Gender based difference in outcomes of myocardial injury in covid-19 positive patients in low to middle income country

Introduction: Myocardial injury is associated with poor outcomes in COVID-19 positive patients. We have limited data about gender-based differences, in terms of outcomes in COVID-19 associated myocardial injury, especially from low to middle income country. Hypothesis: Myocardial injury in COVID-19 positive patients has the same impact on outcomes in either gender. Methods: We prospectively collected data of patients admitted with COVID 19 (nasopharyngeal PCR positive) and myocardial injury (hsTrop I>99th percentile) at Aga Khan University Hospital (AKUH), Karachi, Pakistan from 26 Feburary'2020 to 26 November'2020. Both genders were compared in terms of presentation, complications, and mortality. Calculations were done separately for each variable between two groups keeping the significant criteria of p-value less than or equal to 0.05. Result: Among 171 patients fulfilling inclusion criteria, 28.07% (n=48) were female and 72% (n=123) were male. Baseline demographics demonstrated that hypertension was significantly high among females as compared to male patients (87.5% Female vs 65% Male, p=0.004). During the hospital stay, the need for supplemental oxygen, Noninvasive ventilation, and mechanical ventilation was significantly higher in males compared to females. A statistically non-significant trend towards increased mortality was noted in males. Conclusion: Our study signifies that COVID-19 associated myocardial injury in males is associated with worse hospital course as compare to females. The length of hospital stay, complications such as ARDS, and requirement of invasive and non-invasive ventilatory support were higher in males as compared to females. Further studies evaluating the cause of disparate hospital course based on gender are warranted.

Best Practices For Administering Monoclonal Antibody Therapy For Coronavirus (COVID-19)

COVID-19 is a clinical syndrome due to infection with SARS-CoV-2. It has been discovered in Wuhan, China, in December 2019 and spread to a pandemic level in 2020. Globally it has affected more than 168 million people, with a death toll of more than 3.5 million patients. In the United States, the number of cases is more than 32 million, and the number of people who died from COVID-19 exceeded 586,000 patients (WHO Coronavirus dashboard as of 05/28/2021). Severe Acute Respiratory Syndrome Coronavirus-2 is one of the coronaviruses, single-stranded RNA viruses with close resemblance to the SARS outbreak of 2003.[1] SARS-CoV-2 differs from MERS(middle east respiratory syndrome) and SARS(Severe Acute Respiratory Syndrome)coronaviruses by easier spread and lower fatality rate.[2] SARS-CoV-2 is transmitted by inhalation of air carrying droplets or from person to person through droplets spread by coughing, sneezing, singing, shouting, or even talking. In addition, SARS-CoV-2 has been detected on multiple services, and touching mucous membranes with hands contaminated with the SARS-CoV-2 virus may also be another transmission source. COVID -19 starts after an incubation period of around 5 days after exposure but could range from 2 to 14 days, and most of the patients can identify recent contact with COVID 19 patients. The clinical presentation varies from asymptomatic cases to severe symptoms of fatigue, headache, anosmia (loss of smell sensation), ageusia(loss of taste sensation), dyspnea, and dry cough that is persistent and may stimulate gag reflex and induce vomiting. Hypoxia that may worsen to require assisted ventilation, whether invasive or non-invasive. The physical signs include fever, tachycardia, and hypoxia, resulting in acute respiratory failure and acute respiratory distress syndrome. Extrapulmonary manifestations have been described in many COVID patients, in multiple organ systems, including but not limited to:cutaneous: acral lesions, cardiovascular: myocardial injury and myocarditis, neurologic: headache and stroke, gastrointestinal: nausea, vomiting, and diarrhea, and elevated liver enzymes.[3] The national institute of Health classifies the manifestations of SARS-CoV-2 as follows: Asymptomatic or Presymptomatic Infection: positive testing for SARS-CoV-2 but no symptoms consistent with COVID-19. Mild Illness: Individuals who have any of the various signs and symptoms of COVID-19 but do not have shortness of breath, dyspnea, or abnormal chest imaging. Moderate Illness: the presence of lower respiratory disease and no hypoxia( oxygen saturation (SpO) >=94% on room air). Severe Illness: Hypoxia, Spo <94% on room air, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO/FiO) <300 mm Hg, respiratory frequency >30 breaths/min, or lung infiltrates >50%. Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction. Mild to moderate cases of COVID-19 are usually managed on an outpatient basis. Patients requiring oxygen therapy to maintain their oxygenation are usually hospitalized and may require intensive care management for assisted ventilation, organ support, and treatment of secondary infection. Management of non hospitalized patients with COVID-19 in the outpatient setting involves triaging the severity of symptoms and oxygen requirements. Identifying patients with risk factors for deterioration and close monitoring. Patients without risk factors for deterioration are usually managed with supportive care and self-monitoring. Meanwhile, patients with risk factors for deterioration are offered Anti-SARS-CoV-2 monoclonal antibodies.

