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The resilience of food systems and security to emerging challenges and threats, especially in the context of environmental and climate risks and global pandemics such as the Covid-19 crisis, is currently gaining growing importance in research, policy, and practice. Based on this, the core focus of this book, as a part of a series of CERES publications, consists of identifiying and exploring the best ways to overcome such challenges and shocks and to build resilience in the Global South. More precisely, the book analyzes current dynamics and trends related to the climate resilience of food security and assess the relevance of emerging approaches such as climate-smart agriculture, new roles of agriculture extension, smart farming, and climate adaptation of farming systems.The book includes both conceptual and empirical research reporting lessons learned from many geographical, environmental, social, and policy settings while focusing on Africa, Middle East, and Asia. It also provides research and policy-oriented inputs and recommendations to guide change processes at multiple scales. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.
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Background: Immunization against severe acute respiratory syndrome coronavirus 2 became necessary to control the menace of COVID-19. However, the safety of COVID-19 vaccines must be monitored continuously. The present study aims at comparing the effectiveness and adverse effects of Pfizer and AstraZeneca vaccines among the cohort of medical students. Methods: It was a single-cohort comparative study, and the data were collected using an online survey from participants who took at least two doses of AstraZeneca or Pfizer vaccines. The data included demography, breakthrough infections, and adverse effects following vaccination. Bivariate and logistic regression models were used to find associations between effectiveness and independent variables. Statistical significance was considered at P < 0.05. Results: In total, 115 students who had received Pfizer or AstraZeneca vaccines were included in the study. The mean age of the participants was 21.52. Female (n = 90) participants were more compared to males (n = 25). The majority of them received Pfizer vaccine (95), while AstraZeneca was received by only 20 participants. Overall effectiveness of both AstraZeneca and Pfizer was nearly 85%, while almost 100% protection was observed among those who were vaccinated after contracting the disease. Logistic regression revealed an independent effect of COVID-19 before any vaccination dose offered 66% protection against any subsequent breakthroughs (odds ratio 0.44, 95% confidence interval [CI]: 0.095-2.08). At least one adverse effect was reported by 96 (83.5%) participants (95% CI: 75.4%-89.75%). Pain at the site of injection, fever, generalized weakness, and headache were the most common adverse effects. Fever (P < 0.001), body ache (P < 0.001), generalized weakness (P = 0.002), and joint pain (P = 0.014) were significantly more common in AstraZeneca as compared to Pfizer. Conclusion: Coronavirus vaccines were well tolerated, safe, and induced protection in most participants. Most postvaccine adverse events were mild to moderate, mainly due to induction of immune response by the body for protection. Furthermore, these mild to moderate adverse effects should not be hindrance to vaccination. © The Author(s) 2023.
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Introduction: The current study aimed to assess students' competency of the Faculty of Medicine, Makkah region Saudi Arabia in interpreting common laboratory investigations like Complete Blood Counts. Methods: The current cross-sectional, quantitative and exploratory study was carried out at the Faculty of Medicine, Rabigh, King Abdulaziz University (KAU), Jeddah, from April 1 to April 20, 2022. An online questionnaire was circulated via various social media like Facebook, Twitter, and WhatsApp. Results: A total of 1,010 respondents participated in the survey, representing an overall response rate of 70%. Among all the respondents, females were 677 (67%) while males were 333 (33%). There were 277 (27.4%), 479 (47.4%), and 254 (25.1%) students from the fourth, fifth, and sixth years, respectively. For most of the statements, more than 70% of students responded correctly, but particularly for three of the questions, students' correct responses were 561 (55.5%), 518 (51.3%), and 491 (48.6%), which were not up to the mark. A gender-wise comparison showed that the percentage of correct answers given by female students was significantly higher than that of male students for all statements (p < 0.001). For most of the indices, more than 70% of students responded correctly, while for four questions, students' correct responses were not up to the mark. Comparison between students' gender revealed that, apart from two, the percentage of female students who correctly interpreted the indices was significantly higher than that of male students (p 0.001). In the results of all participants' responses to the clinical scenario interpretation the female students performed significantly better in scenarios 1 and 2 (p 0.001). Conclusions: Overall, our study participants' comprehension of CBC values and interpretation of the case scenarios was adequate. On the other hand, female students demonstrated better conceptual understanding than male students. We recommend improving assessment systems to help students expand their interpretation skills.
