Evaluation of Short-Term Side Effects Following the First Dose of COVID-19 Vaccines Among Physicians and Dentists: A Cross-Sectional Study from India.

Background: Efficacy and safety are fundamental for the development of successful COVID-19 vaccines. Vaccine-associated side effects influence vaccine hesitancy. This study investigated the prevalence, severity, and onset of side effects following the first dose of COVID-19 vaccines among physicians and dentists working in various healthcare settings across India. Methods: A cross-sectional survey collected self-report data from April to June 2021 on side effects following the first dose of the vaccine. An online validated questionnaire using the Google Docs® platform was circulated via email and social media platforms. Results: More than 40% of participants experienced at least one side effect after the first dose of vaccination; the most common were mild and resolved within three days after vaccination. More than 91% of respondents received the Covishield (AstraZeneca) vaccine; the most prevalent adverse effects were soreness of the injected arm (78.9%), tiredness (71.1%), and fever (54.9%). Logistic regression showed that women were almost 60% less likely to report side effects. Conclusion: Findings supported the safety of the first dose of the COVID-19 vaccine based on relatively few self-limiting side effects, mainly soreness of the injected arm and tiredness. Further research is needed to determine the long-term safety of COVID-19 vaccines, especially after booster doses.

Case Study: Rapid Training of Community Health Workers Using Enskill®

The COVID-19 pandemic caused many workers to lose their jobs, and also resulted in rapid surges in demand for workers with particular skills. In public health there was suddenly a huge demand for community health workers to conduct contact tracing, vaccination, and community outreach. To address this need, our team undertook the challenge of creating an online course that trains workers for community health work in half the time of typical training programs. It utilizes the Enskill® learning platform, which uses AI technology to create simulated scenarios in which trainees practice skills with avatars acting as simulated patients. Fifty-seven training participants without college degrees were recruited for the program from the Hampton Roads region, in collaboration with the Hampton Roads Workforce Council. The first cohorts of trainees were able to complete the training successfully in just eight weeks, and are now being placed in public health and healthcare positions. The approach also shows promise for upskilling existing employees to address skill gaps. The Enskill training program is a competitor in the XPRIZE Foundation's Rapid Reskilling competition, to quickly reskill under-resourced workers for the digital revolution.

Microbial Dysbiosis and Epithelial Dysfunction in Vitamin A-Deficient Lungs

Once believed to be sterile, recent studies now show microbes inhabiting healthy lungs that are dysregulated in patients with chronic obstructive pulmonary disease (COPD), asthma, tuberculosis (TB), and SARS-CoV-2 infection. Other studies have shown an increase in pulmonary disease and recurrent respiratory infections in malnourished patients. According to the World Health Organization, vitamin A deficiency (VAD) is now a major public health issue in low-income communities and many developing countries. While VAD has been shown to alter gene expression and tissue morphology in humans and mice, research suggests the lung microbiome plays an intimate role in the metabolic regulation, pathogen inhibition, and inflammatory responses in the lung. Whether dysbiosis is a cause or consequence of chronic respiratory conditions, or whether retinoic acid (RA) - the bioactive metabolite of Vitamin A - is essential for lung microbiome homeostasis, remains unknown. Therefore, we hypothesize that dietary VAD leads to epithelial remodeling which promotes microbial dysbiosis;the dysbiosis then perpetuates epithelial remodeling via host-microbe interactions. Our preliminary results show anatomical/pathological changes to the epithelium in VAD adult mouse lungs compared to controls (VAS). Using our Nkx2- 1creERT2/dnRAR Rosa26 tdTomato transgenic mouse model that selectively induces VAD in the adult lung epithelium following tamoxifen injections, our data supports the hypothesis that host epithelial aberration associated with dietary VAD is induced locally in the lung and not via distal or systemic mechanisms. Our data also indicates the onset of dysbiosis in adult mouse lungs as early as three weeks post-diet modulation as observed through changes in microbial composition in VAD mice compared to controls. Finally, our bulk RNAseq analysis of host and microbial gene signatures has uncovered mechanisms associated with microbial metabolic functions, ciliopathy, host cellular polarity, and immune response to infection, that are dysregulated in the absence of vitamin A. Further, we have also identified altered transcriptional activity of microbes that are traditionally symbiotic or pathobiotic under normal homeostasis. This work indicates the presence of specific host-microbe interactions that are essential for lung homeostasis and protection against lung infection and disease that are dysregulated or lost in the absence of dietary vitamin A.

