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Background: During COVID-19 pandemic, the pattern of hospital admissions for acute ST-elevation myocardial infarction (STEMI) has been changing, and increased mortality and morbidity is being noted in these patients. Patient may present with acute myocardial infarction, myocarditis simulating a presentation like STEMI, coronary spasm, myocardial injury not fulfilling the criteria of type 1 & type 2 acute MI and cardiomyopathy. In this study we have tried to determine some important differences among the patients presented with STEMI during The COVID-19 pandemic versus non-COVID-19 era. Method(s): This prospective observational study was carried out in National Heart Foundation Hospital & Research Institute from 8thMarch,2019 to 7th March, 2021. Total 2531 patients were included. The study populations were divided into two groups. Group I: Acute STEMI patients presenting during pre COVID period (n=1385). Group II: Acute STEMI patients presenting during COVID period (n=1146). COVID period was calculated from 8th march, 2020 onward as first case of COVID -19 was detected on that day in Bangladesh. All patients presented with Acute STEMI was included in the study however NSTEMI-ACS, Unstable angina were excluded from the study. Result(s): Male was predominant in both groups. Regarding risk factors Hypertension, Obesity and family H/O of CAD was statistically significant (p<0.05). Acute STEMI patients presented lately during COVID-19 period probably due to lock down& lack of transport facility. Regarding coronary artery disease severity, vessel score was more during COVID period. SV-CAD were more during pre COVID period while DV-CAD & TV-CAD were more during COVID period. Gensini score was also calculated among the study populations, it was 57.21+/-28.42 and 63.16+/- 40.43respectively in group I and group I, which was statistically significant. Regarding treatment options of the patients, primary PCI was less during COVID period, however medical management, elective PCI and Thrombolysis were more during COVID era. Regarding in hospital outcome, acute LVF, cardiogenic shock were more during COVID period which were also statistically significant. [Formula presented] [Formula presented] Conclusion(s): During COVID -19, STEMI patients presented lately in comparison to pre COVID period. Coronary artery Disease were more severe during COVID period as evaluated by Vessel Score & Gensini Score. During COVID -19 period majority of patients got medical management& routine PCI were done more in comparison to primary PCI. In Hospital outcome of STEMI was worse during COVID-19 period in terms of acute LVF & cardiogenic shock. [Formula presented] [Formula presented] [Formula presented]Copyright © 2023
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The impact of pandemics on the tourism industry should be explored from the perspective of those who will travel, go to the tourist places on vacation, and avail services from tourism and hospitality-related organizations. This study has aimed to identify the reasons for the changed human psychology towards tourism during the COVID-19 Pandemic to develop an attitude-behavioral model. This investigation thus conducted an extensive empirical study among tourists to capture their social, emotional, and financial beliefs. The research then examined the measurement model through confirmatory factor analysis (CFA) before investigating the cause-effect relationship through the structural model. Analysis revealed that the negative effect of attitude on behavioral intention toward this new equilibrium is controlled by the emotional aspect of attitude. Furthermore this paper made several contributions to the literature on human psychology, crisis management, human behavior, marketing, and tourism.
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The aim of this study is to evaluate the perceptions of prospective tourists through parameters by which the tourism and hospitality service sector can withstand the widespread implications to the sector as a result of the current pandemic. In turn this will lead to weighing up the means for recovery. The identified parameters are then classified, categorized and linked up with supply chain drivers to obtain a holistic picture that can feed into strategic planning from which the tourism and hospitality service sector could utilize to establish a resilient supply chain. This data can provide deep insight for both theorists and practitioners to utilize. It was found that reforming six supply chain drivers, whilst at the same time developing core competencies, is the central essence of a resilient supply chain within the tourism and hospitality business sector (who are at present working hard to counterbalance the many threats and consequent risks posed due to the pandemic).
