Association Between ABO Blood Group System and COVID-19 Severity.

OBJECTIVES: A possible association between blood group systems (ABO and Rh) and coronavirus disease 2019 (COVID-19) severity has recently been investigated by various studies with conflicting results. However, due to variations in the prevalence of the ABO and Rh blood groups in different populations, their association with COVID-19 might be varied as well. Therefore, we conducted this study on Libyan participants to further investigate this association and make population-based data available to the worldwide scientific community. METHODS: In this case-control study, ABO and Rh blood groups in 419 confirmed COVID-19 cases in Zawia, Libya, and 271 healthy controls were compared using descriptive statistics and χ 2 tests. RESULTS: Blood group A was significantly more prevalent in patients with severe COVID-19 (64/125; 51.2%) than in patients with nonsevere COVID-19 (108/294, 36.7%) (P < .034), whereas the O blood group prevalence was higher in nonsevere COVID-19 cases (131/294, 44.5%) compared with severe cases (43/125, 34.4%) (P < .001). CONCLUSIONS: The results showed a significant association between blood group A and the severity of COVID-19, whereas patients with blood group O showed a low risk of developing severe COVID-19 infection. No significant association was found between Rh and susceptibility/severity of the disease.

Clinical Characteristics of the First 100 Patients of COVID-19 in Tobruk, Libya: A Brief Report From Low-Resource Settings.

OBJECTIVE: This study aims to report the clinical features of a cohort of patients with suspected coronavirus disease (COVID-19) from Tobruk, Libya, and reflect upon the diagnosis challenge in low-resource settings. METHODS: A descriptive report of the first 100 patients with suspected COVID-19 who have visited the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 screening clinic at the National Centre for Disease Control in Tobruk, Libya. RESULTS: The most common presenting symptoms were fever (90%), cough (89%), dyspnea (85%), sore throat (79%), fatigue (78%), headache (64%), loss of smell (52%), loss of taste (53%), loss of appetite (43%), nausea and vomiting (26%), diarrhea (22%), and rhinorrhea (16%); 51% of the patients had lymphocytopenia, whereas 13% had thrombocytopenia. Bilateral infiltrates were the most common radiologic finding on chest X-ray (76%), and COVID-19 IgM and/or IgG antibodies were detected in 80% of the patients, whereas only 37% of the patients were tested positive by the reverse transcriptase polymerase chain reaction (RT-PCR). CONCLUSIONS: The disease continued its spread across the region. Fever, cough, and dyspnea were the main symptoms; 21% of the patients did not have any chest X-ray abnormalities. Initial negative results for either antibody testing or RT-PCR-testing for COVID-19 do not rule out the infection.

Multi-target endoscopic ultrasound EUS-M guided biopsy is superior to pet scan for staging for malignancies

BackgroundPET scan is widely used not only to diagnose malignancy and its staging, but a small proportion of patients do have false-positive results. EUS now is a well-established modality to get tissue diagnosis, and with multi-target approach can help stage disease more accurately with histopathological results. We share our experience with EUS-M cases with different variety of malignancies.MethodsA total of 25 cases underwent EUS-M from June 2020 till June 2022. Informed consent was obtained, and with Covid screen test with PCR was performed before the procedure. Procedures were done with all SOPs as per institutional guidelines. 22G FNB needle was used in 24 cases, 25G needle in 01 case;Franseen design with the capillary suction method was used to obtain visible core samples for histopathology without ROSE. All cases have confirmed the histopathological diagnosis with the same pathology from other site of Biopsy. Order of Biopsy was Nodes→ Liver metastatic lesion→ Primary Tumour. In cases of nodes mediastinal→ porta-hepatis/pancreatic→ Para-aortic. All samples were adequate for making a confirmatory diagnosis on the tissue sample.ResultsAmong total of 25 cases, Age 54 Mean (22–77) with 16 Males. Duration of procedure 38 Minutes Mean (20–85). Cases with multiple lymphadenopathy from different anatomical regions were 09, while other sites included Liver for metastasis and Primary tumour from pancreas/CBD/GB in 16 cases. Multiple site single pass was performed in 24 cases. 19 cases had malignant pathologies. Final diagnosis of the Disease was pancreatic adenocarcinoma 07, NETs 02, Lymphoma 04, GB Adenocarcinoma/Cholangiocarcinoma 06 and metastatic RCC 01, TB 01. 04 cases had benign disease. All procedures were done under Conscious sedation as day care procedure. There were no immediate or early complications in all cases.ConclusionsEUS-M is a safe and accurate modality to stage malignancy with superiority over PET Scan to obtain a histological diagnosis.

