Spillovers and tail dependence between oil and US sectoral stock markets before and during COVID-19 pandemic

Purpose: This paper examines the extreme dependence and asymmetric risk spillovers between crude oil futures and ten US stock sector indices (consumer discretionary, consumer staples, energy, financials, health care, industrials, information technology, materials, telecommunication and utilities) before and during COVID-19 outbreak. This study is based on the rationale that stock sectors exhibit heterogeneity in their response to oil prices depending on whether they are classified as oil-intensive or non-oil-intensive sectors and the possible time variation in the dependence and risk spillover effects. Design/methodology/approach: The authors employ static and dynamic symmetric and asymmetric copula models as well as Conditional Value at Risk (VaR) (CoVaR). Finally, they use robustness tests to validate their results. Findings: Before the COVID-19 pandemic, crude oil returns showed an asymmetric tail dependence with all stock sector returns, except health care and industrials (materials), where an average (symmetric tail) dependence is identified. During the COVID-19 pandemic, crude oil returns exhibit a lower tail dependency with the returns of all stock sectors, except financials and consumer discretionary. Furthermore, there is evidence of downside and upside risk asymmetric spillovers from crude oil to stock sectors and vice versa. Finally, the risk spillovers from stock sectors to crude oil are higher than those from crude oil to stock sectors, and they significantly increase during the pandemic. Originality/value: There is heterogeneity in the linkages and the asymmetric bidirectional systemic risk between crude oil and US economic sectors during bearish and bullish market conditions;this study is the first to investigate the average and extreme tail dependence and asymmetric spillovers between crude oil and US stock sectors. © 2023, Emerald Publishing Limited.

Superadded Bacterial Infections in COVID–19 Patients, Antimicrobial Susceptibility and Association with Serological Markers

Objective: To determine the frequency and antimicrobial susceptibility pattern of pathogens responsible for superadded bacterial infection in COVID-19 patients and correlate the association of these infections with serological markers. Study Design: Cross-sectional study. Place and Duration of study: Department of Pathology, Combined Military Hospital, Multan Pakistan, from Jan to Dec 2021. Methodology: A total of 290 patients having positive RT-PCR for SARS CoV-2 were included. All samples were processed per Clinical Laboratory Standard Institute (CLSI) protocols. API 20E and API 20NE were used for the identification of Gram-negative rods. Antimicrobial susceptibility testing was performed by the modified Kirby Bauer disc diffusion method. Serological markers, including C-reactive protein (CRP), total leucocyte count (TLC) and serum Ferritin, were determined and compared for significance in positive and negative culture cases. Results: A total of 75 patients had positive bacterial cultures. Among these, 42(56%) were blood culture, 26(35 %) were respiratory culture and 7(9%) were urine culture. Commonly isolated organisms were Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa, i.e., 23(31%), 20(27%), 13(17%), and 12(16%) respectively. CRP, TLC and S. ferritin were markedly raised in superadded bacterial infection compared to patients with COVID-19 infection only. Conclusion: The frequency of superadded bacterial infections in COVID-19 patients is high. The pathogens isolated in these cases were multidrug-resistant, reflecting mostly hospital-acquired flora. The association of serological markers in depicting superadded infection is statistically significant and may be used to screen for superadded bacterial infection in COVID-19 patients. © 2023, Army Medical College. All rights reserved.

Impacts of COVID-19 on dynamic return and volatility spillovers between rare earth metals and renewable energy stock markets

We examine the time-frequency co-movements and return and volatility spillovers between the rare earths and six major renewable energy stocks. We employ the wavelet analysis and the spillover index methodology from January 1, 2018 to May 15, 2020. We report that the COVID-19-triggered significant increase in co-movements and spillovers in returns and volatility between the rare earths and renewable energy returns and volatility. The rare earths act as net recipient of both return and volatility spillovers, while the clean energy stocks are net transmitters of return and volatility spillovers before and during the COVID-19 crisis. The solar and wind stocks are net transmitters/receivers of spillovers before/during the pandemic. The remaining markets shift from net spillover receivers to transmitters or vice versa;evidencing the effects of the pandemic. Our results show that cross-market hedge strategies may have their efficiency impaired during the periods of crises implying a necessity of portfolio rebalancing. © 2022 The Authors

Service analysis examining the outcomes based on dexamethasone duration in Covid patients requiring oxygen in UKhospital

