Comparative analysis of patients' satisfaction level, hospitalized before and during the COVID-19 pandemic

Introduction and aim. Measurement of the satisfaction level with health services is the most frequently used indicator, mainly because of its importance for determining the quality of the care offered. It is the key to succeed in achieving high-quality healthcare. The purpose of this study was to create a retrospective comparative analysis of the satisfaction level amongst patients hospitalized before and during the COVID-19 pandemic. Material and methods. The study covered a total of 966 patients in 19 hospital wards, in the fourth quarter of 2019 (before the pandemic) and in the second quarter of 2021 (during the pandemic) at the Masovian Specialist Hospital in Radom. The level of patient satisfaction was assessed based on the questionnaire prepared and approved by the Quality Assurance Team in the Masovian Specialist Hospital. The statistical analysis was carried out on the basis of the STATISTICA 10.1 program, using the Pearson's chi square test, for the significance level at p<0.05. Results. The high level of satisfaction of patients staying in the hospital during the pandemic applied to the widely understood medical and nursing care as well as sanitary conditions in wards, especially the cleanness of rooms, bed linens and sanitary facilities. Conclusion. The biggest dissatisfaction of hospitalized patients during the COVID-19 pandemic involved certain restrictions of visitations and using pastoral services. © 2022 Publishing Office of the University of Rzeszow. All Rights Reserved.

Molecular docking of bioactive compounds of nut grass (Cyperus rotundus L.) tuber against SARS-CoV-2

Coronavirus Disease-2019 (COVID-19) is a novel coronavirus infection that causes severe acute respiratory syndrome 2 (SARS-CoV-2). Compounds with therapeutic potential for this disease are still being investigated, ranging from approved medications to natural compounds. Nut grass (Cyperus rotundus L.) is a plant that has been reported to have antiviral activities against several types of viruses, however, there have been no reported studies on its tuber antiviral activity against SARS-CoV-2. The purpose of this study was to evaluate the potential antiviral activity of nut grass tubers by applying an in silico approach against the SARS-CoV-2 main protease (Mpro) and spike (S) glycoproteins. Methanol and n-hexane were used to extract the bioactive compounds, which were then analyzed using Gas Chromatography-Mass Spectrometry (GC-MS). The analysis resulted in the identification of 177 probable compounds in methanolic extract and 144 compounds in n-hexane extract. These compounds' anti-SARS-CoV-2 activity was determined using molecular docking with B-d-N4-hydroxycytidine (NHC) (a metabolic product of molnupiravir) as a control ligand. Furthermore, the bioactivity of these compounds was assessed using SwissADME, admetSAR, and PASS Online. This study showed that 7-Hydroxy-6,9a-dimethyl-3-methylene-decahydro-Azuleno[4,5-b]furan-2,9-dione (from methanolic extract);Androstan-17-one,3-ethyl-3-hydroxy,(5a)-(from methanolic extract);2-[4-methyl-6-(2,6,6-Trimethylcyclohex-1-enyl)hexa-1,3,5-Trienyl]cyclohex-1-en-1-carboxaldehyde (from methanolic and n-hexane extracts);2-Vinyl-9-[3-deoxy-ß-d-ribofuranosyl]hypoxanthine (from methanolic extract);and Pregan-20-one, 2-hydroxy-5,6-epoxy-15-methyl-(from methanolic and n-hexane extracts) have best binding affinity and interacted with important amino acid residues at the Mpro and S glycoprotein receptors. The findings of this study indicate that these compounds have the potential to be studied further as antiviral against SARS-CoV-2. © 2023 Author(s).

