Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series.

Saddle pulmonary embolism (SPE) is a rare type of pulmonary embolism that can lead to hemodynamic compromise causing sudden deaths. Due to a dearth of large prospective studies in this area, little is known regarding the epidemiology, and prognosis and factors affecting the latter for COVID-19-associated SPE. We aimed to describe COVID-19-associated SPE and quantify and compare mortality and factors affecting mortality among the cases. We included a total of 25 publications with a total of 35 cases. The average age was 45 ± 16.3 years with 11 females and 24 males. Dyspnoea (82.5%), orthopnoea (43.5%), and cough (43.5%) were the most common symptoms, and obstructive shock was present in five (21.7%) patients. The average reported oxygen (O2) saturation was 85.8% ± 11.9 mm Hg. Hypertension (26.1%), diabetes (21.7%), and deep vein thrombosis (21.7%) were the most commonly reported comorbidities. Right heart strain was recognized in seven (30%) patients on electroencephalogram (S1QIIITIII) and 12 (52.2%) patients on echocardiogram. Anticoagulation, thrombolysis, and percutaneous intervention were tried in 21 (91.3%), 13 (56.5%), and 6 (26.1%) cases, respectively. Despite the aggressive management, 2 of 25 (8.7%) patients died in our smaller case report cohort. We conclude that despite aggressive management modalities, the mortality of SPE remains high in COVID-19.

Assessing the knowledge, attitude and practice (KAP) measures against tuberculosis in patients in the ambulatory department facilities in Pakistan: a cross-sectional analysis.

Tuberculosis (TB), at present, is the leading infectious aetiology of death globally. In Pakistan, there are approximately 510,000 new cases annually, with more than 15,000 of them developing into drug resistant TB, making the nation the fifth leading country in TB prevalence in the world. Due to the ongoing COVID-19 pandemic, focus has drifted away from TB screening, diagnostic, health awareness campaigns and therapeutic measures endangering KAP (knowledge, attitude and practices) towards TB in our population. We conducted a cross-sectional descriptive study in Pakistan to assess the knowledge, attitude and practices of Pakistani residents attending the adult outpatient departments of public hospitals for any health-related concern. Our sample size was of 856 participants, with a median age of 22 years. Occupation-wise, those who were employed had better knowledge of TB than those who were unemployed [odds ratio (OR): 1.011; 95% CI :1.005-1.8005]. No differences were observed in TB knowledge between those adherents to common preventive practices versus not adherent (OR 0.875, 95% CI: 0.757-1.403). More than 90 % of participants agreed that TB is dangerous for the community and a majority opted against stigmatising TB patients (79.1%). People who could read and write were 3.5 times more likely to have a good attitude towards TB compared to those who could not (OR: 3.596;95% CI: 1.821-70.230; p=0.037). Similarly, employed subjects had better attitude compared to unemployed ones (p=0.024), (OR: 1.125; 95% CI: 0.498, 1.852) and those having better knowledge of TB had a better attitude grade (OR:1.749; 95% CI: 0.832-12.350), p=0.020). Age, occupation, and educational status were statistically significant among the two groups (p=0.038, p=0.023, p=0.000) respectively. Literate subjects had thrice good practice towards TB than illiterate (OR: 3.081; 95% CI: 1.869-4.164; p=0.000). Future education and awareness programs should target specific groups such as the unemployed and illiterate with practice-focused approaches. Our study outcomes can enable the concerned officials and authorities taking appropriate evidence-based steps to direct the efforts in an efficient manner to curtail the burden of TB in Pakistan and to limit its progression that could potentially lead our nation to become an MDR-TB endemic territory.

Prevalence and predictors of depression among women in Afghanistan: a cross-sectional study

Depression is a very common mental health illness characterized by a cluster of signs and symptoms ranging from mood disturbances and sleep or appetite disorders to physical manifestations of the body. The purpose of the present study was to estimate the prevalence of depression and its related factors among Afghan women. A cross-sectional study was conducted among women between July 14, 2021, to August 15, 2021, in Kabul, Mazar-e-Sharif and Samangan provinces (Afghanistan). A total of 664 Afghan women participated in the study (mean age = 28.85 years;SD ± 11.57). In order to assess depression among participants, the 19-item validated Dari version of the Center for Epidemiological Studies–Depression Scale was used. Approximately four-fifths of the sample had depression symptoms (79.1%). Participants with depression symptoms were significantly more likely to (i) be aged over 30 years, (ii) live in rural areas, (iii) have a low-income level, (iv) not have an occupation, (v) have any disease/illness, and (vi) have experienced an event that had mentally affected them in the past month. Considering the high prevalence of depression symptoms among Afghan women, there is a need to integrate mental health services for women in Afghanistan. The use of interventions including regular screening for depression symptoms, and educating women and girls concerning the symptoms of depression for early self-diagnosis are essential.

