ABSTRACT
The report describes a study of the opinion of students from the University of Ruse on their use of mobile learning before and during the COVID-19 pandemic. The research uses the survey methodology and for this purpose an online questionnaire was developed. A total number of 469 students from four academic years were surveyed - two before COVID-19 and two during the pandemic. Of the total number of surveyed students, 143 are in the academic year 2021-2022 and 133 are in the academic year 2020-2021, when most of the education was online. 72 are in the academic year 2019-2020 and 121 are in the academic year 2018-2019. An analysis and comparison of the results of these three academic years was performed. Relevant conclusions about the impact of COVID-19 on the use of mobile learning are made. © 2022 IEEE.
ABSTRACT
Background: Bulgaria is among the countries with the lowest vaccination rate of adult population in Europe. The presence of autoimmune rheumatic disease could further contribute to vaccine hesitancy and skepticism and influence patients' attitudes towards vaccination [1, 2]. However, little is still known about the willingness and particular causes of hesitancy in patients with infammatory joint diseases in the skeptical part of adult population across Europe. Objectives: Our goal was to assess the rate of SARS-CoV-2 vaccination among patients with immune-mediated rheumatic joint diseases receiving biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) and to determine the modifable predictors of vaccination hesitancy. Methods: Patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis undergoing biological or targeted synthetic DMARDs therapy were consecutively selected and included in this single-center cross-sectional study. Excluding criteria in patients were psychiatric or neurological disease preventing understanding or responding to the questions, being illiterate, or not willing to participate in the study. Various demographic, anthropometric, and clinical data were collected. Disease activity was determined using DAS28-CRP for rheumatoid arthritis and peripheral psoriatic arthritis and ASDAS for ankylosing spondy-litis and psoriatic spondylitis. All patients were given a questionnaire assessing their vaccination status, hesitancy, and attitude towards vaccination. Binary logistic regression analysis was used to analyze the relationship between self-reported modifable parameters and vaccination status for SARS-CoV-2. Results: Two hundred and one participants were eligible for participating in the study with mean age and BMI of 54.6 years and 28.2, respectively. Of these, 40.3% were women;30.3% had rheumatoid arthritis, 17.9%-psoriatic arthritis, and 51.7%-ankylosing spondylitis. 29.4 % of all participants had already survived a COVID-19 infection with a mean time of 8.4 months since the COVID-19 onset. Only slightly above 1/3 (35.8%) of the study group was fully vaccinated and the majority of them were vaccinated with BNT162b2 (68.1%). Among the modifable factors, we identifed preceding discussion with a rheumatologist, hesitancy due to autoimmune disease presence and (un)awareness of vaccine safety and efficacy as signifcant predictors of vaccination status Conclusion: Our data suggest that there are still possibilities to influence rheumatic patients on their decision to vaccinate against SARS-CoV-2 in Bulgaria. Raising the awareness of the safety and efficacy of the SARS-CoV-2 vaccines and spending more time on the education of patients with rheumatic diseases may positively affect their attitude towards vaccination.
ABSTRACT
Background: Since the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19) (1), our understanding of the underlying pathophysiology is constantly evolving in order to explain the wide range of heterogenic clinical manifestations (2). Nevertheless, limited data are available for the severity and multifactorial causality of musculoskeletal pain in COVID-19 patients (3). Objectives: This study aimed to evaluate the prevalence and intensity of rheumatic pain symptoms-arthralgia and myalgia and their association with anxiety and depression in a cohort of COVID-19 patients, hospitalized at the COVID-19 rheumatology department of the University Hospital St. Marina, Varna, Bulgaria. Methods: In the present single-center cohort study, a prospective analysis was performed among COVID-19 patients who were hospitalized from 1 Oct 2021 to 20 Jan 2022 and self-reported for new-onset of musculoskeletal pain. All 226 patients (age 26-91 years) were treated for moderate or severe SARS-CoV-2 infection confrmed by laboratory tests, including positive antigen test or polymer-ase chain reaction (PCR) test, and imaging modality. Detailed disease history and clinical examination were carried out by a fully certifed rheumatologist. All patients who reported new-onset of musculoskeletal pain during the acute phase of the infection, participated on a voluntary basis in a questionnaire survey, by completed Zung self-rating anxiety scale (SAS), Zung self-rating depression scale (SDS) and visual analogue scale (VAS) for arthralgia and myalgia. The questionnaire form also elicited information on sociodemographic characteristics of the patients. In all patients, infammation and thrombotic biomarkers were assessed. The level of signifcance was set to 0.05. Results: Among all 226 COVID-19 patients with musculoskeletal pain, 46.5% (n =105) were women and 53.5% (n = 121), were men. Mean age was 65.6 years. We found a signifcant correlation of depression and anxiety scales scores with pain intensity (both arthralgia and myalgia), all < 0.001. A multiple regression analysis found that SDS and SAS accounted for signifcant variance in the prediction of muscle pain (β = 0.441, p < 0.001;β = 0.293, p = 0.003, respectively) while SDS signifcantly predicted joint pain (β = 0.341, p = 0.043). On the other hand, musculoskeletal pain does not correlate with any of infammation and thrombotic biomarkers assessed in SARS-CoV-2 patients (p > 0.05). Conclusion: Rheumatic pain manifestations are part of the heterogeneous spectrum of COVID-19 disease. The pain intensity is signifcantly associated with anxiety and depression symptoms and does not correlate with infammation and thrombotic biomarkers.
ABSTRACT
Background: Recently evolved from a monochromic flu-like disease to a polysyndromic “spectrum of disease”, our understanding of coronavirus disease 2019 (COVID-19) is still far from being complete [1]. Hyperinflammation involving not only the lungs but also the musculoskeletal system, skin, cardiovascular, genitourinary systems is immune-mediated resembling the flares of a full-blown rheumatic disease [2,3]. Objectives: To describe the prevalence and type of rheumatic manifestations in a cohort of COVID-19 patients hospitalized in the COVID-19 rheumatology department in University Hospital St. Marina, Varna, Bulgaria. Methods: In the present single-center cohort study, a retrospective database analysis was performed among all COVID-19 patients hospitalized from 1 Dec 2020 to 22 Jan 2021. All 243 patients (age 19 -93 years) were treated for moderate or severe SARS-CoV-2 infection confirmed by laboratory tests, including positive polymerase chain reaction (PCR) test, and imaging modality. Inpatient treatment included antibiotics, dexamethasone, anticoagulants, and antiviral drug remdesevir (optional). Detailed disease history and clinical examination were carried out by a fully certified rheumatologist and/or specialist in internal medicine. Results: Among all 243 COVID-19 patients, those with prominent self-reported myalgia and arthralgia were 26% (n = 63) and 21.3 (n = 52), respectively. We had 4 (1.6%) cases of newly developed cutaneous vasculitis and 2 (0.8%) cases of severe Raynaud's phenomenon after SARS-CoV-2 infection onset. Two patients experienced severe muscle weakness, had elevated creatine phosphokinase, and were diagnosed with inflammatory myopathy secondary to COVID-19. Lupus-like syndrome was observed in 2 (0.8%) patients. Conclusion: Rheumatic manifestations are part of the heterogeneous spectrum of COVID-19 disease. Amidst the COVID-19 crisis, each newly onset rheumatic manifestation warrants exclusion of SARS-CoV-2 infection. Therefore, a rheumatologist should be a part of a multidisciplinary approach towards the COVID-19 treatment.