Impact of the Covid-19 Pandemic in Patients Attending Renal Clinic at Kingston Public Hospital, Jamaica

Introduction: Early in the pandemic various lockdown measures were implemented to decrease spreading of Covid-19. This resulted in many clinics and hospitals observing a decrease in the usual numbers of patients accessing care. Patients have also expressed fears and challenges with accessing care at health clinics and hospitals during this time. Since May 2020, there has been a gradual decrease in the restrictions and stay at home orders for Covid-19 by the government in Jamaica and more persons have begun to access care again at health facilities. The impact of the Covid-19 pandemic in patients with chronic kidney disease especially those who were not admitted with Covid-19 is limited. This study seeks to determine why patients were not accessing care early in the pandemic and the possible longer-term impact of the Covid-19 pandemic on the care and prognosis of patients with chronic kidney disease. Method(s): All patients who attended Renal clinic, Kingston Public Hospital (KPH) from April 20th to July 14th 2021 were eligible for inclusion in the study. Those who consented to participate in the study had an interview with the researcher at the Renal clinic where a questionnaire was administered. Demographic data was collected as well as whether they were a new or follow-up patient and number of appointments missed was noted. Their renal diagnosis and labs were obtained from their dockets by the researchers. The data was analysed using Microsoft excel and Epi info software Results: There were 185 participants. 45.7% of the participants were 51 to 70 years old. 61.1% were females and 38.9% were males. Follow-up patients accounted for 76.2% of the participants whilst 23.8% were new patients. 92.2% of the follow-up patients reported attending clinic in the past year. 15.1% of the participants reported missing at least one appointment in the past year. Most common reasons given for missing appointments were forgot date of appointment, afraid of coming to hospital, was sick at home or admitted to hospital. 2.7% of the participants reported having had Covid-19. Only 7.0% of the study participants were on dialysis. 76.9% of those receiving dialysis were started on haemodialysis since March 2020. 93.0% reported receiving all or most of their medications through the free public health care system during the pandemic. 44.3% of the participants reported working in the past year. Most common reasons given for not working in the past year were medical condition, receiving family support or retired. Only 3.6% reported being sent home by an employer due to the pandemic. The most common renal diagnoses were diabetic nephropathy and hypertensive nephrosclerosis followed by lupus nephritis and sickle cell nephropathy. 49.2% were CKD stage 3b to Stage 5. 14.6% of those who were CKD stage 3 near to March 2020 progressed to CKD stage 4 or 5 by a year later. Conclusion(s): During the pandemic, attendance of patients at Renal clinic, Kingston Public Hospital and their access to medications remained high. Approximately 15% of those with CKD stage 3 near the onset of the pandemic progressed to CKD stage 4 or 5 by a year later. This warrants further study. No conflict of interestCopyright © 2023

A hitchhiker's guide to mucosal and systemic immunity.

PEGylated lipid protein immunogens delivered intranasally to mice and macaques drive production of IgG and IgA antibodies at other mucosal sites (Hartwell et al.).

Improved Target-specific Stance Detection on Social Media Platforms by Delving into Conversation Threads (preprint)

Target-specific stance detection on social media, which aims at classifying a textual data instance such as a post or a comment into a stance class of a target issue, has become an emerging opinion mining paradigm of importance. An example application would be to overcome vaccine hesitancy in combating the coronavirus pandemic. However, existing stance detection strategies rely merely on the individual instances which cannot always capture the expressed stance of a given target. In response, we address a new task called conversational stance detection which is to infer the stance towards a given target (e.g., COVID-19 vaccination) when given a data instance and its corresponding conversation thread. To tackle the task, we first propose a benchmarking conversational stance detection (CSD) dataset with annotations of stances and the structures of conversation threads among the instances based on six major social media platforms in Hong Kong. To infer the desired stances from both data instances and conversation threads, we propose a model called Branch-BERT that incorporates contextual information in conversation threads. Extensive experiments on our CSD dataset show that our proposed model outperforms all the baseline models that do not make use of contextual information. Specifically, it improves the F1 score by 10.3% compared with the state-of-the-art method in the SemEval-2016 Task 6 competition. This shows the potential of incorporating rich contextual information on detecting target-specific stances on social media platforms and implies a more practical way to construct future stance detection tasks.

