ABSTRACT
The negative impact of COVID on the respiratory system is well characterized in a general population. The increased complexity of COVID in lung transplant recipients (LTRs) and assessment of injury severity is less defined. We compared allograft injury as measured by donor derived cell-free DNA (dd-cfDNA) in LTRs with post-transplant COVID. We hypothesized more severe COVID infection would be associated with higher lung injury, as evidenced by higher dd-cfDNA. All LTRs positive for COVID with peri-infection dd-cfDNA (%, AlloSure, CareDx) from Memorial Hermann Hospital (MHH) and University of Texas Health Science Center San Antonio (UTHSC-SA) were evaluated. LTRs were stratified on hospitalized vs not hospitalized for COVID. Time between dd-cfDNA result and COVID infection was calculated and graphed. LTRs with concurrent immune events (acute cellular rejection or antibody mediated rejection) were excluded. Twenty-eight LTRs had post-COVID dd-cfDNA results available (MHH 18, UTHSC-SA 10). Peri-COVID infection dd-cfDNA trends are shown in Figure 1. Seventeen (61%) were hospitalized and 39% (n=11) were not. Median max dd-cfDNA in hospitalized LTRs was 1.10% (IQR 0.82, 2.40) drawn at median 50 days (IQR 35, 151) post-COVID. Median max dd-cfDNA in not hospitalized LTRs was 0.94% (IQR 0.45, 1.80) drawn at median 81 days (IQR 43, 235). As dd-cfDNA levels were not drawn at the same times post-COVID between hospitalized and not hospitalized patients, differences cannot be directly compared. However, there are clear elevations in median dd-cfDNA among COVID hospitalized LTRs indicating a higher degree of allograft injury in those patients. Both the dd-cfDNA elevation preceding date of COVID positivity and the following decay between hospitalized and not hospitalized LTRs could be important prognostically. Investigation into effect of COVID treatment on dd-cfDNA, time to return to dd-cfDNA baseline levels, and resolution of pulmonary function are warranted. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
With the emergence of COVID-19, many educational pillars have been altered from conventional ways to online solutions. The educational assessment has been administered in online environments despite all encountered challenges. This descriptive study aimed to uncover the online assessment challenges that were confronted. Furthermore, it intended to display the impact of these challenges on the assessment principles. A mixed-method approach was adopted for data collection. A survey was used to collect quantitative data from 60 academic staff at Sultan Qaboos University in Oman, and semi-structured interviews were conducted with four of them. The study found some challenges when applying online assessment such as learners’ refusal to turn on cameras, heavy teaching loads, cheating, the long time required for developing online assessment instruments, impersonation/dishonesty, assessing practical experiences, plagiarism, grades’ inflation, assessing group’s work, academic integrity and a large number of students per section. The study concluded that these challenges respectively threatened assessment principles of validity, efficiency, fairness, reliability and variability. Practitioner Notes 1. Reasons standing behind each of the found online assessment challenges should be explored and solutions for each particular challenge should be examined. 2. Principles of validity, reliability, fairness, variability and efficiency of the online assessment need to be addressed. 3. The study recommended applying various alternative assessment strategies embedded in the online course activities to reduce the likelihood of cheating and increase the validity and reliability of the overall assessment process. 4. Due to the found challenges of online assessment, academic staff should avoid conducting a single heavy-weighted strategy for summative assessment. 5. Teachers should attend to individual cases facing difficulties carefully in the online assessment contexts;and prepare flexible alternative assessment plans. © 2022, University of Wollongong. All rights reserved.
ABSTRACT
Background: Covid-19 pandemic has brought the world to a standstill where the only hope to end this is the prevention and control of the disease. Medical students hold significant importance in this crisis as being the individuals at increased risk as well as future health care providers. Aim: To assess the knowledge and practice regarding Covid-19 Methods: A cross-sectional study was conducted at Lahore Medical and Dental College, Tulspura. The duration of study was three months from Feb 2021 till April 2021 after the approval of synopsis by IRB committee, LMDC. Study Population included final year MBBS students. Sample size was n=113.Sampling technique used was non-probability convenience sampling technique. Data collection was done using a structured questionnaire consisting of three sections viz socio demographic characteristics, knowledge and practice about Covid-19. Data entry and analysis was done using IBM SPSS version 21. Results: Study participants included 48.7% males and 51.3% females. Most of the students 99.1% were aware of the Covid-19 pandemic. About 99.1% students also knew that it is an infectious disease and 96.5% knew that a virus is the causative agent of Covid-19. However, 84.1% had correct knowledge regarding the incubation period of the disease. Maximum respondents 73.5% believed that everyone is equally susceptible to get infected with Covid-19. Fever and cough are the most common symptoms of the disease and internet and electronic media are most common source of information regarding Covid-19. Majority 46% of respondents did not adopt good practice of regular washing of hands. Nearly 63.7% ate healthy food and 73.5% maintained healthy life style focusing on outbreak Conclusion: The medical students had adequate basic knowledge regarding the disease, electronic media and internet being the most common source of knowledge. The practices of mask wearing and adoption of healthy lifestyle were widely adopted yet the practice of hand hygiene and reduced social mobility was poorly conducted.