Background: Recent RECOVERY trial showed use of dexamethasone lead to reduction in 28 days mortality in patients with COVID pneumonia requiring oxygen. NICE recommends offering dexamethasone for 10 days in patients with COVID positive pneumonia. However, outcomes from real world data are lacking. Aim: The aim of this study was to analyse the impact of different duration of dexamethasone on mortality rate in patients with COVID positive pneumonia requiring oxygen. Method: The study was performed retrospectively from single centre using electronic PICS (prescribing information and communication system). We included patients admitted in hospital between the periods of 29/12/2020 to 7/1/2021 with diagnosis of COVID pneumonia, requiring dexamethasone. Data extracted included patient demographics, diabetes status and number of days on dexamethasone. We evaluated outcomes in three groups based on duration of dexamethasone as Group A (10 days), Group B (4-9 days) and Group C (≤3 days). Primary outcomes were mortality rate and length of stay. Results: We identified 179 patients. Mean (SD) age was 65 (17) years, 45.8% were female. Mean BMI was 31(14) kg/m2, 56.9% were Caucasian, 18.9% South Asian,4.4% were Afro-Caribbean,46.9% had diabetes. 128 patients were nursed on general medical ward (GIM) and 51 patients needed ITU setting. The mortality rate was 25 %, 20% and 43.7% in group A, B and C respectively. Mean length of stay (LOS) was 9 (11) days,10 (7) days and 9 (6) days in group A, B and C respectively. Further analysis of patients nursed on GIM ward showed mortality rate of 11.9%, 25% and 66.6% in group A, B and C suggesting an association between longer duration of dexamethasone and reduction in mortality. No difference in LOS was noted. No similar analysis was conducted in patients nursed on ITU setting because of small sample size. Discussion: Longer duration of dexamethasone was associated with better mortality rate in patients nursed on GIM ward and hence we should offer full course of 10 days dexamethasone in patients admitted with Covid pneumonia requiring oxygen. However, our study had small sample size, from single centre and result was not adjusted for co-variables like age, gender, BMI, and amount of oxygen requirement. We need future study with large sample size, multicentre and addressing these limitations.

Burnout in diabetes and endocrinology specialist registrars across England, Scotland and Wales in the pre-COVID era.

BACKGROUND: Presence of either emotional exhaustion, depersonalization or lack of personal accomplishment define Burnout Syndrome which may lead to decreased workforce productivity, increased absenteeism, depression and medical errors as well as decreased patient satisfaction. OBJECTIVE: The aim of this study was to assess the frequency of burnout syndrome among Diabetes Specialist Registrars across England, Scotland and Wales and to identify any self-reported factors which may be contributory to burnout. METHODS: Over 430 Diabetes Specialist Registrars were invited to anonymously participate in an electronic survey which used Maslach Burnout Inventory and selfreporting questionnaire to identify burnout and contributory factors. RESULTS: In this pre-pandemic times study, Burnout was identified in 61 (57.5%; n = 106) respondents using Maslach burnout cut-off scores. 45.2% (48/106) participants had scored high in Emotional Exhaustion, while lack of personal accomplishment and depersonalization was seen in 24.5% (26/106) and 21.6% (23/106) of the respondents respectively. The commonest self-reported stressors by participants were "General Internal Medicine workload" 60.4% (64/106) followed by "Lack of specialty training" 36.8% (39/106) and "Lack of audit/research/Continuing Professional Development time" 10.8% (11/106) CONCLUSION: Burnout syndrome is frequent among the participating Diabetes Specialist Registrars and urgent steps may be required address this problem nationally to ensure that these physicians remain physically and mentally healthy, especially after the pandemic.

An audit on the use of variable rate intravenous insulin infusions (VRIII) in patients diagnosed with SARS-CoV-2