RNA-Seq of Untreated Wastewater to Assess COVID-19 and Emerging and Endemic Viruses For Public Health Surveillance

Background The COVID-19 pandemic showcased the power of genomic sequencing to tackle the emergence and spread of infectious diseases. However, metagenomic sequencing of total microbial RNAs in wastewater has the potential to assess multiple infectious diseases simultaneously and has yet to be explored. Methods A retrospective RNA-Seq epidemiological survey of 140 untreated composite wastewater samples was performed across urban (n=112) and rural (n=28) areas of Nagpur, Central India. Composite wastewater samples were prepared by pooling 422 individual grab samples collected prospectively from sewer lines of urban municipality zones and open drains of rural areas from 3rd February to 3rd April 2021, during the second COVID-19 wave in India. Samples were pre-processed and total RNA was extracted prior to genomic sequencing. Findings This is the first study that has utilised culture and/or probe-independent unbiased RNA-Seq to examine Indian wastewater samples. Our findings reveal the detection of zoonotic viruses including chikungunya, Jingmen tick and rabies viruses, which have not previously been reported in wastewater. SARS-CoV-2 was detectable in 83 locations (59%), with stark abundance variations observed between sampling sites. Hepatitis C virus was the most frequently detected infectious virus, identified in 113 locations and co-occurring 77 times with SARS-CoV-2;and both were more abundantly detected in rural areas than urban zones. Concurrent identification of segmented virus genomic fragments of influenza A virus, norovirus, and rotavirus was observed. Geographical differences were also observed for astrovirus, saffold virus, husavirus, and aichi virus that were more prevalent in urban samples, while the zoonotic viruses chikungunya and rabies, were more abundant in rural environments. Interpretation RNA-Seq can effectively detect multiple infectious diseases simultaneously, facilitating geographical and epidemiological surveys of endemic viruses that could help direct healthcare interventions against emergent and pre-existent infectious diseases as well as cost-effectively and qualitatively characterising the health status of the population over time Funding UK Research and Innovation (UKRI) Global Challenges Research Fund (GCRF) grant number H54810, as supported by Research England.

Anxiety and Depression Among Sudanese Nurses During the COVID-19 Pandemic: A Cross-sectional Study

Background: While treating patients during a pandemic, nurses are at risk of mental health issues caused by the stress they face. This study aimed to examine the degree of anxiety and depression among Sudanese nurses throughout the coronavirus disease 2019 (COVID-19) pandemic and demographic features and their association with depression and anxiety. Methods: An online-based cross-sectional study was conducted on Sudanese nurses. Data were collected from eligible nurses using a three-part questionnaire: demographic questions, the generalized anxiety disorder-7 (GAD-7), and the major depression index (MDI). We used the Chi-square test and Spearman or point biserial correlation to assess the association between demographics, anxiety, and depression. Results: Two hundred and forty-six nurses from Sudan participated in this study. Around 69.5% of participants experienced mild to severe anxiety, while 26.4% revealed mild to severe depression. We found a significant association between depression and anxiety (P < 0.001). However, we did not find a significant association between depression or anxiety categories and the baseline characteristics of participants. Conclusion: Our study demonstrates high rates of anxiety and depression among Sudanese nurses throughout the COVID-19 pandemic. As we found no association between anxiety and depression with personal characteristics, psychological support should be given to all nurses' categories as all of them nearly have the same risk for anxiety and depression.

STRUCTURAL SOCIO-ECONOMIC FACTORS ENHANCING M-COMMERCE: A MACROECONOMIC PERSPECTIVE OVER THREE CLUSTERS OF THE EU27

Alongside economic development, trade enhancement and digitalization, both e-commerce and m-commerce have increased gradually over the last decade and are forecasted to increase further over the following years. In the latest years, one of the most important catalyzers of these evolutions was the emergence of the COVID-19 pandemic. Within this paper, we aim at assessing the impact of some structural economic and social factors upon m-commerce. Specifically, we test the relationship between m-commerce and digitalization, education, economic growth, unemployment and income inequalities within three different clusters of countries of the European Union, for the period 2010 - 2020, using panel date regression models. Our results confirm a positive relationship between m-commerce and digitalization, education and economic growth, while showing a negative link between m-commerce and unemployment in all clusters. On the other hand, our empirical analysis concludes upon quite different results across the three clusters, when considering the relationship between m-commerce and income inequalities. © 2022, Bucharest University of Economic Studies. All rights reserved.

Characterization and Reach of Orthopaedic Research Posted to Preprint Servers: Are We "Undercooking" Our Science?