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Introduction: Large number of health care workers (HCW) were infected and died due to COVID-19 infection. It is needed to know the actual seroprevalence of COVID in HCWs to assess the risk and to take protective measures. This study was aimed to measure IgG antibodies against nucleocapsid protein (N) of COVID as a serological marker for detection of viral status in risk prone HCW of Bangladesh and possible association with reno-cardio-metabolic risk factors Methods: This longitudinal study was conducted from May 2021 to January 2022 among physicians and non-physician health care workers (HCW) in three non- COVID designated tertiary hospitals in Bangladesh. Participants' demographic data, medical history and information on past COVID-19 infection and vaccination status were collected. Serial blood samples were collected at 1.5 month in all (n=633) later at 3, 6 and 9 months in vaccinated group. A qualitative measurement of IgG antibody against nucleocapsid protein (N) of SARS-CoV-2 was done by was done by CMIA developed by Abbott (FDA-EUA approved). Result(s): The mean age was 35+/-10years where70% were female. Physician 32%, Nurse 45% and others was 23%. Diabetics were 9.5%, hypertensive 9% and asthma in 5.1%. The two doses of vaccine against COVID-19was completed in 56%. History of past COVID-19 infection was found among 20% participants at recruitment, out of which 13% was diagnosed by rt-PCR. History of past COVID-19 infection was found among 18% participants based on 1gG against N protein. But the subjects in two groups were different. Combination of RTPCR and N protein igG showed 35% seropositive for covid. Comparisons between covid infection positive vs. negative showed only age was different (37+/-11 vs. 34+/-9, years p<0.001) but other risk factors like BMI, SBP, DBP, S Albumin, glucose, hemoglobin were not different (P=NS) between the two groups. Further comparisons for eGFR cut-offs showed higher infection in lower eGFR (infection present vs. absent for >90ml/min group was 17% & 83% and in 60-90 ml/min group 32% &. 68 %). Prevalence of COVID 19 infection based on presence of N antibody (cutoff value >1.5) among vaccinated HCWs at 1.5, 6 and 9 month was 13.6%, 8.8% and 7.7% respectively. The mean titer of IgG (against N protein) >1.5 among vaccinated HCWs at 1.5 month was 3.1+/-1.5 and reduced to 0.87+/-0.96 at month 6 (p<0.001). Conclusion(s): The prevalence of COVID-19 infection in HCWs during the second wave was 35% based on test for RTPR or IgG against N protein positivity. In vaccinated persons, based on antibody against N protein, re-infection rate was around 8% up to 9 months post vaccine. Although no difference was seen for covid infection for cardio-metabolic risk factors, there seems to have some relation of higher infectivity with decreased GFR level. No conflict of interestCopyright © 2023
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The impact of pandemics on the tourism industry should be explored from the perspective of those who will travel, go to the tourist places on vacation, and avail services from tourism and hospitality-related organizations. This study has aimed to identify the reasons for the changed human psychology towards tourism during the COVID-19 Pandemic to develop an attitude-behavioral model. This investigation thus conducted an extensive empirical study among tourists to capture their social, emotional, and financial beliefs. The research then examined the measurement model through confirmatory factor analysis (CFA) before investigating the cause-effect relationship through the structural model. Analysis revealed that the negative effect of attitude on behavioral intention toward this new equilibrium is controlled by the emotional aspect of attitude. Furthermore this paper made several contributions to the literature on human psychology, crisis management, human behavior, marketing, and tourism.
