Increased inflammatory cytokines and oxidative stress enhanced antibody production in breast and prostate cancer patients with COVID-19 related depression.

Cancer management is highly dependent on the immune status of the patient. During the COVID-19 pandemic, a large number of people suffered from anxiety and depression, especially cancer patients. The effect of depression on breast cancer (BC) and prostate cancer (PC) patients, during the pandemic has been analyzed in this study. Levels of proinflammatory cytokines (IFN-γ, TNF-α, and IL-6) and oxidative stress markers malondialdehyde (MDA) and carbonyl content (CC) were estimated in patients' serum samples. Serum antibodies against in vitro hydroxyl radical (•OH) modified pDNA (•OH-pDNA-Abs) were estimated using direct binding and inhibition ELISA. Cancer patients showed increased levels of proinflammatory cytokines (IFN-γ, TNF-α, and IL-6) and oxidative stress markers (MDA and CC levels), which were further significantly enhanced in cancer patients with depression compared to normal healthy (NH) individuals. Increased levels of •OH-pDNA-Abs were detected in breast cancer (0.506 ± 0.063) and prostate cancer (0.441 ± 0.066) patients compared to NH subjects. Serum antibodies were found to be significantly elevated in BC patients with depression (BCD) (0.698 ± 0.078) and prostate cancer patients with depression (PCD) (0.636 ± 0.058). Inhibition ELISA also exhibited significantly high percent inhibition in BCD (68.8% ± 7.8%) and PCD (62.9% ± 8.3%) subjects compared to BC (48.9% ± 8.1%), and PC (43.4% ± 7.5%) subjects. Cancer is characterized by enhanced oxidative stress and increased inflammation, which may be exaggerated with COVID-19 related depression. High oxidative stress and compromised antioxidant homeostasis exerts alterations in DNA, leading to formation of neo-antigens, subsequently leading to the generation of antibodies. COVID-19 pandemic related depression needs to be addressed globally for improved cancer patient care and cancer disease management.

Correlates of poor clinical outcomes related to COVID-19 among older people with psychiatric illness - a mixed methods study

Objective: COVID-19 leads to highly variable clinical outcomes among older people with psychiatric and medical co-morbidities. Evidence guiding management of future outbreaks among this vulnerable population in in-patient psychiatry settings are sparse. Hence, we aimed to investigate the correlates of poor clinical outcomes related to COVID-19 and to explore the perspectives of COVID-19 survivors in in-patient psychiatry settings. Method: We investigated the correlates of poor clinical outcomes related to COVID-19 using retrospective chart review of 81 older people in in-patient psychiatry settings. Correlates of clinical outcomes related to COVID-19 were assessed by multiple logistic regression models. Moreover, we explored the perspectives of 10 of those COVID-19 survivors by qualitative interviews. We analysed the qualitative data using thematic analysis. Results: Although 25.9% (n = 21) participants were asymptomatic, there was high COVID-19 related mortality rate (14.8%;n = 12). Vitamin-D deficiency, anticholinergic burden, and isolation policies within psychiatric wards were significantly (P < 0.05) associated with COVID-19 related deaths. Participants emphasised the importance of strengthening local support networks and making vaccination centres more accessible. Conclusions: Reducing anticholinergic prescriptions and improving isolation policies may mitigate poor clinical outcomes. Future research investigating the impact of vitamin-D supplementation on COVID-19 related outcomes are warranted. © The Author(s) 2023.

