The shock of the SARS-CoV-2 pandemic on health professionals’ education: A pilot qualitative study in Malaysia

Various measures were introduced globally to prevent the spread of COVID-19, including travel restrictions, social distancing, and closure of educational establishments. Implementing these measures resulted in appreciable changes to health professions’ education (HPE) with concerns regarding the level of preparedness among faculty members and students towards e-learning, including laboratory, clinical, and other forms of hands-on training. In addition, the affordability of devices and Internet bundles arose, especially among students in low and middle-income countries. A pilot qualitative study was conducted in Malaysia to ascertain critical challenges and how higher learning establishments addressed them. The study was undertaken among 10 purposely selected educators in both public and private universities in Malaysia using an established questionnaire to ascertain critical challenges and responses. The main issues included unfamiliarity with e-learning approaches and inadequate availability of devices and Internet bundles among students. Furthermore, the study revealed a lack of interaction between faculty members and students, concerns with conducting practicals and clinical examinations, and mental distress among faculty members. Measures introduced to address concerns included supporting digital needs through the provision of software, devices, and Internet bundles, enhanced training of educators in e-learning approaches, providing clinical case banks and curated patient data, and establishing clear policies and procedures for classroom and clinical teaching. Psychological support, including stress management, was also provided. The challenges and lessons learned in Malaysia regarding HPE during the pandemic were similar to other countries with hybrid learning here to stay. © 2022 Ambigga Krishnapillai et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).

SARS-COV-2 EPIDEMIOLOGY, PREVENTION, RISK FACTORS, EVALUATION, DIAGNOSIS, MANAGEMENT AND VACCINES

What we have learned about COVID-19 is ongoing as research continues to evolve. This article will serve to provide a succinct, comprehensive overview of SARS-CoV-2 with respect to epidemiology, risk factors, prevention, presentation, management and vaccinations.

COVID-19 vaccination and breakthrough infections in patients with cancer.

BACKGROUND: Vaccination is an important preventive health measure to protect against symptomatic and severe COVID-19. Impaired immunity secondary to an underlying malignancy or recent receipt of antineoplastic systemic therapies can result in less robust antibody titers following vaccination and possible risk of breakthrough infection. As clinical trials evaluating COVID-19 vaccines largely excluded patients with a history of cancer and those on active immunosuppression (including chemotherapy), limited evidence is available to inform the clinical efficacy of COVID-19 vaccination across the spectrum of patients with cancer. PATIENTS AND METHODS: We describe the clinical features of patients with cancer who developed symptomatic COVID-19 following vaccination and compare weighted outcomes with those of contemporary unvaccinated patients, after adjustment for confounders, using data from the multi-institutional COVID-19 and Cancer Consortium (CCC19). RESULTS: Patients with cancer who develop COVID-19 following vaccination have substantial comorbidities and can present with severe and even lethal infection. Patients harboring hematologic malignancies are over-represented among vaccinated patients with cancer who develop symptomatic COVID-19. CONCLUSIONS: Vaccination against COVID-19 remains an essential strategy in protecting vulnerable populations, including patients with cancer. Patients with cancer who develop breakthrough infection despite full vaccination, however, remain at risk of severe outcomes. A multilayered public health mitigation approach that includes vaccination of close contacts, boosters, social distancing, and mask-wearing should be continued for the foreseeable future.

Concordance between the physician's and the patient's assessment of disease activity in rheumatoid arthritis: Results of the autodas-meac study at one year

