Burnout among medical students and correlation with academic performance, sleep quality during COVID19 pandemic online class in Erode district

Medical students have found distance learning to be a difficult challenge as a result of the coronavirus disease 2019 (COVID-19) pandemic. This study investigated the correlation between academic performance, sleep quality, and burnout among Medical students who participated in distance learning during the COVID-19 pandemic. The study included 154 Medical students at Government Erode Medical College in Tamilnadu, data were collected in June 2021. The survey was conducted using a Google Forms containing informed consent along with Demographic Details, self-rated sleep quality, academic performance, and The Maslach Burnout Inventory-Student Survey burnout questionnaire. Correlation between academic performances, sleep quality, Emotional Exhaustion, Cynicism, and Academic Efficacy was analyzed using Karl Pearson correlation method. 18% of students experienced severe burnout during distance learning. 60% of students don't like online classes. More than 60% internal mark scored students (P=0.02) are having significantly high Academic Efficacy Scores. Cronbach's Alpha is 0.7498. Distance learning was reported a significant negative impact on their academic performance. To develop a favourable learning environment for medical students, medical instructors should consider creative learning methodologies.

Téléconsultation en rhumatologie : enquête de satisfaction en période pandémique COVID-19

La téléconsultation en situation de pandémie représentait un moyen simple de maintenir la continuité des soins. Elle permettait d'assurer le suivi médical des patients confinés, en limitant la propagation du virus et l'exposition des professionnels de santé. L'objectif du travail était d'évaluer le taux de satisfaction des patients à la suite d'une téléconsultation en rhumatologie pendant le confinement mondial. Étude prospective comportant une enquête de satisfaction réalisée dans notre formation où la téléconsultation a été mise en place pour remplacer une partie les consultations programmées à l'unité d'ostéopathies fragilisantes entre 2020 et 2021. Les critères d'inclusion : tous les patients ayant bénéficié de la consultation à distance durant cette période. Au total, 125 patients ont été vus en téléconsultation sur une période de 6 mois d'inclusion et 42 patients ont complété le questionnaire. L'âge moyen était de 61,71 ans et un sexe-ratio H/F de 0,023. Au total, 90 % des patients étaient sans profession et 64,3 % avaient un niveau intellectuel bas ;68,3 % des patients étaient suivis pour ostéoporose, 46,3 % pour hypovitaminose D, 22 % pour ostéopénie et 2,4 % pour hyperparathyroïdie. Au total, 97 % des malades ont utilisé le téléphone pour la consultation à distance ;64,3 % des patients ont pu évoquer tous leurs problèmes de santé de façon libre et en confidentialité, 58,5 % des patients n'avaient rencontré aucune difficulté matérielle lors de la téléconsultation et 34 % avaient un problème de connexion au réseau. Au total, 10,3 % des patients avaient rencontré une difficulté dans la réception de l'ordonnance émise pour récupérer le traitement ;34 % avaient rencontré une difficulté dans l'émission des résultats des bilans au médecin et 28,6 % ont été re-convoqués en présentiel à la suite d'une consultation à distance. Le taux de satisfaction globale était de 45,2 %. Nos résultats montrent bien que la téléconsultation ne permettait pas une prise en charge médicale complète mais en situation de pandémie, elle a été bien accueillie par les patients. Elle représentait un moyen simple de maintenir la continuité des soins médicaux tout en réduisant le risque de contamination par contact direct entre les patients et le personnel soignant. (French) [ FROM AUTHOR]

Respiratory mucosal immunity against SARS-CoV-2 after mRNA vaccination.

SARS-CoV-2 mRNA vaccination induces robust humoral and cellular immunity in the circulation; however, it is currently unknown whether it elicits effective immune responses in the respiratory tract, particularly against variants of concern (VOCs), including Omicron. We compared the SARS-CoV-2 S-specific total and neutralizing antibody responses, and B and T cell immunity, in the bronchoalveolar lavage fluid (BAL) and blood of COVID-19-vaccinated individuals and hospitalized patients. Vaccinated individuals had significantly lower levels of neutralizing antibody against D614G, Delta (B.1.617.2), and Omicron BA.1.1 in the BAL compared with COVID-19 convalescents despite robust S-specific antibody responses in the blood. Furthermore, mRNA vaccination induced circulating S-specific B and T cell immunity, but in contrast to COVID-19 convalescents, these responses were absent in the BAL of vaccinated individuals. Using a mouse immunization model, we demonstrated that systemic mRNA vaccination alone induced weak respiratory mucosal neutralizing antibody responses, especially against SARS-CoV-2 Omicron BA.1.1 in mice; however, a combination of systemic mRNA vaccination plus mucosal adenovirus-S immunization induced strong neutralizing antibody responses not only against the ancestral virus but also the Omicron BA.1.1 variant. Together, our study supports the contention that the current COVID-19 vaccines are highly effective against severe disease development, likely through recruiting circulating B and T cell responses during reinfection, but offer limited protection against breakthrough infection, especially by the Omicron sublineage. Hence, mucosal booster vaccination is needed to establish robust sterilizing immunity in the respiratory tract against SARS-CoV-2, including infection by the Omicron sublineage and future VOCs.