Effect of the COVID-19 Pandemic on Infra-Inguinal Vein Bypass Graft Surveillance DUS Scans: Single Unit Experience

Introduction: Vein bypass graft surveillance has been a controversy in the literature. The pros are that it allows early detecting of graft complications and intervention;however, the cons are its time and cost burden, without significant benefit. The established practice in our unit is to offer duplex ultrasound (DUS) scan for patients who had infra-inguinal bypass surgeries using autogenous veins for the first two years. Scans should be done at six weeks, three months, six months, one year, and two year intervals. Our aim was to compare graft surveillance scan practice during the COVID-19 pandemic to practice in previous years. Methods and data collection: We collected the data from electronic patients records completed by the unit for two years on 2016 – 2017 and from March 2020 until the end of February 2021. Patients who are scheduled for scans but have not yet reached the scan date were counted in the non-applicable group. We included only the first six months of graft surveillance. Results: Thirty-four patients had bypass at this time;four patients were excluded as two of them had predischarge occlusion, one was done using synthetic graft, and a patient passed away after discharge. The six week scan compliance was as follows: 17 scans were successfully done;11 scans were not done;and five patients were non-applicable. The three month scan compliance was as follows: 11 scans were successfully done, 17 scans were not done, and five scans were non-applicable. The six month scan compliance was distributed as follows: one scan was done;19 scans were not done;and 12 scans were non-applicable. Graft surveillance compliance percentages between 2016 and 2017 to the COVID-19 pandemic year (March 2020 – March 2021) were as follows: six week scan compliance was 86% – 60%;three month scan compliance was 79% – 42%;and six month compliance was 76% – 39%. Six interventions were offered to bypass patients based on the findings of DUS graft surveillance: five patients had graft angioplasty and one had graft thrombolysis. A predischarge surveillance scan was done for 12 patients, representing 36% of the total number of patients. The findings detected three patent grafts, one graft had mild stenosis, five grafts had moderate stenosis, one graft had severe stenosis, and two grafts had complete occlusion. Conclusion and recommendations: The COVID-19 pandemic has negatively affected the number of graft surveillance scans. A predischarge graft surveillance scan was found useful as it detected significant findings that could be missed upon discharge. Therefore, when there are constraints on getting surveillance scans during the COVID-19 pandemic, it is reasonable to do predischarge scans to identify patients who would be at a higher risk of developing graft complications. [Formula presented]

MOULDING THE EXCELLENCE OF HUMAN RESOURCES - 'TEACHERS AND STUDENTS' THROUGH RESILIENCE IN THIS POST-PANDEMIC ERA

Human Resource excellence throughmanagement paradigms and passion is the latest footstep in the organization. "Each individual creature on this beautiful planet is created by God to fulfil a particular Role" (Dr. A.P.J. Abdul Kalam). Taking this uniqueness into consideration, this study creates and makes a new path, and welcomes all individuals to their passion zone. Human resource excellence through resilience is a recent area of research in the organization to overcome all pitfalls of the work. A contemporary field of research in the organisation is human resource excellence through resilience to overcome all difficulties at work. All institutions are closed as a result of the COVID-19 pandemic wave in order to lower the disease's prevalence. It spread quickly throughout the entire world and peaked in February and March. Thus, it has an impact on the entire education sector. The traditional lecture method of instruction has been replaced with a virtual classroom system due to the spread of the virus and the lockdown system. Even though the abrupt change had an impact across the board, instructors and kids were the most troubled by the situation's repercussions. Therefore, the teachers who taught the tenth, eleventh, and twelfth graders who take the public exams are the main subject of this study. This study aims to reduce the stress, worries, and technological issues that teachers and the students are experiencing. The study is conducted on 60 teachers who are working in a college. The result shows that resilience has prevented negative mental health, and stress in work and increased the well-being of employees, and has created signature strength in their work.

Moulding and Sustaining Excellence and Passion of Teachers through Resilience in the Post-Covid-Pandemic Era

Human resource excellence through resilience is a recent area of research in organisations to overcome all pitfalls of the workforce. Due to the pandemic wave of COVID-19, all institutions were closed for reducing the crisis dilemma;the entire world was affected especially the education sector. The lockdown system throughout the world arose out of the Corona epidemic and has created changes in the model of teaching, that is, from a conventional-lecture method to a virtual classroom system. Though the sudden shift affected the entire sector of education, the aftermath of this situation has adversely disturbed the college teachers and students. This study aimed at reducing the stress, worries and technological issues that college teachers are experiencing in Thrissur district, Kerala. By following a simple random sampling method, the study was conducted among 268 teachers who were working in a college by administering a self-structured questionnaire. The result through the SEM analysis has shown that resilience has prevented negative mental health, and stress in work while there was an increased work?life balance, that is, the well-being of teachers. It has created a signature strength in their work.

Assessment of Simulated Surveillance Testing and Quarantine in a SARS-CoV-2-Vaccinated Population of Students on a University Campus.