BACKGROUND: Although biomedical preprint servers have grown rapidly over the past several years, the harm to patient health and safety remains a major concern among several scientific communities. Despite previous studies examining the role of preprints during the Coronavirus-19 pandemic, there is limited information characterizing their impact on scientific communication in orthopaedic surgery. QUESTIONS/PURPOSES: (1) What are the characteristics (subspecialty, study design, geographic origin, and proportion of publications) of orthopaedic articles on three preprint servers? (2) What are the citation counts, abstract views, tweets, and Altmetric score per preprinted article and per corresponding publication? METHODS: Three of the largest preprint servers (medRxiv, bioRxiv, and Research Square) with a focus on biomedical topics were queried for all preprinted articles published between July 26, 2014, and September 1, 2021, using the following search terms: "orthopaedic," "orthopedic," "bone," "cartilage," "ligament," "tendon," "fracture," "dislocation," "hand," "wrist," "elbow," "shoulder," "spine," "spinal," "hip," "knee," "ankle," and "foot." Full-text articles in English related to orthopaedic surgery were included, while nonclinical studies, animal studies, duplicate studies, editorials, abstracts from conferences, and commentaries were excluded. A total of 1471 unique preprints were included and further characterized in terms of the orthopaedic subspecialty, study design, date posted, and geographic factors. Citation counts, abstract views, tweets, and Altmetric scores were collected for each preprinted article and the corresponding publication of that preprint in an accepting journal. We ascertained whether a preprinted article was published by searching title keywords and the corresponding author in three peer-reviewed article databases (PubMed, Google Scholar, and Dimensions) and confirming that the study design and research question matched. RESULTS: The number of orthopaedic preprints increased from four in 2017 to 838 in 2020. The most common orthopaedic subspecialties represented were spine, knee, and hip. From 2017 to 2020, the cumulative counts of preprinted article citations, abstract views, and Altmetric scores increased. A corresponding publication was identified in 52% (762 of 1471) of preprints. As would be expected, because preprinting is a form of redundant publication, published articles that are also preprinted saw greater abstract views, citations, and Altmetric scores on a per-article basis. CONCLUSION: Although preprints remain an extremely small proportion of all orthopaedic research, our findings suggest that nonpeer-reviewed, preprinted orthopaedic articles are being increasingly disseminated. These preprinted articles have a smaller academic and public footprint than their published counterparts, but they still reach a substantial audience through infrequent and superficial online interactions, which are far from equivalent to the engagement facilitated by peer review. Furthermore, the sequence of preprint posting and journal submission, acceptance, and publication is unclear based on the information available on these preprint servers. Thus, it is difficult to determine whether the metrics of preprinted articles are attributable to preprinting, and studies such as the present analysis will tend to overestimate the apparent impact of preprinting. Despite the potential for preprint servers to function as a venue for thoughtful feedback on research ideas, the available metrics data for these preprinted articles do not demonstrate the meaningful engagement that is achieved by peer review in terms of the frequency or depth of audience feedback. CLINICAL RELEVANCE: Our findings highlight the need for safeguards to regulate research dissemination through preprint media, which has never been shown to benefit patients and should not be considered as evidence by clinicians. Clinician-scientists and researchers have the most important responsibility of protecting patients from the harm of potentially inaccurate biomedical science and therefore must prioritize patient needs first by uncovering scientific truths through the evidence-based processes of peer review, not preprinting. We recommend all journals publishing clinical research adopt the same policy as Clinical Orthopaedics and Related Research®, The Bone & Joint Journal, The Journal of Bone and Joint Surgery, and the Journal of Orthopaedic Research, removing any papers posted to preprint servers from consideration.

The role of extracorporeal membrane oxygenation in COVID-19.