Public Attitudes Towards COVID-19, Antibiotic Resistance, Preventive Measures: A Multi Center Cross-Sectional Study in the Arab Countries.

BACKGROUND AND AIM: COVID-19 has shown how crucial awareness of the need to protect public health is to global security. Antibiotic resistance due to antibiotic misuse is seen as a worldwide health issue. Antibiotic use was significant during the COVID-19 epidemic, according to several nations. This research aims to investigate public attitudes on COVID-19, antibiotic resistance, and preventive measures during the COVID-19 pandemic in the Middle East. METHODS: An online quantitative cross-sectional study in 17 Arabic nations was carried out between January 3 and March 4, 2022, using a structured questionnaire to evaluate participants' knowledge of COVID-19, their attitudes toward the new standard during the pandemic, and their use of antibiotics, and their resistance to them. The research was available to all Arabic people over 18 nations in the middle east. A convenient snowball sampling technique was used. SPSS version 20.0 was used to analyze the data. To analyze the results, binominal logistic regression was utilized. Statistical significance was defined as a p value of 0.05. RESULTS: Of the 6145 responders, 24.1% believed COVID-19 might spread to asymptomatic people, whereas 13.6% thought using antibiotics would accelerate recovery from any illness. Moreover, half of the respondents said antibiotics only work against bacteria (64.6%). 70.8% of participants adopted the necessary safety measures. More than a third of respondents strongly supported placing foreign immigrants in quarantine (33%). However, more than 50% of those surveyed (52.5%) firmly supported using face masks in all public settings. Individuals with a medical education background had 2.6 times more appropriate understanding of antibiotic resistance than others. Furthermore, participants in the 30-49 age range had a better handle on the use of antibiotics and antibiotic resistance than other respondents by 1.1 times. CONCLUSION: Arab Health authorities should reconsider this health issue as soon about the inadequate level of awareness toward antibiotic use, resistance, and preventative practices during COVID-19. Many suggested strategies, especially solving the irregular antibiotic prescriptions during a COVID19 pandemic, should be implemented to increase public awareness of COVID19.

The Past, Present, and Future of Monkeypox: A Rapid Review Regarding Prevalence and Prevention.

While monkeypox virus (MPXV) remained endemic in central and western African countries, a sudden unusual spike of global cases among non-endemic countries is an enigma for scientists. With 257 cases reported as of 26th May 2021, a multi-country outbreak of monkeypox has been declared in countries including the UK, EU/EEA states, and North America. Even though the likelihood of transmissibility of MPXV is limited compared to COVID-19, yet a coordinated multidisciplinary effort is required to prevent any further global expansion. Few appropriate responsive approaches to contain the infection could be; limiting the contact with potential animal reservoirs, isolation of confirmed cases, using PPEs to prevent human-human transmission, awareness activities, and administration of pre and post prophylactic vaccination. In this review, we have discussed the previous and current outbreaks of MPXV along with the abrupt actions that are needed to address the situation.

Parents' acceptance to vaccinate children against COVID-19: A Syrian online survey

After the widespread of COVID-19 virus worldwide, vaccination targeted reducing spread of cases and mortality rates. However, vaccination hesitancy was observed among the communities worldwide. Vaccination hesitancy involved parents regarding the decision of vaccinating their children- After obtaining ethical approval, an online cross-sectional study was conducted from 1 March to 22 April 2021 to evaluate the parents' acceptance of vaccinating their children against the COVID-19 virus in Syria. Data were analyzed using descriptive and multivariate logistic regression analysis in IBM, SPSS V. 28.0 package program (IBM Corporation, Armonk, NY, USA). Among 283 participants, 105 participants agreed to vaccinate their children, and 178 were not. A significant correlation between age and vaccine willingness was found (P-value < 0.0001*), especially in the age group between 18 and 30 years old (45.2%). Parents who accepted vaccinating themselves were more willing to vaccinate their children (34.6%). According to our results, there is a greater need to enhance awareness and knowledge programs about the vaccine's effectiveness and encourage parents to accept giving the vaccine to their children.

