Impact of Covid-19 Pandemic on Undergraduate Medical Students: Lessons for the Future.

BACKGROUND: The implementation of public health measures is a key aspect of the fight against the pandemic. However, the current literature suggests that the effectiveness of measures is influenced by various factors, and these factors are most pronounced among young people. Finding the causes and reasons for non-compliance is essential for increasing the effectiveness of measures and reducing their negative effects. SUBJECTS AND METHODS: We evaluated the degree of non-comopliance with epidemiological measures and the reasons for such behaviour among students attending medical colleges at four universities in Croatia (Zagreb, Split, Osijek, Rijeka) in view of altered social, academic, mental, and economic conditions during the pandemic by using an anonymous online questionnaire with 36 Likert scale based questions which was distributed to students in Croatia in March of 2021. RESULTS: A total of 605 students filled out the questionnaire. Female students reported a higher negative impact of social distancing (3.24±1.08 vs 2.95±1.11; p=0.006) and were more concerned about getting infected with SARS-CoV-2 (2.81±1.06 vs. 2.46±0.94; p=0.0005) and about the health of their family and friends during the pandemic (3.83±1.09 vs. 3.50±1.04; p=0.0005). Simultaneously, they were more compliant with the mitigation measures (4.06±0.71 vs. 3.85±0.83; p=0.0413) and were more aware that irresponsible behaviour can place other people at risk. In contrast, male students considered COVID-19 more often as a threat affecting only the elderly (3.11±1.1 vs. 2.78±1.23; p=0.0036). While all students reported high responsibility levels, they did describe violating the measures at times they wanted to socialise. CONCULSIONS: Gender, working status, care for their health, and the health of loved ones were modifying factors for young people behaviour. Assessing social, economic, and health factors must be applied when tailoring public health policies during crisis management.

Teaching resources for the European Open Platform for Prescribing Education (EurOP2E)-a nominal group technique study.

The European Open Platform for Prescribing Education (EurOP2E) seeks to improve and harmonize European clinical pharmacology and therapeutics (CPT) education by facilitating international collaboration and sharing problem-based, online, open educational resources. The COVID-19 pandemic forced teachers to switch to virtual modalities, highlighting the need for high-quality online teaching materials. The goal of this study was to establish the online problem-based teaching resources needed to sustain prescribing education during the pandemic and thereafter. A nominal group technique study was conducted with prescribing teachers from 15 European countries. Results were analyzed through thematic analysis. In four meetings, 20 teachers from 15 countries proposed and ranked 35 teaching materials. According to the participants, the most necessary problem-based-online teaching materials related to three overarching themes. Related to learning outcomes for CPT, participants proposed creating prescription scenarios, including materials focusing on background knowledge and resources on personalized medicine and topical/ethical issues such as the prescription's impact on planetary health. Second, related to teaching, they proposed online case discussions, gamification and decision support systems. Finally, in relation to faculty development, they recommend teacher courses, a repository of reusable exam questions and harmonized formularies. Future work will aim to collaboratively produce such materials.

Teaching resources for the European Open Platform for Prescribing Education (EurOP2E)—a nominal group technique study

The European Open Platform for Prescribing Education (EurOP2E) seeks to improve and harmonize European clinical pharmacology and therapeutics (CPT) education by facilitating international collaboration and sharing problem-based, online, open educational resources. The COVID-19 pandemic forced teachers to switch to virtual modalities, highlighting the need for high-quality online teaching materials. The goal of this study was to establish the online problem-based teaching resources needed to sustain prescribing education during the pandemic and thereafter. A nominal group technique study was conducted with prescribing teachers from 15 European countries. Results were analyzed through thematic analysis. In four meetings, 20 teachers from 15 countries proposed and ranked 35 teaching materials. According to the participants, the most necessary problem-based-online teaching materials related to three overarching themes. Related to learning outcomes for CPT, participants proposed creating prescription scenarios, including materials focusing on background knowledge and resources on personalized medicine and topical/ethical issues such as the prescription’s impact on planetary health. Second, related to teaching, they proposed online case discussions, gamification and decision support systems. Finally, in relation to faculty development, they recommend teacher courses, a repository of reusable exam questions and harmonized formularies. Future work will aim to collaboratively produce such materials.