An extracorporeal membrane oxygenation (ECMO) program is an important component in the management of patients with COVID-19, but it is imperative to implement a system that is well-supported by the institution and staffed with well-trained clinicians to both optimize patient outcomes and to keep providers safe. There are many unknowns related to COVID-19, and one of the most challenging aspects for clinicians is the lack of predictive knowledge as to why some patients fail medical therapy and require advanced support such as ECMO. These factors can create challenges during a time of resource scarcity and interruptions in the supply chain. In the current environment, in which resources are limited and an ongoing pandemic, healthcare practitioners need to focus on evidence-based best practice for supportive care of patients with COVID-19 in refractory respiratory or cardiac failure. with As experience is gained, a greater understanding will develop in this cohort of patients regarding need and timing of ECMO. As this pandemic continues, it will be important to compile and analyze multicentered data pertaining to patient-specific outcomes to help guide clinicians caring for patients with COVID-19 undergoing ECMO support. In this paper, the authors demonstrate the strategies utilized by a major quaternary care center in the utilization and management of ECMO for patients with COVID-19.

A Retrospective Analysis of the Effects of Time on Compliance and Driving Pressures in ARDS.

BACKGROUND: The evolution of compliance and driving pressure in ARDS and the effects of time spent on noninvasive respiratory support prior to intubation have not been well studied. We conducted this study to assess the effect of the duration of noninvasive respiratory support prior to intubation (ie, noninvasive ventilation [NIV], high-flow nasal cannula [HFNC], or a combination of NIV and HFNC) on static compliance and driving pressure and retrospectively describe its trajectory over time for COVID-19 and non-COVID-19 ARDS while on mechanical ventilation. METHODS: This is a retrospective analysis of prospectively collected data from one university-affiliated academic medical center, one rural magnet hospital, and 3 suburban community facilities. A total of 589 subjects were included: 55 COVID-19 positive, 137 culture positive, and 397 culture-negative subjects. Static compliance and driving pressure were calculated at each 8-h subject-ventilator assessment. RESULTS: Days of pre-intubation noninvasive respiratory support were associated with worse compliance and driving pressure but did not moderate any trajectory. COVID-19-positive subjects showed non-statistically significant worsening compliance by 0.08 units per subject-ventilator assessment (P = .24), whereas COVID-19-negative subjects who were either culture positive or negative showed statistically significant improvement (0.12 and 0.18, respectively; both P < .05); a statistically similar but inverse pattern was observed for driving pressure. CONCLUSIONS: In contrast to non-COVID-19 ARDS, COVID-19 ARDS was associated with a more ominous trajectory with no improvement in static compliance or driving pressures. Though there was no association between days of pre-intubation noninvasive respiratory support and mortality, its use was associated with worse overall compliance and driving pressure.

Student's Perceptions about Physics, Teacher's Influence, Online Learning Access, and Student's Motivation: A Qualitative Descriptive Study

This study aims to describe students' perceptions about physics, teachers' influences, online learning access, and students' motivation on online physics learning during the covid-19 pandemic. The qualitative descriptive method is used as the research method, and the sample is 305 high school students. The form of open-ended questions accompanied by explanation statements is used as the research instrument. The results show that most students think that physics is a difficult subject, but they also think physics is fun. In general, online physics learning can be done well. Still, it is very dependent on teachers' influences, the quality of teachers in teaching, and learning access, that is, the internet speed. Then, students' motivation to study physics is influenced by three factors from the lowest percentage to the highest percentage: students' interest in physics, physics characteristics that are important for understanding the natural phenomena, and future career factors in physics. The results of this study can be a basis for considerations for teachers in designing a good quality physics learning to assist students in achieving good physics learning outcomes, which are not only based on the personal teacher's attention but also consider students' perceptions. Future research could investigate the changes in these factors in various learning conditions, whether during the covid-19 pandemic or not. © 2023 American Institute of Physics Inc.. All rights reserved.

Effectiveness of rapid SARS-CoV-2 genome sequencing in supporting infection control for hospital-onset COVID-19 infection: Multicentre, prospective study.