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Purpose: Conclusive evidence from Pre-Covid research has exhibited a moderately positive correlation between Students' Engagement with Academic Achievement(AA) as significant precursors of student-centred learning (Hao Lei et al., 2018). Gunuc and Kuzu (2014) defined Student Engagement (SE) in terms of psychological, emotional, cognitive and behavioural reactions to the students' learning process. However, the dynamics aligned to these constructs remains ambiguous for want of research on Behavioural, Cognitive & Emotional engagement of students in Post Covid offline classroom of higher educational institutions (HEIs). This study measured Student Engagement basis the three sub-constructs, its impact on Academic Achievement, and its subsequent impact on Knowledge Management, given the fact that there is a perception that post covid offline classrooms have suffered on the mentioned accounts. Design/Methodology/Approach: A structured questionnaire catering to constructs of components of Student Engagement viz Emotional, Cognitive, Behavioural Engagement, Academic Achievement & Knowledge Management was floated amongst the target population, and Structural equation modelling evaluated the inter-relationship dynamics between the constructs. Findings: Structural Equation Modelling (SEM) was applied after confirmatory analysis. Examination of Path coefficients revealed that Emotional Engagement, Behavioural Engagement and Cognitive Engagement have significant relationships with Academic Achievement. The results also conveyed that Academic Achievement relates to Knowledge Management conclusively in offline classroom settings Post Covid. Originality/Value: Pedagogical research & teaching-learning outcomes in research mandate the significance of Student Engagement & the subsequent effect on Academic Achievement and Knowledge Management in HEIs. This study reinforced the relevance of this equation and its applicability in Post Covid offline classrooms in HEIs of North India.. 300 university & college students were a part of this study to evaluate the Post Covid learning paradigm, as offline classes took over. © 2022,Journal of Content, Community and Communication. All Rights Reserved.
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BACKGROUND: Only 30% of coronary heart disease (CHD) patients are screened and treated for depression, far below general population rates. Utilizing a theoretical framework based on the Behavior Change Wheel integrated with patient-centered design processes, we conducted a second round of postcoronavirus disease 2019 (COVID-19) beta-phase testing of a web-based, electronic shared decision-making (eSDM) tool for depression screening and follow-up in patients with CHD. METHODS: We recruited English-speaking patients who had internal medicine or cardiology clinic appointments from October 2020-January 2021. All participants were aged ≥21 years with CHD and a diagnosis of and/or positive screen for depression by the patient health questionnaire (PHQ)-2 and/or -8. Think aloud usability sessions with participants verbalizing their thoughts on the eSDM tool were conducted remotely. Sessions lasted approximately one hour. Pre-and post-session questionnaires assessed comfort, ease-of-use of the tool, and perceived barriers to success, and included the Decisional Conflict Scale (DCS) and System Usability Scale (SUS). Think aloud and survey feedback were analyzed for recurring themes. RESULTS: Four patients participated before we reached saturation (25% aged > 65;75% male;75% White). The average SUS score was 77.00 (C, or “Good” on the scale). Three of four participants found the tool easy to use and straightforward, and none expressed confusion/difficulty utilizing the tool. Only 25% felt the tool alone was sufficient to make informed treatment decisions (pre-post decisional conflict increased from 21.3 to 27.5). Postsession, we observed lower perceived barriers to treatment related to access/ coordination (75% vs. 50%), stigma/motivation/efficacy (100% vs. 75%) but not in cost of treatment (50% vs. 50%) or time/travel (50% vs 50%). Three of four participants found the tool's video depicting a patient's depression treatment journey after experiencing a heart attack helpful but two found it retraumatizing. Finally, all participants indicated they would spend time reading about cardiac wellness topics at the end of the tool. CONCLUSIONS: Using an innovative theory-based approach to usability testing, we found high acceptability and usability of our eSDM tool but highlighted several features that will need to be optimized to improve postCOVID-19 adoption rates (e.g., traumatization considerations and increased decisional support). Our study adds further evidence to concerns that selfadministered eSDM tools may be insufficient without provider and clinician level intervention components. Enhancing a tool's features may improve its usefulness to patients, ultimately improving patient and provider adoption.