Parents' knowledge and management of children's fevers in Saudi Arabia after the COVID-19 pandemic

Introduction: Fever is a common childhood symptom that is considered to be the cause of around 70% of pediatric visits. Objectives: This study aimed to assess parents' knowledge about and management of fevers in children since the COVID-19 pandemic in Saudi Arabia. Methods: This cross-sectional study collected data from 488 Saudi Arabian parents using a self-administered questionnaire to assess the parents' knowledge about fevers and how to manage them in children. SPSS was used for analysis. Results: The mean total knowledge score was 8.85 +/- 2.09 out of 18, indicating poor knowledge levels. Females had higher total knowledge scores than males. Only 3.69% of respondents identified the rectum as the best location for taking children's temperatures. A total of 59% knew that fever scan lead to seizures, but 65% believed it also leads to blindness. Most used ear thermometers (51.43%). A majority (76.43%) thought COVID-19 made them more concerned about fevers, with 65.98% becoming more worried about children's fevers after COVID-19. Conclusion: Saudi Arabian parents have low levels of knowledge about children's fevers after COVID-19, despite believing the pandemic improved their knowledge. More health-promoting campaigns are needed to boost knowledge about childhood fevers.

Assessment the levels of fibroblast growth Factor 21, Fetuin-A and lipid profile in patients with COVID-19 after infection

Objective: We evaluated Fetuin-A, FGF-21 and lipid profiles in the serum of recovered patients from coronavirus disease 2019 (COVID-19).

Mathematical model of COVID-19 transmission dynamics incorporating booster vaccine program and environmental contamination.

COVID-19 is one of the greatest human global health challenges that causes economic meltdown of many nations. In this study, we develop an SIR-type model which captures both human-to-human and environment-to-human-to-environment transmissions that allows the recruitment of corona viruses in the environment in the midst of booster vaccine program. Theoretically, we prove some basic properties of the full model as well as investigate the existence of SARS-CoV-2-free and endemic equilibria. The SARS-CoV-2-free equilibrium for the special case, where the constant inflow of corona virus into the environment by any other means, Ω is suspended ( Ω = 0 ) is globally asymptotically stable when the effective reproduction number R 0 c < 1 and unstable if otherwise. Whereas in the presence of free-living Corona viruses in the environment ( Ω > 0 ), the endemic equilibrium using the centre manifold theory is shown to be stable globally whenever R 0 c > 1 . The model is extended into optimal control system and analyzed analytically using Pontryagin's Maximum Principle. Results from the optimal control simulations show that strategy E for implementing the public health advocacy, booster vaccine program, treatment of isolated people and disinfecting or fumigating of surfaces and dead bodies before burial is the most effective control intervention for mitigating the spread of Corona virus. Importantly, based on the available data used, the study also revealed that if at least 70% of the constituents followed the aforementioned public health policies, then herd immunity could be achieved for COVID-19 pandemic in the community.

Effects of the face mask on the skin during the COVID-19 pandemic in Saudi Arabia

Introduction: The use of face mask in these COVID-19 times has increased manifolds. This has led to various skin problems due to the adverse reaction caused by the mask. This study aimed to observe the skin effects of the face mask during the COVID-19 pandemic among individuals in Saudi Arabia. Materials and Methods: Cross-sectional study in different regions of Saudi Arabia with data collection was done using a self-administered online questionnaire in the adults above 18 years of age of both sexes. Results: The study involved 516 participants who were mostly young population with male predominance. In general, 37% of face skin reactions related to mask use, whereas 63% of participants did not notice any skin reaction from face mask wearing. Most of them wear surgical masks (85.5%), of which 36.7% of them reported adverse skin reactions (ASRs) related to surgical masks. Furthermore, using the mask for >4 h is approximately double the risk of skin changes, and a significant association has been found between the duration of mask use and ASRs. Finally, no significant association was observed between prolonged face mask use and aggravation of pre-existing skin diseases by face masks. Conclusion: The overall prevalence of skin reactions associated with face masks was 37%. The most frequent skin reaction was acne and itching symptoms, followed by acne alone. Regarding mask type, both surgical and cloth masks were associated with a significantly high incidence of ASRs, which was statistically significant. [ FROM AUTHOR] Copyright of Advances in Human Biology is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Growth performance, carcass and meat quality, bone strength, and immune response of broilers fed low-calcium diets supplemented with marine mineral complex and phytase.