In Silico Based Bioinformatics Project During the COVID-19 Lockdown Period: An Alternative to Wet Lab Study

In the weeks and months following the COVID outbreak, millions of students around the world are forced to switch over from traditional classroom learning to online learning. This unprecedented move had tremendous impact on the mode of learning project based courses. In particular, the field of biological science project based courses which require the students and faculty to work in the laboratory was impacted. 5 students and a faculty from Kalasalingam Academy of Research and Education used modern in silico tools, databases and software to study a biological problem related to antibiotic resistance in a bacterium called Enterobacter hormaechei subsp. hoffmannii OIPH-N069. The students used freely available modern bioinformatics tools, databases and software such as NCBI, PROTPARAM, SOPMA, BLAST, CLUSTAL O M E G A, C D D, S W I S S-M O D E L s e r v e r, PATCHDOCK, PYMOL and CARD to carry out the research work. This method of doing the project has resulted in the phase I completion of the project course successfully. This methodology of usage of freely available tools, databases and software will help students worldwide to pursue the project based biology courses successfully. The significance of this study is the capability of students in completion of the biology project with the usage of only computer and internet and not to depend upon expensive wet lab study. © 2022, Rajarambapu Institute Of Technology. All rights reserved.

Role of Local Governing Institutions in Community-Based Management of COVID-19 Pandemic in Two States of South-India: Mixed Method Cross-Sectional Study (preprint)

Background: The COVID-19 pandemic has highlighted that community engagement and health governance are critical for mitigating the impact and enhanced preparedness. This study assesses the knowledge, attitudes, and practices (KAP) among elected Gram panchayat representatives (Sarpanches) and volunteers. The study explores enablers and barriers for community-level management of COVID-19 and vaccination in two states of South India – Andhra Pradesh (AP) and Telangana (TS). In addition, the availability and utilization of COVID-19 related care and other Primary Healthcare services including Non-COVID clinical care, Maternal and Child health services was also studied.Methods: A mixed-method cross-sectional study consisting of 183 semi-structured interviews and 15 in-depth interviews from two districts of AP and TS. In depth interviews were conducted with 10 COVID-19 recovered patients and 20 lactating mothers were conducted. Results: Quantitative findings suggest a significant association between socioeconomic status and educational level with knowledge. 74% of participants practiced wore masks and 59% washed hands whereas 91% were vaccinated. Sarpanches ensured community compliance and supported the COVID-19 control activities. Most of the COVID-19 patients reported being stigmatized even after recovery. Lactating mothers were dissatisfied with services in government hospitals and high expenditures in private hospitals.Conclusion: The study established the crucial role of sarpanches and volunteers in COVID-19 response. It is important to build their capacities further for better community-based preparedness. Primary health care services should be strengthened for uninterrupted access during such pandemics. 

Burnout amongmedical students and correlation with academic performance, sleep quality during covid19 pandemic online class in erode district

Medical students have found distance learning to be a difficult challenge as a result of the coronavirus disease 2019 (COVID-19) pandemic. This study investigated the correlation between academic performance, sleep quality, and burnout among Medical students who participated in distance learning during the COVID-19 pandemic. The study included 154 Medical students at Government Erode Medical College in Tamilnadu, data were collected in June 2021. The survey was conducted using a Google Forms containing informed consent along with Demographic Details, self-rated sleep quality, academic performance, and The Maslach Burnout Inventory –Student Survey burnout questionnaire. Correlation between academic performances, sleep quality, Emotional Exhaustion, Cynicism, and Academic Efficacy was analyzed using Karl Pearson correlation method. 18% of students experienced severe burnout during distance learning. 60% of students don’t like online classes. More than 60 % internal mark scored students (P=0.02) are having significantly high Academic Efficacy Scores. Cronbach’s Alpha is 0.7498. Distance learning was reported a significant negative impact on their academic performance. To develop a favourable learning environment for medical students, medical instructors should consider creative learning methodologies.