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Objective: To determine patient concerns and anxiety regarding orthodontic treatment and appointments during COVID-19 Pandemic Methodology: After approval from Sharif Medical Research Center (SMRC) and the Ethics Committee of Sharif Medical City Hospital (SMCH), 247 orthodontic patients were selected from the Orthodontics Department of SMCH, Lahore, who had ongoing orthodontic treatment. The total duration of the study was two and a half months from 12th March to 30th May 2021. Data was analyzed by IBM SPSS version 25. Percentages of the responses in each domain of the questionnaire were calculated. Chi-square test, one-way ANOVA and Pearson’s correlation coefficient were applied where applicable to determine the significance of associations between different variables, with p<0.05 taken as significant. Results: Two hundred and forty seven patients were sent the questionnaire links, while 213 patients responded, out of which 132 were females and 81 were males, with mean age 22.81±2.93 years. Anxiety about the coronavirus pandemic ranged from 5.32 ±2.30. Patients were particularly concerned about the length of time it would take to complete their orthodontic treatment as a result of quarantine (55.9 percent). 5.68±2.15 was the mean anxiety level. Conclusion: The quarantine recommended due to the COVID-19 pandemic impacted orthodontic appointments and patients' anxieties and anxiety, since a statistically significant correlation was established between quarantine and coronavirus sentiments and orthodontic appointment willingness. Males were more willing to get braces than females. Delay in treatment end, bracket breaking, and growing malocclusion were patients' top concerns. Patients said the most critical precaution in orthodontics was changing the dentists' disposable lab coats after every visit to avoid cross-contamination.
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Background: Currently, the world is in a challenging situation due to Covid-19. The ministry of health in Pakistan reported the first case of Covid-19 on 26th February 2020 in Karachi whereas on the same day in Islamabad, the second case was confirmed in Pakistan. Objective: To assess the prevalence and risk factors of covid-19 mortality and its impact on social life of Pakistani population Methodology: This retrospective study was carried out at the Department of Pathology, Gomal Medical College, Medical Teaching Institute, Dera Ismail Khan, Pakistan for a period of ten months from March 2021 to December 2021. All the data was taken from the hospital record to determine the prevalence and risk factors associated with the mortality of covid-19. For determining the influence of covid-19 on the social life, online survey was conducted. Data was entered and analyzed by using SPSS version 24. Results: In the current study, the overall prevalence of covid-19 was 6%. The most common risk factors associated with the covid-19 was Diabetes mellitus in 25 (71.43%) subjects, hypertension in 22 (62.86%), ischemic heart disease in 16 (45.71%) while chronic liver disease was observed in 3 (8.57%) subjects. According to the survey, 420 (70%) participants thought that covid-19 will be controlled worldwide while 450 (75%) subjects thought that covid-19 will be controlled in Pakistan. Worry of contracting covid-19 even with protective measures was observed in 420 (70%) subjects. Conclusion: Our study reported that the prevalence of covid-19 was 6%. Diabetes mellitus, hypertension and ischemic heart disease were the major associated risk factors with the mortality of covid-19 and the overall impact of covid-19 on social life of Pakistani population was not good according to our study.
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The COVID-19 pandemic has necessitated rapid top-down dissemination of reliable and actionable information. This presents unique challenges in engaging low-literate communities that live in poverty and lack access to the Internet. We describe the design and deployment of a voice-based social media platform, accessible over simple phones, for actively engaging such communities in Pakistan with reliable COVID information. We developed three strategies to overcome users' hesitation, mistrust, and skepticism in engaging with COVID content. Users were: (1) encouraged to listen to reliable COVID advisory, (2) incentivized to share authentic content with others, and (3) prompted to critically think about COVID-related information behaviors. Using a mixed-methods evaluation, we show that users approached with all three strategies had a significantly higher engagement with COVID content compared to others. We discuss how new designs of social media can enable users to engage with and propagate authentic information. © 2022 ACM.