Immunopathogenic overlap between COVID-19 and tuberculosis identified from transcriptomic meta-analysis and human macrophage infection.

Current and previous tuberculosis (TB) increase the risk of COVID-19 mortality and severe disease. To identify mechanisms of immunopathogenic interaction between COVID-19 and TB, we performed a systematic review and patient-level meta-analysis of COVID-19 transcriptomic signatures, spanning disease severity, from whole blood, PBMCs, and BALF. 35 eligible signatures were profiled on 1181 RNA-seq samples from 853 individuals across the spectrum of TB infection. Thirteen COVID-19 gene-signatures had significantly higher "COVID-19 risk scores" in active TB and latent TB progressors compared with non-progressors and uninfected controls (p<0·005), in three independent cohorts. Integrative single-cell-RNAseq analysis identified FCN1- and SPP1-expressing macrophages enriched in severe COVID-19 BALF and active TB blood. Gene ontology and protein-protein interaction networks identified 12-gene disease-exacerbation hot spots between COVID-19 and TB. Finally, we in vitro validated that SARS-CoV-2 infection is increased in human macrophages cultured in the inflammatory milieu of Mtb-infected macrophages, correlating with TMPRSS2, IFNA1, IFNB1, IFNG, TNF, and IL1B induction.

Telehealth e-mentoring in postgraduate musculoskeletal physiotherapy education: A mixed methods case study to inform implementation for advanced clinical practice

Keywords: Telehealth e-mentoring, Advanced musculoskeletal practice, Professional development Purpose: Mentored clinical practice is central to development of advanced clinical practice in musculoskeletal physiotherapy, and core within national and international educational standards. Whilst mentoring is traditionally delivered face-to-face, telehealth e-mentoring is a novel alternative, affording a unique andragogy to facilitate mentee critical reflection, deep learning and enhanced knowledge translation – all developed to optimise patient care. With COVID-19 resulting in widespread adoption of telehealth and access to specialist mentors often limited by clinic space, geography and cost, the potential value of telehealth e-mentoring is considerable. The purpose of this study was to understand the experiences and outcomes of/for multiple stakeholders (patients, student-mentees and mentors) engaged in musculoskeletal physiotherapy telehealth e-mentoring. Methods: Using case study design, sequential mixed methods explored stakeholder experiences of a 20-week telehealth e-mentoring service in a UK University as part of an advanced practice Masters programme. Quantitatively, validated outcome measures, patient participant experiences for care and empathy, patient empowerment and change in musculoskeletal health were collected at baseline and discharge. Qualitatively, semi-structured interviews exploring experiences of telehealth e-mentoring, including influence on critical thinking, clinical reasoning, communication skills, confidence, motivation, career enhancement etc. with mentee participants, and a focus group with mentor participants (topic guide informed by earlier analysis) were audio recorded and transcribed verbatim. Quantitative data were analysed using descriptive statistics (median, IQR) and qualitative data were analysed following the Framework Method. Trustworthiness was assured through reflexivity and code/recode audits with experts. Results: Data from patients (n = 90), mentees (n = 10) and mentors (n = 6) contributed to the developed analytic framework. Patients were aged median 42 years (18-73 years) presenting with a range of musculoskeletal complaints;n = 52 receiving follow up appointments. Of those followed up, improvements > MCID were clear, with MSK-HQ increasing by 11 points (MCID 6), Patient Specific Functional Scores improving by 4 points (MCID 2.7), and high scores for the Consultation and Relational Empathy and Patient Enablement Instrument. Mentors and mentees provided rich descriptions of their experiences. Main themes (sub-themes) for mentee participants’ included a) social learning (group mentorship, feedback, individualisation), b) advanced professional practice (communication, clinical reasoning, reflective practice), c) learner experience (expectation/acceptance, enjoyment/motivation) and c) limitations of telehealth (hands-on skill development, caseloads, therapeutic relationship). Mentor participants included a) preparedness (telehealth skills, relationship building, managing perceptions/expectations), b) journey of development (formative feedback, peer discussions, mimicking behaviours) and c) challenges (non-verbal communication, home environment, exercise prescription/goal-setting). Conclusion(s): Telehealth e-mentoring is an appropriate alternative to face-to-face mentored clinical practice, with improved patient outcomes and developed advanced musculoskeletal physiotherapy skills, knowledge and attributes. Planning for telehealth e-mentoring requires multi-stakeholder preparation, including setting expectations, embracing creativity in practice, and acquisition of technical skills. Impact: Adoption of telehealth e-mentoring may enhance opportunities for practice-based professional development and provide needed additional capacity to support profession specific skill development and service capability, to meet planned growth in advanced musculoskeletal physiotherapists. This study provides evidence from patients, mentees and mentors to support e-mentorship within teleheal h clinical practice. Preparation, planning and articulation of clear expectations are important to optimise the experience. Funding acknowledgements: Elsevier Research Award, MACP 2020