Importance: The importance of surveillance testing and quarantine on university campuses to limit SARS-CoV-2 transmission needs to be reevaluated in the context of a complex and rapidly changing environment that includes vaccines, variants, and waning immunity. Also, recent US Centers for Disease Control and Prevention guidelines suggest that vaccinated students do not need to participate in surveillance testing. Objective: To evaluate the use of surveillance testing and quarantine in a fully vaccinated student population for whom vaccine effectiveness may be affected by the type of vaccination, presence of variants, and loss of vaccine-induced or natural immunity over time. Design Setting and Participants: In this simulation study, an agent-based Susceptible, Exposed, Infected, Recovered model was developed with some parameters estimated using data from the 2020 to 2021 academic year at Duke University (Durham, North Carolina) that described a simulated population of 5000 undergraduate students residing on campus in residential dormitories. This study assumed that 100% of residential undergraduates are vaccinated. Under varying levels of vaccine effectiveness (90%, 75%, and 50%), the reductions in the numbers of positive cases under various mitigation strategies that involved surveillance testing and quarantine were estimated. Main Outcomes and Measures: The percentage of students infected with SARS-CoV-2 each day for the course of the semester (100 days) and the total number of isolated or quarantined students were estimated. Results: A total of 5000 undergraduates were simulated in the study. In simulations with 90% vaccine effectiveness, weekly surveillance testing was associated with only marginally reduced viral transmission. At 50% to 75% effectiveness, surveillance testing was estimated to reduce the number of infections by as much as 93.6%. A 10-day quarantine protocol for exposures was associated with only modest reduction in infections until vaccine effectiveness dropped to 50%. Increased testing of reported contacts was estimated to be at least as effective as quarantine at limiting infections. Conclusions and Relevance: In this simulated modeling study of infection dynamics on a college campus where 100% of the student body is vaccinated, weekly surveillance testing was associated with a substantial reduction of campus infections with even a modest loss of vaccine effectiveness. Model simulations also suggested that an increased testing cadence can be as effective as a 10-day quarantine period at limiting infections. Together, these findings provide a potential foundation for universities to design appropriate mitigation protocols for the 2021 to 2022 academic year.

COVID-19 in the absence of eosinophils: a case series of confirmed infection whilst on treatment with benralizumab

BackgroundBlood eosinopaenia was one of the earliest reported findings in hospitalised patients with COVID-19, questioning whether eosinophils could have an anti-viral or deleterious role in the immune response against SARS-CoV2. Benralizumab is an anti-IL5R monoclonal antibody licensed for the treatment of severe eosinophilic asthma (SEA) and causes the near-complete depletion of blood and tissue eosinophils. As such, it offers the opportunity to explore the impact of eosinopaenia at the time of infection on outcome with COVID-19.MethodPatients started on treatment with benralizumab (up until April 2021) for SEA at our regional asthma centre were contacted by telephone throughout May and June 2021 to establish whether they had experienced a confirmed (PCR-positive) SARS-CoV2 infection since commencing benralizumab. Clinical and demographic characteristics were recorded along with the outcome of infection, including the need for hospitalisation or intensive care admission. Patients requiring hospitalisation were compared to those experiencing mild infections.ResultsData on 268 patients treated with benralizumab was collected with 24/268 (9%) confirming SARS-CoV2 infection with a positive PCR test. Of these 18/24 (75%) experienced mild infections that did not require hospitalisation. Of the 6/24 requiring hospitalisation, the median (IQR) length of stay was 6 (1–8) days. No patients required ICU admission or mechanical ventilation. There was no significant difference in baseline characteristics between hospitalised and non-hospitalised patients. However, it is noteworthy that a higher proportion of hospitalised patients were male (50.0% vs 38.9%) and had a higher mean BMI (32.1 vs 29.5).DiscussionIn the context of drug-induced eosinopaenia with benralizumab, 75% of patients with severe asthma experienced mild COVID-19 disease. This is likely to be an underestimate given that other patients may have experienced an asymptomatic infection or not pursued PCR testing in the context of mild infection. Although caution is needed due to the small sample size, these results do not support a significant role for eosinophils in SARS-CoV2 infection.

