Effect of COVID-19 on severity of signs and symptoms of autoimmune diseases

It is an observational cross-sectional study, the data collected by convenience sampling method from 33 patients in the Ranya General Hospital and private clinics for follow-up patient's autoimmune diseases state in the Ranya city from the 10th November 2020 to the 20th May 2021 and the study included all the patients had autoimmune diseases that recovered from the COVID-19 disease. For the study materials, the data was collected by a questionnaire form that included demographic and autoimmune disease questions also questions about the patient's intensity of their autoimmune disease's signs and symptoms before and after they recovered from COVID-19. Determine patient's autoimmune disease signs and symptoms intensity based on the prescribed drug for a treat the autoimmune diseases which are changed by special doctors. Furthermore, the data were analysed by SPSS software to produce descriptive statistic measures and to find the difference between dependent categorical variables Sign tests were used but the Chi-square test was used for the categorical independent variables with regarding 0.05 as a significant critical value. The result reveals that the range of their age started from 42 to 74 years old with mean..standard deviation (57.3 .. 8.06) and most of the cases 15(45.5%) were between (55-65) years old, followed by less than 55 years old 13(39.4%) and more than 65 years old age 5(3.8%) cases respectively. Rheumatoid arthritis was a major type 16 (48.5%) of the autoimmune disease compared to other types, Ankylosing Spondylitis 8(24.2%) cases, and Ulcerative Colitis 6(18.2%) cases respectively while Crohn's disease was the minimum 3(9.1%) cases and before the got COVID-19 most of the cases 25(75.8%) had moderate intensity signs and symptoms of their autoimmune diseases and 8(24.2%) cases had severe signs and symptoms but after they recovered from the COVID-19 disease the rate of their signs and symptoms changed to mild 19(57.6%) and moderate 14(42.4%) intensity while severe intensity signs and symptoms were zero with highly significant differences (P-value 0.0001). Despite the current study concluded autoimmune disease patients recovered from the COVID-19 their autoimmune diseases signs and symptoms intensity decreased significantly but still further studies are needed with a bigger sample size to determine and explain this association.

Deep Vein Thrombosis, Septic Pulmonary Emboli and Methicillin-Resistant Staphylococcal Aureus Bacteremia Complicated by a Furuncle in a Child

Staphylococcal aureus infection in children is a major public health problem globally. It causes a varied spectrum of clinical disease including bacteremia, endocarditis, skin and soft tissue infection, pleuro-pulmaonry and osteo-articular infection. Deep vein thrombosis (DVT) is a known complication of staphylococcal infection. We report a case series which included, 10-year old boy developed DVT, septic pulmonary emboli and Methicillin-resistant Staphylococcal aureus (MRSA) bacteremia following a furuculosis and 13 year old girl with thrombosis of internal and external jugular vein, cavernous sinus with pulmonary emboli and MRA bacteremia. Both patients are previously healthy showed complete recovery after aggressive appropriate antibiotics, anticoagulants and supportive care. The high index of suspicion of DVT in MRSA infection is needed, prompt diagnosis and aggressive appropriate therapies improve the outcomes and minimize the complications.

Development of a smart active respirator for comfortable and hygienic breathing

The current COVID-19 pandemic has increased the use of facial masks globally, which of late have registered their presence as a part of our civilization. The N95 mask is one of the most popular choices under the current situation. However, the available masks cannot provide breathing comfort for an extended period, which results in rebreathing of exhaled air that is CO2 rich, and which remains in the breathing space of the respirator. Furthermore, problems like moisture settlement on the covered area of the face due to the multiple layers of fabric-like material causes significant discomfort. Hence, the need for a mask with an air-purification activity is the need of the hour. The present innovation relates to the invention of a mask that is battery-powered or solar-operated and addresses the aforementioned problems. This mask not only regulates the airflow, which is beneficial to our body in every way, but also lowers the discomfort of sweating and heating. The effect of the addition of the self-developed active respirator to the commercially available masks on the inspired CO2 level, thermal comfort, and speech clarity has been demonstrated in this study. We have exhibited through in vitro experiments that the filtration capability of the active-respirator improvised mask, we call the Bose shield, does not deter from that of the standard N95 mask. To our understanding, the use of this novel mask can reduce the occurrence of CO2 rebreathing in respiratory protective devices and its impact on workers who inevitably wear them for a prolonged period of time. © 2022 Author(s).