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SESSION TITLE: Critical Care Infections SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 09:15 am - 10:15 am INTRODUCTION: Francisella tularensis is a zoonotic disease by an aerobic, gram negative coccobacillus. It is transmitted by exposure to infected animal or vectors in individuals who landscape or camp. Common symptoms are fever, chills, anorexia, and headache. Abdominal tularemia can present with abdominal pain, emesis, diarrhea, and rarely intestinal ulceration and hemorrhage. It is treated with aminoglycosides, fluoroquinolones and tetracycline. CASE PRESENTATION: 38-year-old male presented with fever, cough, anorexia, and black stool for 5 days. Patient worked as a landscaper. He has no pets, travel history or sick contacts. He does not take any medications at home. Physical exam was significant for sinus tachycardia and rhonchi of right upper lobe. Significant labs include WBC of 9.8 with 41% bands, hemoglobin 15.5, sodium 125, procalcitonin 27.3, and lactic acid 1.8. COVID-19, MRSA, Legionella and Pneumococcal urine antigen were negative. CTA chest revealed mass-like opacity in right upper lobe with multiple bilateral pulmonary nodules. Lower respiratory culture showed Candida albicans. Patient was empirically started on ceftriaxone and azithromycin. He was transferred to intensive care for worsening respiratory status and was placed on non-invasive ventilation on hospital day 1. Antibiotics were broadened to ceftaroline and levofloxacin due to suspicion of tularemia. Amphotericin B was added. Labs for Histoplasma, Blastomyces, TB, Leptospira, and HIV were negative. Patient then suffered a cardiac arrest on hospital day 2 after having large brown secretions pouring from his mouth. Cardiopulmonary resuscitation was initiated and patient was intubated and started on vasopressors with return of spontaneous circulation. Massive blood transfusion protocol was initiated. Emergent bedside upper endoscopy showed large blood clot adherent to duodenal ulcer. Interventional radiology planned on performing gastric duodenal artery embolization. However, patient suffered two more cardiac arrest with resuscitation efforts terminated per family request. Karius Digital Culture later was positive for Francisella tularensis. Autopsy revealed diffuse alveolar hemorrhage, hilar lymphadenopathy, and perforated duodenal ulceration with large adherent clot. DISCUSSION: Gastrointestinal tularemia is rare and usually from drinking contaminated water or oral inoculation of bacteria. Intestinal tract involvement can present with mesenteric lymphadenopathy and ulcerative lesions resulting in gastrointestinal bleeding with case fatality rate of 50%. Even though this is noted in the literature, to our knowledge no case reports have been published. CONCLUSIONS: Careful history taking and early identification of risk factors are important when severe tularemia infection is suspected such as in individuals with extensive outdoor activities. Treatment should be empirically initiated in high risk patients. Reference #1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4585636/ Reference #2: https://casereports.bmj.com/content/2017/bcr-2017-22125. Reference #3: Altman GB, Wachs JE. Tularemia: A pathogen in nature and a biological weapon. Aaohn Journal. 2002 Aug;50(8):373-9. DISCLOSURES: No relevant relationships by Maria Haider Baig
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SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Since the start of Covid-19 pandemic, several respiratory microorganisms have been identified that cause coinfection with Sars-Cov-2. Bacteria like Staphylococcus aureus and viruses like influenza are some of the identified pathogens. Rarely, fungal infections from Aspergillus are also being reported. CASE PRESENTATION: 59-year-old male with past medical history of hypertension and hyperlipidemia was admitted for shortness of breath and was found to be positive for Covid-19. He received Remdesivir, dexamethasone & tocilizumab. He required non-invasive ventilation via continuous positive airway pressure but continued to remain hypoxemic with elevated procalcitonin, he was treated with cefepime for bacterial pneumonia. Patient required emergent intubation and eventually underwent tracheostomy. He developed methicillin-resistant Staphylococcus aureus pneumonia for which he received