Follow-up of patients under biologics in the era of lockdown

Background: The management of patients with inflammatory rheumatic diseases under biologics has raised many questions about the global management of patients in the time of COVID-19 pandemic. This period could have been particularly painful for the patients due to the virus itself, and to the difficulty to access to healthcare facilities due to the lockdown. Objectives: To assess the impact of the lockdown in patients under biologics. Methods: This is a descriptive study, conducted between 03/01/2021 and 07/31/2021 in the Department of Rheumatology of the University Hospital of Ibn Rochd in Casablanca. Inclusion criteria were all patients on biologics during the lockdown period. The number of painful, swollen joints, pain visual analogue scale, and disease activity were collected before and during the lockdown. Results: Thirty-one patients under biologics were included. The average age was 43.4 years. There were 17 males and 14 females (sex ratio M/F 1,21). Cormibidities were hypertension and type 2 diabetes (9.7%), hypertension and dyslipidemia (6.5%), arrhythmia (6.5%), smoking (9.7%), hypertension and dysthyroidism (3.2%). All the patients were under biologics with an average duration of 2 years distributed as follows: 3 patients on etanercept (9.67%), 8 patients on tocilizumab (28.8%), 10 patients on infliximab (32.25%), 5 patients on adalimumab (16.12%)), 4 patients under golimumab (12.90%), 1 under secukinumab (3.22%). Biologics were associated with conventional synthetic disease-modifying antirheumatic drugs in 38.7% (methotrexate 12.9%, salosopyrine25, 8%), corticosteroids in 25.7%, non-steroidal anti-inflammatory drugs in 16.1%. The disease activity before COVID-19 of the patients was: 48.39% weak activity, 35.4% remission, 16.13% moderate activity. No patient reported a flare of the disease. During lockdown, 5 patients reported a flare of their disease (16.12%) They were followed for: 2 spondyloarthritis, 1 rheumatoid arthritis, 1 psoriatic arthritis, 1 adult onset Still's disease. All the patients have temporarily stopped their drugs because they couldn't come to their appointments because of the lockdown. Conclusion: Our study notes that the patients who kept their follow-up during lockdown have maintained a control of their disease activity. Our results are consistent with the observations of a French study on the impact of lockdown on the activity of rheumatoid arthritis. However, those who couldn't come to their control appointment due to the lockdown had a flare of their disease. This study remains limited due to the monocentric nature and the small size of our sample.

Impact of COVID-19 on patients with rheumatic diseases: Experience of the department of rheumatology of the university hospital of IBN rochd of casablanca

Background: The COVID-19 outbreak has been a source of major concern for the management of rheumatic patients, particularly those under immunosuppressants. It is generally admitted that patients followed for autoimmune diseases have an increased risk of infectious complications compared to the general population (1). However, to date, there is no established relationship between autoimmune diseases and an increased risk of infection with SARS-CoV-2 (2). Objectives: The primary objective was to assess the severity of COVID-19 in patients followed in our department. The secondary objective was to assess the subgroup of patients on immunosuppressants. Methods: We conducted a descriptive retrospective study of patients followed in the Department of Rheumatology of the University Hospital of Ibn Rochd, Casablanca. The patients who presented with COVID-19 between 08/2020 and 12/2020 were included. Epidemiological, clinical, therapeutic, and evolutionary data were collected and analyzed. Results: Our series included 30 patients, with a sex ratio M/F of 0.3. The mean age of the patients was 46.4 years (±16.3), with a mean follow-up time of 8.1 years. 7 patients had a metabolic syndrome. Patients were followed for rheumatoid arthritis (n = 4), spondyloarthritis (n = 10), systemic lupus erythematosus (n = 5), scleroderma (n = 2), polymyalgia rheumatica (n = 1), adult onset Still'sdisease (n = 1), polyosteoarthritis (n = 6), benign osteopathy (n = 1). 17 patients were in low disease activity when they presented the COVID-19. 8 patients presented moderate to high activity, of which 2 (25%) developed a form requiring hospitalization. 7 patients were under NSAIDs, 13 under corticosteroids, 19 under csDMARD, 7 under bDMARD. The COVID-19 disease was symptomatic in 83% of cases, with fatigue (68%), cough (52%), back pain (48%), anosmia (48%), ageusia (44%), arthritis (44%), fever (36%). The diagnosis was made with polymerase chain reaction (83%), serology (10%), CT scan (23%). The CT lung lesions reached 25-50% in 2 lupus patients with a moderate disease activity, under corticosteroids and hydroxychloroquine. The involvement was > 75% in 2 patients, who admitted to intensive care: one was followed for polyarthrosis and was hypertensive and poorly balanced diabetic, and the other was followed for Horton's disease. The treatment was administered on an outpatient basis in 77.4% of cases, in an intensive care unit in 16% of cases. 30 patients fully recovered from infection, one patient died secondary to pulmonary embolism. The subgroup of patients on immunosuppressants consisted of 23 patients (76%), of whom 5 (22%) developed a moderate to severe form of COVID-19 requiring hospitalization. Among these hospitalized patients, 2 (40%) had moderate to high disease activity of their rheumatism. Conclusion: Most of the patients in our series presented a mild form of COVID-19, including those under immunosuppressants. Patients who were under hydroxychloroquine were not spared from COVID-19, but developed a mild form. The disease activity of the chronic rheumatism did not appear to influence the severity of the COVID-19.

