over time. This is the first study in Lebanon to clarify aspects of FMF knowledge, diagnosis, and symptoms as well as evaluation of COVID-19 and FMF interplay. The complex interaction and consequences between COVID-19 infection and the genetic autoinflammatory FMF is being further investigated.

Influence of COVID-19 pandemic lockdown on a sample of Egyptian children with Down syndrome

Background: Down syndrome (DS) is characterized by variable degrees of intellectual disability (ID). The coronavirus disease-2019 (COVID-19) lockdown prevented children with DS from reaching their rehabilitation facilities. This could have led to deterioration of their abilities and mental health hazards. The aim of this cohort study was to investigate frequency of COVID-19, the influence of COVID-19 pandemic on health, and some abilities of children with DS, and to explore factors that could have governed receiving home-based training during the lockdown. A survey of 150 individuals with Down syndrome was answered by their caregivers. Additionally, 135 participants were subjected to assessment of cognitive, language, and motor abilities using Portage program. They were divided into 2 groups: group I who received online therapy sessions during the lockdown and group II who did not receive sessions. Logistic regression was used to determine the factors which influenced getting home-based training. Results: The percentage of COVID-19 cases was 3.3%. All evaluated abilities were reduced despite receiving online sessions particularly language performance (P < 0.001). Male gender, having severe ID and low parental education were among the factors which encouraged parents to get virtual training. Conclusion: COVID-19 pandemic had a negative impact on the abilities of DS children even those who got rehabilitation sessions. Their dependence on social interaction could have limited the benefit of virtual sessions. Factors that influence a parent’s decision to get home-based training should be monitored and targeted in order to overcome obstacles or concepts that may prevent families from enduring home-based intervention.

Clinical and Laboratory Predictors of Stroke Associated with COVID-19 Disease

Background. Although SARS-CoV-2 predominantly targets the respiratory system, it has also been associated with vascular complications including stroke. Identifying COVID-19 patients at elevated risk for stroke can help inform target anticoagulation strategies. We sought to understand how symptoms and laboratory markers at presentation with COVID-19 relate to stroke risk. Methods. We enrolled a cohort of 1324 subjects who were hospitalized with COVID-19 across six PennMedicine hospitals between April and August 2020 and performed retrospective, manual chart review to measure exposures including presenting symptoms and admission inflammatory markers. Data were organized with a REDCap database, and analyses were performed using R statistical software, with Bayesian binomial regression models fit using Stan Hamiltonian Monte Carlo via the "brms" package. Results. Among 1324 subjects, 19 stroke events were observed within 30 days of COVID-19 diagnosis. Admission inflammatory markers, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ferritin, and D-dimer, were poor predictors of stroke risk. Among presenting symptoms, including respiratory, gastrointestinal, dermatologic, and neurologic features of COVID-19 disease, only altered mental status documented on presentation (in 529 subjects) was significantly associated with stroke risk (odds ratio 6.06, 95% credible interval 2.16 - 18.7). Conclusion. Inflammatory markers associated with COVID-19 disease severity did not discriminate patients at high versus low risk of stroke in this cohort. Altered mental status documented on presentation was significantly associated with incident stroke during COVID-19 disease.

A uniquely violent year: The impact of social and political events on 2020 urban injury patterns

INTRODUCTION/HYPOTHESIS: 2020 was marked by social and political events that substantially disrupted healthcare. The COVID-19 pandemic, lockdown, public health measures, as well as civic and political unrest over racial tensions during an election year could plausibly impact injury care. We hypothesized that increased injuries related to high-risk activities during 2020 was temporally related to sociopolitical unrest and pandemic public health measures. METHODS: Retrospective data from two Level 1 urban, adult trauma centers in different US states (City A population:1.6M, City B:0.21M) were assessed (1/1/2020- 12/31/2020). Calendar months were divided into quartiles and compared to analogous quartiles in years 2016 -2019. Variables studied (demographics, injury mechanisms and outcomes) were compared between years, and across 2020 quartiles, against a backdrop of key sociopolitical events. RESULTS: More patients presented for injury in 2020 (A: n=1057, B: n= 1053) than in prior years (p< 0.05). Compared to 2016-2019, 2020, patients were more often black (A:63.1% vs. 69.8% p< 0.001;B:31.0% vs. 34.3%, p=0.02). Institution A patients were more likely to be male (p=0.002) & younger (p< 0.001) in 2020 vs. 2016-2019. Both institutions noted a steep rise in gunshot wound (GSW) and motor vehicle collision (MVC) injuries following state lockdowns (Fig A, B) with a persistent rise in GSWs until late fall (Fig C). CONCLUSIONS: 2020 was a unique year of sociopolitical unrest interwoven with a pandemic. Most affected populations were young, black males in two different urban centers and primarily involved GSWs and MVCs. Future disaster response planning should consider the drivers of these trends to mitigate their impact, especially in vulnerable populations.

