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Novel and complex digital threats that are increasingly interwoven with means and products of biology that can affect society. Much work in Biocybersecurity/Cyberbiosecurity (BCS/CBS) discuss vulnerabilities, but few deeply address malicious actor varieties as attacks at this intersection are new. The path to those attacks remains mostly theoretical, presenting considerable difficulty to accomplish in practical scenarios. In terms of advanced persistent threats (APTs) this of course needs to change as biomanufacturing facilities are at risk, considering Covid-19 and other potential pandemics. Further attacks are not out of reach and thus we must start to imagine how BCS APTs may appear. This paper in progress aims to open discussion regarding the definition of the concept BCS/CBS APTs and their implications, as well as create call to action for increased attention.
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Aim: Although there are few studies on the predictive value of C-reactive protein-to-albumin ratio (CAR) in coronavirus disease-2019 (COVID-19) patients, to the best of our knowledge, there are no studies specifically conducted in COVID-19 patients with cardiovascular disease (CVD). This study assessed the use of baseline CAR levels to predict death in hospitalized COVID-19 patients with CVD. Methods: This study was designed as a single-center cross-sectional study. Patients diagnosed with COVID-19 who were admitted to the University of Health Sciences Turkey, Bagcilar Training and Research Hospital between April 16 and May 20, 2020 were analyzed retrospectively. The patients were divided into 2 groups: those who died and those who survived, considering the follow-up period. The CAR values of the study population, as well as patients with CVD, were calculated, and the association of CAR with in-hospital mortality was evaluated. Results: The in-hospital mortality rate was 11.1% (49/442 pts) in all populations. Deceased patients had significantly more frequent CVD (p<0.001) and the mortality rate was 34.4% (30/96 pts) in those patients. Median CAR values were higher in nonsurvivors than among survivors (p<0.001). Multivariate analysis demonstrated that CAR was an independent predictor of mortality in patients with CVD [hazard ratio 1.013 (95% confidence interval: 1.002-1.022), p=0.018]. Conclusion: CAR is an inflammatory risk marker that independently predicts mortality in all COVID-19 hospitalized patients and patients with CVD.
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Aim: To determine the COVID-19 fear level of family physicians during the pandemic working in Sivas and its relationship to their experienced problems. Methods: This descriptive study was delivered to 225 family physicians in Sivas between December-January 2021 via an online survey containing 24 questions of participants' sociodemographic data, the problems they experienced in family medicine, and the COVID-19 Fear Scale. Descriptive statistics and logistic regression analysis were used to analyze the data. Results: A total of 138 family physicians whose mean age was 37.6±7.3, with 52.2% males and 47.8% females, included. Participants’ 16.7% had the COVID-19 infection. COVID-19 Fear Scale mean score of 18.3±6.5, appearing significantly higher in females (19.6±5.8) than in males (17.2±6.9). 28.3% of subjects needed taking professional psychological support, on which increase of working period in family medicine and COVID-19 Fear Scale Score and being single had a positive effect. Also, 86.2% experienced primary health care services problems, most frequently ranked as cancer screening, mobile service, and chronic illness follow-up. Conclusion: Necessary psychosocial support should be provided to all healthcare workers, especially family physicians, during the pandemic. So, we recommend authorities take proper precautions to continue without interruption for primary preventive health services. © 2021, Eurasian Society of Family Medicine. All rights reserved.
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OBJECTIVE: We aimed to test the efficiency of CHA2DS2-VASc, CHA2DS2-VASc-HS, R2CHA2DS2-VASc score systems on the prediction of mortality in the patients with COVID-19. PATIENTS AND METHODS: The data were collected from 508 hospitalized patients with COVID-19. Comorbidity features including coronary artery disease, peripheral arterial disease, congestive heart failure, hypertension, atrial fibrillation, diabetes mellitus, hyperlipidemia, smoking, chronic obstructive pulmonary disease, cerebrovascular event, cancer status, and renal disease were recorded. The patients were divided as surviving group (n=440) and non-survivors (n=68). RESULTS: The in-hospital mortality rate of the patients with COVID-19 was 13.4%. Factors found to be associated with mortality in univariate analysis were CHA2DS2-VASc, CHA2DS2-VASc-HS, R2CHA2DS2-VASc, cancer state, atrial fibrillation, hemoglobin, lymphocyte count, CRP, albumin and ferritin. Model 1 multivariate cox regression analysis revealed CHA2DS2-VASc, hemoglobin, CRP and ferritin levels to be independently associated with mortality. Factors that were found to be independently associated with in-hospital mortality in Model 2 analysis were CHA2DS2-VASc-HS, R2CHA2DS2-VASc, hemoglobin, CRP and ferritin whereas except hemoglobin in Model 3 analysis, the other variables had been the same. Predictive power of R2CHA2DS2-VASc was better than of both CHA2DS2-VASc (p=0.002) and CHA2DS2-VASc-HS (p=0.034) in determining the in-hospital mortality. Patients with higher R2CHA2DS2-VASc (> 3 points), CHA2DS2-VASc-HS (> 3 points) and CHA2DS2-VASc (> 2 points) scores exhibited the highest mortality rate in survival analysis by using Kaplan-Meier and long-rank tests. CONCLUSIONS: CHA2DS2-VASc, CHA2DS2-VASc-HS, and R2CHA2DS2-VASc were found to be independent predictors of mortality in hospitalized COVID-19 patients. The current study revealed that the predictive ability of R2CHA2DS2-VASc was better than the both of CHA2DS2-VASc and CHA2DS2-VASc-HS score.