ABSTRACT
Background: Sotrovimab is a pan-sarbecovirus neutralizing monoclonal antibody shown to be safe and effective for the treatment of early COVID-19 in high-risk patients and retains activity against variants of concern, including delta and omicron. To facilitate wider access to sotrovimab, it was formulated to allow for either intramuscular (IM) or intravenous (IV) administration. Methods: COMET-TAIL (NCT04913675) is a Phase III, randomized, multicenter, open-label, noninferiority (NI) study of IM vs IV sotrovimab for the treatment of mild/moderate COVID-19 in participants ≥12 years of age at high risk of disease progression. Participants were randomized to receive sotrovimab by single 500 mg IV infusion or IM injection (500 mg or 250 mg). The primary objective was to evaluate the efficacy of 500 mg IM vs 500 mg IV sotrovimab in preventing hospitalization for >24 hours for acute management of illness due to any cause or death. The 250 mg IM arm discontinued early due to a greater number of hospitalizations seen in that arm. A 3.5% NI margin on the risk difference scale was prespecified. Results: COMET-TAIL enrollment occurred from Jun-Aug 2021, coinciding with a surge in the SARS-CoV-2 delta variant in southern USA. The majority (∼85%) of participants were Hispanic or Latino and ∼25% were ≥65 years of age. In the 500 mg IM sotrovimab arm, 10/376 (2.7%) participants compared with 5/378 (1.3%) in the sotrovimab 500 mg IV arm met progression criteria for the primary endpoint (adjusted risk difference: 1.07% [95% CI:-1.25%, 3.39%]), meeting the NI margin of 3.5%. The overall rate of adverse events and injection/infusion-related reactions was low and similar between the 500 mg treatment arms. Most injection-site reactions were mild (grade 1), occurred shortly after dosing, and were limited in duration. Disease-related events (DREs) were balanced between the 500 mg IV and 500 mg IM arms. The most frequent DREs were COVID-19 pneumonia and pneumonia. There was a low percentage of participants (∼1%) with serious adverse events across all treatment arms, and none were considered related to treatment. Two participants (1 with BMI 69 mg/kg2 and an 82-year-old man) in the 500 mg IM arm died due to progression of COVID-19;no deaths occurred in the 500 mg IV arm. Conclusion: In the COMET-TAIL trial, sotrovimab given by 500 mg IM injection was found to be noninferior to IV infusion and was well tolerated. The option of IM administration will expand the potential for outpatient treatment with sotrovimab.
ABSTRACT
BACKGROUND: Clinical severity of coronavirus disease 2019 (COVID-19) may vary over time; trends in clinical severity at admission during the pandemic among hospitalized patients in the United States have been incompletely described, so a historical record of severity over time is lacking. METHODS: We classified 466677 hospital admissions for COVID-19 from April 2020 to April 2021 into 4 mutually exclusive severity grades based on indicators present on admission (from most to least severe): Grade 4 included intensive care unit (ICU) admission and invasive mechanical ventilation (IMV); grade 3 included non-IMV ICU and/or noninvasive positive pressure ventilation; grade 2 included diagnosis of acute respiratory failure; and grade 1 included none of the above indicators. Trends were stratified by sex, age, race/ethnicity, and comorbid conditions. We also examined severity in states with high vs low Alpha (B.1.1.7) variant burden. RESULTS: Severity tended to be lower among women, younger adults, and those with fewer comorbidities compared to their counterparts. The proportion of admissions classified as grade 1 or 2 fluctuated over time, but these less-severe grades comprised a majority (75%-85%) of admissions every month. Grades 3 and 4 consistently made up a minority of admissions (15%-25%), and grade 4 showed consistent decreases in all subgroups, including states with high Alpha variant burden. CONCLUSIONS: Clinical severity among hospitalized patients with COVID-19 has varied over time but has not consistently or markedly worsened over time. The proportion of admissions classified as grade 4 decreased in all subgroups. There was no consistent evidence of worsening severity in states with higher vs lower Alpha prevalence.