Caution with Mild COVID19 Pneumonia: A Case of Cavitary Lesions and Pneumothorax in a Young Male with No Past Medical History

Introduction: Cavitary lesions have a very broad differential diagnosis. Some case studies have shown COVID19 to cause cavitary lesions1,2 and others have shown COVID19 to cause pneumothorax3. We describe a case report of a young man with no significant past medical history who was hospitalized for COVID19 pneumonia and was subsequently developed a pneumothorax. Case Report: A 39-year-old male presented to the hospital for acute onset shortness of breath. On admission, he was found to have right-sided pneumothorax and a pigtail catheter was placed with a proper expansion of the right lung. Approximately one month previously, he had been admitted for mild COVID19 pneumonia and successfully treated with dexamethasone and was discharged home with stable condition.On further evaluation, chest CT revealed multiple cavitary lesions with one large cavitation in the inferior right upper lobe with prominent mediastinal and hilar nodes. Quantiferon gold, AFB x3, and mycobacterium complex PCR were all negative. Fungitell, 1-3 B-D gluten, and coccioides antibodies were also negative. The patient had no other suggestive features to warrant vasculitis or malignancy evaluation. Discussion:The importance of this case is recognizing the late sequela of COVID19 pneumonia such as cavitary lesions and pneumothorax as seen with our patient. Some studies showed the development of pneumothorax associated with COVID19 but no previous studies showed the development of these findings in a patient without any past pulmonary history3. We attributed the development of cavitary lesions to covid19 and subsequently, because of that, the patient developed pneumothorax. Conclusion: It is important to consider the long term sequela of COVID19 pneumonia especially in those we consider to have mild disease. It is important to minimize potential severe consequences such as pneumothorax which occurred due to intense coughing as seen with our patient.

Evaluating the Antimicrobial Properties of Commercial Hand Sanitizers.

Hand sanitizers have been developed as a convenient means to decontaminate an individual's hands of bacterial pathogens in situations in which soap and water are not available. Yet to our knowledge, no study has compared the antibacterial efficacy of a large collection of hand sanitizers. Using zone of growth inhibition and kill curve assays, we assessed the performance of 46 commercially available hand sanitizers that were obtained from national chain big-box stores, gasoline stations, pharmacies, and boutiques for antibacterial activity toward prototypical Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacterial pathogens. Results revealed substantial variability in the efficacy of many sanitizers evaluated. Formulations following World Health Organization-recommended ingredients (80% ethanol or 75% isopropyl alcohol) or those including benzalkonium chloride as the active principal ingredient displayed excellent antibacterial activity, whereas others exhibited modest or poor activity in the assays performed. Results also revealed that E. coli was generally more susceptible to most sanitizers in comparison to S. aureus and that there was significant strain-to-strain variability in hand sanitizer antimicrobial efficacy regardless of the organism evaluated. Further, tests of a subset of hand sanitizers toward severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) revealed no direct correlation between antibacterial and antiviral performance, with all ethyl alcohol formulations performing equally well and displaying improved activity in comparison to benzalkonium chloride-containing sanitizer. Taken together, these results indicate that there is likely to be substantial variability in the antimicrobial performance of commercially available hand sanitizers, particularly toward bacterial pathogens, and a need to evaluate the efficacy of sanitizers under development.IMPORTANCE In response to the coronavirus disease 2019 (COVID-19) pandemic, hand hygiene has taken on a prominent role in efforts to mitigate SARS-CoV-2 transmission and infection, which has led to a radical increase in the number and types of hand sanitizers manufactured to meet public demand. To our knowledge, no studies have evaluated or compared the antimicrobial performance of hand sanitizers that are being produced under COVID-19 emergency authorization. Tests of 46 commercially available hand sanitizers purchased from national chain brick-and-mortar stores revealed considerable variability in their antibacterial performance toward two bacterial pathogens of immediate health care concern, S. aureus and E. coli Expanded testing of a subset of hand sanitizers revealed no direct correlation between antibacterial performance of individual sanitizers and their activity toward SARS-CoV-2. These results indicate that as the pandemic subsides, there will be a need to validate the antimicrobial efficacy of sanitizers being produced.