Aims: To assess VRIII utilisation in SARS-CoV-2 positive patients with diabetes mellitus at Queen Elizabeth Hospital, Birmingham, and adherence to Joint British Diabetes Society (JDBS) standards. Methods: This was a retrospective data-based study. All patients admitted to Queen Elizabeth Hospital Birmingham who tested positive for SARS-CoV-2 requiring VRIII between March and June 2020 were included in the study. Data were extracted using our electronic database Prescribing Information and Communication System (PICS). Data were collected on demographics, diabetic history and VRIII use. Primary outcome measures were substrate use, diabetes medication management, glycaemic control, adverse events as analysed by rate of hypoglycaemia, hyponatraemia and hypokalaemia and monitoring of renal function and capillary blood glucose, in accordance with the JDBS guidelines. Pre-planned subset analysis was performed based on the patient location (ward or intensive care unit (ICU)). All results are shown as median±SD. Results: A total of 85 patients were included in the study, with 55 patients treated in the ICU and 28 patients treated on the wards. The median age of ICU patients was lower than those on the wards (57±10.23 years vs 71.5±16.81 years) and BMI was higher (29.7±6.56 kg/m2 vs 27.8±6.43 kg/m2). The percentage of male patients in ICU was higher compared with those on the wards (76.4% (42/55) vs 53.6% (15/28)). The substrate was used appropriately in 53.3% of VRIII episodes on the ward compared with only 5.4% on ICU. This was due to the concomitant use of NG feeds in 90%. Daily monitoring of electrolytes whilst on a VRIII was higher in the ICU (94.5%, 52/55) than on the ward (71.42%, 21/28). Long-acting insulin was continued in 100% of all type 1 diabetes in both wards and ICU. Median VRIII duration was higher in ICU, given prolonged stay and patients being more unwell, than on the ward (233±184.32 hours vs 14.5±52.26 hours). Target glycaemic control whilst on VRIII was better achieved in the ICU than on the wards. Conclusion: Intensive care with close monitoring has demonstrated better adherence to VRIII as outlined by JBDS for management of hyperglycaemia in patients with diabetes and COVID-19. The longer use of VRIII in unwell ICU patients may reflect higher insulin insensitivity. A further interventional multicentre study is required to gain further insight.

Demographics, management and outcomes of inpatients with newly diagnosed diabetes in acute covid-19 infection

Aim: To investigate the demographics, management and outcomes of patients with newly diagnosed diabetes in covid-19 infection admitted to Queen Elizabeth Hospital, Birmingham. Methods: All patients with a new diagnosis of diabetes on their admission with covid-19 pneumonia (pre-dexamethasone use) between March and June 2020 were examined. Demographics, comorbidities, medication history, investigations, management and outcomes were analysed. Results: Twelve patients were identified. Demographic analysis revealed (all median [IQR]);Age 59.5 [51.5-69.3] years, body mass index 27.4 [26.0-28.9] kg/m2 and length of admission 21.5 [7.5-28.8] days. The majority of patients were male (9/12) and most were diagnosed with type 2 diabetes (9/12). Seven patients had no diabetes symptoms prior to admission and positive family history was uncommon (1/12). Median glucose reading on admission was 16.0 [10.0-29.0] mmol/l, HbA1c 62.5 [47-104] mmol/mol. During admission, median percentage of glucose in target (5-15 mmol/l) for individual patients was 71.6 [46.4-91.0]% and median percentage of glucose levels in hypoglycaemic range (<4 mmol/l) was 0.8 [0.0-2.6]%. Intravenous insulin was required by half of patients (6/12). 5/12 (41.7%) patients were admitted to the critical care unit versus 69/497 (13.8%) patients with pre-existing diabetes and covid-19, median length of stay was 18.5 [13.3-23.0] days versus 7 [3-13] days. 3/12 patients died during admission (25.0%) versus 112/497(23%) patients with pre-existing diabetes and covid-19. Of the nine patients discharged, six required long-term antidiabetes therapy;five with insulin and one with oral diabetic treatment. Conclusion: A new diagnosis of diabetes in combination with covid-19 infection is associated with high rates of complication relating to glucose control and need for intensive care during admission.

Managing People with Diabetes Fasting for Ramadan During the COVID-19 Pandemic: A South Asian Health Foundation Update.

The month of Ramadan forms one of the five pillars of the Muslim faith. Adult Muslims are obligated to keep daily fasts from dawn to sunset, with exceptions. This year Ramadan is due to begin on 23 April 2020 and the longest fast in the UK will be approximately 18 hours in length. In addition, due to the often high-calorie meals eaten to break the fast, Ramadan should be seen as a cycle of fasting and feasting. Ramadan fasting can impact those with diabetes, increasing the risk of hypoglycaemia, hyperglycaemia and dehydration. This year, Ramadan will occur during the global COVID-19 pandemic. Reports show that diabetes appears to be a risk factor for more severe disease with COVID-19. In addition, the UK experience has shown diabetes and COVID-19 is associated with dehydration, starvation ketosis, diabetic ketoacidosis and hyperosmolar hyperglycaemic state. This makes fasting in Ramadan particularly challenging for those Muslims with diabetes. Here, we discuss the implications of fasting in Ramadan during the COVID-19 pandemic and make recommendations for those with diabetes who wish to fast.