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COVID-19/mortality , Comorbidity , Severity of Illness Index , Adult , Aged , Aged, 80 and over , Area Under Curve , COVID-19/pathology , COVID-19/virology , Female , Hemoglobins/analysis , Hospital Mortality , Hospitalization , Humans , Kaplan-Meier Estimate , Lymphocyte Count , Male , Middle Aged , Proportional Hazards Models , ROC Curve , SARS-CoV-2/isolation & purificationABSTRACT
Introduction: The aim of this study was to evaluate the physical activity level of the elderly, physical activity barriers during the COVID-19 restrictions and the effects of the restrictions on well-being. Materials and method: An online survey was used that included demographic characteristics, the Physical Activity Scale for the Elderly, Physical Activity Barriers Scale for the Elderly and questions about well-being. Stepwise logistic regression analysis was performed to examine the risk factors for physical inactivity. Results: Of 131 respondents (mean age, 70.97±5.87 years), 82.4% stated that they were less physically active due to the restrictions. Mean physical activity score was 80.79±65.18 and the most common physical activity was house-hold activities. Inactive elderly had more physical activity barriers (p=0.003). Risk factors for physical inactivity were age, medication, other occupants of the house and house type (Odds ratios were 1.13, 3.3, 3.25, 2.52 and 95% confidence intervals were 1.03-1.23, 1.36-8.05, 1.33-7.93, 1.05-6.06 respectively, p<0.05). Participants stated that they had gained weight, they felt more bored, anxious, angry, uneasy (47.3%, 78.6%, 75.6%, 54.2%, 74% of the participants respectively) since the curfews started. Conclusion: During the restrictions, the level of physical activity of the elderly decreased. Risk factors for physical inactivity are older age, taking multiple medications, living with a caregiver and living in a home without a garden or terrace. Measures to increase the level of physical activity and decrease physical activity barriers should be taken into consideration for well-being during the restrictions.
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The evolving nature of warfare has been changing with cybersecurity and the use of advanced biotechnology in each aspect of the society is expanding and overlapping with the cyberworld. This intersection, which has been described as “biocybersecurity” (BCS), can become a major front of the 21st-century conflicts. There are three lines of BCS which make it a critical component of overall cybersecurity: (1) cyber operations within the area of BCS have life threatening consequences to a greater extent than other cyber operations, (2) the breach in health-related personal data is a significant tool for fatal attacks, and (3) health-related misinformation campaigns as a component of BCS can cause significant damage compared to other misinformation campaigns. Based on the observation that rather than initiating the necessary cooperation COVID-19 helped exacerbate the existing conflicts, the authors suggest that BCS needs to be considered as an essential component of the cyber doctrine, within the Defending Forward framework. The findings are expected to help future cyber policy developments. Copyright © 2021, IGI Global.
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Babies are born into different families, cultures, environments;their first interaction environment is the family. This study investigates the opinions of the mothers who have children with special needs based on the experiences to cope with the children's problem behaviors in the Coronavirus pandemic process. This study was designed in the qualitative research method. Eleven mothers whose children continue to special education rehabilitation centers in a provincial center in the Southeastern Anatolia Region constitute the participant group of the study.The data obtained using the semi-structured interviews were analyzed with the content analysis method;the findings were described under eight main themes. While observing that the mothers were responsible for in-house communication during the staying home process, their feelings were loneliness, not usually receiving support from partners and relatives. Mothers stated that their children showed self-harm, aggressiveness, and nonrestraint;suggested that the special education institutions' managers and teachers' professional competiencies should be strengthened regarding distance education process;family-based effective intervention programs should be developed.
