Covid-19 Vaccine Hesitancy in Pakistan: A Cross-Sectional Study to Assess Resistance and Related Fears and Misconceptions

Objective: The purpose of this study was to assess willingness to receive COVID-19 vaccine in Pakistan and to understand the reasons causing hesitation towards vaccine administration. Study Design: A cross-sectional study was done through an online survey that was created using google forms. Place and Duration of Study: The study was conducted online from Mar to Aug 2021 in different cities of Pakistan employing nonprobability convenience sampling technique. The link to the questionnaire was shared on different social media platforms such as WhatsApp and Facebook. Methodology: Any individual over the age of 16 and willing to fill the questionnaire was enrolled. Questionnaire used were standardized Oxford COVID-19 vaccine hesitancy scale to assess intent and Oxford general vaccine hesitancy scale to assess attitude towards vaccinations in general. SPSS v25 was used for data analysis. Results: A total of 589 valid responses were finally analyzed. Among the respondents, 24%(141) showed at least some hesitancy regarding COIVD-19 vaccination and 9%(53) of the respondents showed extreme hesitancy. The Pearson correlation coefficient indicated a significant positive correlation (p<0.000) between hesitancy to childhood vaccines and COVID vaccine hesitancy. There was also a significant correlation (p<0.000) between belief in conspiracy's related to COVID-19 virus and refusal to get vaccinated. Conclusion: Vaccine hesitancy is present in roughly 1/4th of the study population. Conspiracy theories and low vaccine acceptance among the general public pose a severe danger to COVID-19 vaccination success. Public vaccine education programs should be started to educate the public regarding their fear of vaccination. © 2022, Army Medical College. All rights reserved.

The Impact of Covid-19 on Student Mental Health and Online Learning Experience

The ongoing coronavirus pandemic has affected every facet of human life in the contemporary world. Consequently, university students have to adjust to radically change learning environments. Moreover, the movement restrictions from the government-imposed lockdowns negatively affected students' mental health due to mental issues such as stress, frustration, and depression. The pandemic has caused considerable changes in our daily lives. These reasons are why the virus has hurt individuals' mental health, especially students who had to cope with changes in the education system and even the loss of loved ones. The ambiguity resulting from the pandemic has yet to be fully covered, particularly the students' well-being and the new learning landscape that they are anticipated to navigate seamlessly without their usual support systems. Covid-19 did disrupt the normal and put us all in numerous stressful circumstances' and forced us to have to face overwhelming difficulties at a time. Covid-19 lockdown and pandemic did bring about a sense of anxiety and fear around the world. The spectacle has led to students' long-term and short-term mental health and psychological implications. The paper presents research showing that most students were not prepared for this change, and that indeed they were affected mentally by remote learning. Additionally, the effect of prolonged pandemic fatigue and lockdown on university scholars and academic experiences is unclear. This paper reviews articles about mental health aspects of students and online learning experiences impacted by Covid-19 and provides a roadmap for an ongoing research. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Simulation in Urological Training: The Hybrid Model of Institute of Kidney Diseases Peshawar A Comparative Study

Background:"I fear the man who has practised one kick 10,000 times." Lee Bruce This aphorism highlights the growing importance of simulation in postgraduate urology training, especially during the COVID 19 pandemic, when all teaching and training activities were stopped, jeopardising postgraduate residents' education. Postgraduate residents must perform hours of surgical training to overcome urological learning curves. According to study, residents educated on simulators boost their summative scores. By introducing simulation to urology training in a way comparable to the well-known Halsted apprenticeship model, the current study emphasises the hybrid model of IKD. Objective(s): to compare the formative assessment results between residents taught on simulators and residents in the conventional apprenticeship model on factors of communication skills, technical competence, and overall capacity to conduct procedure on OSAT and DOPS. Material(s) and Method(s): from 2019 to 2021 this comparative study was conducted in the Department of Urology by Team C at the Institute of Kidney Diseases Peshawar. Group A (10 residents) and Group B (10 residents, 5 from the second and third years) received STEPS method OT instruction in the first phase. These simulators were used to impart knowledge to Group "B" Harvey for counseling and medical examinations Simulator for PCNL The second phase included a six-month training assignment swap between the two groups. A standard QSAT and DOPS proforma was used to evaluate each resident. Data analysis was done using SPSS 24.0. Result(s): Residents in Group A, who were originally exposed to the conventional technique, considerably outperformed Group B on Harvey (mean: 50.5;standard deviation: 2.21.1) in terms of communication skills, professionalism, and ethical concern during the first phase (p 0.001). However, the Group p0.05 shown considerably higher technical proficiency and overall process performance capacity. The mean technical skill and overall capacity to finish the process had a somewhat positive association in phase 1 in favour of group B (r=0.630, p 0.01). All QSAT and DOPS metrics significantly improved in the second phase. However, both groups did not vary significantly (p> 0.05). According to Pearson coefficient correlation, both groups considerably overcame their gaps in technical proficiency, communication skills, and procedural competence. (P= 0.001) Results are shown in Figures 1 through 06 and Tables 1 through 2. Conclusion(s): To improve the standard of urology residency in Pakistan, a hybrid paradigm that includes both simulation and actual performance is necessary. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Epitopes Determination for OMICRON: The COVID-19 New Variant