Impact of the SARS-CoV-2 pandemic in a population of patients followed in a rheumatology department

Background: The COVID-19 pandemic had various impacts onpatients' realities. It had many physical but also psychological repercussions. It led to the onset of general stress, anxiety and depression affecting different age groups. In this study, we report the frequency of anxiety in patients followed in the department of rheumatology during the COVID-19 outbreak. Objectives: To assess the impact of the COVID-19 pandemic in patients followed for inflammatory rheumatic disorders (IRD) or degenerative diseases in the Department of Rheumatology during the period of breakdown and health restrictions. Methods: This is a cross-sectional study conducted in the department of rheumatology over a 5-month period from August 2020 to December 2020. Included patients were followed for IRD or degenerative pathology in the department. A pre-established questionnaire collected the symptoms and results of COVID-19 tests, the possible deterioration of the general condition since breakdown, as well as the increase of the disease activity of the rheumatism, pain, fatigue, anxiety, and the onset of signs of depression or sleep disturbances.The impact of the decrease in physical activity and the cessation of basic treatments of rheumatism with the different causes was also collected. Results: 159 patients were included: 27 with Rheumatoid arthritis, 58 with Spondyloarthropathies, 32 with chondrocalcinosis, 9 with gouty arthropathies, and 33 with osteoarthritis. Of these, 15% had symptoms consistent with COVID-19. 25 patients performed the PCR test, of which 17 were positive and only 3 required hospitalization.None were put on oxygen. 32% reported a worsening of their rheumatism since the beginning of the epidemic, of which 35.9% reported increased pain and 21 noted a decrease in physical activity. 27.1% felt more stressed and irritated, and 14% felt more depressed. 54% had more sleepdisturbance, 22.2% had more fatigue compared to their state before the epidemic. 41.2% were afraid to come for consultation or hospitalization. 11.8% had stopped the basic treatment of their rheumatism, either for a shortage of the product in the pharmacy, or for the inability to obtain a travel authorization from the authorities Conclusion: The physical and mental impact of the COVID-19pandemic affected approximately one-third of our population. Patients described worsening rheumatism and pain, as well as impaired sleep, fatigue and anxiety[1].Decreased physical activity was associated with increased rheumatism activity and pain. More than 50% of the patients presented a deterioration in their physical and mental health linked to the health situation[2]. Our results are consistent with the literature. It is classically admitted that rheumatic pathologiesare disabling and therefore lead to a withdrawal into oneself, generating an anxious state. It is essential to assess the psychological status of patients followed for rheumatism in order to develop preventive treatments and prevent its worsening linked to the impact of the pandemic[3].

Uncoupling of macrophage inflammation from self-renewal modulates host recovery from respiratory viral infection.

Tissue macrophages self-renew during homeostasis and produce inflammatory mediators upon microbial infection. We examined the relationship between proliferative and inflammatory properties of tissue macrophages by defining the impact of the Wnt/ß-catenin pathway, a central regulator of self-renewal, in alveolar macrophages (AMs). Activation of ß-catenin by Wnt ligand inhibited AM proliferation and stemness, but promoted inflammatory activity. In a murine influenza viral pneumonia model, ß-catenin-mediated AM inflammatory activity promoted acute host morbidity; in contrast, AM proliferation enabled repopulation of reparative AMs and tissue recovery following viral clearance. Mechanistically, Wnt treatment promoted ß-catenin-HIF-1α interaction and glycolysis-dependent inflammation while suppressing mitochondrial metabolism and thereby, AM proliferation. Differential HIF-1α activities distinguished proliferative and inflammatory AMs in vivo. This ß-catenin-HIF-1α axis was conserved in human AMs and enhanced HIF-1α expression associated with macrophage inflammation in COVID-19 patients. Thus, inflammatory and reparative activities of lung macrophages are regulated by ß-catenin-HIF-1α signaling, with implications for the treatment of severe respiratory diseases.

Fulminant hepatic failure: A rare and devastating manifestation of Coronavirus disease 2019 in an 11-year-old boy.

Although several typical manifestation of novel coronavirus disease 2019 (COVID-19) including respiratory symptoms, weakness, fever, and fatigue have been reported, some rare and novel manifestations have also been observed, particularly in children. We report a pediatric case of fulminant hepatic failure associated with COVID-19. Although the patient was treated for acute fulminant hepatic failure in the context of COVID-19, he died following the progression of the disease to stage 4 hepatic failure with encephalopathy and brain death.