An Interventional Program for Nursing Staff about Prevention of Corona Virus Disease

Objectives: The objectives of the study is determining the effectiveness of interventional program on nursing staffs' knowledge about prevention of Covid-19. Methodology: A pre-experimental design (one group design: pre-test and post-test) conducted at Isolation Ward in Al-Diwaniyah Teaching Hospital. The study period from (13th October, 2021 to 4th March, 2022) on a non-probability (purposive) sample consisting of (34 nurses) working in Isolation Ward. Results: The study demonstrated that all the study sample responses at the pre-test were low knowledge with a statistical mean of scores (1.2817). Other than the post-test, the table shows that (100%) of the study sample have high knowledge at the mean of scores (1.8978). Also, the results revealed a highly significant difference between the pre-test and post-test of the study sample after participated in the interventional program at the p-value (0.0001). In addition to, this study indicated that there were significant differences in nurses knowledge in post-test compared to pre-test (in the post test M= 1.89 versus in the pretest M= 1.28 at p-value 0.0001). Conclusion: The level of nurses' knowledge was not as required (poor).After giving the interventional program the knowledge of nursing staff was improved.

Title Favipiravir for the Treatment of Coronavirus Disease 2019;A Propensity Score Matched Cohort Study

Background. We investigated clinical outcomes of favipiravir in patients with COVID-19 pneumonia. Methods. Patients who between 23 May 2020 and 18 July 2020 received ≥24 hours of favipiravir were assigned to the favipiravir group, while those who did not formed the non-favipiravir group. The primary outcome was 28-day clinical improvement, defined as two-category improvement from baseline on an 8-point ordinal scale. Propensity scores (PS) for favipiravir therapy were used for 1:1 matching. Cox regression was used to examine associations with the primary endpoint. Results. The unmatched cohort included 1,493 patients, of which 51.7% were in the favipiravir group, and 48.3% were not receiving supplemental oxygen at baseline (table 1). Favipiravir was started within a median of 5 days from symptoms onset. Significant baseline differences between the two unmatched groups existed, but not between the PSmatched groups (N = 774) (table 1). After PS-matching, there were no significant differences between the two groups in the proportion with 28-day clinical improvement (93.3% versus 92.8%, P 0.780), or 28-day all-cause mortality (2.1% versus 3.1%, P 0.360) (Table 2). Favipiravir was associated with more viral clearance by day 28 (79.8% versus 64.1%, P < 0.001) (table 2). In the adjusted Cox proportional hazards model, favipiravir therapy was not associated 28-day clinical improvement (adjusted hazard ratio 0.978, 95% confidence interval 0.862 -1.109, P 0.726) (Table 3). Conclusion. Favipiravir therapy for COVID-19 pneumonia is well tolerated but is not associated with an increased likelihood of clinical improvement or reduced allcause mortality by 28 days.

Tocilizumab Use in the Second Trimester Pregnant Patients with Severe Covid-19 Pneumonia and their Maternal and Fetal Outcomes: Two Case Reports

Background. Tocilizumab is an interleukin-6 monoclonal antibody with widespread use in rheumatologic conditions. Observational studies have shown a promising role of Tocilizumab in severe COVID-19 patients with cytokine storm syndrome. Data about tocilizumab use in pregnant patients is limited. We report two outcomes of two pregnant patients with COVID-19 in the second trimester who received tocilizumab Methods. A 24-year-old 20 weeks pregnant lady with a history of asthma and gestational diabetes mellitus presented with three days history of fever, cough and shortness of breath (Figure 1). She was clinically stable but later developed ARDS and developed increased oxygen demand up to 10 liters/min. She received Tocilizumab on. Patient was observed in a high dependency unit but did not require mechanical ventilation. Patient was discharged home with full recovery and later delivered a healthy baby. Timeline of medicines used during hospital (Figure 2). Case 2: 39-year-old 23 weeks pregnant lady presented with seven days history of fever cough and shortness of breath (Figure 1). On presentation, she had progressive worsening hypoxic respiratory failure and was intubated. Patient had her nasopharyngeal swab for CODI-19 RT PCR was positive. The patient had severe ARDS requiring ECMO (extracorporeal membrane oxygenation) for respiratory support. Tocilizumab 400 mg was given on the presentation, along with other medications (Figure 3). Patient had regular monitoring of fetus;however, she had intrauterine fetal demise on day 14. Patient It is unclear if IUFD was due to using of tocilizumab or severity of COVID19 itself. The patient stayed in ICU for 20 days and was discharged after full recovery. Figure 1. Case 1 treatment timeline. Abberviations: Azithro: Azithromycin, HCQ: Hydroxychloroquine, CQ: Chloroquine, LPV/r: lopinavir/Ritonavir, Osel: Oseltamivir, MP: Methylprednisolone, Ampi-sulb: Ampicillin-sulbactam, TCZ: tocilizumab Figure 2. Case 2 treatment timeline Results. Learning points: Tocilizumab use in pregnant patients with severe COVID-19 pneumonia during the second trimester improved maternal outcomes in our cases. Tocilizumab use may be associated with worse fetal outcomes, including intrauterine fetal demise (IUFD). Conclusion. The pharmacological management of pregnant patients with severe COVID-19 pneumonia poses significant challenges. The use of Tocilizumab may improve maternal outcomes but may also increase the risk of worse fetal outcomes. Caution should be exercised in using this agent, and risks and benefits should be discussed with the patients.