Background: Viral sequencing of SARS-CoV-2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings. Methods: We conducted a prospective non-randomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4-week baseline data collection period, followed by intervention periods comprising 8 weeks of 'rapid' (<48 hr) and 4 weeks of 'longer-turnaround' (5-10 days) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital-onset COVID-19 infections (HOCIs; detected ≥48 hr from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on the incidence of probable/definite hospital-acquired infections (HAIs), was evaluated. Results: A total of 2170 HOCI cases were recorded from October 2020 to April 2021, corresponding to a period of extreme strain on the health service, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longer-turnaround (incidence rate ratio 1.60, 95% CI 0.85-3.01; p=0.14) or rapid (0.85, 0.48-1.50; p=0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8 and 7.4% of all HOCI cases in rapid and longer-turnaround phases, respectively, and 17.2 and 11.6% of cases where the report was returned. In a 'per-protocol' sensitivity analysis, there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. Capacity to respond effectively to insights from sequencing was breached in most sites by the volume of cases and limited resources. Conclusions: While we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days. Funding: COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) (grant code: MC_PC_19027), and Genome Research Limited, operating as the Wellcome Sanger Institute. Clinical trial number: NCT04405934.

Evaluating automated electronic case report form data entry from electronic health records.

Background: Many clinical trials leverage real-world data. Typically, these data are manually abstracted from electronic health records (EHRs) and entered into electronic case report forms (CRFs), a time and labor-intensive process that is also error-prone and may miss information. Automated transfer of data from EHRs to eCRFs has the potential to reduce data abstraction and entry burden as well as improve data quality and safety. Methods: We conducted a test of automated EHR-to-CRF data transfer for 40 participants in a clinical trial of hospitalized COVID-19 patients. We determined which coordinator-entered data could be automated from the EHR (coverage), and the frequency with which the values from the automated EHR feed and values entered by study personnel for the actual study matched exactly (concordance). Results: The automated EHR feed populated 10,081/11,952 (84%) coordinator-completed values. For fields where both the automation and study personnel provided data, the values matched exactly 89% of the time. Highest concordance was for daily lab results (94%), which also required the most personnel resources (30 minutes per participant). In a detailed analysis of 196 instances where personnel and automation entered values differed, both a study coordinator and a data analyst agreed that 152 (78%) instances were a result of data entry error. Conclusions: An automated EHR feed has the potential to significantly decrease study personnel effort while improving the accuracy of CRF data.

Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study.

BACKGROUND: The mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke. OBJECTIVE: To describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. METHODS: We conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020. RESULTS: The total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002). CONCLUSION: COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.