Iot-based reusable medical suit for daily life use in the era of covid-19

Coronavirus disease (COVID-19) is a big problem that scares people all over the world. Life over the world has changed, new aspects for daily life have been introduced. A main problem with COVID-19 is the way it spreads. Covid-19 spreads, primarily, through contact with an infected person when they cough or sneeze, or with an infected surface. Thus, a novel way to make a protec-tion against COVID-19 is to stay away or make yourself isolated from infected people and surfaces. To this end, this work, mainly, aims to design and develop a novel auto-sterilized suit embedded with some medical sensors and other Internet of Things (IoT) devices to provide the required level of isolation, safety, tracking and monitoring of COVID-19 and other pandemic diseases. The developed suit is an auto-sterilized suit for medical purposes and for daily life use. The sterilizing process of the suit is controlled by the IoT paradigm to provide the required control and interface in an automated way. According to the location of the user, wearing the suit, an appropriate sterilizing mode is activated automa-tically and the suit is sterilized via distributed nozzles over the suit. Furthermore, the distributed medical sensors represent a wireless body area network (WBAN) that is integrated with an IoT gateway to provide periodic measures of medical healthcare parameters such as body temperature, breathing rate, oxygen saturation level and pulse rate. These measures are used to identify the user’s health and the probability of being infected by COVID-19. All measures are transferred to the remote IoT cloud to analyze these data and monitor people around the day. In case of unusual measures, users are moved among three databases associated with health, infected and properly infected users. The suit is under prototyping and the work is mainly introduced to present the design stages. © 2022, Tech Science Press. All rights reserved.

The Epidemiological and Spatiotemporal Characteristics of the 2019 Novel Coronavirus Disease (COVID-19) in Libya.

COVID-19 is a global pandemic that has affected all aspects of life. Understanding its geographical and epidemiological characteristics has become particularly important in controlling the spread of the pandemic. Such studies are lacking in North African countries, particularly in Libya, which has the second largest area of any country in Africa and the longest coast facing Europe. The objectives of this study are to determine the epidemiological parameters and spatiotemporal patterns of COVID-19 and outline strategies for containing the spread and consequences of the pandemic. This comprehensive study included all the confirmed cases of COVID-19 since its emergence in Libya on March 24, 2020 until July 31, 2020. The epidemiological characteristics of COVID-19 were analyzed and the spatial dynamic trends were explored. Regional counts of weekly reported cases were used to characterize the spatial dynamics of COVID-19. A total of 3,695 confirmed cases of COVID-19 were recorded: 2,515 men (68.1%) and 1,180 women (31.9%), with a male-to-female ratio of 2.1:1. Ages ranged between 2 and 78 years. Older patients infected with COVID-19 were at a risk of higher disease severity and mortality. Broad geographic variability and spatiotemporal spread variation of the COVID-19 pandemic in Libya was observed, indicating a significant increase of COVID-19 spread starting in the middle of July 2020, particularly in the western and southern regions, although it was consistently reported in the central and eastern regions as well. Assessing the spatiotemporal dynamics of COVID-19 in the early stages of the epidemic is particularly important in understanding the pandemic spread. Such assessments are essential for designing effective prevention and control programs aimed at reducing the impact of the COVID- 19 pandemic, particularly in countries with limited resources.

The epidemiological characteristics of COVID-19 in Libya during the ongoing-armed conflict. (preprint)

Introduction: COVID-19 can have even more dire consequences in countries with ongoing armed conflict. Libya, the second largest African country, has been involved in a major conflict since 2011. This study analyzed the epidemiological situation of the COVID-19 pandemic in Libya,  examined the impact of the armed conflict in Libya on the spread of the pandemic, and proposes strategies for dealing with the pandemic during this conflict.Methods: We collected the available information on all COVID-19 cases in the different regions of Libya, covering the period from March 25 to May 25, 2020. The cumulative number of cases and the daily new cases are presented in a way to illustrate the patterns and trends of COVID-19 and the effect of the ongoing armed conflict was assessed regionally.Results: A total of 698 cases of COVID-19 were reported in Libya during a period of three months. The number of cases varied from one region to another and was affected by the fighting. The largest number of cases was reported in the southern part of the country, which has been severely affected by the conflict in comparison to the eastern and western parts of the country.Conclusion: This study describes the epidemiological pattern of COVID-19 in Libya and how it has been affected by the ongoing armed conflict. This conflict seems to have hindered access to populations and thereby masked the true dimensions of the pandemic. Hence, efforts should be combined to combat these consequences.