Influence of marine mineral complex (CeltiCal) as a partial substitute for limestone on growth efficiency, carcass traits, meat quality, bone strength, calcium (Ca) retention, and immune response was investigated in broilers fed low-Ca diets with or without phytase (PHY) addition for a 35-d trial period. A total of 300 one-day-old Ross 308 straight-run broilers were randomly allocated to: T1 (positive control), recommended Ca levels + PHY; T2 (negative control), 0.2% below the recommended Ca levels + PHY; T3, 0.1% below the recommended Ca levels + 0.2% CeltiCal + PHY; T4, 0.2% below the recommended Ca levels + 0.4% CeltiCal + PHY; T5, 0.2% below the recommended Ca levels + 0.4% CeltiCal. PHY was added at 500 phytase units/kg diets. Each dietary treatment had 10 replications of 6 chicks each. Results revealed that production efficiency factor was greater for T4 compared to T2 and T5 during 22-35 d and for T1, T3, and T4 compared to T2 during 0 to 35 d (P < 0.05). Feed conversion ratio was lower for T3 and T4 compared to T2 and T5 during 0 to 35 d (P < 0.05). T4 had a greater (P < 0.05) dressing percentage than T2, which had a lighter (P < 0.01) small intestinal relative weight than all other treatments. Breast meat temperature at 15 min postmortem was highest for T1 and lowest for T3 (P < 0.001). Breast meat pH was greater for T1 compared to T5 at 15 min postmortem and for T3 compared to T4 at 24 h postmortem (P < 0.05). T5 had a lower breast meat redness than all other treatments at 15 min postmortem and then T1 and T3 at 24 h postmortem (P < 0.01). Tibia and femur weights were greater (P < 0.05) for T3, T4, and T5 compared to T2, which had the lowest tibia ash content (P < 0.05) and femur geometric properties (P < 0.001). Greater antibodies to infectious bronchitis virus (P < 0.01) and Ca retention (P < 0.001) were observed for T3 and T4 in comparison to T2. Based on the findings of this research, CeltiCal can adequately replace a considerable portion of limestone in broiler reduced-Ca diets containing PHY.

Gender specific considerations in septorhinoplasty, a retrospective observational study and review of the literature.

Introduction: In our service experience, we found we had a high proportion of male patients undergoing septorhinoplasty. This encouraged us to research gender specific differences in anatomy, surgical techniques, expectations and outcomes. Methods: We performed a retrospective chart review of patients who have had rhinoplasty surgery under a single otolaryngology consultant with a special interest in rhinoplasty. Patient information and results of the 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey for Functional and Cosmetic Rhinoplasty pre and post-surgery were collected. Results: There was no statistically significant difference in the mean pre-operative symptom (29.31 vs 32.29 p = 0.559), change in symptom (23.25 vs 24.14 p = 0.827) or satisfaction scores (8.69 vs 7.29 p = 0.089) between male and female patients. A discussion on gender specific anatomical features and deformities is presented. Conclusion: All patients reported improved symptoms and high levels of satisfaction. Careful patient counselling and patient-specific surgical planning help to achieve optimal outcomes.

Predicting Intensive Care Unit Admission for COVID-19 Patients from Laboratory Results.

Trends in routine laboratory tests, such as high white blood cell and low platelet counts, correlate with COVID-19-related intensive care unit (ICU) admissions. Other related biomarkers include elevated troponin, alanine aminotransferase, and aspartate transaminase levels (liver function tests). To this end, the aim of this study was to investigate the effect of changes in laboratory test parameters on ward-based and ICU COVID-19 patients. A total of 280 COVID-19 patients were included in the study and were divided based on admission status into ICU (37) or ward (243) patients. ICU admission correlated significantly with higher levels of several tested parameters, including lactate dehydrogenase, creatinine, D-dimer, creatine kinase, white blood cell count, and neutrophil count. In conclusion, routine laboratory tests offer an indication of which COVID-19 patients are most likely to be admitted to the ICU. These associations can assist healthcare providers in addressing the needs of patients who are at risk of COVID-19 complications.