vancomycin. He was eventually discharged to long term acute care facility. Patient was readmitted after 2 months due to worsening respiratory status. Computed Tomography Angiography of chest was negative for pulmonary embolism but showed pleural effusion. He underwent thoracentesis which showed exudative effusion with negative cultures. Echocardiogram showed right heart failure. Patient's symptoms were believed to be due to Covid-19 fibrosis. He required home oxygen and also received pulmonary rehabilitation. One year after the initial Covid-19 infection, he developed pulmonary hypertension and was referred for lung transplant consultation. However, he developed severe hemoptysis requiring intubation and vasopressors. Galactomannan was positive, Karius digital culture revealed Aspergillus Niger for which he received voriconazole. He was not deemed a suitable candidate for lobectomy. Patient developed arrhythmia and had prolonged QT interval so voriconazole was switched to Isavuconazole. He continued to have hemoptysis and his condition did not improve so family requested to transition care and patient passed away. DISCUSSION: Several studies have proven co-infection of Aspergillus with Covid-19. This case highlights Aspergillus infection approximately 1 year after initial Covid-19 infection. Sars-Cov-2 causes damage to airway lining which can result in Aspergillus invading tissues. IL-6 is increased in severe Covid-19 infection. Tocilizumab is an anti-IL-6 receptor antibody that has been approved for treatment of Covid-19 pneumonia. However, IL-6 provides immunity against Aspergillus so use of tocilizumab decreases protection against Aspergillosis which is usually the reason for co-infection. However, in this case patient developed fungal infection later during Covid-19 fibrosis stage. CONCLUSIONS: Recognizing fungal etiology early on is important in Covid-19 patients as mortality is high and appropriate intervention can reduce morbidity and mortality. Some patient may eventually require lung resection. Reference #1: Kakamad FH, Mahmood SO, Rahim HM, Abdulla BA, Abdullah HO, Othman S, Mohammed SH, Kakamad SH, Mustafa SM, Salih AM. Post covid-19 invasive pulmonary Aspergillosis: a case report. International journal of surgery case reports. 2021 May 1;82:105865. Reference #2: Nasrullah A, Javed A, Malik K. Coronavirus Disease-Associated Pulmonary Aspergillosis: A Devastating Complication of COVID-19. Cureus. 2021 Jan 30;13(1). Reference #3: Dimopoulos G, Almyroudi MP, Myrianthefs P, Rello J. COVID-19-associated pulmonary aspergillosis (CAPA). Journal of Intensive Medicine. 2021 Oct 25;1(02):71-80. DISCLOSURES: No relevant relationships by Maria Haider Baig
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The risk of developing Acute Kidney Injury (AKI) increases manifold during severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Therefore, the aim of this study is to conduct a comprehensive pharmacotherapeutic evaluation of AKI in COVID-19 patients. A retrospective cohort study was conducted from July to August 2021 among COVID-19 patients admitted to the Institute of Kidney Diseases, Hayatabad Medical Complex hospital in Peshawar Pakistan. The data were extracted based on demographics, diagnosis, laboratory parameters, vital signs, and the treatment used during hospitalization. The association of independent variables was explored using parametric statistics such as regression analysis, one-way ANOVA, and Kruskal-Wallis. Data of N=595 COVID-19 patients with positive PCR tests as per pre-defined criteria were collected. It was observed that fever (n=575 [96.6%]), shortness of breath (n=570 [95.8%]), dry cough (n=449 [75.5%]) and body aches (n=129 [21.7%]) were some of the most common symptoms among the patients. Most of the patients were on a multi-drug regimen during hospitalization. Overall, it was observed that most of the laboratory variables significantly declined in COVID-19 patients with Stage III AKI. Mortality among the patients with AKI was 42% [0.418 [0.269 - 0.632], p=<0.001] as compared to non-AKI patients. There was a significant reduction in mortality by 96% (1.968 [1.277 - 3.033], p-0.002) with the use of intravenous dexamethasone. The prime goal of a clinician is to avoid the use of nephrotoxic drugs during hospitalization and maintain adequate oxygen saturation in order to avoid the development of AKI in COVID-19 patients.
