MOBILISE-UTHM Resilient Tracker (RITTER) for Resilient Educational Communities in Malaysia During the COVID-19 Pandemic

Coronavirus disease has caused a pandemic across the globe and it is now representing a significant threat to global health. Certainly, managing COVID-19 as compared to other types of disasters comes with a lot of unique challenges to many sectors including the educational sector, especially to higher education institutions (HEI). Since the announcement of movement control orders by the government of Malaysia, most of the Malaysia HEI students, including UTHM, have left their campuses, but the problems wrought by COVID-19 have not. UTHM employees from academic and supporting staff are also worried about their future for not continuously working as usual. The aim of the paper is to propose a disaster decision support system by combining UTHM Tracker and MOBILISE Digital System named MOBILISE-UTHM Resilient Tracker (RITTER) for UTHM students to build resilience during the COVID-19 outbreak and further to provide real-time intelligence for rapid disaster response combining UTHM Tracker and MOBILISE system for UTHM students during the COVID-19 outbreak in UTHM. Copyright © 2021, IGI Global.

Burnout among doctors working at a tertiary care hospital during pandemic of COVID-19 in Kashmir Valley, India

Introduction: Burnout syndrome (BO) has negative consequences for the doctors, their family members, coworkers, and also the patients. We conducted this study to estimate the prevalence of BO among doctors working in a tertiary care hospital in Kashmir valley just after the peak of the second COVID-19 wave. Methods: This cross-sectional study was conducted among doctors working at one tertiary care hospital in Kashmir Valley. Participants included interns, residents (junior and senior residents) and faculty members. An online questionnaire containing Oldenburg Burnout Inventory to estimate burnout was used for data collection from 1st to 10th July 2021. In addition, the questionnaire captured demographic information, job profile and work-related information. Mean scores of ≥ 2.25 on exhaustion and ≥ 2.1 in the disengagement domain were used to define burnout. Binary logistic regression was used to evaluate associations. Results: Of the 322 participants in the study, 119 (36.9%) had completed their post-graduate degree. Of the participants, 150 (46.6%) had to perform 6 or more-night shifts per month and, 61 (18.9%) had previously been diagnosed with COVID-19. Of the participants, 257 (79.8%) had BO, 24 (7.5%) were exhausted and 17 (5.3%) were disengaged. BO was associated with female gender, younger age, number of night duties and emergency room duties per month, being a resident doctor and history of COVID-19 infection on binary logistic regression. Conclusion: This survey reported a very high prevalence of burnout among doctors. Addressing BO among healthcare workers should be a key priority for improving quality of life among doctors and to improve quality of care. This journal is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License.

COVID 19 Testing Cannot Replace Clinical Judgement

Since the onset of the coronavirus disease 2019 (COVID-19) due to the SARS-CoV-2 virus, recommendations for diagnostics and therapeutics have rapidly evolved. The World Health Organization recommends nucleic acid amplification testing (NAAT) such as reverse transcriptase PCR (RT-PCR) as the standard for COVID-19, with a sensitivity of 95%. However, many factors can affect the results including timing of test, specimen quality, specimen handling, pooling specimens, and other technical reasons, resulting in false negatives. The case below describes a patient with a clinical presentation concerning for COVID-19 despite three negative RT-PCR tests and highlights the importance of treating patients based on their entire clinical impression rather than a single data point. A 53-year-old Hispanic male with no medical history presented to the hospital with 4 days of dyspnea and cough. He was admitted to the intensive care unit with acute hypoxemic respiratory failure requiring heated high flow nasal cannula. No associated fever, myalgias, anosmia, diarrhea, and he denied any known ill contacts, inhalation exposures or prior smoking history. Laboratory workup was notable for thrombocytosis, lymphopenia, elevated ferritin, C-reactive protein, D-dimer and lactate dehydrogenase as commonly seen with COVID-19. Infectious screen resulted with negative SARS-CoV-2 PCR by nasal swab, negative respiratory viral panel, negative HIV PCR, and negative fungal pneumonia screen. Imaging showed bilateral ground-glass opacities consistent with multifocal pneumonia (figure). He was started on a 5-day course of antibiotics for community acquired pneumonia and given high suspicion for COVID-19 pneumonia was started on dexamethasone 6mg daily with a plan to repeat SARS-CoV-2 testing. Repeat SARS-CoV-2 PCR was negative on hospital day 2 and 4 but SARS-CoV-2 antibody was positive on hospital day 6 (10 days after symptom onset). Given the positive antibody test and clinical course consistent with COVID-19 pneumonia, he was continued on dexamethasone for a total of 10 days, completed a 5-day course of remdesivir, and received 1 unit of convalescent plasma with clinical improvement. He was discharged home on hospital day 15 with supplemental oxygen. With increasing rates of infection with the SARS-CoV-2 virus, it becomes critically important to quickly and accurately diagnose patients. While RT-PCR has high sensitivity, there are still several factors that affect the accuracy and may result in false-negative results with potential implications such as delay in treatment and failure to quarantine. This case highlights the importance to treat patients based on a comprehensive clinical impression rather than a single test result.