Gastric Perforation as a Complication of COVID-19 Infection: A Case Report.

Pulmonary symptoms are the primary manifestation of the COVID-19 disease, which originated in Wuhan in China in December 2019. However, it is now established to show widespread extrapulmonary manifestations, including gastrointestinal involvement. Abdominal pain, diarrhea, nausea, and vomiting are considered the most common gastrointestinal symptoms. Gastric perforation in association with COVID-19 is rarely reported in the literature. Here, we report a case of a 71-year-old male COVID-19-infected patient, medically free, who presented to the emergency department complaining of severe abdominal pain for a one-week duration. He was diagnosed with a case of perforated viscus and septic shock. The patient was shifted to the operating room for exploratory laparotomy. We aim in this report to highlight this fatal complication of COVID-19 infection in order to improve patients' outcomes.

Public Perceptions and Commitment to Social Distancing "Staying-at-Home" During COVID-19 Pandemic: A National Survey in Saudi Arabia.

OBJECTIVE: Social distancing measures, such as stay-at-home, are currently implemented to control the COVID-19 pandemic in many countries, including Saudi Arabia. The aim of this study was, therefore, to evaluate the awareness and adherence of the Saudi population to these measures. METHODS: A web-based questionnaire was designed with 16 questions (eight questions related to demographics, three related to the awareness of social distancing (stay-at-home) and five related to the overall practice of social distancing). RESULTS: A total of 5105 participants completed the survey [58.4% females, 66.3% young individuals (aged 18-37 years), 55.8% bachelor degree holders and 51.0% from the western region]. The Saudi Ministry of Health (MOH) was the main source of information about COVID-19 for most of the participants (78.2%). High awareness (81.3%) regarding stay-at-home was observed, associated mainly with female participants, those from the middle region and those with a high education and income. The overall implementation of social distancing was satisfactory (score 3.13/5), with 37.8% never leaving home during the stay-at-home period. Better adherence to social distancing was observed among female participants, higher degree holders and those aged over 38 years. CONCLUSION: Organised plans by the Saudi MOH have been effective in raising awareness and improving the practice of social distancing among public. However, the observed lower practice of social distancing by individuals with a lower education and income indicates the need for targeted interventions to achieve better outcomes.

Anticancer, antioxidant, antiviral and antimicrobial activities of Kei Apple (Dovyalis caffra) fruit.

Secondary plant metabolites remain one of the key sources of therapeutic agents despite the development of new approaches for the discovery of medicinal drugs. In the current study, chemical analysis, and biological activities of Kei apple (Dovyalis caffra) methanolic extract were evaluated. Chemical analysis was performed using HPLC and GC-MS. Antiviral and anticancer effect were assessed using the crystal violet technique and activity against human liver cells (HepG2), respectively. Antibacterial activity was tested with the disc diffusion method. The obtained results showed that chlorogenic acid (2107.96 ± 0.07 µg/g), catechin (168 ± 0.58 µg/g), and gallic acid (15.66 ± 0.02 µg/g) were the main bioactive compounds identified by HPLC techniques. While, compounds containing furan moieties, as well as levoglucosenone, isochiapin B, dotriacontane, 7-nonynoic acid and tert-hexadecanethiol, with different biological activities were identified by GC-MS. Additionally, inhibition of 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) scavenging was 79.25% at 2000 µg/mL, indicating its antioxidant activity with IC50 of 728.20 ± 1.04 µg/mL. The tested extract exhibited potential anticancer activity (58.90% toxicity) against HepG2 cells at 1000 µg/mL. Potential bacterial inhibition was observed mainly against Escherichia coli and Proteus vulgaris, followed by Staphylococcus aureus and Bacillus subtilis with a diameter of growth inhibition ranging from 13 to 24 mm. While weak activities were recorded for fungi Candida albicans (10 mm). The extract showed mild antiviral activity against human coronavirus 229E with a selective index (SI) of 10.4, but not against human H3N2 (SI of 0.67). The molecular docking study's energy ratings were in good promise with the experiment documents of antibacterial and antiviral activities. The findings suggest that D. caffra juice extract is a potential candidate for further experiments to assess its use as potential alternative therapeutic agent.