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Introduction: Acute eosinophilic pneumonia (AEP) is an uncommon lung disease. Its incidence and epidemiology remain understudied till date. The hypothesized etiology of AEP is an acute hypersensitivity reaction to an inhaled antigen such as tobacco smoke and other peculiar environmental factors. Vaccines as triggers of AEP, albeit very rare, have been reported in the literature. Case presentation: A 64-year-old male with history of hyperlipidemia on atorvastatin presented to the emergency room with complaints of cough productive of pink tinged sputum, exertional shortness of breath, chills and fever with maximum recorded temperature of 101 °F. His symptoms started within a few hours of receiving tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine two days ago. He denied any recent travel. He was a lifelong non-smoker and was employed as hospital case manager. His vitals were significant for tachycardia 116/min, tachypnea 30 breaths/min and SaO2 of 93 % on 10L. On physical examination, he was noted to have coarse and diminished breath sounds in both lung fields. Initial lab work showed elevated leukocyte count of 20.4 k/uL with absolute eosinophil count of 1.6 k/uL. Other labs were unremarkable. Diffuse bilateral reticulonodular and alveolar opacities were visualized on chest X-ray. Computed tomography (CT) of the chest showed profuse pulmonary nodules, scattered ground glass opacities and septal thickening concerning for bilateral multifocal pneumonia (figure 1). Blood cultures and sputum cultures were obtained and he was empirically treated with ceftriaxone and azithromycin. Sputum eosinophil smear was positive raising concerns for fungal and parasitic infections. Cultures remained negative and his hypoxia worsened. Thus, infectious diseases and pulmonology were consulted. Extensive infective disease work-up for bacterial, fungal, parasitic and viral pathogens came back negative. CT guided biopsy of a lung nodule demonstrated interalveolar eosinophil and fibrin deposition consistent with eosinophilic pneumonia (figure 2). Patient was started on glucocorticoids with dramatic improvement in his symptoms, imaging and oxygen needs. With his symptom onset following Tdap vaccine and negative infective work-up, AEP was suspected to be triggered by the vaccine. Discussion: AEP provoked by vaccination is rare. Cases have been reported with influenza, pneumococcal and also COVID-19 vaccines. To the best of our knowledge, this is the first report of AEP following Tdap vaccine in adults. Only up to 30% of patients with AEP will have peripheral eosinophilia. Diagnosis is usually confirmed on lung biopsy and patients respond very well to glucocorticoids.
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Aim: To assess the respiratory outcomes twelve weeks after the management with non-invasive positive pressure ventilation (NIPPV) in patients recovered from severe corona virus disease 2019 (COVID-19). Methodology: The cross-sectional analytical study was conducted in the Department of Pulmonology, Sir Ganga Ram Hospital Lahore between October 2020 and March 2021. Total 124 patients visiting the hospital twelve weeks after recovery from COVID-19 were enrolled using convenience sampling. After excluding patients with a history of previous respiratory symptoms before the development of COVID-19, data from 87 patients who required oxygen >15 L/minute and NIPPV support were subjected to final analysis. Results: The proportion of middle-aged adults was 52.9%, males 64.4% and smokers 49.4%. Twelve weeks after treatment with NIPPV, O2 saturation <97.0% at rest was found in 97.7% patients, PR >100 at rest in 16.1% patients, severe dyspnea in 65.5% patients, O2 dependency >5 L/min in 2.3% patients, severe CXR abnormalities in 20.7% patients and lung fibrosis in 27.6% patients. The distribution of SpO2, PR, and dyspnea status twelve weeks after recovery from severe COVID-19 were not significantly different between NIPPV duration groups (p-value >0.05). However, the number of patients with O2 dependency, severe CXR abnormality, and lung fibrosis were significantly different between NIPPV duration groups (all p-values <0.05). Conclusion: Oxygen desaturation, severe dyspnea and severe CXR abnormalities twelve weeks after the treatment with NIPPV were common among patients recovered from COVID-19. Severe CXR abnormality, lung fibrosis, and O2 dependency were significantly associated with prolonged duration of NIPPV.