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly evolved in the last couple of years. This has created major havoc and concern because it has affected millions of people around the world. The new variants of covid-19 are classified into two types, VOI (variant of interest) and VOC (variant of concern). The major variants of concern (VOCs) have shared mutations in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The spike proteins of the novel coronavirus located mostly on the S1 unit result in a higher transmissibility rate and affect the viral virulence and clinical outcome. The spike protein and other non-structural protein mutations in VOCs may lead to escape the approved vaccinations. Here the VOC mutations i.e., OMICRON VARIANT have been discussed in detail, and the therapeutic strategies to enhance the host immune responses have been proposed. Additionally, a computational approach is proposed to design the drug and vaccine for the variant. The protein structure for the OMICRON variant has been predicted through bioinformatics tools and several databases have been used to identify suitable natural inhibitors. The OMICRON variant was analyzed to identify suitable vaccine candidates by identifying B-Cell epitopes. To design a drug, REPAGLINIDE and ENT-NATEGLINIDE were identified as natural inhibitors based on docking score. To design a vaccine the B-cell epitope i.e., CLIGAEYVNNSYECD was found to the highest antigenicity score. The present study identifies natural inhibitors and potential antigenic Epitopes which may be used as effective drug and vaccine candidates to suppress the novel coronavirus. Copyright 2023 by the authors. Licensee Zoological Society of Pakistan.

INVESTIGATING THE RELATIONSHIP BETWEEN RACE/ETHNICITY AND CLINICAL OUTCOMES IN COVID-19

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To determine whether race/ethnicity is a risk factor for severe disease or death in COVID-19. METHODS: Retrospective analysis of adult patients >18 years-of-age with laboratory-confirmed COVID-19, hospitalized between March 1 to June 30, 2020 to nine acute-care hospitals within a metropolitan healthcare organization. Information on demographics, co-morbid conditions and outcomes were obtained from a system-wide database. Multiple regression analysis was performed to determine independent predictors of invasive-mechanical ventilation (MV), hospital length-of-stay (LOS), discharge disposition and mortality related to race/ethnicity controlling for age, gender and comorbidity. RESULTS: The cohort consisted of 3727 subjects (mean age 60.5±17.1 years, 55.8% male);2278 (61.1%) were black and 640 (17.1%) were white. Seven-hundred fifty (20.1%) patients received invasive-MV, 520 (13.9%) died, and median hospital LOS was 6.2 (IQR: 3.2-12) days. There were 2970 (80.4%) patients who were black or hispanic (Black/Hispanic). Black/Hispanic patients were younger compared to others (59.7 [16.6] vs 63.7 [18.4] P <0.0001), but equally distributed by sex (47.4% vs 48.5%;P=0.61). In the unadjusted analysis, black/Hispanic patients required more invasive-MV (20.6% v 15.3%;P=0.001) and had longer hospital LOS (6.6 [3.4-12.8] vs 5.2 [2.8-10.2]). In the adjusted analysis, being black/Hispanic was independently associated with invasive-MV (OR 1.54, CI 1.18-2.03;P=0.002) and longer hospital LOS (P<0.001) after controlling for age, gender, and comorbidity. However, there were no differences in mortality between black/Hispanic patients and other races (P=0.52). When comparing black patients as a distinct group with non-black patients, the black patients were more likely to receive invasive-MV (OR 1.38, CI 1.1-1.7;P=0.003) and less likely to be discharged home (OR.72, CI.6-.86;P<0.001) after adjustments for confounding factors. Hospital LOS was 21% longer in black patients (P<0.001) compared to other races, but there was no between-group difference in mortality (P=0.39). CONCLUSIONS: Race/ethnicity was independently associated with important clinical outcomes after adjustments for major confounding variables. Patients who were black or black/Hispanic were more likely to receive invasive-MV and had longer hospital LOS. However, there were no differences in mortality between minority patients and other races. CLINICAL IMPLICATIONS: Clinical outcomes in COVID-19 patients may be related to racial health-disparities. DISCLOSURES: No relevant relationships by Muhtadi Alnababteh, source=Web Response No relevant relationships by Mansi Chaturvedi, source=Web Response Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 07/01/2020 by Gail Drescher, source=Web Response, value=Consulting fee Technical Editor Resp Care Journal relationship with American Association for Respiratory Care Please note: $1001 - $5000 Added 07/01/2020 by Gail Drescher, source=Web Response, value=Salary No relevant relationships by Muhammad Hashmi, source=Web Response No relevant relationships by Fatima Hayat, source=Web Response No relevant relationships by Lakshmi Jayaram, source=Web Response No relevant relationships by Akshay Kohli, source=Web Response No relevant relationships by Emil Oweis, source=Web Response No relevant relationships by Akram Zaaqoq, source=Web Response