Bacterial Coinfection and Antibiotic Resistance Profiles among Hospitalised COVID-19 Patients.

While it is reported that COVID-19 patients are more prone to secondary bacterial infections, which are strongly linked to the severity of complications of the disease, bacterial coinfections associated with COVID-19 are not widely studied. This work aimed to investigate the prevalence of bacterial coinfections and associated antibiotic resistance profiles among hospitalised COVID-19 patients. Age, gender, weight, bacterial identities, and antibiotic sensitivity profiles were collected retrospectively for 108 patients admitted to the intensive care unit (ICU) and non-ICU ward of a single center in Saudi Arabia. ICU patients (60%) showed a significantly higher percentage of bacterial coinfections in sputum (74%) and blood (38%) samples, compared to non-ICU. Acinetobacter baumannii (56%) and Klebsiella pneumoniae (56%) were the most prevalent bacterial species from ICU patients, presenting with full resistance to all tested antibiotics except colistin. By contrast, samples of non-ICU patients exhibited infections with Escherichia coli (31%) and Pseudomonas aeruginosa (15%) predominantly, with elevated resistance of E. coli to piperacillin/tazobactam and trimethoprim/sulfamethoxazole. This alarming correlation between multi-drug resistant bacterial coinfection and admission to the ICU requires more attention and precaution with prescribed antibiotics to limit the spread of resistant bacteria and improve therapeutic management.

Pulmonary Embolism in COVID-19 Patients: A Retrospective Case-Control Study.

BACKGROUND: Coagulopathy is a well-recognized complication in patients with coronavirus disease 2019 (COVID-19). Pulmonary embolism (PE) has substantial morbidity and mortality if the diagnosis is missed or the management is delayed. Computed tomography pulmonary angiography (CT-PA) is the imaging modality of choice for PE. Therefore, this study aimed to investigate the positive rate of CT-PA for PE among patients with COVID-19. METHODS: We conducted a retrospective study examining the diagnostic yield of CT-PA in patients with confirmed COVID-19 and compared it with that in patients without COVID-19. The study included all adult patients with confirmed COVID-19 who presented from June 2020 to June 2021. RESULTS: The study included 316 patients, including 158 patients with COVID-19, who underwent CT-PA for ruling out PE. Overall, 76 patients were found to have PE on the CT-PA scan, yielding a positive rate of 24.1%, with a significant difference between patients with COVID-19 (8.2%) and those without COVID-19 (39.9%). Further, 138 (87.3%) patients with COVID-19 had elevated D-dimer levels compared with 34 (21.5%) patients without COVID-19. A multivariable regression analysis model revealed that the smoking status (odds ratio [OR] = 1.94; 95% confidence interval [CI]: 1.4-3.8) and obesity (OR = 4.1; 95% CI: 1.5-8.9) were independent predictors of PE among patients with COVID-19. However, the elevated D-dimer level was not significantly associated with PE among patients with COVID-19 (OR = 0.7; 95% CI: 0.4-1.8). CONCLUSION: The study found that the positive rate of CT-PA for PE was lower among patients with PE indicating probable overutilization of investigation in these patients. Additionally, patients with COVID-19 had a higher proportion of elevated D-dimer levels that may be a contributor to the increased investigation for PE. Lastly, patients with COVID-19 who were current smokers had a higher tendency of having PE.

Awareness and Practice of COVID-19 Precautionary Measures Among Healthcare Professionals in Saudi Arabia.