Ebola virus disease outbreak: A global approach for health systems

Introduction: Ebola virus disease is a severe, highly infectious, and often fatal illness. The pharmacists’ experience regarding Ebola in Sierra Leon is valuable for other countries, insofar they can learn from it and benefit from it globally. Objective: To describe the tasks carried out in Sierra Leone during the Ebola outbreak. Methods: This is a documentary review based on the regulations developed and the technical documents published by the Sierra Leone Ministry of Health. Conclusions: Health systems need collaborative work, especially in cases of epidemics or pandemics. The information presented shows what could be achieved in the Ebola epidemic for detecting emerging foci, as well as for guaranteeing communication among professionals, and for saving lives. This learning should be used, in the case of COVID-19, where interconnection among professionals and health authorities is required, together with accurate and agile information targeted towards the population as well as coordinated progress to obtain the best treatments for patients. © 2020, Editorial Ciencias Medicas. All rights reserved.

Systematic evaluation of transcriptomic disease risk and diagnostic biomarker overlap between COVID-19 and tuberculosis: a patient-level meta-analysis.

BACKGROUND: The novel coronavirus, SARS-CoV-2, has increased the burden on healthcare systems already strained by a high incidence of tuberculosis (TB) as co-infection and dual presentation are occurring in syndemic settings. We aimed to understand the interaction between these diseases by profiling COVID-19 gene expression signatures on RNA-sequencing data from TB-infected individuals. METHODS: We performed a systematic review and patient-level meta-analysis by querying PubMed and pre-print servers to derive eligible COVID-19 gene expression signatures from human whole blood (WB), PBMCs or BALF studies. A WB influenza dataset served as a control respiratory disease signature. Three large TB RNA-seq datasets, comprising multiple cohorts from the UK and Africa and consisting of TB patients across the disease spectrum, were chosen to profile these signatures. Putative "COVID-19 risk scores" were generated for each sample in the TB datasets using the TBSignatureProfiler package. Risk was stratified by time to TB diagnosis in progressors and contacts of pulmonary and extra-pulmonary TB. An integrative analysis between TB and COVID-19 single-cell RNA-seq data was performed and a population-level meta-analysis was conducted to identify shared gene ontologies between the diseases and their relative enrichment in COVID-19 disease severity states. RESULTS: 35 COVID-19 gene signatures from nine eligible studies comprising 98 samples were profiled on TB RNA-seq data from 1181 samples from 853 individuals. 25 signatures had significantly higher COVID-19 risk in active TB (ATB) compared with latent TB infection (p <0·005), 13 of which were validated in two independent datasets. FCN1 - and SPP1 -expressing macrophages enriched in BALF during severe COVID-19 were identified in circulation during ATB. Shared perturbed ontologies included antigen presentation, epigenetic regulation, platelet activation, and ROS/RNS production were enriched with increasing COVID-19 severity. Finally, we demonstrate that the overlapping transcriptional responses may complicate development of blood-based diagnostic signatures of co-infection. INTERPRETATION: Our results identify shared dysregulation of immune responses in COVID-19 and TB as a dual risk posed by co-infection to COVID-19 severity and TB disease progression. These individuals should be followed up for TB in the months subsequent to SARS-CoV-2 diagnosis.