ABSTRACT
The Covid-19 pandemics caused by SARS-CoV-19, and the inadequacy of targeted medications, compelled scientists to seek new antiviral drugs. We present our current understanding of plant extracts containing polyphenols that inhibit Covid-19. Natural phytochemicals (polyphenols) derived from plants have the potential to establish research using extracts and/or individual compounds in the treatment and prevention of coronavirus. The polyphenolic drugs (antivirus) capable of inhibiting the coronavirus protein, that are vital for infection and virus replication. The benefit of phytochemicals is that they promote patient well-being while causing minimal side effects. To understand the antiviral behavior of isolated phytochemicals 1–6, various molecular descriptors, molecular electrostatic potential (MEP), and frontier molecular orbitals (FMO) were investigated. A systematic analysis of isolated phytochemicals was accomplished then molecular descriptors, docking score, active sites, and FMOs energies were compared to the commonly used drugs recently to treat COVID19, namely favipiravir, remdesivir dexamethasone and hydroxychloroquine. Using a molecular docking technique, we demonstrate for the first time that these plant phytochemicals can be inhibited by the core protease (6LU7) protein of COVID19. © 2021
ABSTRACT
Background: latrogenic and nosocomial infections are a serious threat to a healthcare setting especially during a pandemic. Hand hygiene among the health-care workers stands out to be a pivotal preventive measure. Practical application of hand hygiene measures during third wave of COVID-19 pandemic primarily depend upon the current knowledge among the health care workers. Methods: A cross-sectional study design based on validated WHO questionnaire for hand hygiene among the health care workers was conducted during March till May2021 in the settings of Shalamar and Central Park hospital and medical colleges. Results: The sample consisted of 271 participants with 110 males and 161 females, with the mean age of 24.72+ 4.174 years. The sample consisted of 36.2% of medical students, 49.1% of doctors and 14.8% of paramedical staff. Nearly 50.6% of the individuals claim to receive formal training. 47.6% believe that "Health-care workers' hands when not clean" are the main route of cross-transmission. Nearly 57.2% believed that the hospital environment (surfaces)the most frequent source of germs. Comparison of hand-rubbing and washing revealed that major percentage believe hand rub to be rapid however less effective causing dryness. A majority believe that hand hygiene before touching the patient, immediately after exposure to body fluids or immediate surroundings of patients prevents transmission of germs to the patient and vice versa afterwards prevents transmission to HCW. Conclusion: A large proportion of the sample has considerable knowledge regarding essential hand hygiene in a health care setting. However more frequent training sessions should be conducted to improve it further.
ABSTRACT
BACKGROUND: Many factors have been identified which can predict severe outcomes and mortality in hospitalized patients of COVID-19. This study was conducted with the objective of finding out the association of various clinical and laboratory parameters as used by International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO)- ISARIC/WHO 4C Mortality score in predicting high risk patients of COVID-19. Ascertaining the parameters would help in triage of patients of severe disease at the outset, and shall prove beneficial in improving the standard of care. METHODS: This cross-sectional study was carried out in COVID-19 Department of Ayub Teaching Hospital, Abbottabad. All COVID-19 patients admitted from 15th April to 15th July 2020 were included. RESULTS: A total of 347 patients were included in the study. The mean age was 56.46±15.44 years. Male patients were 225 (65%) and female 122 (35%). Diabetes (36%) was the most common co-morbidity, followed by hypertension (30.8%). Two hundred & six (63.8%) patients recovered and 117 (36.2%) patients died. Shortness of breath (80%), fever (79%) and cough (65%) were the most common presenting symptoms. Patients admitted with a 4C Mortality score of 0-3 (Low Risk Category), the patients who recovered were 36 (90%) and those who died were 4 (10.0%). In patients admitted with a 4C Mortality score of more than 14 (Very High-Risk Category), the number of patients who recovered was 1 (20%), and those who died were 4 (80%). The difference in mortality among the categories was statistically significant (p<0.001). Hypertension was a risk factor for death in patients of COVID-19 (Odds ratio=1.24, 95% CI [0.76-2.01]). Lymphopenia was not associated with statistically significant increased risk for mortality. CONCLUSIONS: The ISARIC 4C mortality score can be used for stratifying and predicting mortality in COVID-19 patients on arrival in hospital. We propose that it should be used in every patient of COVID-19 presenting to the hospital. Those falling in Low and Intermediate Risk Category should be managed in ward level. Those falling in High and Very High Category should be admitted in HDU/ICU with aggressive treatment from the start.