Intravenous immunoglobulin (IVIg) therapy in hospitalised adult COVID-19 patients: A systematic review and meta-analysis.

Intravenous immunoglobulin (IVIg) therapy has been suggested as a potential treatment option for hospitalised COVID-19 patients. The aim of this systematic review and meta-analysis was to investigate the potential impact of IVIg on mortality and length of hospitalisation in adult COVID-19 patients. PubMed, Scopus, Web of Science and medRxiv were searched in the week of 20.12.2021 for English language, prospective trials, and retrospective studies with control groups, reporting on the use of intravenous immunoglobulin therapy in adult hospitalised COVID-19 patients. Exclusion criteria were: studies evaluating the use of IVIg in paediatric COVID-19 cases, trials using convalescent anti-SARS-CoV-2 plasma or immunoglobulins derived from convalescent anti-SARS-CoV-2 plasma. A random effects meta-analysis with subgroup analyses regarding study design and patient disease severity according to WHO criteria was also performed. A total of 13 studies were included, of which 6 were prospective, on a total of 2313 (IVIg = 1104, control = 1209) patient outcomes. Meta-analysis results indicated that IVIg therapy had no statistically significant effect on mortality (RR 0.91 [0.59; 1.39], p = 0.65, I²  = 69% [46%; 83%]) or length of hospital stay (MD 0.51 [-2.80; 3.81], p = 0.76, I²  = 96% [94%; 98%]). Subgroup analyses indicated no statistically significant impact on either outcome, but prospective studies' results suggested that IVIg may increase the length of hospitalisation in the severe COVID-19 patient group (MD 2.66 [1.43; 3.90], p < 0.01, I²  = 0% [0%; >90%]). The results of this meta-analysis do not support use of IVIg in hospitalised adult COVID-19 patients.

The development of biologics to target SARS-CoV2: Treatment potential of antibodies in patient groups with poor immune response.

Development of novel antibodies to combat the novel SARS-CoV-2 virus is ongoing. Importantly, particular subgroups are more prone to severe disease, namely patients with poor immune responses. This includes cancer patients with solid and haematological disease, solid organ transplant (SOT) patients and those with congenital or acquired immunodeficiency. Outcomes for patients with poor immune responses receiving antibody therapy for underlying disease and SARS-CoV-2 severe infection are undergoing investigation. The objective of this study was to perform a search on patients with poor immune responses with severe SARS-CoV-2 infection, to assess if antibody therapy is beneficial in such populations. We performed searches using PubMED and medrXiv up to May 2021 of patients with solid and hematologic malignancy, SOT patients and acquired or congenital immunodeficiency. The primary outcome was to assess if antibody therapy was included during SARS-CoV-2 infection and the clinical outcomes of such treatment in this population. Here we find that there is a repurposing of monoclonal antibodies to target cytokine release syndrome, along with the use of convalescent plasma (CP). Despite CP demonstrating promising results, we reiterate evidence that CP forces mutational escape and subsequent variant development. Repurposing of antibody therapies (such as Tocilizumab) proved effective, especially in SOT patients. This also potentially opens an avenue for the use of anti-SARS-CoV-2 spike protein neutralizing monoclonal antibodies; however, studies have yet to focus on patients with poor immune responses as a subpopulation.

Safety and efficacy of fluvoxamine in COVID-19 ICU patients: An open label, prospective cohort trial with matched controls.