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Background. Finding reliable clinical predictors for severity of COVID-19 has been challenging. Interferon gamma (IFNG) plays an important role in viral replication. QuantiFERON-TB (QFT) test relies on IFNG release in response to antigens. A positive or negative test signifies adequate IFNG response, whereas an indeterminate result is obtained when such a response is lacking. In this study, we have attempted to see if an indeterminate QFT result can provide prognostic information on patients with COVID-19. Survival Probability in patients with Covid - 19 and an indeterminate TB Quantiferon test result Methods. This is a retrospective study of patients who were admitted at our institute with COVID-19 and had a QFT done within one month of the positive SARSCoV-2 nucleic acid amplification test result. Patient charts were analyzed for clinical course and outcomes, including in-hospital mortality (primary outcome), 90-day mortality, respiratory failure, requirement for intubation and other complications that would portend a more severe disease course. Results. A total of 120 patient charts were analyzed, out of which 43 (35.8%) had an indeterminate QFT. All the indeterminate results were due to an inadequate mitogen response. The indeterminate QFT group had a 41.86% (18/43) in-hospital mortality vs. 9.09% (7/77) in the negative or positive QFT group (p-value of < 0.001). The 90-day mortality was similar between the two groups. Patients with indeterminate QFT also had a higher incidence of respiratory failure (97.7% vs. 75.3%;p-value = 0.020), requirement for mechanical ventilation (55.8% vs. 23.4%;p-value < 0.001), requirement of ECMO (25.58% vs. 0%;p-vale < 0.001), requirement of pressor (48.83% vs. 14.28%;p-value < 0.001) and requirement for renal replacement therapy (32.5% vs. 1.3%;p-value < 0.001), when compared to patients with a negative or positive QFT. Patients in indeterminate group had a higher hospital length of stay than the other group (p-value = 0.035). Conclusion. Our study indicates that patients with COVID-19 who fail to mount an adequate IFNG mitogen response in QFT assay have worse clinical outcomes and a more complicated and protracted clinical course. Evaluating cell-mediated immune responses through commercially available IFNG release assays may yield a promising strategy to predict COVID-19 clinical outcomes.
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Recently, the world is going through a global pandemic COVID-19 caused by SARS—COV2. Which has raised huge and difficult challenges in front of world for every layer of society and from every aspect, be it economy crisis, temporary unemployment, starvation, collision of fundamental services, educational pause, it has affected every sector globally. This disease is hitting the medical system of almost 213 countries brutally. If we talk about health issues raised by global pandemic, so at one side where it is drastically dangerous for physical health of a person, at the same time, there are many psychological impacts of COVID-19 on human health. Its highly spreading nature is the reason why restrictions have been made to cope against its growth throughout the world, due to which almost everyone whether they are student, teachers, business persons, is locked inside to stop the outbreak of this virus. Now this situation leads to the mental health issues in people sitting far apart from each other since long, a feeling of loneliness, anxiety, depressive symptoms, and other negative emotions of mental illness can be seen largely in people during pandemic around the globe. There could be many reasons, like sitting at home for so long, fear of being infected by the virus, bereavement, rumors and myths in the society about diseases and what not. The main aim of this work is to implement the dataset gathered in the direction of getting useful information and generating results out of it, to study the psychological impacts of COVID-19 on human health, what are the different symptoms, what could be the reasons, and a general solution roadmap to the respective problem. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Objective: To establish correlation between serum albumin during early days of ICU admission and risk of death in COVID-19 pneumonia. Methods: In this retrospective study, we included 76 patients hospitalized in ICU, who stayed for at least four days with COVID-19 pneumonia, from May 1, 2020 to June 30, 2020 in Lahore Health Care Hospital and Al-Shafi Hospital. Patients were labelled as COVID-19 pneumonia on radiological basis as bilateral 'ground-glass opacity' in lower zones and RT-PCR positive result in nasopharyngeal swab. All patients were oxygen dependent, either on high flow oxygen via non rebreathing mask or invasive positive pressure ventilation support. Serum albumin levels were measured daily from first day to fourth day of ICU admission. The data was analyzed using SPSS version 26 and Microsoft excel 2016. Results: Out of 76 patients of COVID-19 pneumonia admitted in ICU who stayed for more than four days, 38 patients expired. The mean age of all the patients was 58.9±12.56 years, 38(50%) of the patients were ≥60 years and 49 (62%) of them were male. On day four of ICU admission, mean serum albumin of discharged patients was 3.83±0.22 g/dl while mean serum albumin level of expired patients was 2.96±0.46 g/dl. Strong negative correlation (r = -767) was found between decrease in serum albumin level and increase number of deaths from COVID-19 pneumonia. Weak correlation was observed between increase in serum CRP and increase number of deaths in the same patients. Conclusion: Daily monitoring of serum albumin level of COVID-19 pneumonia patients can be used as a biological marker for monitoring of cytokine storm and risk of death in COVID-19 pneumonia.
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Objective: To measure the satisfaction level of COVID-19 patients regarding their physical therapy services in Islamabad Methodology: This cross-sectional study was conducted at Riphah International Hospital and Max Health Hospital, Islamabad from March to July 2020 and comprised 47 patients suffering from COVID-19. A semi-structured questionnaire was used to collect data. We used Short-Form Patient Satisfaction Questionnaire and Medrisk instrument. Data were analyzed using SPSS-23. Results: Out of the 47 subjects, 22(46.8%) were males and 25(53.2%) females. Mean age was 26.36 +/- 7.37 years. The satisfaction response was positive in 43(91.5%) cases and negative in 4(8.51%) cases (p<0.05) Conclusion: Satisfaction level of physiotherapy services was mostly positive among the COVID-19 patients.
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Coronavirus - 2019 (COVID-19)-a respiratory syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2)-is responsible for the world's latest pandemic unlike any seen since the 1980s HIV/AIDs pandemic. While significant effort has been made towards acute management, long-term management has received less attention. To address this, our study identified patients diagnosed with COVID-19 and recorded the time to enrollment into a formal pulmonary rehabilitation program at an academic center;the differences in time allowed us to assess whether earlier enrollment led to differences in physiologic and psychologic outcomes. First, we hypothesize that enrollment into a pulmonary rehabilitation program is essential to a patient's long term treatment and management of post-infectious, chronic COVID-19 symptoms. Second, we aim to demonstrate that early participation leads to improvements in dyspnea, anxiety and depression as supported by the UCSD SOBQ, GAD-7 and PHQ-9 scores respectively. Through chart review, we collected data from 24 patients enrolled in a post-COVID recovery program centered around pulmonary rehabilitation at an academic medical center in Texas. We administered: (1) pulmonary function test (PFT);(2) University of California - San Diego (UCSD) Dyspnea Questionnaire;and (3) six-minute walk (6MW) tests when a patient entered and completed the program. We used this data to assess for subjective and objective changes in respiratory function postrehabilitation. To analyze the indirect benefits of pulmonary rehabilitation on mental health effects of COVID-19, we used the Generalized Anxiety Disorder 7 (GAD7) and Patient Health Questionnaire (PHQ9) questionnaires to evaluate a patients' anxiety and depression respectively at the same time points. Our results showed that it took patients an average 67.8 days to initiate rehabilitation after initial diagnosis. 13 of 24 patients began rehab earlier than the average and had an average decrease in UCSD SOBQ score of 35.6 and 6MW increase of 64.5 m compared to the group averages of 17.8 and 74.7 m respectively. The average initial GAD7 and PHQ9 scores were 6.7 and 8.7, with an average decrease of 1.5 and 2.2 respectively. Through our study, we highlight the benefit of early initiation of pulmonary rehabilitation in the post-COVID 19 recovery period. Through both subjective and objective measurements of patient respiratory function and mental health, our study supports inclusion and standardization of early pulmonary rehabilitation as a component of COVID-19 recovery.