PLASMAPHERESIS FOR HYPERTRIGLYCERIDEMIA-INDUCED PANCREATITIS

SESSION TITLE: Critical Renal and Endocrine Disorders Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: About 7% of acute pancreatitis (AP) cases are caused by hypertriglyceridemia (HTG). In such cases bowel rest, IV fluids, symptomatic therapy, and triglyceride (TG) lowering interventions are initiated. Plasmapheresis is one of the treatment options, but it has specific indications. We present a case of severe hypertriglyceridemia-induced pancreatitis that required plasmapheresis. CASE PRESENTATION: A 30 y/o man with type 2 diabetes, hyperlipidemia, multiple previous admissions for HTG-AP, presented with severe abdominal pain, nausea, and vomiting x 1 day. On admission, he was tachycardic, hypotensive, afebrile, SpO2 > 96% on RA. Labs: Glu 491 mg/dL, TG > 1000 mg/dL, Cholesterol 509 mg/dL, Lipase 987 U/L, Cr/BUN 2.4 mg/dL /20 mg/dL, VBG pH 7.25/PCO2 36.2 mmHg/PO2 19.4 mmHg/Ca 0.8/lactate 5.6;WBC 13.07 K/cm;COVID PCR positive. CXR: diffuse patchy opacities. CTAP with contrast was deferred because of AKI. He was admitted to the ICU and started on insulin drip with no improvement over 24hrs. He was still acidotic, Ca persistently low, TG still >1000, and kidney function worsened. Plasmapheresis was initiated. After one session his TG lowered to 700. He was restarted on insulin drip and in the next 24hr TG decreased to < 500 and metabolic acidosis resolved. Once AKI resolved, CT abdomen/pelvis with contrast confirmed acute pancreatitis, with focal hypodensities within the uncinate process and the proximal body, concerning infarcts as well as large phlegmon surrounding the pancreas, but no evidence of necrotizing or hemorrhagic pancreatitis. His hospital course was complicated with sepsis and DVT, which resolved with therapy. He was discharged home with TG lowering agents, Apixaban, and his previous T2DM regimen. DISCUSSION: Plasmapheresis is indicated in patients with severe HTG (>1000- 2000 mg/dl), severe HTG-AP, and when standard treatment options are inadequate. It lowers the lipid levels and removes proinflammatory markers and cytokines stopping further inflammation and damage to the pancreas and other organs faster compared to conservative therapy. Most patients need only one session which lowers TG level by 50-80%, as seen in our patient. CONCLUSIONS: Plasmapheresis should be considered in cases of HTGP with worrisome features such as lactic acidosis, hypocalcemia, worsening inflammation, and multi organ failure. Reference #1: Rajat Garg, Tarun Rustagi, "Management of Hypertriglyceridemia Induced Acute Pancreatitis", BioMed Research International, vol. 2018, Article ID 4721357, 12 pages, 2018. https://doi.org/10.1155/2018/4721357 Reference #2: Pothoulakis I, Paragomi P, Tuft M, Lahooti A, Archibugi L, Capurso G, Papachristou GI. Association of Serum Triglyceride Levels with Severity in Acute Pancreatitis: Results from an International, Multicenter Cohort Study. Digestion. 2021;102(5):809-813. doi: 10.1159/000512682. Epub 2021 Jan 21. PMID: 33477149. Reference #3: Gavva C, Sarode R, Agrawal D, Burner J. Therapeutic plasma exchange for hypertriglyceridemia induced pancreatitis: A rapid and practical approach. Transfus Apher Sci. 2016 Feb;54(1):99-102. doi: 10.1016/j.transci.2016.02.001. Epub 2016 Feb 20. PMID: 26947356. DISCLOSURES: No relevant relationships by Adam Adam No relevant relationships by Moses Bachan No relevant relationships by Chen Chao No relevant relationships by Vaishali Geedigunta No relevant relationships by Zinobia Khan No relevant relationships by Jelena Stojsavljevic