AIMS: Fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) and sigma-1 receptor agonist, has so far shown promise in the prevention of COVID-19 progression as an early treatment option in three trials. The aim of this study was to evaluate the safety and efficacy of fluvoxamine in COVID-19 patients if administered later in the course of the disease. METHODS: The study was designed as an open-label, prospective cohort trial with matched controls. In April and May 2021, 51 ICU COVID-19 patients hospitalised in the University Hospital Dubrava and University Hospital Centre Zagreb, Croatia, were treated with fluvoxamine 100 mg three times daily for 15 days in addition to standard therapy and they were prospectively matched for age, gender, vaccination against COVID-19, disease severity and comorbidities with 51 ICU controls. RESULTS: No statistically significant differences between groups were observed regarding the number of days on ventilator support, duration of ICU or total hospital stay. However, overall mortality was lower in the fluvoxamine group, 58.8% (n = 30/51), than in the control group, 76.5% (n = 39/51), HR 0.58, 95% CI (0.36-0.94, P = .027). CONCLUSION: Fluvoxamine treatment in addition to the standard therapy in hospitalised ICU COVID-19 patients could have a positive impact on patient survival. Further studies on the effects of fluvoxamine in COVID-19 patients are urgently required.

Using Twitter for sentiment analysis towards AstraZeneca/Oxford, Pfizer/BioNTech and Moderna COVID-19 vaccines.

INTRODUCTION: A worldwide vaccination campaign is underway to bring an end to the SARS-CoV-2 pandemic; however, its success relies heavily on the actual willingness of individuals to get vaccinated. Social media platforms such as Twitter may prove to be a valuable source of information on the attitudes and sentiment towards SARS-CoV-2 vaccination that can be tracked almost instantaneously. MATERIALS AND METHODS: The Twitter academic Application Programming Interface was used to retrieve all English-language tweets mentioning AstraZeneca/Oxford, Pfizer/BioNTech and Moderna vaccines in 4 months from 1 December 2020 to 31 March 2021. Sentiment analysis was performed using the AFINN lexicon to calculate the daily average sentiment of tweets which was evaluated longitudinally and comparatively for each vaccine throughout the 4 months. RESULTS: A total of 701 891 tweets have been retrieved and included in the daily sentiment analysis. The sentiment regarding Pfizer and Moderna vaccines appeared positive and stable throughout the 4 months, with no significant differences in sentiment between the months. In contrast, the sentiment regarding the AstraZeneca/Oxford vaccine seems to be decreasing over time, with a significant decrease when comparing December with March (p<0.0000000001, mean difference=-0.746, 95% CI=-0.915 to -0.577). CONCLUSION: Lexicon-based Twitter sentiment analysis is a valuable and easily implemented tool to track the sentiment regarding SARS-CoV-2 vaccines. It is worrisome that the sentiment regarding the AstraZeneca/Oxford vaccine appears to be turning negative over time, as this may boost hesitancy rates towards this specific SARS-CoV-2 vaccine.

Will vaccination refusal prolong the war on SARS-CoV-2?

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that appeared in Wuhan, China in January 2020 and caused a global pandemic drastically changing everyday life. Currently, there are vaccine candidates in clinical trials and development, so it is only a matter of time before one is authorised for human use. MATERIALS AND METHODS: We collected public opinion survey results about attitudes towards SARS-CoV-2 vaccination conducted in 2020 in 26 European countries. RESULTS: The pooled surveys were conducted on a total of 24 970 participants; on average only 58% (n=14 365/24 970) of responders across Europe were willing to get a SARS-CoV-2 vaccine once it becomes available, 16% (n=3998/24 970) were neutral, and 26% (n=6607/24 970) were not planning to vaccinate against SARS-CoV-2. Such a low vaccination response could make it exceedingly difficult to reach the herd immunity threshold for SARS-CoV-2 through vaccination. CONCLUSION: It is very important to start conducting educational public health activities on the topic of vaccination as soon as possible, before a vaccine becomes available, in order to improve attitudes towards SARS-CoV-2 vaccination. Only by educating the general public about the benefits, safety and efficacy of vaccines can we hope to avoid the unnecessary prolongation of the COVID-19 pandemic.