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Introduction: On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization. The disease has had a major impact on public health and the global economy with more than 70 million people infected worldwide and more than 1.5 million mortalities. However, less is known about the long-term consequences of the disease. Objective: Evaluate the long-term health effects of COVID-19 on hospitalized and non-hospitalized subjects. Methods: We identified all patients who presented to the COVID-19 recovery clinic at the University of Texas Medical Branch (UTMB) in the period from March 16, 2020, to October 8, 2020. Data regarding persistent symptoms, patient health questionnaire (PHQ-9) score, generalized anxiety disorder (GAD- 7) questionnaire score and six-minute walk distance was collected. Comparisons between patients with a history of hospitalization for COVID-19 related symptoms and those who were not hospitalized were performed using Chi-square test or Fisher's exact test for categorical variables, and independent t-test for numeric values. Results: We identified a total of 93 patients who presented to the COVID-19 recovery clinic during the study period. Patients were predominantly females (69.9%), mean age was 52 years and the majority were white (58%). Obesity (body mass index ≥30) was present in 62% of subjects and 73% had at least one comorbidity. The most common noted comorbidities were hypertension (53.8%), asthma (29%) and diabetes (22.6%). The mean duration from positive COVID-19 test to clinic visit was 62 days (Table 1). Persistent fatigue, cough and dyspnea on exertion were reported by 60%, 57% and 56% of patients, respectively. The mean six-minute walk distance was 952 feet. Of the entire cohort, 46 (49.5%) were not hospitalized for COVID-19 related symptoms, these patients were younger (48 vs 56 years, P 0.006), and out of the comorbidities studied, obesity was less common (50% vs 74.4%, P 0.037) compared to those who were hospitalized. The mean six-minute walk distance was greater in the non-hospitalized cohort (1067 vs 841 feet, P 0.016) compared to those who were hospitalized. There was no difference between both groups in the prevalence of persistent symptoms, depression or anxiety. Conclusion: Persistent symptoms including fatigue, dyspnea, depression and anxiety were common in patients who recovered from COVID-19, regardless of their hospitalization history. Performance on the six-minute walk test was lower in patients who were hospitalized.
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Rationale: Medical trainees are at risk of psychological and emotional distress during the coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to assess the prevalence and explore the factors associated with depression and anxiety among medical trainees taking care of patients with COVID-19 in the United States (US). Methods: The study is cross-sectional, anonymous, web-based survey of medical trainees distributed in the US via email and social media between April 14, 2020 and May 5, 2020. Participants were stratified based on whether they were in a residency or fellowship program. Practice settings were stratified based on hospital type (academic or community-based) and location. Study outcomes were prevalence and factors associated with depression and anxiety using the 9-item Patient Health Questionnaire (PHQ-9;range: 0- 27) and the 7-item Generalized Anxiety Disorder (GAD 7;range 0-21) questionnaires, respectively. Univariate analysis utilizing summary statistics and Chi-square test were performed to show the association of covariates with outcomes. We performed a multivariate analysis with logistic regression for each outcome. A p-value < 0.05 was considered significant. Results: In all, 239 trainee submitted surveys, predominantly females (51.9%), aged 31-40 (52.3%), and non-Hispanic White (59.8%). Overall, the prevalence for both depression and anxiety was 45.6%. Higher likelihood of depression and anxiety was observed among medical trainees who have COVID-19 exposure, those uncomfortable with infection control policies, and those not provided adequate PPE. Trainees who reported increased stress due to didactics, and those who had continued didactics once a week, also had a higher likelihood of depression and anxiety. Depression alone was more common in those who provided service in emergency department (ED).Multivariate analysis (Table 1) revealed greater odds of depression among females (odds ratio [OR] = 1.95;95% confidence interval [CI] = 1.01-3.74), and those who reported increased stress due to didactics (OR = 4.1;95% CI = 2-8.4). Similarly increased odds for anxiety were observed among medical trainees, and those who reported increased stress due to didactics (OR = 2.6;95% CI = 1.3-5.2). Conclusion: The majority of trainees surveyed had a high burden of depression and anxiety early in the COVID- 19 pandemic in the US, which was associated with increased stress due to didactics. Organizations and institutions will need to develop preventive and management strategies to optimize and sustain the mental health of medical trainees, particularly under pandemic conditions.