P39. Telehealth and spine care: Surgeon experiences and perceptions

BACKGROUND CONTEXT Telehealth use in spine surgery has become widespread due to the COVID-19 pandemic. The degree of global adoption remains unknown. To our knowledge, this is the first global survey to directly evaluate provider perspectives surrounding telemedicine use-cases. PURPOSE To elicit the extent of adoption of international spine telehealth. We aimed to explore telemedicine platform used, ease of use, and acceptable use-cases. STUDY DESIGN/SETTING Cross-sectional email survey, international. PATIENT SAMPLE Spine Surgeons. OUTCOME MEASURES Perspectives and practices of spine telemedicine. METHODS An anonymous, cross-sectional email survey was sent to the members of AO Spine. Survey questions covered provider experiences with and perceptions of telemedicine. Descriptive statistics were used to depict responses and responses were compared amongst regions. RESULTS A total of 485 spine providers responded to the survey. As of May 2020, telemedicine usage comprised >39.0% of all visits — up from <10.0% of visits pre-pandemic. A majority of providers (60.5%) performed at least 1 telemedicine visit. The format of “telemedicine” varied widely by region: African (45.2%) and European (50.0%) providers were more likely to use phone calls (no video), whereas North (66.7%) and South American (77.0%) surgeons more commonly used audio-visual telemedicine (p<0.001). North American providers used telemedicine the most during COVID-19 (>60.0% of all visits). There were 81.9% of all providers who “agreed/strongly agreed” telemedicine was easy to use. Respondents tended to “agree” that imaging review, the initial appointment, and postoperative care could be performed using telemedicine. Almost all (95.4%) surgeons preferred at least one in-person visit prior to the day of surgery. CONCLUSIONS Our study noted significant geographical differences in the rate of telemedicine usage and the platform of telemedicine utilized. Spine surgeons found telemedicine feasible for imaging review, initial visits, and follow-up visits although the vast majority still preferred at least one in-person preoperative visit. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Benefits of Surveillance Testing and Quarantine in a SARS-CoV-2 Vaccinated Population of Students on a University Campus (preprint)

Surveillance testing and quarantine have been effective measures for limiting SARS-CoV-2 transmission on university campuses. However, the importance of these measures needs to be re-evaluated in the context of a complex and rapidly changing environment that includes vaccines, variants, and waning immunity. Also, recent guidelines from the CDC suggest that vaccinated students do not need to participate in surveillance testing. We used an agent-based SEIR model to evaluate the utility of surveillance testing and quarantine in a fully vaccinated student population where vaccine effectiveness may be impacted by the type of vaccination, the presence of variants, and the loss of vaccine-induced or natural immunity over time. We found that weekly surveillance testing at 90% vaccine effectiveness only marginally reduces viral transmission as compared to no testing. However, at 50%-75% effectiveness, surveillance testing can provide over 10-fold reduction in the number of infections on campus over the course of the semester. We also show that a 10-day quarantine protocol for exposures has limited effect on infections until vaccine effectiveness drops to 50%, and that increased surveillance testing for exposures is at least as effective as quarantine at limiting infections. Together these findings provide a foundation for universities to design appropriate mitigation protocols for the 2021-2022 academic year.

Implications of the use of hydroxychloroquine on cardioactive drugs

Hydroxychloroquine (HCQ) is a relatively safe drug, and has been emerged as one of the treatment options for the management of COVID-19. This review is from the viewpoint of cardiologists, and it covers the pharmacokinetics, pharmacodynamics, and mechanism of drug interaction of HCQ with the commonly used cardioactive drugs.

Early clinical experience of a large hospital trust virtual COVID-19 follow up clinic

Introduction A Virtual Covid-19 Follow-up Clinic was designed in response to the need to review a large number of in-patients, at a large hospital trust, recovering from Covid-19 but without any significant increase in resources. Methods Patients complete a structured online/telephone symptom and psychological health questionnaire and have a chest x-ray 12 weeks after their illness. These results, and their medical records, are reviewed asynchronously by the medical team in a virtual clinic. Patients are then triaged to further virtual review, telephone review, face to face review, or are discharged. All patients receive comprehensive written information to aid their recovery. Results During the first 8 weeks of the service, 388 patients have completed the questionnaire (63% online) and been reviewed. Current symptoms are shown in figure 1. The questionnaire has identified the holistic needs of patients and allowed triaged follow-up with 122 discharged and 53 urgent face-to-face review appointments completed. 25 CT pulmonary angiogram scans were arranged for patients with typical symptoms of pulmonary emboli;no thromboembolic disease was identified. Conclusion This early experience of a new service has highlighted 5 learning points:.

COVID-19 in lung transplant recipients.

Solid organ transplant recipients are considered at high risk for COVID-19 infection due to chronic immune suppression; little data currently exists on the manifestations and outcomes of COVID-19 infection in lung transplant recipients. Here we report 8 cases of COVID-19 identified in patients with a history of lung transplant. We describe the clinical course of disease as well as preexisting characteristics of these patients.