An Inverted Virtual Faculty Development Program for Remote Teaching: Pilot for Replication

Background: Due to the COVID 19 pandemic, all the universities worldwide are experiencing a paradigm shift to online learning. Baby boomers and Generation X need to cope with the challenging transformation, so an emerging need for a faculty development program was needed towards achieving the goal of that transformation. Objectives: To describe and assess an inverted virtual faculty development program (VFDP) that was designed and implemented for the first time in the school to equip educators with the necessary technology competencies for remote online learning. Methods: An interventional prospective study held in a university setting post need analysis conduction to prioritize the required technological skills for faculty members. The program was designed to integrate five essential skills needed to by faculty members to teach remotely. The intervention comprised attending five virtual sessions after watching a pre-distributed material, then evaluated using the Kirkpatrick model. Results: Almost 81% of faculty members completed the program and 80 % of participants were satisfied with the content of the program. There was a statistically significant difference between the perceived ability of the participants to share and record video lectures before and after the VFDP (p value <0.001). The percentage of the departments that applied the program components showed that 96% of them were able to record lectures. In addition, 80% of them were able to develop online quizzes. Conclusion: The inverted virtual faculty development program (VFDP) has supported the participating faculty in developing their needed technological competencies required to bridge the gap of remote teaching/learning. © 2022, Ain Shams University Faculty of Medicine. All rights reserved.

The role for pre-operative CT chest scans in suspected COVID-19 patients requiring emergent surgery

Objective: To study the role for preoperative CT chest scans in suspected COVID-19 patients requiring emergent surgery. Design: Retrospective - observational. Participants: A total of 98 patients admitted for emergency surgery with COVID-19 infection and underwent preoperative CT chest scanning. Main outcome measurements: Incidence of clinical symptoms of COVID-19 infection upon presentation, imaging characteristics in chest CT and semi-quantitative CT severity score. Results: The median age of the study cohorts was 50 years (interquartile range (IQR): 40-60 years) and 52/98 (53.1%) were males. The most common symptoms were fever (80.6%) and cough (65.3%). 50/98 had positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR test prior to CT scan, while 48/98 had positive reverse transcriptase-polymerase chain reaction (RT-PCR) result returned after imaging. The imaging characteristics were bilateral infiltrates on CT of 90/98, with 70/98 of infiltrates located peripherally and 28/98 located peripherally and centrally. The most common disease pattern was ground-glass opacities, observed in 95/98. The median total COVID-19 CT severity score was 7 (IQR: 4-14), corresponding to 5-25% global lung involvement. Conclusion: Patients with mild symptomatic COVID-19 in this study displayed CT evidence of SARS-CoV-2 infection. Preoperative CT imaging should be considered for identifying suspected active SARS-CoV-2 cases in resource limited environments with high community spread, to aid in resource allocation and personal protective equipment (PPE) rationing.

Epidemic Analysis of COVID-19 in Egypt, Qatar and Saudi Arabia using the Generalized SEIR Model (preprint)

Background. Since its emergence in late December 2019 and its declaration as a global pandemic by World Health Organization (WHO) on March 11, 2020, the novel coronavirus disease known as (COVID-19) has attracted global attention. The process of modeling and predicting the pandemic behavior became crucial as the different states needed accurate predictions to be able to adopt suitable policies to minimize the pressure on their health care systems. Researchers have employed modified variants of classical SIR/SEIR models to describe the dynamics of this pandemic. In this paper, after proven effective in numerous countries, a modified variant of SEIR is implemented to predict the behavior of COVID-19 in Egypt and other countries in the Middle East. Methods. We built MATLAB simulations to fit the real data of COVID-19 Active, recovered and death Cases in Egypt, Qatar and Saudi Arabia to the modified SEIR model via Nelder-Mead algorithm to be able to estimate the future dynamics of the pandemic. Findings. We estimate several characteristics of COVID-19 future dynamics in Egypt, Qatar and Saudi Arabia. We also estimate that the pandemic will resolve in the countries under investigation in February 2021, January 2021 and 28th August 2020 with total death cases of 9,742, 5,600 and 185 and total cases of 187,600, 490,000 and 120,000 respectively.

Saudi Heart Association, National Heart Center and National Cardiopulmonary Resuscitation Committee taskforce statement on CPR and resuscitation during COVID-19 pandemic.

Corona virus disease 2019 is a global pandemic, which affects around 2million individuals with a high death rate that exceeds 90,000 death cases across the globe. The Saudi Heart Association and the national cardiopulmonary resuscitation committee developed a taskforce to discuss the magnitude of clinical situation and CPR management on COVID-19 patients in a prehospital and in-hospital settings. Meanwhile, the taskforce aims to develop a nation-wide clinical guidance to be used by health care workers and untrained laypersons to resuscitate COVID-19 suspected and diagnosed patients.