SARS-CoV- 2 infection among vaccinated rheumatic and musculoskeletal diseases (RMDs) patients -A tertiary hospital experience in Malaysia

Purpose: To evaluate the SARS-CoV- 2 infection rate among vaccinated RMD patients in a tertiary hospital and its associations. Methodology: This cross-sectional study was performed among adult rheumatology patients who attended follow up at our centre from 1st April 2022 to 30th April 2022. Demographics and clinical data were compared between the vaccinated patients with SARS-CoV- 2 infection, Group 1 (G1) and without SARS-CoV- 2 infection, Group 2 (G2). Descriptive and inferential statistics were conducted using SPSS version 26. Result(s): We enrolled a total of 212 patients with underlying diagnosis of rheumatoid arthritis (94 patients, 44.3%), systemic lupus erythematosus (59 patients, 27.8%), spondyloarthropathies (30 patients, 14.2%) and others (29 patients, 13.7%). Of all these patients, 57 (26.9%) had SARS-CoV- 2 infection (G1) with mean (SD) age of 45.2 (+/-14.65) years compared to 53.4 (+/-15.22) years in G2 (P = 0.001). In G1, 50 (87.7%) were female, 32 (56.1%) were Malay and 26 (45.6%) with >= 1 comorbidity. Most patients in G1 received 3 doses of vaccine (n = 36, 63.2%) while 21 (36.8%) completed 2 doses of vaccine. Majority in G1 (n = 46, 80.7%) had clinical stage 2 SARS-CoV- 2 infection. Seven required admission to health care facilities with median stay of 6 +/- 2 days. Twenty-three patients (32.9%) in G1 received more than one immunosuppressive drug. Twenty-one out of 63 patients (33.3%) who had 2 doses of SARS-CoV- 2 vaccine had SARS-CoV- 2 infection compared to 36 out of 149 patients (24.2%) who received 3 doses of vaccine, albeit not significant. Conclusion(s): Despite a quarter of the cohort acquired SARS-CoV- 2 infection, the disease was notably less severe, attributed to younger age, less comorbidity and vaccine effectiveness. Type of immunosuppression and use of more than one immunosuppressive drugs were not associated with SARS-CoV- 2 infection.

An Unusual Misplacement of a Femoral Vascular Catheter in a Renal Transplant Recipient

Background: Femoral vascular catheter misplacements are rare events more commonly reported in the paediatric population with potentially catastrophic sequelae. Left sided femoral catheters have been misplaced in the iliolumbar vessels, lumbar vessels and abdominal cavity. To our knowledge, this is the first reported case of a femoral vascular catheter tip positioned in the pelvis of a kidney transplant. Case Report: A 62 year old female with a right iliac fossa renal transplant from 2007 was admitted with severe acute kidney injury and coronavirus disease 2019 (COVID-19) pneumonitis. A right sided femoral vascular catheter was inserted for continuous venovenous haemodiafiltration (CVVHDF) on admission in the intensive care unit under ultrasound guidance using the seldinger technique. No resistance was encountered at insertion and there was no difficulty aspirating or flushing the catheter. The catheter tip position was not confirmed radiologically. CVVHDF was commenced and patient appeared to receive adequate haemodialysis clinically and biochemically. A computer tomography of the abdomen performed a week after catheter insertion revealed the catheter tip to be within the superior pole parenchymal vein of the kidney transplant. This was associated with a small renal cortical defect representing a renal infarct. The catheter was promptly removed and replaced. The patient remained dialysis dependent and subsequently passed away from severe COVID-19 pneumonitis. Conclusion(s): Clinicians should be aware of this unusual complication in patients with femoral vascular catheters inserted ipsilateral to a kidney transplant. Ongoing vigilance of catheter malposition and catheter migration or displacement should be maintained. However, this may be challenging in an intubated and sedated patient with a denervated kidney transplant.

Clinical severity of COVID-19 with omicron variant predominance in relation to vaccination status, age, comorbidities- a single center in Selangor, Malaysia.