TUBERCULOUS PLEURAL EFFUSION MASQUERADING AS DRUG-INDUCED LUPUS

SESSION TITLE: Critical Care Presentations of TB SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: TNFα plays a pivotal role in inflammation and maintenance of immune response against tuberculosis. The use of TNF inhibitors (TNFi) is associated with a significant increase in the incidence of tuberculosis (TB). TNFi may cause drug-induced lupus (ATIL) presenting as constitutional symptoms, rashes, pericardial and pleural effusions with positive autoantibodies. We present a case of pleural TB masquerading as drug-induced lupus. CASE PRESENTATION: A 68y/o woman with a history of ulcerative colitis (on infliximab, mesalamine), hypertension, T2DM, CAD, complained of low-grade fever, rashes, left-sided chest pain, dyspnea, and arthralgias for two weeks. Chest pain- worse with inspiration and cough. She emigrated from India to the USA 40 years ago. Six months before infliximab therapy, Quantiferon gold was negative. Exam: faint hyperpigmentation over shins, minimal swelling of MCPs and ankles, dullness to percussion over the left chest with decreased breath sounds. Labs: CRP 101 mg/dL, Hb 10.8 iron deficient, rheumatoid factor and anti-CCP negative, ANA 1:40, dsDNA 1:640, a reminder of ENA negative, anti-histone negative, C3/C4 normal, UA bland, protein/Cr 0.4 mg/gm, negative blood cultures, SPEP and LDH normal. CXR: opacification of the left lung up to midfield. CT chest: moderate left and small right pleural effusions, enlarged mediastinal lymph nodes. COVID and Quantiferon: negative. Thoracentesis: 850 ml of exudative fluid (2 out of 3 Light's criteria), lymphocytic predominance (76% of 4148 nucleated cells), adenosine deaminase (ADA) 42 U/L, gram stain, culture, acid-fast and MTB PCR negative, cytology negative. Thoracoscopy with biopsy of the parietal pleura: necrotizing granulomatous pleuritis with acid-fast bacilli. Sensitivity: pan-sensitive M. tuberculosis. Sputum: negative for TB. She was discharged on RIPE treatment for reactivation of TB. DISCUSSION: The incidence of infliximab-induced lupus is approximately 0.19% and confirming the diagnosis is challenging. The immunogenicity of infliximab is high, 66% of patients develop positive ANA. Anti-histone antibodies are less commonly associated with ATIL as opposed to classic drug-induced lupus and dsDNA is positive in up to 90% of cases of ATIL. Renal involvement is rare. The diagnostic usefulness of ADA (over 40 U/L) in lymphocytic pleural effusions for the diagnosis of tuberculosis in an immunosuppressed individual is demonstrated here. In countries with low TB burden, such as the USA, the positive predictive value of ADA in pleural fluid declines but the negative predictive value remains high. CONCLUSIONS: Tuberculous pleuritis is not always easily diagnosed since AFB smears and sputum may remain negative. When ADA level in lymphocytic pleural fluid is not low thorough search for TB with thoracoscopy and biopsy is justified. Reference #1: Shovman O, Tamar S, Amital H, Watad A, Shoenfeld Y. Diverse patterns of anti-TNF-α-induced lupus: case series and review of the literature. Clin Rheumatol. 2018 Feb;37(2):563-568. Reference #2: Benucci, M., Gobbi, F. L., Fossi, F., Manfredi, M. & Del Rosso, A. (2005). Drug-Induced Lupus After Treatment With Infliximab in Rheumatoid Arthritis. JCR: Journal of Clinical Rheumatology, 11 (1), 47-49. Reference #3: Valdés L, San José ME, Pose A, Gude F, González-Barcala FJ, Alvarez-Dobaño JM, Sahn SA. Diagnosing tuberculous pleural effusion using clinical data and pleural fluid analysis A study of patients less than 40 years-old in an area with a high incidence of tuberculosis. Respir Med. 2010 Aug;104(8):1211-7. DISCLOSURES: No relevant relationships by Adam Adam No relevant relationships by Moses Bachan No relevant relationships by Chen Chao No relevant relationships by Zinobia Khan No relevant relationships by Milena Vukelic

Safe haven, hedge and diversification for African stocks: cryptocurrencies versus gold in time-frequency perspective

The specific properties of assets such as cryptocurrencies, gold, and stocks have welcomed more empirical studies in assessing their nexus. As a result, market conditions, whether good or bad, become imperative to assess the benefits of safe have, hedges or diversification. Also, the presence of uncertainties in markets may have asymmetrical effects which make it necessary to assess their impact over time. The emergence of COVID-19 pandemic as a global uncertainty has altered the dynamics of most financial markets. Consequently, this may influence the lead/lag relationships in most financial time series at various frequencies to contribute to the heterogeneous nature of market participants. Hence, the study examines the interdependencies between cryptocurrencies, selected stocks markets of Africa, and Gold returns in a time-frequency domain before and during the COVID-19 pandemic. Using a day-to-day observations, from August 8th, 2015 to May 5th, 2020, we assess the benefits of portfolio diversification, hedges, and safe haven with the bi-wavelet technique. The findings reveal that gold and cryptocurrencies provide a safe haven, diversification and, hedge for investors of African stock especially in the Ghanaian stock market (short-term) and also during this COVID-19 period. These findings contribute to the literature on financial market interdependencies, asymmetries to demonstrate financial market participants' diverse investment horizons. Again, policymakers and governments of these stock markets should institute a sound system of controls in regulating stock markets. This will enable the benefits of safe haven, hedges or diversification to be efficiently realized for Gold and Cryptocurrencies during different market conditions.