Hijab or Niqab Interacts with Facemasks Usage at Healthcare Settings in Kabul, Afghanistan: A Multi-Center Observational Study.

Purpose: We aimed to understand the extent of facemask usage resulting from the third wave of the COVID-19 pandemic in an Afghan context. In Afghanistan, new COVID-19 variants, low vaccination rates, political turmoil, and poverty interact not only with the third wave of the COVID-19 pandemic but also with facemask usage. Methods: We collected data (n = 1970) by visually observing the usage and type of facemasks used among visitors entering healthcare facilities in Kabul. We conducted an observational study observing the use of facemasks among 1279 men and 691 women. Results: While 71% of all participants adhered to wearing facemasks, 94% of these users wore surgical masks, and 86% wore all types of facemasks correctly. Interestingly, women adhered to wearing facemasks more than men. Specifically, of all the participants who were not wearing masks, 20% were men, and only 8% were women. Even though men were more in number in our study (64.9%), women have a higher adherence rate to wearing facemasks than men. Conclusions: We conclude that gender socialization and expectations of women to wear the niqab or hijab interact with their adherence to wearing facemasks. Additionally, since Afghanistan is one of the poorest countries in the world, which has witnessed a considerable period of political turmoil, we spotlight that our findings are rare in scholarship as they represent a distinct non-Western Islamic society with a low scale of COVID-19 vaccination. Therefore, more research is needed to assess the general population's socioeconomic and geopolitical barriers to facemask use, given that Afghanistan is an underrepresented social context. Our findings are expected to aid health policymakers in developing novel prevention strategies for the country.

Rare case of pneumoperitoneum in nonintubated COVID‐19 patient

We report a rare case of a 50‐year‐old female patient with COVID‐19 presented to the emergency department where supplementary oxygen is delivered via noninvasive face mask ventilation. X‐ray imaging confirmed the existence of pneumoperitoneum. CT scan was not applicable due to the advanced status of the patient. There have been a few cases of COVID‐19 patients getting pneumoperitoneum after they were intubated or given mechanical ventilation. We suggest that doctors think about this complication when treating patients with COVID‐19 so that they can respond fast to save the patient's health and avoid more serious problems.

Assessment of COVID-19 related preventive measures in medical students across a lower-middle-income country: A cross-sectional study from Pakistan.

Objectives: This study aims to identify the effect of having COVID-19 positive close contact on practices and evaluate practices regarding COVID-19 prevention among medical students and the differences among clinical and preclinical students. Study design: The cross-sectional study included medical students from the Micro-fest++ event held on 30th May 2020. Methods: Participants filled a questionnaire of 15 questions regarding COVID preventive measures practices having satisfactory reliability (Cronbach's alpha = 0.715) and validity. The Statistical Package for Social Sciences (IBM SPSS) 26.0 was used for data analysis. Out of 1342 medical students, the majority were female (N = 881, 65.6%). Greater proportion (47%) of students had good practices (>85.7%) (p < 0.05). Results: Having COVID-19 positive relatives resulted in higher positive responses for practices with 11.86 ± 1.94 (out of 14) compared to 11.78 ± 2.38 for the COVID-19 negative group. Clinical year students compared to preclinical students responded positively to all questions, except one, and had a better score of 11.90 ± 2.28 (out of 14) compared to 11.61 ± 2.37 (p < 0.05). A significant difference was noted for "Information on preventive measures" (p < 0.01), "Avoiding crowds and staying home" (p < 0.05), "Social distancing (maintain 3 feet)" (p < 0.01), and "Practices of disinfection after going outside" (p < 0.05). Conclusions: Overall, medical students showed good practices, but a lack of knowledge in certain areas requires addressing infection during clinical rotations. A greater proportion of clinical students and those having a COVID-19 positive relative showed better adherence to practices.

Burnout in health care workers during the fourth wave of COVID-19: A cross sectional study from Pakistan.