A phase iia, double-blinded, randomized placebo-controlled trial of mapkapk2 inhibition by ati-450 in treatment of moderate-severe covid-19 pneumonia

RATIONALE: The novel coronavirus disease 2019 (COVID-19) is a rapidly spreading global viral pandemic with a high-risk of mortality in selected populations (i.e. elderly, immunocompromised, cardiopulmonary diseases). A hyperinflammatory state caused by excessive inflammatory cytokine production (i.e. TNFα, IL-1β, IL6, IL-8) has been attributed to the pathobiology of COVID-19-mediated acute respiratory distress syndrome, worsened lung fibrosis and increased mortality. Inflammation and inflammatory disorders signal primarily through the MAPK pathway. Activation of p38α is important for regulating inflammation, and aberrant p38α activation is associated in the pathobiology of diseases such as idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease and tissue fibrosis. The downstream target of p38α is the protein MAPKAPK2 (MK2) and is responsible for transcriptional production of pro-inflammatory cytokines also elevated in COVID-19 inflammation. Further evidence in other severe viral illnesses (i.e. Dengue, Influenza, CMV) show activation of p38-MK2 signaling axis for mediating inflammation. Potentially, COVID-19 mediated inflammatory cytokine production may signal through p38α-MK2 axis and MK2 pathway blockade may suppress unwanted inflammation. However, it remains unknown whether reducing the inflammatory state can improve COVID-19 outcomes particularly in those with pre-existing conditions. We hypothesized that blockading this pathway would reduce inflammatory cytokine burden and improve respiratory failure-free survival in moderate-severe COVID-19 infected patients. Methods: We designed an investigator-initiated trial (IND#:149790;ClinicalTrials.gov Identifier: NCT04481685) using an oral MK2 inhibitor (ATI-450, Aclaris Pharmaceuticals) in COVID-19. This single-center trial is a Phase IIa, doubleblinded, randomized placebo-controlled proof-of-concept study. COVID-19 positive hospitalized patients with pulmonary signs and symptoms of moderate-severe hypoxic respiratory distress were randomized to ATI-450 or placebo twice-daily for up to 14 days. Results: Study enrollment is completed (n=20 subjects;n=11 male;median age 63 years old). The primary endpoint of this trial is respiratory failure-free survival at 14 days. Secondary endpoints include: changes in WHO-Ordinal scale, additional respiratory and survival outcomes, biochemical assays of circulating cytokines, and safety endpoints. Given the incomplete knowledge of MK2 pathway blockade effects on immune cell function, this study will further explore immune cell characterization in COVID-19 patients treated with ATI-450 via immunophenotyping and 10X Genomics single-cell gene expression analysis. We surmise that myeloid cell activation following COVID-19 infection contributes to localized and systemic tissue injury and will examine the effect of MK2 pathway blockade on eliciting myeloid cell inflammatory activation-suppression. Conclusion: Analyses of the safety, efficacy, and biology of MK2 inhibition, via ATI-450, in treating moderate-severe COVID-19 will be presented.

Geospatial dashboards for mapping and tracking of novel coronavirus pandemic

In mid of December 2019, Wuhan sea food, China a new mysterious illness was reported lately called Coronavirus (COVID-19, The virus triggered a severe respiratory disease, rapidly speeded to many other states of China and around the world. COVID-19 is a new strain that had not been previously identified in humans. Hundreds of millions of people have been placed in some form of isolation. Governments announcing country wide lockdown while declaring the emergency to fight the sharp rise in coronavirus infection. The epidemic’s consequences are devastating, currently around the globe more than three million confirm cases reported. Unfortunately, we are still counting the days, the cases and, most sadly of all, the deadly virus has taken more than three hundred thousand lives. The Wealth Health Organization (WHO) officially has called Covid-19 a Pandemic. The previous viruses SARS-CoV, Avian Influenza, MERS-CoV and the Ebola, emerged the geographic information system, remote sensing applications, mapping and tracking techniques and social media platforms were provided an indispensable support for appropriate, accurate and timely response in the epidemic outbreak. The aim of the research is to critical review the development of geospatial dashboards which are using in real time monitoring and providing decision support in terms of visualization and integration of mapping in Covid-19 pandemic. This paper presents a comparison of Covid-19 geospatial dashboards and key technologies and applications use to fight with deadly virus. © IEOM Society International.