Perceptions of Saudi Plastic Surgery Residents and Attendings of Online Education during the COVID-19 Pandemic.

BACKGROUND: The world has faced an unprecedented challenge in controlling the spread of COVID-19-a rapid reshaping of the healthcare system and education was inevitable. Consequently, residency programs adopted e-learning as a social distancing tool for the continuity of the learning process. In this study, we explore the opinions and perspectives of plastic surgery attending doctors and residents on the implications of e-learning. METHODS: After obtaining ethical approval, this cross-sectional study was conducted electronically between October and December 2020 among plastic surgery residents and board-certified plastic surgeons in Saudi Arabia. Participants completed a validated, anonymous, self-administered questionnaire. The questionnaire gathered participants' demographic data, perceptions of online webinars, and audiovisual evaluations. Finally, we compared traditional (in-person) teaching with online webinars. The analysis was performed at a 95% confidence interval using the Statistical Package for Social Sciences (SPSS), version 23.0 (IBM, Armonk, N.Y.). RESULTS: A total of 61 responses were included in this study. The majority of respondents (78.7%) were comfortable during webinars, with 38 (62.3%) believing they should supplement traditional teaching methods. Overall, 50.8% were satisfied with the webinars. However, 37.7% were neutral. Most believed that the webinars increased their clinical (67.2%) and surgical skills (67.2%) to reasonable levels. CONCLUSIONS: Online education provided an excellent educational tool as a viable option to supplement traditional face-to-face training, with most residents being satisfied, supporting the use of this educational tool. More objective research is required to refine existing online plastic surgery teaching methods while creating novel distance e-learning approaches for the future.

The Public's Awareness and Willingness to Undergo Plastic Surgery Procedures during the COVID-19 Pandemic.

BACKGROUND: In March 2020, the Saudi Ministry of Health implemented mitigation measures to control the Coronavirus Disease 2019 (COVID-19) pandemic, including media campaigns, a nationwide lockdown, and closures of plastic surgery clinics. The aim of this study was to explore the public's knowledge of COVID-19, their willingness to undergo cosmetic surgery during the pandemic, and the factors influencing their decisions. METHODS: An internet-based cross-sectional survey was conducted. We collected data on demographic information, knowledge about COVID-19, and willingness to undergo cosmetic procedures. Participants also completed the cosmetic procedure screening questionnaire to assess body dysmorphic disorder. RESULTS: The sample included a total of 1643 participants (women, n = 1002; 61%). A total of 613 (37.3%) participants were aged between 30 and 40 years. The majority (n = 1472; 89.6%) referred to official government accounts for information regarding COVID-19. Most participants (n = 1451; 88.3%) felt that the pandemic was serious, and 1387 (85%) said they would not leave home to undergo cosmetic procedures during the outbreak. Being women, the presence of body-image concerns, and higher cosmetic procedure screening questionnaire scores were associated with an increased willingness to undergo cosmetic procedures. CONCLUSIONS: This is the first study to explore the public's willingness to undergo cosmetic procedures during the COVID-19 pandemic. The public was well educated about the pandemic, via government actions. This was reflected in participants who wished to undergo a cosmetic plastic procedure; we identified factors associated with an increased willingness to undergo procedures, which may help design awareness initiatives.