Objective: To assess the burnout among the healthcare workers during the fourth wave of COVID-19. Methods: In this cross-sectional study, burn out was measured in health care professionals using the MBI scale inventory during the fourth wave of COVID-19. Age, gender, marital status, having children, hospital, job type, experience, and workload, as well as the severity of burnout in each subscale, were all measured. We used the chi-square test to detect the difference between the level of burnout and other demographic variables, and a multiple logistic regression test was used to define the predicted correlation between the high level of burnout and the risk factors. Odds ratios and corresponding 95% confidence intervals (CI) were reported. A p-value of less than 0.05 indicated a statistically significant outcome. Results: Out of 776 healthcare workers who participated in our study, 468 (63.2%), 161 (21.7%) and 112 (15.1%) participants experienced low, moderate and high levels of emotional exhaustion, respectively. For the depersonalization subscale, 358 (48.3%), 188 (25.4%) and 195 (26.3%) people suffered from low, moderate, and high levels of depersonalization, respectively while 649 (87.6%), 40 (5.4%) and 52 (7.0%) respondents had low, moderate and high levels in the personal accomplishment subscale, respectively. Conclusion: During the fourth wave of COVID-19, the healthcare workers reported increased level of burnout overall possibly due to the long term physical and mental impacts that the pandemic has had over the time. Moreover, healthcare workers in Pakistan were more prone to burnout as compared to other countries.

Rare case of pneumoperitoneum in nonintubated COVID-19 patient.

We report a rare case of a 50-year-old female patient with COVID-19 presented to the emergency department where supplementary oxygen is delivered via noninvasive face mask ventilation. X-ray imaging confirmed the existence of pneumoperitoneum. CT scan was not applicable due to the advanced status of the patient.

Unraveling the Jeopardy: Child health in Afghanistan.

A humanitarian crisis started in Afghanistan after the United States and international Allies withdrew in August 2021, causing numerous challenges and have especially impacted children. Children in Afghanistan have been affected by a long history of suffering from violence, war, and poverty. The US withdraw and COVID-19 pandemic have caused an economic crisis causing high rates of child malnutrition and prevented them from receiving healthcare and education. In the long run, the impacts of the current situation will significantly affect the child growth, education, and psychological health. There is a need for international organizations to intervene now to ensure children do not further suffer and have the option for a bright future. In turn, ensuring a brighter future for Afghanistan.

Antiviral and antiretroviral drug shortages amidst COVID-19: How Africa is struggling.

Antiviral drugs are of paramount importance in the accomplishment of the vision of zero new cases of COVID-19 globally, through sustainable retaliation against viral diseases. However, several challenges currently exist in Africa which include insufficient infrastructure, deteriorating health systems, and rising costs of healthcare delivery with concomitant rising inequity with regards to access to health services amid the COVID-19 pandemic. The pandemic itself has stimulated an increased use of phytotherapy in Africa as a result of essential drug shortages that have been attributed to a plethora of contributing factors such as travel restrictions, reduced per capita income as well as increased expenditure on transport. As a result, the paucity of antiviral along with antiretroviral drugs used to combat COVID-19 as well as several other endemic viral diseases in Africa has created a worrisome state. This article therefore discusses and aims to underscore the causes, effects, and implications of antiviral and antiretroviral shortages amid COVID-19 in Africa.

Self-Medication in Africa during COVID-19 Pandemic.

Self-medication is known as "the usage of drugs, herbs or home remedies on one's own initiative, or on the advice of another person, without consulting a doctor'. In Africa, self-medication has reached a critical stage, with people using and taking any drug regardless of how poisonous the material may be as long as unprofessional suggestions advocate it as a solution to their health problem. In this article, we looked at the consequences, effects, and recommendations for reducing the use of self-medication as a habit among Africans.

Cytokine storm and neuropathological alterations in patients with neurological manifestations of COVID-19.

