Anxiety, Depression and Stress Among Medical Students in Malaysia During COVID-19: A Cross-Sectional Study

Introduction: This study aimed to determine the prevalence and factors associated with psychological distress following the COVID-19 pandemic among medical students at one of the public universities in Malaysia. Method: From August to October 2020, a web-based cross-sectional study was conducted among undergraduate medical students at a public university. DASS-21, Brief Resilience Scale and WHOQOL-Bref questionnaires were used in this study. Results: The prevalence of depression was 40.5%, anxiety 46.0% and stress 30.9%. Based on multivariate logistic regression, a higher quality of life score is associated with a lower likelihood of depression (AOR=0.583, p<0.001), anxiety (AOR=0.726, p<0.001), and stress, (AOR=0.702, p<0.001) respectively. Likewise, a higher resilience score is less likely to be associated with depression (AOR=0.880, p=0.002), anxiety (AOR=0.880, p=0.002), and stress (AOR=0.850, p<0.001). Older age (OR=0.700, p=0.020) was associated with less stress and being on campus (OR=3.436, p=0.021) was at risk of stress during the COVID-19 pandemic. Conclusion: Our results suggest that medical students with higher quality of life and resilience scores had less depression, anxiety and stress. Older age was associated with less stress, and during the COVID-19 pandemic, being on campus was at risk of stress. Various stakeholders need to keep these findings in mind and identify those who are at risk for developing depression, anxiety, and stress in order to take further action to improve their quality of life and resilience. © 2023 UPM Press. All rights reserved.

PUTTING THE "SARS” IN "SARS-COVID-19": A CASE OF SARCOID-LIKE INFLAMMATORY REACTION AFTER COVID-19 VACCINATION

SESSION TITLE: Issues After COVID-19 Vaccination Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Sarcoidosis and sarcoid-like reactions tend to be diagnoses of exclusion when evaluating patients with malignancy, and have a number of inciting causes. This is a unique case of a patient diagnosed with non-necrotizing granulomatous inflammation on biopsy of mediastinal lymph nodes and skin lesions after receiving SARS-CoV-2 vaccine, while also being on Temozolamide (TMZ). Biopsy-proven sarcoid has rarely been reported in the literature following SARS-CoV-2 vaccine or TMZ. CASE PRESENTATION: 66-year-old female with a history of prolactinoma complicated by recurrence and progression of disease despite surgery, radiation, and medical therapy, who started her first cycle of TMZ and received her first SARS-CoV-2 vaccine 9 days later. About 2 weeks later, she noted numerous painless "bumps” on her bilateral upper and lower extremities with erythema, without fevers, joint pains, or other symptoms. She underwent a positron emission tomography (PET) scan which demonstrated multiple hypermetabolic subcutaneous lesions, along with intensely hypermetabolic bilateral hilar lymphadenopathy. She underwent punch biopsy notable for sparse inflammation. She underwent her second SARS-CoV-2 vaccine and second cycle of TMZ. After 1 week, she noticed increased induration and erythema over her lesions, and held her TMZ. She underwent incisional biopsy of her thigh which demonstrated granulomatous panniculitis. She also underwent bronchoscopy with endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA) of her paratracheal and subcarinal lymph nodes, which demonstrated non-necrotizing granulomatous inflammation. Labs were only significant for ACE level of 60u/L (normal<40u/L). With a relative paucity of symptoms and no other obvious vital organ involvement, she was not treated, continued her TMZ without flares, and her symptoms self-resolved after opting out of the third SARS-CoV-2 vaccine. DISCUSSION: Sarcoid-like inflammatory reactions have rarely been reported in the literature following SARS-CoV-2 vaccine or TMZ. One case of panniculitis secondary to TMZ administration was reported that improved after discontinuation of TMZ [1]. Our patient continued TMZ therapy without further symptoms, which makes TMZ less likely as her inciting cause. Three cases of sarcoid-like reactions secondary to SARS-CoV-2 vaccine have been reported [2, 3] but two of these cases were diagnosed clinically as Löfgren syndrome without biopsy [3], making this case the second reported case of biopsy-proven de novo sarcoid reaction in the setting of SARS-CoV-2 vaccine. CONCLUSIONS: Sarcoid-like inflammatory reactions following SARS-CoV-2 vaccine have not been well-reported in the literature. This case, among the other limited cases reported, underscores the need to consider sarcoid on the differential of vaccine-related side effects, especially in those with bilateral hilar lymphadenopathy and cutaneous lesions. Reference #1: Virmani P., Chung E., Marchetti M. A. (2015). Cutaneous adverse drug reaction associated with oral temozolomide presenting as dermal and subcutaneous plaques and nodules. Jaad. Case. Rep. 1, 286–288. 10.1016/j.jdcr.2015.06.012 Reference #2: Bauckneht, M., Aloè, T., Tagliabue, E. et al. Beyond Covid-19 vaccination-associated pitfalls on [18F]Fluorodeoxyglucose (FDG) PET: a case of a concomitant sarcoidosis. Eur J Nucl Med Mol Imaging 48, 2661–2662 (2021). https://doi.org/10.1007/s00259-021-05360-w Reference #3: Rademacher JG, Tampe B, Korsten P. First Report of Two Cases of Löfgren's Syndrome after SARS-CoV-2 Vaccination-Coincidence or Causality? Vaccines (Basel). 2021 Nov 11;9(11):1313. doi: 10.3390/vaccines9111313. PMID: 34835244;PMCID: PMC8619392 DISCLOSURES: no disclosure on file for Alexander Geyer;No relevant relationships by Mustafa Jafri

Optimizing peptide inhibitors of SARS-Cov-2 nsp10/nsp16 methyltransferase predicted through molecular simulation and machine learning.