OBJECTIVE: Healthcare workers (HCWs) are the backbone of the healthcare system and a skilled and healthy workforce is vital during a health crisis, such as the present coronavirus disease 2019 (COVID-19) pandemic. Healthcare workers are at higher risk of exposure to and transmission of the severe acute respiratory coronavirus-2 (SARS-CoV-2). Hence, HCWs should possess good knowledge and attitudes toward COVID-19 to protect not only themselves but also their colleagues, families and the larger community. Thus, the current study aims to assess the knowledge and practice of protective measures by HCWs in Saudi Arabia during the first wave of the COVID-19 pandemic to identify awareness of the disease, potential trends and associated predictors. METHODS: A cross-sectional, web-based study was conducted among HCWs about knowledge related to COVID-19 and practice of protective measures, such as social distancing and use of personal protective equipment (PPE) during the pandemic. A Fisher exact test and one-way analysis of variance (ANOVA) were used to investigate the level of association among variables. RESULTS: A total of 674 HCWs were recruited in the study (51.8% male, 42.7% aged 28-37 years old and 52% specialists). The Saudi Ministry of Health (MoH) was the main source of knowledge for most of the HCWs (89%) followed by the WHO (44.5%) and social media (42.3%). Washing hands before touching the face was the most selected choice (97.9%) as a precautionary method to limit SARS-CoV2 transmission. Most of the HCWs (74.6%) scored low for staying at home while the majority (71.2%) showed a high practice of personal protective methods, with pharmacists and general physicians scoring the highest. CONCLUSION: Saudi HCWs showed high knowledge and practice of protective measures for COVID-19. Good knowledge correlates with adoption of appropriate practices to prevent spread of infection. The current findings highlight the importance of interventions such as tailored education and training courses for those with low scores to improve overall knowledge and practice.

Dental Professionals Management of Avulsed Teeth and Implementation of COVID-19 Related Safety Precautions

Aim: One of the most common dental problems is oral trauma, which is a great threat to the dental health of children and adolescents. This study aims to improve Saudi dentists' knowledge of the management of avulsed teeth and the safety precautions necessitated by the coronavirus disease 2019 (COVID-19) pandemic. Materials and methods: A cross-sectional study was conducted. The 403 participants, who were from Saudi Arabia, were recruited through social media. The data were collected by a questionnaire that assessed their knowledge about managing avulsed teeth. Significance was set at p=0.05. Results: The mean score for the correct answers to 22 questions to assess clinical knowledge about avulsed teeth was 15.26 (SD=3.48). According to the responses, 93.3% knew that an avulsed permanent tooth can be replanted, 72.2% indicated that an avulsed primary tooth can be replanted, 63.8% were aware of the best splinting materials, and 58.3% knew the optimal splinting duration. Only 29.8% indicated knowledge about the most recent (2020) International Association for Dental Traumatology guidelines for avulsed permanent teeth. The mean score for the correct answers to the four questions about the management of avulsed teeth during the COVID-19 pandemic was 3.27 (SD=1.02). Conclusion: Saudi dental professionals were found to have moderate levels of knowledge about the management of tooth avulsion. The answers to the COVID-19-related questions revealed good knowledge about managing avulsed teeth during the pandemic. Health campaigns or online lectures would be helpful in improving dentists' knowledge about managing avulsed teeth.

Knowledge and practice of personal protective measures during the COVID-19 pandemic: A cross-sectional study in Saudi Arabia.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is an emergent infectious pathogen causing an acute respiratory disease called corona virus disease 2019 (COVID-19). Virus transmission may occur by contact, droplet, airborne or via contaminated surfaces. In efforts to effectively control the COVID-19 outbreak, the world health organization (WHO) and the Saudi Ministry of Health (MOH) have advised the public to practice protective measures to reduce transmission of the virus and reduce incidence of infection. These measures include hand washing, wearing masks and gloves and avoidance of touching the face with unwashed hands. The current study aimed to investigate knowledge and adherence of the Saudi population to these protective actions during the pandemic. After determining the required sample size using power analysis, a cross-sectional online self-reported survey of 5105 Saudi residents was conducted between 25th March to 17th April 2020 to evaluate public knowledge of COVID-19. Participants were all aged 18 years or above, Arabic speakers and residents of Saudi Arabia. Scores were calculated based on knowledge and adherence of the individuals to protective measures. About 90% of participants exhibited a high level of knowledge (scored 2/2) and practice (scored > 3/6) in relation to hand hygiene and wearing gloves and masks. Practice scores were positively associated with females and individuals with high income. Lower practice scores were linked to youth and residents of the northern and western regions of the Kingdom. Over two thirds of participants preferred hand washing to alcohol disinfection, and the frequency and performance of hand washing improved during the pandemic for more than half of respondents. Overall, the findings reflected high public knowledge of SARS-CoV2 transmission routes and adherence to personal protective measures. However, public awareness campaigns with an emphasis on the youth and individuals with low education and income are required to improve overall practice.