Hybrid endoscopic ultrasound in the covid-19 era for the tissue diagnosis of solid lesions;an initial experience from a tertiary care centre from Pakistan

BackgroundEndoscopic Ultrasound (EUS) is a well-established mode of intervention for tissue acquisition in solid organs with rapid on-site evaluation (ROSE). In the Covid-19 era, the implementation of infection control mechanisms has led to modified hybrid techniques to get high diagnostic yield for tissue sampling. Combination of Covid-19 SOPs and tissue acquisition method outline this hybrid technique to get a high diagnostic Yield. We share our initial experience of EUS cases performed with this approach without ROSE.MethodsAll 125 cases who underwent EUS-guided biopsy from June 2020 till June 2022 were included. The Procedure was done in a negative pressure room with all SOPs as per institutional guidelines for patient and staff safety with a minimum number of persons during the procedure.ResultsAmong these cases, 85 were male, mean age of 56 years (range 22–90), Mean duration of procedure 28 minutes mean (10–90 min). 91 cases for organs targeted for malignant pathology include pancreas 53, liver 03, lymph nodes 22, subepithelial lesions 10, mediastinal lesions 15, common-bile duct/gall bladder 07, gastric and retroperitoneal 01 case, 13 cases had a multi-targeted biopsy for the additional staging of disease. The number of ‘passes’ with the needle was average 02 with single pass 20, two pass 60, three passes 20, multitarget single pass in 25. Needle size (Franseen design) used for procedures was 22G in 115 cases and 25G in 10. Common tissue diagnoses include pancreatic adenocarcinoma 38, neuroendocrine tumours 06, tuberculosis 07, gastrointestinal stromal tumours 03, leiomyoma 05, lymphoma 06, metastatic renal cell carcinoma 05, squamous cell carcinoma 05, cholangiocarcinoma/gall bladder adenocarcinoma 13, Sarcoma 03, solid pseudopapillary epithelial neoplasm of pancreas (SPEN) 03 and one case for Schwannoma, breast metastasis, accessory spleen, ectopic pancreas, sarcoidosis There were no immediate or early complications in all cases.ConclusionsHybrid EUS in Covid 19 Era has emerged as a useful/cost-effective and safe approach to get tissue yield without the need for ROSE.

Experience of Telemedicine in Gastroenterology Out-Patient Practice During the COVID-19 Pandemic: Experiences from a Tertiary-Care Hospital in a Developing Country

Objective Telemedicine is being widely implemented in the COVID-19 pandemic to avoid infection risk. However, its effectiveness has not been evaluated, especially in developing countries, where it is invaluable for healthcare access. This study assesses physicians’ and patients’ perspectives of the usefulness and challenges of telemedicine in the gastroenterology department to identify its pitfalls. Methods A cross-sectional telephonic survey was conducted on patients presenting to the gastroenterology department at a tertiary care hospital in Pakistan. An online survey was sent to physicians in the department. Results A total of 160 patients participated, with a mean age 49.8 years, and 42.8% (n=68) males. There were 23.8% (n=38) initial visits and 76.3% (n=122) follow-ups. More than 85% of patients agreed telemedicine saved cost and time, 46.5% (n=74) said it improved healthcare access, and 76.3% (n=122) wanted to use it again. More than 80% were satisfied with the physician-patient interaction. Of the 7 physicians who participated, most felt telemedicine was inadequately facilitated, but felt comfortable with technology. Most felt it did not negatively affect healthcare, but thought it was complex for patients and that lack of physical interaction is a limitation. Nearly half were in favor of continuing its use after the pandemic. Conclusion Telemedicine is an effective alternative to in-person visits. Patients find it convenient, with adequate interaction. Physicians have reservations that need addressal, such as poor administration. Most patients and half of physicians are welcome to using telemedicine in the post-COVID era.

Healthcare Simulation: A Key to the Future of Medical Education – A Review

Aim Simulation originates from its application in the military and aviation. It is implemented at various levels of healthcare education and certification today. However, its use remains unevenly distributed across the globe due to misconception regarding its cost and complexity and to lack of evidence for its consistency and validity. Implementation may also be hindered by an array of factors unique to the locale and its norms. Resource-poor settings may benefit from diverting external funds for short-term simulation projects towards collaboration with local experts and local material sourcing to reduce the overall cost and achieve long-term benefits. The recent shift of focus towards patient safety and calls for reduction in training duration have burdened educators with providing adequate quantity and quality of clinical exposure to students and residents in a short time. Furthermore, the COVID-19 pandemic has severely hindered clinical education to curb the spread of illness. Simulation may be beneficial in these circumstances and improve learner confidence. We undertook a literature search on MEDLINE using MeSH terms to obtain relevant information on simulation-based medical education and how to best apply it. Integration of simulation into curricula is an essential step of its implementation. With allocations for deliberate practice and mastery learning under supervision of qualified facilitators, this technology is becoming essential in medical education. Purpose To review the adaptation, spectrum of use, importance, and resource challenges of simulation in medical education and how best to implement it according to learning theories and best practice guides. Conclusion Simulation offers students and residents with adequate opportunities to practice their clinical skills in a risk-free environment. Unprecedented global catastrophes provide opportunities to explore simulation as a viable training tool. Future research should focus on sustainability of simulation-based medical education in LMICs.