INTRODUCTION: Recently, the rapid surge of reported COVID-19 cases attributed to the Omicron variant of severe acute respiratory syndrome coronavirus (SARS-CoV-2) created an immediate concern across nations. Local information pertaining to the new variant of concern (VOC) is lacking. We aimed to determine the clinical characteristics of COVID-19 during a period of Omicron prevalence among patients hospitalised from February 1 to 21, 2022 at Sungai Buloh Hospital and to estimate the risks of disease progression presumably caused by this variant in association with gender, age, comorbidity, and vaccination status. MATERIALS AND METHODS: In this retrospective, singlecentered, retrospective cohort study, all hospitalised adults with laboratory-confirmed COVID-19, aged 18 and above, were recruited from February 1 to 21, 2022. Clinical characteristics, investigations, and outcomes were assessed. RESULTS: A total of 2279 patients aged 18 years and above with laboratory-proven COVID-19 were recruited and analysed, excluding 32 patients owing to incomplete data. Majority of the study population had a mean age of 41.8 ± 17.7, was female-predominant (1329/2279, 58.6%), had completed a primary series of vaccination with a booster (1103/2279, 48.4%), and had no underlying medical conditions (1529/2279, 67.4%). The risk of COVID-19-related disease progression was significantly lower in hospitalised patients under the age of 50 who were female, had no comorbidity, and had completed two doses of the primary series with or without a booster. [respectively, OR 7.94 (95% CI 6.16, 10.23); 1.68 (1.34, 2,12); 2.44 (1.85, 3.22); 2.56 (1.65, 3.97), p< 0.001]. CONCLUSION: During the period of Omicron prevalence, a favourable outcome of COVID-19 was strongly associated with female gender, age below 50, a comorbidity-free condition, and having completed immunization. With this new observation, it could help improve public health planning and clinical management in response to the emergence of the latest VOC.

Burnout and risk factors in Southeast Asian gastroenterologists: A multi-national study in the COVID-19 era

Background and Aim: The coronavirus disease-2019 (COVID-19) pandemic has placed significant stress on gastroenterologists worldwide. However, its toll on the mental health of gastroenterologists within Southeast Asia was unknown. A mixed methods, multi-national study was conducted to elucidate the prevalence of burnout and its stressors within the region. Methods: A survey was disseminated electronically to 1761 gastroenterologists via the gastroenterology and endoscopy societies of Brunei, the Philippines, Indonesia, Malaysia, Singapore, and Thailand from September 1 to December 7, 2020. This included the 22-item Maslach Burnout Inventory to detect burnout. Ethical approval was granted. Quantitative and qualitative data were collected. Logistic regression identified associations between variables and burnout. Qualitative data were analyzed by content analysis method. Results: The response rate was 38.8%;66.6% reported significant stress. The regional prevalence of burnout was 17.1% although inter-country variation existed (Fig. 1A). Depression, being a trainee, public sector work, and the lack of awareness or access to mental health support services increased burnout risk significantly (Fig. 1B). The 50.1% of gastroenterologists were unaware of or did not have access to support services. The onset of depression intra-pandemic was 2.1%;the pre-pandemic prevalence was 2.2%. Stressors commonly involved service requirements (53.2%), difficult relationships with patients and relatives (23.0%), and difficult relationships with colleagues (20.5%). Specific to the pandemic, the three most common stressors were fear of getting infected (39.7%), reduced income (28.0%), and stringent infection control measures adding to workload (18.5%). Conclusion: Burnout is common in gastroenterologists in Southeast Asia;however;better safeguards for mental health are urgently needed.

Multiplex sequencing of SARS-Cov-2 genome directly from clinical samples using the Ion Personal Genome Machine (PGM).

Various methods have been developed for rapid and high throughput full genome sequencing of SARS-CoV-2. Here, we described a protocol for targeted multiplex full genome sequencing of SARS-CoV-2 genomic RNA directly extracted from human nasopharyngeal swabs using the Ion Personal Genome Machine (PGM). This protocol involves concomitant amplification of 237 gene fragments encompassing the SARS-CoV-2 genome to increase the abundance and yield of viral specific sequencing reads. Five complete and one near-complete genome sequences of SARS-CoV-2 were generated with a single Ion PGM sequencing run. The sequence coverage analysis revealed two amplicons (positions 13 751-13 965 and 23 941-24 106), which consistently gave low sequencing read coverage in all isolates except 4Apr20-64- Hu. We analyzed the potential primer binding sites within these low covered regions and noted that the 4Apr20-64-Hu possess C at positions 13 730 and 23 929, whereas the other isolates possess T at these positions. The genome nucleotide variations observed suggest that the naturally occurring variations present in the actively circulating SARS-CoV-2 strains affected the performance of the target enrichment panel of the Ion AmpliSeq™ SARS CoV 2 Research Panel. The possible impact of other genome nucleotide variations warrants further investigation, and an improved version of the Ion AmpliSeq™ SARS CoV 2 Research Panel, hence, should be considered.