EXTRACORPOREAL MEMBRANE OXYGENATION AS RESCUE THERAPY FOR COVID-19 INDUCED HYPOXIA: SINGLE-CENTER STUDY

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To examine COVID-19 patients requiring invasive mechanical ventilation (MV) and/or Extracorporeal Membrane Oxygenation (ECMO) to better understand patient selection for ECMO, clinical management, and short-term outcomes. METHODS: Retrospective study of patients >18-years-old admitted to the hospital with COVID-19 requiring MV. Lung-protective ventilation was used in all patients with initial set PEEP of 8-10 cm H20 for plateau pressure <30 cm H20. ECMO was considered per pre-specified institutional criteria for refractory hypoxemia despite maximum-medical therapy, in qualifying patients. Exclusion criteria for ECMO included age >65 years, multi-system organ failure, and MV >10 d. Data captured included baseline patient characteristics, co-morbidities, pre-ECMO respiratory support, ECMO settings, laboratory results, and COVID-19 therapeutic interventions. RESULTS: We analyzed 59 patients who required invasive MV, including 13 who met criteria for ECMO. There were no between-group differences in gender, BMI, or co-morbidities. More ECMO patients received Tocilizumab (p=.003), but steroid use was similar (p=.44). Nine ECMO (69.2%) patients were decannulated. Crude ICU mortality was comparable between the ECMO and MV groups (6/13 [46.15%] vs. 22/46 patients [47.82%];p=0.92). Higher pre-ECMO D-dimer (9.740 [4.84-20.00] mcg/mL vs. 3.800 [2.19-9.11] mcg/mL;p=0.05), LDH (1158 ±344.5 units/L vs. 575.9 ±124.0 units/L;p=0.001), and troponin (0.4315 ±0.465 ng/mL vs. 0.034 ±0.043 ng/mL;p=0.04) were associated with mortality. Time on MV was significantly longer in the ECMO group (563.3 [422.1-613.9] h vs. 247.9 [101.8-479] h in MV;p<.001) as well as ICU length of stay (LOS) (576.2 [457.5-652.8] h in ECMO vs. 322.2 [120.6-569.3] h in MV;p=0.01). CONCLUSIONS: ECMO was associated with prolonged MV and extended ICU LOS. Markers of coagulation, inflammation and cardiac injury were elevated in ECMO patients who did not survive. CLINICAL IMPLICATIONS: ECMO is a potentially effective rescue therapy for COVID-19 associated pneumonia. DISCLOSURES: No relevant relationships by Muhtadi Alnababteh, source=Web Response No relevant relationships by Rajus Chopra, source=Web Response Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 07/01/2020 by Gail Drescher, source=Web Response, value=Consulting fee Technical Editor Resp Care Journal relationship with American Association for Respiratory Care Please note: $1001 - $5000 Added 07/01/2020 by Gail Drescher, source=Web Response, value=Salary No relevant relationships by Muhammad Hashmi, source=Web Response No relevant relationships by Fatima Hayat, source=Web Response No relevant relationships by Akshay Kohli, source=Web Response No relevant relationships by Emil Oweis, source=Web Response No relevant relationships by Karthik Vedantam, source=Web Response No relevant relationships by Akram Zaaqoq, source=Web Response