The COVID-19 pandemic is caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), a respiratory pathogen with neuroinvasive potential. Neurological COVID-19 manifestations include loss of smell and taste, headache, dizziness, stroke, and potentially fatal encephalitis. Several studies found elevated proinflammatory cytokines such as TNF-α, IFN-γ, IL-6 IL-8, IL-10 IL-16, IL-17A, and IL-18 in severely and critically ill COVID-19 patients, which may persist even after apparent recovery from infection. Biomarker studies on CSF and plasma and serum from COVID-19 patients have also shown a high level of IL-6, intrathecal IgG, neurofilament light chain (NFL), glial fibrillary acidic protein (GFAP), and tau protein. Emerging evidence on the matter has established the concept of COVID-19 associated neuroinflammation, in the context of COVID-19 associated cytokine storm. While the short-term implications of this condition are extensively documented, its long-term implications are yet to be understood. The association of the aforementioned cytokines with the pathogenesis of neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, Huntington disease, and amyotrophic lateral sclerosis, may increase COVID-19 patients' risk to develop neurodegenerative diseases. Analysis of proinflammatory cytokines and CSF biomarkers in patients with COVID-19 can contribute to the early detection of the disease's exacerbation, monitoring the neurological implications of the disease and devising risk scales, and identifying treatment targets.

Public Perception and Preparedness to Fight Against the Third Wave of COVID-19 in Kabul, Afghanistan.

The avalanche of Corona Virus 2019 (COVID-19) cases has placed an unprecedented load on Afghanistan's government and public health authorities, putting the country in jeopardy. The primary goal of this research was to shed light on the country's capital, Kabul, and to examine the existing preparedness and perceptions of its population in the midst of COVID-19's third wave, which could result in decentralization and fragmentation of the already overburdened health-care system. An online, cross-sectional survey was conducted by the lecturers of the Kabul University of Medical Sciences between April 15, 2021 and April 25, 2021, to evaluate the preparedness of the Kabul citizens amidst the third wave of COVID-19. About 1736 citizens from Kabul participated in the survey. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. All categorical variables were reported using frequencies and percentages. The findings revealed that the most common source of COVID-19-related information was social media (74.8%). In addition, 34.4% of subjects had previously been infected with COVID-19. It was reassuring to see that 78.4% of residents said they knew more about COVID-19 than they did about prior COVID-19 waves. A majority (81.5%) expressed willingness to resist the third wave, but 89.4% said that the country's government would be unable to develop an effective COVID-19 vaccine within the next 6 months. The findings of this present study indicates that citizens of Kabul are active in obtaining accurate information and disseminating it in the community. The citizens also reported sufficient COVID-19 related knowledge; however, they were more motivated to fight against the third wave of COVID-19. In regards to vaccination, they believed that the government could not vaccinate the public anytime soon. Hence, the enactment of non-pharmaceutical measures is important in the fight against the pandemic.

Knowledge, Attitude, and Practices Toward Tuberculosis Among Hospital Outpatients in Kabul, Afghanistan.

Background: Tuberculosis (TB) is a high-burden respiratory infectious disease. There was a sharp decline in the number of confirmed TB cases during the pandemic; this is likely to be influenced by the COVID-19 pandemic response, with under-reporting due to resource diversion. There are typically 13,000 tuberculosis-associated deaths in Afghanistan annually, with significant problems posed by drug-resistant TB. Method: A cross-sectional descriptive study was conducted in Afghanistan on Kabul residents who visited the adult outpatient departments of public hospitals for any health-related reason from 1st January to 20th March 2022. The study scored their knowledge, attitude, and practices (KAP) toward tuberculosis. The sample size was calculated using Epi-Info, and the minimum sample size was 385. The sampling method is chosen the non-probability convenient sampling for data gathering. Data were analyzed using SPSS version 28, and we used the Mann-Whitney test, Chi-square or fisher extract test, spearman correlations, and binary logistic regression model. Results: Of 829 participants, 450 (54.3%) were males and 379 (45.7) females. The median age was 28 years, and 63.3% were married. Most participants were unemployed (75.5%), but 54% had a monthly income >3,000 Afghanis, indicating the reliance on family. By TB knowledge score, 727 (87.7%) participants had good knowledge, and 800 (96.5%) participants had a positive attitude toward treatment and control. Only 2 participants reported poor practices regarding prevention. Regarding the binary logistic regression, young age, being a male, belonging to the "1,000-3,000" Afghani monthly income category, and having a positive attitude were significant predictors of good TB knowledge (P-value = 0.009, 0.000, 0.003, and 0.009), respectively. A positive attitude was expected to have good knowledge 6.035 times more than a negative attitude (95% CI: 1.572-23.167). Conclusion: The study findings highlighted that outpatients in Kabul had good knowledge, attitude, and practice toward TB. More studies are needed to highlight KAP in different Afghan populations, including in other parts of the country.