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Introduction: For families with type 1 diabetes (T1D), anxiety from the COVID-19 pandemic may be elevated due to potential for increased vulnerability. Objectives: We aimed to describe the impact of the pandemic on adolescents with T1D and their parents. Methods: In a 2-site (Seattle WA, Houston TX USA) clinical trial of a psychosocial intervention targeting stress/resilience, adolescents 13-18 years old with T1D ≥ 1 year and diabetes distress (PAID-T ≥30) were enrolled with a parent. Using a mixed-methods approach, participants enrolled August 2020-June 2021 completed a survey about the pandemic, including an open-ended question about how COVID impacted T1D management. Survey responses were summarized using frequencies and percentages, and associations between variables were assessed by Chi-squared tests. A1C was extracted from clinical records. Results: Adolescents (n=122) were 56% female, 80% White race, 18% Hispanic, mean A1c = 8.5±2.1%. Parents (n=102) were 79% White, 14% Hispanic, 61% college graduate, 67% reporting annual household income ≥75K USD. 10% of adolescents reported history of COVID-19 infection, 51% had a family member/other important person diagnosed, and 12% had a family member/other important person die from COVID-19 complications. 49% of parents reported loss of job or salary reduction. 29% of adolescents and 33% of parents reported significant struggle to manage T1D during the pandemic (Table 1). Adolescents who reported more difficulty with T1D management were more likely to have A1C ≥ 8%, p<.01. Qualitative themes indicated perceived positive, negative, and neutral effects of the pandemic on: T1D self-care, exercise, food, mental health, telehealth, and motivation. Conclusions: Discussing how the pandemic impacted families' T1D management may be an important focus for clinicians, especially for adolescents with above-target A1C. Strategies to improve resilience for ongoing and future stress may be of value. (Table Presented).
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Introduction: The COVID-19 pandemic has been a major stressor for adolescents with T1D, a group already at risk for elevated mood concerns. Objectives: We aimed to describe teens' perspectives on pandemicrelated stress and their coping strategies and resilience resources. Methods: In a 2-site clinical trial of a psychosocial resiliencepromotion intervention, enrolled adolescents were 13-18 years old with T1D ≥ 1 year and diabetes distress (PAID-T) ≥30. Participants enrolled August 2020-June 2021 were asked to write responses to 2 open-ended prompts about: 1) how COVID-19 affected their lives and 2) what was helping them through the pandemic. Qualitative analysis included: conventional content analysis by 3 coders to develop code categories and thematic analysis to identify overarching themes reflecting pandemic-related stress and resilience. Themes were subsequently mapped onto 3 domains of resilience. Results: Adolescents (n=120) were 56% female, 75% White race, 18% Hispanic with mean A1C of 8.5% ± 2.1%. Adolescents described numerous negative effects of COVID-19 cutting across many major domains of life: Family, Social, School, Medical/Physical, and Mental Health. They also described numerous resources and strategies consistent with stress, coping and resilience theories. Note: 6 participants reported nothing was helping them through the pandemic. Conclusions: Adolescents' responses underscore the pervasive stress impact of COVID-19 across nearly all major life domains. Coping strategies align with theory and suggest likely resilience in the face of pervasive stress. Given the elevated risks for distress in this population, there is a need for interventions to offer diverse stress management tools and resilience resources for adolescents with T1D. (Table Presented).
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Introduction: Diabetes clinics have rapidly adopted the use of telemedicine to support ambulatory diabetes care during the COVID-19 pandemic. Objectives: The aim of this study was to explore barriers to and facilitators of the integration of telemedicine in ambulatory diabetes care for adolescents with type 1 diabetes (T1D). Methods: Eight focus groups of parents (n=19) and diabetes care team members (n=18) were conducted in the Seattle, WA metropolitan area. Semi-structured questions were used to elicit views about their experience with telemedicine diabetes clinic visits during the COVID-19 pandemic. Analysis was conducted using an iteratively developed codebook and themes were mapped onto the technology acceptance model (TAM). Results: Barriers (n=5) and facilitators (n=5) were mapped to TAM domains (Table). Facilitators of perceived usefulness and perceived ease of use domains included (1) clinic visit accessibility that aligned with adolescent lifestyle, (2) access to context of daily life at home, and (3) adolescent literacy with videoconferencing technology. Barriers included (1) inability to conduct a physical exam and incorporate findings, (2) inconsistent availability of diabetes technology data, and (3) inability to ensure confidential communication with adolescent. Participant attitudes toward ongoing use of telemedicine were informed by the anticipated level of adolescent engagement in a virtual setting and equity determinants, including the challenges related to attending clinic visits. All participants, especially parents, saw the value in a hybrid model of telemedicine/inperson visits as beneficial for future ambulatory diabetes care. Conclusions: Parents and diabetes care team members report that telemedicine visits are useful and align well with communication and lifestyle needs of adolescents. However, diabetes clinics need to address accessibility issues, improve appointment preparation, and develop techniques for confidential communication. (Table Presented).