Impact of COVID-19 outbreak on rheumatic patients' perceptions and behaviors: A cross-sectional study.

AIM: The dynamics of coronavirus disease 2019 (COVID-19) pandemic has become of special concern to the rheumatology community. Rheumatic patients are required to engage in effective health management but their behavior is often influenced by intrinsic and extrinsic factors. This cross-sectional study aims to examine patients' experiences during the current pandemic and its implication on their health perception and behavior. METHOD: A patient-centered electronic survey was used, randomly sampling rheumatic patients in Saudi Arabia during March and April 2020. Questions included patients' socio-demographics, diseases, medications, COVID-19 knowledge, source of information, fear level, disease activity perception, health care utilization, medication accessibility, and therapeutic compliance (measured using a modified version of Medication Adherence Reporting Scale). Correlation and regression coefficients were used to evaluate associations among the aforementioned variables. RESULTS: A total of 637 respondents were included. The majority were rheumatoid arthritis patients (42.7%). Patients' knowledge about COVID-19 was correlated with social media use (P = .012). Fear of COVID-19 infection correlated with healthcare facility for follow-up visits (P = .024) and fear of disease deterioration if contracting the infection correlated with patients' levels of knowledge (P = .035). Both types of fear did not correlate with patients' perceptions of disease activity. However, patients' perceptions of worsened disease activity were correlated with unplanned healthcare visits (P < .001), medication non-adherence, and difficulty accessing medication (P = .010 and .006, respectively). CONCLUSION: The COVID-19 pandemic and surrounding public health measures could affect rheumatic patients' health management which might contribute to disease flare-up and subsequently taxing healthcare systems even further.

Prognostic significance of hemoglobin level and autoimmune hemolytic anemia in SARS-CoV-2 infection.

Higher levels of D-dimer, LDH, and ferritin, all have been associated with the poor prognosis of COVID-19. In a disease where there are acute inflammation and compromised oxygenation, we investigated the impact of initial hemoglobin (Hgb) levels at Emergency Department (ED) triage on the severity and the clinical course of COVID-19. We conducted a cross-sectional study on 601 COVID-19 patients in a COVID-19 national referral center between 13 and 27 June 2020. All adult patients presented at our hospital that required admission or hotel isolation were included in this study. Patients admitted to the intensive care unit (ICU) had a lower initial Hgb than those admitted outside the ICU (12.84 g/dL vs. 13.31 g/dL, p = 0.026) and over the course of admission; the prevalence of anemia (Hgb < 12.5 g/dL) was 65% in patients admitted to ICU, whereas it was only 43% in non-ICU patients (odds ratio of 2.464, 95% CI 1.71-3.52). Anemic ICU patients had a higher mortality compared with non-anemic ICU patients (hazard ratio = 1.88, log-rank p = 0.0104). A direct agglutination test (DAT) for all anemic patients showed that 14.7% of ICU patients and 9% of non-ICU patients had autoimmune hemolytic anemia (AIHA). AIHA patients had significantly longer length of hospital stay compared with anemic patients without AIHA (17.1 days vs. 14.08 days, p = 0.034). Lower Hgb level at hospital presentation could be a potential surrogate for COVID-19 severity.