Personalised 3D printed respirators for healthcare workers during the COVID-19 pandemic

Widespread issues in respirator availability and fit have been rendered acutely apparent by the COVID-19 pandemic. This study sought to determine whether personalized 3D printed respirators provide adequate filtration and function for healthcare workers through a Randomized Controlled Trial (RCT). Fifty healthcare workers recruited within NHS Lothian, Scotland, underwent 3D facial scanning or 3D photographic reconstruction to produce 3D printed personalized respirators. The primary outcome measure was quantitative fit-testing to FFP3 standard. Secondary measures included respirator comfort, wearing experience, and function instrument (R-COMFI) for tolerability, Modified Rhyme Test (MRT) for intelligibility, and viral decontamination on respirator material. Of the 50 participants, 44 passed the fit test with the customized respirator, not significantly different from the 38 with the control (p = 0.21). The customized respirator had significantly improved comfort over the control respirator in both simulated clinical conditions (p < 0.0001) and during longer wear (p < 0.0001). For speech intelligibility, both respirators performed equally. Standard NHS decontamination agents were able to eradicate 99.9% of viral infectivity from the 3D printed plastics tested. Personalized 3D printed respirators performed to the same level as control disposable FFP3 respirators, with clear communication and with increased comfort, wearing experience, and function. The materials used were easily decontaminated of viral infectivity and would be applicable for sustainable and reusable respirators.

Changing of Balanced Nutrition Behavior and the Immune System during the New Normal Era of COVID-19 in South Sulawesi, Indonesia

BACKGROUND: The COVID-19 cases in Indonesia have increased during the new normal era of COVID-19. In addition to implementing health protocols, balanced nutrition to support the immune system is essential for preventing the further impact of COVID-19 contraction. AIM: This study identified the pattern of balanced nutrition behavior before and during implementing the new normal concept in South Sulawesi. METHODS: A cross-sectional survey of people aged 15 and above living in the province of South Sulawesi was conducted from November to December 2021 using online questionnaires. The survey was carried out through WhatsApp by spreading the link of the questionnaire. Data processing and analysis were performed by SPSS v.16.0 software. Differences in balanced nutrition patterns before and during the new normal era were analyzed using the Wilcoxon signed-rank test with a significant level of 0.05. RESULTS: The study shows that the community consumption patterns were significantly declined during the implementation of the new normal concept, especially the composition of dishes (p = 0.000), animal-sourced foods (p = 0.000), vegetables (p = 0.000), fruit (p = 0.000), and milk (p = 0.000). CONCLUSIONS: The implementation of the new normal behavior reduced public awareness in consuming balanced nutrition in South Sulawesi. Thereby, it might be contributing to a decrease in the immune system.

Public Misperceptions of the Existence of Makassar Community Lung Health Center Services

BACKGROUND: The incidence of tuberculosis (TB) disease is not a new disease like several other infectious diseases such as bird flu, swine flu, and the latest disease, namely, coronavirus disease (COVID)-19 which has hit human health globally. Various realities show that people are not willing to access TB health services. This is because there is still a negative stigma for TB disease as a disease and it is embarrassing because of the lack of public knowledge. AIM: The aim is to dig in-depth information about the causes of public misperceptions of TB services at the Makassar Community Lung Health Center. METHODOLOGY: This research is descriptive-interpretative research with a qualitative approach. The data collection technique was carried out by in-depth interviews. In-depth interviews were conducted by interviewing informants about research questions by hunting for the answers the informants to get specific answers. The way of hunting for answers is through the development of new questions that are developed from the answers raised by the informants. RESULTS: The results showed that the informants’ relatively lack of knowledge about TB services at the Makassar Community Lung Health Center made the informants build erroneous perceptions. The informant’s knowledge about the function of the Makassar Pulmonary Health Center is only devoted to tuberculosis services, thus limiting the decision making to seek treatment only when suffering from TB. This service is open to all types of diseases. Meanwhile, the attitude shown by informants in using services tends to be embarrassed because of the cultural construction that defines TB as a cursed disease. CONCLUSION: Based on the results of the research above, it can be concluded that some people still have less knowledge so there is a misperception about TB services at the Makassar Community Lung Health Center.