COVID-19 and African immigrants in North Africa; A hidden pandemic in a violent region. (preprint)

Since being declared a pandemic in March 2020, COVID-19 has brought difficult situations for citizens of nations worldwide. The effects, however, may be more severe for vulnerable communities such as immigrants, who are already in desperate situations and under deteriorating conditions. There are still very limited data on how the pandemic is impacting immigrant communities. Immigrant camps are fostering an environment that poses a great threat to the health of their inhabitants, especially at the time of a pandemic. Overcrowding, poor sanitation, inadequate healthcare, and difficulty containing contagious diseases are well documented in African immigration detention centers [1]. Furthermore, they are unlikely to take priority in a moment in which governments are mobilizing all resources to care for their citizens. Their situation is even more complicated if they are hosted in courtiers plugged by war, as in North Africa[2,3].

The Epidemiological and Spatiotemporal Characteristics of 2019 novel coronavirus diseases (COVID-19) in Libya (preprint)

Background: COVID-19 is a global pandemic that affectedaffects all aspects of life. Studies on understanding the geographical and epidemiological characteristics become particularly important in controlling the spread of the pandemic. Such studies are lacking in Northern African countries, particularly in Libya, which is considered being, the second largest country in Africa, with the longest coast facing Europe. The objectives of this study are to; determine the epidemiological parameters and spatiotemporal patterns of COVID-19 in this large country and outline the needed strategies to contain the spread and the consequences of the pandemic. Methods:  This comprehensive study included all the confirmed cases of COVID-19 since its emergence in Libya, from early April 2020 until July 31th31. The epidemiological characteristics of COVID-19 were analyzed, and the spatial dynamic trends were explored. A region Region-based counts of weekly reported cases were used to characterize and quantify the spatial dynamics of COVID-19.Results: A total  of 3695 of confirmed cases of OVID-19 were collected,; 2515 (68.1%) were males , and 1180 (31.9%) were females with a male-to-female (M:F) ratio of 2.1:1. Aged between 2 -and 78 years old. Older age patients infected with COVID-19 are at higher severity and mortality. A broad geographic variability and spatiotemporal spread variation of the COVID-19 pandemic in Libya was observed. Indicating. This indicates a more significant increase ofin COVID-19 from the middle of July, particularly in the West and Southern regions, although it was consistently observed in the Meddle and Southern regions.Conclusion: Evaluating the epidemiological data and the spatiotemporal dynamic trends of COVID-19 at early stages are particularly   important in understanding the pandemic spread.   These parameters are essential in designing effective prevention and control programs aimed at reducing the impact of the COVID- 19 pandemic, particularly in countries with limited resources.

The Epidemiological and Spatio-temporal Characteristics of 2019 Novel Coronavirus Diseases (COVID-19) in Libya (preprint)

Background: COVID-19 is a global pandemic that affected all aspects of life. Studies on understanding the geographical and epidemiological characteristics become particularly important in controlling the spread of the pandemic. Such studies are lacking in Northern African countries particularly in Libya, which considered being, the second largest country in Africa with the longest coast facing Europe. The objectives of this study are to; determine the epidemiological parameters and spatiotemporal patterns of COVID-19 in this large country and outline the needed strategies to contain the spread and the consequences of the pandemic. Methods:  This comprehensive study included all the confirmed cases of COVID-19 since its emergence in Libya, from early April 2020 until August 31th. The epidemiological characteristics of COVID-19 were analyzed and the spatial dynamic trends were explored.  A region -based counts of weekly reported cases were used to characterize and quantify the spatial dynamics of COVID-19. Results: A total  3695  of confirmed cases of OVID-19 were collected, 2515(68.1%) were males and 1180(31.9%) female with a male-to-female(M:F) ratio 2.1:1. Aged between 2 -78 years old. Older age patients infected with COVID-19 are at higher severity and mortality. A broad geographic variability and Spatiotemporal spread variation of the COVID-19 pandemic in Libya was observed. Indicating a higher significant increase of COVID-19 from the middle of July particularly in the West and Southern regions although it was consistently observed in Meddle and Southern regions. Conclusion: Evaluating the epidemiological data and the spatiotemporal dynamic trends of COVID-19 at early stages are particularly  important in understanding the pandemic spread.  These parameters are essential in designing effective prevention and control programs aimed at reducing the impact of COVID- 19 pandemic particularly in countries with limited resources.