Coronaviruses, including the recent pandemic strain SARS-Cov-2, use a multifunctional 2'-O-methyltransferase (2'-O-MTase) to restrict the host defense mechanism and to methylate RNA. The nonstructural protein 16 2'-O-MTase (nsp16) becomes active when nonstructural protein 10 (nsp10) and nsp16 interact. Novel peptide drugs have shown promise in the treatment of numerous diseases and new research has established that nsp10 derived peptides can disrupt viral methyltransferase activity via interaction of nsp16. This study had the goal of optimizing new analogous nsp10 peptides that have the ability to bind nsp16 with equal to or higher affinity than those naturally occurring. The following research demonstrates that in silico molecular simulations can shed light on peptide structures and predict the potential of new peptides to interrupt methyltransferase activity via the nsp10/nsp16 interface. The simulations suggest that misalignments at residues F68, H80, I81, D94, and Y96 or rotation at H80 abrogate MTase function. We develop a new set of peptides based on conserved regions of the nsp10 protein in the Coronaviridae species and test these to known MTase variant values. This results in the prediction that the H80R variant is a solid new candidate for potential new testing. We envision that this new lead is the beginning of a reputable foundation of a new computational method that combats coronaviruses and that is beneficial for new peptide drug development.

Active site prediction of phosphorylated SARS-CoV-2 N-Protein using molecular simulation.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) nucleocapsid protein (N-protein) is responsible for viral replication by assisting in viral RNA synthesis and attaching the viral genome to the replicase-transcriptase complex (RTC). Numerous studies suggested the N-protein as a drug target. However, the specific N-protein active sites for SARS-CoV-2 drug treatments are yet to be discovered. The purpose of this study was to determine active sites of the SARS-CoV-2 N-protein by identifying torsion angle classifiers for N-protein structural changes that correlated with the respective angle differences between the active and inactive N-protein. In the study, classifiers with a minimum accuracy of 80% determined from molecular simulation data were analyzed by Principal Component Analysis and cross-validated by Logistic Regression, Support Vector Machine, and Random Forest Classification. The ability of torsion angles ψ252 and φ375 to differentiate between phosphorylated and unphosphorylated structures suggested that residues 252 and 375 in the RNA binding domain might be important in N-protein activation. Furthermore, the φ and ψ angles of residue S189 correlated to a 90.7% structural determination accuracy. The key residues involved in the structural changes identified here might suggest possible important functional sites on the N-protein that could be the focus of further study to understand their potential as drug targets.

Mathematics education students’ experiences during lockdown: Managing collaboration in elearning

The current world crisis of COVID‐19 has enforced international lockdowns in educational institutions, necessitating that these institutions quickly transition to online learning. In mathematics education studies, where collaborative problem‐solving is considered a necessary pedagogical approach, lecturers have had challenges incorporating collaborative problem‐solving in an authentic manner. There are now also complex living and learning contexts in which the students have to undertake their learning processes. This paper examines students’ experiences of the rapid transition to online learning and their perceptions of the advantages and barriers that ensued. A small comparative case study was used to explore the complexity of the situation, within rich, authentic settings. Questionnaires and semi‐structured interviews were used. The participants found that personal circumstances related to having children and partners at home while they studied, and aspects such as not interacting directly with other students to clarify and mediate their thinking, led to major initial frustrations with collaborating. While some of these continued throughout lockdown they did adjust and recognize that the advantages, such as a mix of formal and informal digital pedagogical media, gave them greater flexibility and led to deeper reflective thinking. We contend that some elements related to the adaptions made should become permanent features of face‐to‐face learning. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

COVID-19 responsive teaching of undergraduate architecture programs in India: learnings for post-pandemic education

Purpose: The purpose of this paper is to have an overview of how Indian institutions offering undergraduate architecture programs have responded to the pandemic situation. It seeks to appraise the alternative approaches adopted for teaching-learning, communication, assignment and evaluation and assess their effectiveness for progressive improvisations or integration with pedagogy. The paper articulates a view on the suitability of online teaching for architecture education in India, on basis of educators' experiences of teaching during the pandemic. Design/methodology/approach: An online survey was conducted for obtaining primary data from the educators given the paucity of information. The questions elicited structured information on aspects of the transition process, IT/online platform and tools, the efficacy of online teaching-learning and trajectory of blended learning. Findings: All institutions managed the transition to online teaching without much difficulty. However, the paper raises the need for professional training and feedback from students. One-third of the respondents express satisfaction with online teaching, despite low satisfaction about the effectiveness of online teaching of a design studio. The results convey the need for more engagement with digital tools and representational software on integrated platforms. The study finds consensus on the future potential of blended learning and advocates developing an integrated framework and curriculum for architecture education in India. Originality/value: The paper synthesizes viewpoints on online teaching-learning of architecture program in wake of the pandemic from an educators' perspective. The emergent perspectives are viewed dialogically in context of global voices to articulate a future trajectory of blended learning in the domain of architecture education. © 2020, Emerald Publishing Limited.