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Background and Aim: SARS-CoV2 enters human cells via the human angiotensin-converting enzyme 2 (ACE2) receptor, which is highly expressed by type 2 alveolar cells in the lung. Thus, lungs are the principal target and the most important cause of mortality in COVID-19 disease. Although myocardial cells scarcely express ACE 2 receptors under physiologic conditions, the situation changes in case of the presence of cardiovascular and renal diseases. The precise mechanism(s) by which SARS-CoV2 causes myocardial injury and chronic kidney disease (CKD) are yet to be elucidated. The primary objective of this study was to investigate the effects of myocardial infarction with chronic kidney disease comorbidity on mortality and survival in hospitalized COVID-19 patients. Methods: The present study was carried out according to international agreements (Declaration of Helsinki and World Medical Association). The study protocol was approved by our Hospital's Clinical Studies Ethics Committee. This study was a retrospective analysis of consecutive patients who were admitted either to the general hospital ward or to the intensive care unit of our hospital with the diagnosis of Covid19 and were followed up to death or discharge from the hospital before March 15, 2020. All patients with PCR-based COVID-19 diagnosis were enrolled. Patients who were below 18 years-old, who did not have PCR-based COVID-19 diagnosis, and who did not have serum troponin measurements were excluded from the study. Demographic characteristics, comorbid conditions, laboratory values, including hemogram parameters, serum creatinine, C-reactive protein, albumin, and high-sensitivity troponin I were extracted from the electronic database of the hospital and recorded by two investigators after cross-check. Results: A total of 300 patients (135 male (55.0%), mean age 57.4±14.2 years), were included in this retrospective study. The percentages of patients who had hypertension, congestive heart failure, and chronic kidney disease were 45%, 5%, and 12%, respectively. The median serum troponin I value was 3.6 ng/mL (IQR, 1.5-14.8). Seventy-five patients (25.0%) had acute myocardial injury. Patients who developed myocardial injury were significantly older than patients without myocardial injury (mean ages 63±11.96 vs 55.3±14.2 years, respectively). In the myocardial injury group, coronary artery disease, hypertension, chronic kidney disease, and congestive heart failure were significantly more frequent compared with the patients without myocardial injury. Median NLR was also significantly higher in patients with myocardial injury compared to patients without myocardial injury. Only hypertension and CKD were significantly more common among the deceased compared with surviving patients. Conclusions: Myocardial injury was not uncommon among hospitalized patients with COVID-19. One-fourth of all patients had myocardial injury. The presence of underlying chronic kidney disease and hypertension effect in-hospital mortality.
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OBJECTIVE: The primary objective of this study was to evaluate the frequency and impact of acute myocardial injury on prognosis in hospitalized COVID-19 patients. PATIENTS AND METHODS: This was a retrospective study that included consecutive hospitalized patients with COVID-19. Clinic-demographic characteristics, laboratory values, and high-sensitivity troponin I were extracted from the electronic database. Mortality and other clinical complications, including respiratory failure requiring invasive mechanical ventilation and acute kidney injury were recorded. Myocardial injury was defined as having a serum troponin I value >19.8 ng/mL. We performed Kaplan-Meier survival analysis and Cox regression to determine survival times and independent predictors of mortality. RESULTS: A total of 324 patients were included. Seventy-seven patients (23.8%) had acute myocardial injury. The primary outcome measure, namely death, occurred in 54.5% and 3.2% of the patients with and without myocardial injury, respectively. Notably, 75.3% of the patients with myocardial injury and 6.5% of the patients without myocardial injury developed ARDS. Overall, 50 out of 324 patients (15.4%) died during the study period. The mortality rate was 54.5% in patients with myocardial injury and 3.2% in patients without myocardial injury. Mean survival times were significantly different between the groups (15.1±0.9 days in patients with myocardial injury and 24.4±0.7 days in patients without myocardial injury, log-rank test p-value <0.001). CONCLUSIONS: The presence of chronic kidney disease and application of invasive mechanical ventilation were found to be independent predictors of in-hospital mortality. The presence of acute myocardial injury was common but not independently associated with mortality among hospitalized COVID-19 patients.
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COVID-19/complications , COVID-19/mortality , Heart Injuries/mortality , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , Female , Heart Injuries/diagnosis , Hospital Mortality , Hospitalization , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , SARS-CoV-2 , Survival Rate , Troponin I/bloodABSTRACT
BACKGROUND: Because of the lack of sufficient data, we aimed to investigate the role of serum 25(OH) vitamin D level on COVID severity and related mortality. METHODS: This was a retrospective observational study. Data, including sociodemographic features, clinical characteristics, and laboratory data, and 25(OH) vitamin D levels were recorded for each study participant. Patients were stratified into different vitamin D groups; Normal (Serum 25(OH) vitamin D level >30 ng/mL), Vitamin D insufficiency (21-29 ng/mL), and deficiency (<20 ng/mL). The severity of COVID was classified according to the Chinese Clinical Guideline for classification of COVID-19 severity. Mortality data were determined for participants. Univariate and multivariate Logistic regression analysis was performed to determine independent predictors of in-hospital mortality. RESULTS: Overall, 149 COVID-19 patients (females 45.6%, mean age 63.5 ± 15.3 (range 24-90 years) years) were included. Forty-seven patients (31.5%) had moderate COVID-19, whereas 102 patients (68.5%) had severe-critical COVID-19. The mean 25(OH) vitamin D level was 15.2 ± 10.3 ng/mL. Thirty-four (22.8%) and 103 (69.1%) patients had vitamin D insufficiency and deficiency, respectively. Mean serum 25(OH) vitamin D level was significantly lower in patients with severe-critical COVID-19 compared with moderate COVID-19 (10.1 ± 6.2 vs. 26.3 ± 8.4 ng/mL, respectively, p<0.001). Vitamin D insufficiency was present in 93.1% of the patients with severe-critical COVID-19. Multivariate logistic regression analysis revealed that only lymphocyte count, white blood cell count, serum albumin and, 25(OH) vitamin D level were independent predictors of mortality. CONCLUSION: Serum 25(OH) vitamin D was independently associated with mortality in COVID-19 patients.