Background: Involving the patients with rheumatoid arthritis (RA) in the assessment of their disease may increase their adherence to treatment, improve the disease outcomes and facilitate the application of telehealth. We previously reported an excellent concordance between the Disease Activity Score (DAS-28) performed by physicians and patients at the baseline visit of this prospective study (1). Objectives: To evaluate the persistence of the concordance between the physician' and the patient's assessment of disease activity in RA using DAS-28 after one year. Methods: At the baseline visit, patients with RA from 7 Middle Eastern Arab Countries (MEAC) were briefed about DAS-28 by their rheumatologist during a routine consultation and given smartphone access to a video in Arabic language explaining the performance of DAS-28. At 3, 6 and 12 months (± 3 months), the patients were asked to self-report DAS-28, blinded to the physician's assessment. Concordance between the continuous DAS-28 at each visit was calculated using paired t-test numerically and the Bland-Altman method graphically. Agreement between physician-and patient-DAS categories (remission, low-, moderate-and high disease activity) was calculated at each visit using weighted kappa for category comparison. Weighted kappa of the different agreements were compared over time using their respective confidence intervals (CIs). Predictive factors of positive concordance between physician and patient-DAS were identified using binary logistic regression. Results: The study included 428 patients over a period of three years (2018 to 2020). The mean age of participants was 49.8 years, 82.5% were females, 44.3% had a university degree and the mean disease duration was 11.4 years. At baseline, the average patient-DAS was higher (4.06 (±1.52)) than the physician-DAS (3.97 (±1.52)). The mean difference was -0.09 [95%CI -0.14;-0.04] and most of the pairs were within the limit of agreement in the Bland-Altman graph, indicating a good concordance, particularly in cases of remission. During the study follow-up, 299 patients consulted for visit 2 (69.9% of the total population), 232 for visit 3 (54.2%) and 199 for visit 4 (46.5%). The weighted kappa was 0.80 [95%CI 0.76;0.85] at visit 1 and 0.79 [95%CI 0.72;0.88] at visit 4 (Figure 1 showing kappa for DAS-28, CDAI and SDAI as well). A minor numerical decrease in kappa was observed over time;however, the CIs were overlapping over the four visits and the agreement was considered stable, remaining in the excellent range. At visit 4, a positive concordance between the physician-and the patient-DAS was associated with the profession (lower in blue collar, p=0.001), the educational level (higher in high school and university, p=0.034) and the baseline physician's DAS (higher in high disease activity, p=0.46). Conclusion: The agreement between the DAS-28 performed by the physician and by the patient was excellent at baseline and remained stable over one year. A positive concordance was associated with the profession, the educational level and the level of disease activity. The present study can help the rheumatologist make informed decisions about the patients who may be suitable for a remote evaluation of their disease activity, that can be of particular interest in the context of the COVID-19 pandemic.

Tuberculosis versus covid-19 mortality: A new evidence

BACKGROUND: Coronavirus current pandemic (COVID-19) is the striking subject worldwide hitting countries in an unexplained non-universal pattern. Bacillus Calmette–Guérin (BCG) vaccine was an adopted recent justification depending on its non-specific immune activation properties. Still the problem of post-vaccine short duration of protection needs to be solved. The same protective mechanism was identified in active or latent tuberculosis (TB). For each single patient of active TB, there are about nine cases of asymptomatic latent TB apparently normal individuals living within the community without restrictions carrying benefits of immune activation and involved in re-infection cycles in an excellent example of repeated immunity training sessions of the whole community. AIM: We aimed to asses the correlation between TB burden and COVID-19 mortality in all affected countries having different BCG vaccination policies. METHODS: Publicly available data were extracted for 191 countries including population size, TB estimations, national BCG vaccination policy, the World Health Organization regions and economic classification, and COVID-19 mortality and number of cases. The analysis was performed using Spearman’s correlation test. RESULTS: Significant large negative correlation (−0.539, p < 0.001) was found between TB prevalence and COVID-19 mortality rate worldwide. Medium negative significant correlations were found between TB cases and COVID-19 mortality in the high and lower middle-income countries, and those having current BCG vaccination programs (−0.395, p = 0.001, −0.365, p = 0.015, and −0.476, p < 0.001, respectively). CONCLUSION: Countries with high TB prevalence have higher chances of protection against COVID-19 mortality through the theory of widely distributed natural immune activation within community. Confounders should be assessed separately.