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The huge numbers of non-healthcare personnel (non-HCP) who get infected by corona virus disease 2019 (COVID-19) not only paralyze health care systems but also put health care personnel (HCP) at potential risk globally. Objective of the study was to compare the Healthcare personnel (HCP) and non-HCP COVID-19 cases. This prospective observational study was carried out in National Heart Foundation Hospital and Research Institute of Bangladesh from March 08, 2020 to July 20, 2020. During this study period all admitted non-HCP who subsequently was diagnosed as COVID-19 positive by rRT-PCR and HCP of this hospital, who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace and become COVID-19 positive, were included. Out of 320 infected patients, 181(56.6%) patients were non-HCP and 139(43.4%) were HCP. Non-HCP were older than HCP (Mean age: 52.95+/-13.82 years vs. 34.08+/-11.11 years;p=0.001). Non-HCP were predominantly male and HCP were predominantly female (73.5% vs. 41% & 26.5% vs. 59%;p=0.001). Non-HCP had more risk factors and co-morbidities than HCP (p=0.001). Typical symptoms of COVID-19 such as fever and cough were prevalent in HCP. More aggressive treatment was required for non-HCP. Non-HCP had more severe disease and higher case fatality rate (9.4% vs. 0.7%;p=0.001) than HCP. Disease severity (OR 0.03, 95% CI 0.01-0.15) and DM (OR 0.09, 95% CI 0.01-0.94) were the independent predictor of mortality. Non-HCP was older in age, predominantly male and had more co-morbidities than HCP. Typical symptoms of COVID-19 were prevalent in HCP. Non-HCP had more severe disease and higher case fatality rate than HCP.
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Background: The use of optical coherence tomography−angio co-registration (OCT-ACR) in routine clinical practice is evolving with limited reporting of clinical outcomes. We conducted this study to evaluate the impact of OCT-ACR on clinician decision making during percutaneous coronary intervention (PCI). Methods: Patients with clinically significant stenosis of >70% in at least 1 coronary artery were enrolled in the study. The pre- and post-PCI procedural strategies were prospectively assessed after angiography, OCT, and ACR with data analyzed by an independent core lab. We enrolled 500 patients from 9 centers in south Asia. Twenty-eight patients had inadequate imaging, whereas data from 75 patients are yet to be analyzed by core lab due to COVID-19. Results: The interim results included 397 patients with a mean age of 57.8 ± 10.8 years. Pre-procedural OCT resulted in a change in PCI strategy in 76% of lesions including change in stent length (57%), diameter (34%), strategy (10%), and landing zone (57%) (Figure). The use of ACR additionally altered treatment strategy in 23% lesions. Postprocedural OCT demonstrated edge dissections (3%), underexpansion (18%), malapposition (17%), tissue/thrombus prolapse (8%), and incomplete coverage (1%), thereby requiring additional interventions for optimization in 36% lesions. No change in strategy was observed with post-procedural ACR. [Formula presented] Conclusion: This is the first South Asian study reporting outcomes of OCT-ACR−guided PCI in patients with coronary artery disease. The use of OCT resulted in overall pre-procedural change of PCI strategy in 76% lesions compared with angiography. Real-time ACR had an additional significant impact with change in strategy in 23% of lesions. Categories: IMAGING: Imaging: Intravascular
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Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiology & pacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.