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Although several pharmacological agents are under investigation to be repurposed as therapeutic against COVID-19, not much success has been achieved yet. So, the search for an effective and active option for the treatment of COVID-19 is still a big challenge. The Spike protein (S), RNA-dependent RNA polymerase (RdRp), and Main protease (Mpro) are considered to be the primary therapeutic drug target for COVID-19. In this study we have screened the drugbank compound library against the Main Protease. But our search was not limited to just Mpro. Like other viruses, SARS-CoV-2, have also acquired unique mutations. These mutations within the active site of these target proteins may be an important factor hindering effective drug candidate development. In the present study we identified important active site mutations within the SARS-CoV-2 Mpro (Y54C, N142S, T190I and A191V). Further the drugbank database was computationally screened against Mpro and the selected mutants. Finally, we came up with the common molecules effective against the wild type (WT) and all the selected Mpro. The study found Imiglitazar, was found to be the most active compound against the wild type of Mpro. While PF-03715455 (Y54C), Salvianolic acid A (N142S and T190I), and Montelukast (A191V) were found to be most active against the other selected mutants. It was also found that some other compounds such as Acteoside, 4-Amino-N- {4-[2-(2,6-Dimethyl-Phenoxy)-Acetylamino]-3-Hydroxy-1-Isobutyl-5-Phenyl-Pentyl}-Benzamide, PF-00610355, 4-Amino-N-4-[2-(2,6-Dimethyl-Phenoxy)-Acetylamino]-3-Hydroxy-1-Isobutyl-5-Phenyl-Pentyl}-Benzamide and Atorvastatin were showing high efficacy against the WT as well as other selected mutants. We believe that these molecules will provide a better and effective option for the treatment of COVID-19 clinical manifestations.
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Background and importance The importance of health promotion and disease prevention among the general public has been reinforced following the COVID-19 pandemic. Although national campaigns have been active for years, reports have highlighted the opportunities for the greater use of pharmacy teams for improving this, in light of their location, accessibility, convenience and relationship with the public. Aim and objectives To assess the level of knowledge on important health topics of patients and learn their preferences for future learning in order to develop a targeted and effective health promotion programme. Material and methods In July 2019, patients waiting for a prescription to be filled in a hospital outpatient pharmacy were approached for inclusion in the study. Those who consented were interviewed via a confidential questionnaire (revised following a pilot on 5 patients) until 100 patients were recruited. The results were submitted into Excel for analysis. Results The participation rate was approximately 30% (47% men and 53% women, aged 18-70 years). Approximately 10% of patients were unaware of the risks of high blood pressure and 28% had never had their blood pressure monitored. 28% did not know the maximum recommended units of alcohol permitted per week. All smokers (28%) had been unsuccessful in previous attempts to stop smoking. Although all patients were aware of the correct signs of breast cancer, 17% of patients were unsure of the signs of prostate cancer. 40% of patients were unable to give two correct symptoms of depression and some patients mentioned inaccurate ones. Although over 75% of patients preferred to receive health promotion information via a one-to-one consultation with pharmacy staff, 74% of patients thought watching health promotion videos while waiting for a prescription was a good idea. All patients had access to a mobile phone or a computer and were happy to receive information via their electronic devices. Conclusion and relevance The study highlighted gaps in knowledge, particularly in the areas of alcohol intake, depression and prostate cancer, giving ideas of where to target future health promotion campaigns. Although patients prefer personal consultations with pharmacy staff, novel ways of delivering health promotion, including the use of phones and electronic devices, should be considered.