Thrombocytopenia Secondary to COVID-19 Vaccination: Side Effect or Coincidence?

  While widespread coronavirus disease 2019 (COVID-19) vaccination has helped achieve some control of the pandemic, vaccines have presented with side effects of their own, both common and rare. We present an unusual case of a 66-year-old who presented with severe thrombocytopenia following vaccination with the Pfizer-BioNTech mRNA vaccine. Our patient is a 66-year-old African American female with a known history of Sjogren's syndrome and hepatitis C who presented to our facility as a direct admit from our affiliated infusion clinic where routine lab work revealed a platelet count of 14,000. On arrival, she reported a one-month history of progressive tiredness, intermittent epistaxis, and bruising on her legs. Her physical exam was notable for multiple petechiae and non-palpable purpura on all four extremities. Further questioning revealed that she had received her COVID-19 vaccine booster (Pfizer-BioNTech) three weeks prior to presentation and that is when all the symptoms had started. Rheumatology was consulted and the patient was started on intravenous immunoglobulin infusion for two days and pulse dose prednisone. Her platelet count showed improvement after treatment, and she was discharged home with a platelet count of 42,000. Though largely safe and efficacious, COVID-19 vaccines can present with rare systemic side effects and physicians must have a high index of suspicion and report these cases so that more data is available for interpretation.

The PSYCARE model: Its efficacy in mental health care during the fourth outbreak of COVID-19 in Vietnam.

Objective: Ho Chi Minh City (Vietnam) was seriously affected by the 4th COVID-19 outbreak. This study aimed to provide mental health care services for people through a psychological intervention model, called "PSYCARE." The model included five MHC services: active and passive education, propagation, 24-h hotline consultation, online interventions/counseling, and crisis intervention. Methods: The entire workflow was implemented in the three steps under the leadership of the Ho Chi Minh City government: (1) Preparation and mobilization, (2) Multidisciplinary team establishment, and (3) Feedback mechanism, and project completion. By statistical method on service usage data of people during the outbreak, we evaluated the results as well as discussed the model's effectiveness. Results: In 42 days of implementation, there were a total of 149 posts, 1660 shares in social networks with more than 4,000 interactions per week. A MHC handbook was published. Ten episodes of MHC radio and ten live TV programs were broadcast with more than 10,000 listening times. We successfully propagated 35 topics at 4 COVID-19 hospitals and 34 quarantine areas. A total of 2,069 hotline consultations were done. 1,382 cases were counseled online, and 145 one-on-one crisis interventions were done to three groups: COVID-19 infected/affected children and adults, vulnerable people, frontline medical, and military staff. Conclusion: The PSYCARE model has been proven to positively affect the general population's mental health during the COVID-19 outbreak. Our framework and model could be used as an expert reference guide in providing effective psychological intervention in the COVID-19 pandemic.

A call for citizen science in pandemic preparedness and response: beyond data collection.

The COVID-19 pandemic has underlined the need to partner with the community in pandemic preparedness and response in order to enable trust-building among stakeholders, which is key in pandemic management. Citizen science, defined here as a practice of public participation and collaboration in all aspects of scientific research to increase knowledge and build trust with governments and researchers, is a crucial approach to promoting community engagement. By harnessing the potential of digitally enabled citizen science, one could translate data into accessible, comprehensible and actionable outputs at the population level. The application of citizen science in health has grown over the years, but most of these approaches remain at the level of participatory data collection. This narrative review examines citizen science approaches in participatory data generation, modelling and visualisation, and calls for truly participatory and co-creation approaches across all domains of pandemic preparedness and response. Further research is needed to identify approaches that optimally generate short-term and long-term value for communities participating in population health. Feasible, sustainable and contextualised citizen science approaches that meaningfully engage affected communities for the long-term will need to be inclusive of all populations and their cultures, comprehensive of all domains, digitally enabled and viewed as a key component to allow trust-building among the stakeholders. The impact of COVID-19 on people's lives has created an opportune time to advance people's agency in science, particularly in pandemic preparedness and response.

A Community-Based Model of Care During the Fourth Wave of the COVID-19 Outbreak in Ho Chi Minh City, Vietnam.

In response to a call for help during a surge in coronavirus disease-19 (COVID-19) cases in Ho Chi Minh City in July 2021, the University of Medicine and Pharmacy at Ho Chi Minh City developed and implemented a community care model for the management of patients with COVID-19. This was based on three main principles: home care; providing monitoring and care at a distance; and providing timely emergency care if needed. One team supported patients at home with frequent contacts and remote monitoring, while a second team transferred and cared for patients requiring treatment at field emergency care facilities. COVID-19-related mortality rates at the two districts where this approach was implemented (0.43% and 0.57%) were substantially lower than the overall rate in Ho Chi Minh City over the same period (4.95%). Thus, utilization of a community care model can increase the number of patients with COVID-19 who can be effectively managed from home, and use of field emergency care facilities limited the number of patients that had to be referred for tertiary care. Importantly, the community care model also markedly reduced the mortality rate compared with traditional methods of COVID-19 patient management.

Now protected or still stigmatized? A 25-year outlook on the impact of the Americans with Disabilities Act

Purpose>In 1990, the Americans with Disabilities Act (ADA) was signed into law by President George H.W. Bush. This law was intended to prevent discrimination against people with disabilities (PWD) in employment, public accommodations, transportation and other areas of life. However, the degree of impact in these sectors has not been studied in tandem. Addressing these sectors together is the primary objective of this paper.Design/methodology/approach>Results are analyzed and presented regarding ADA impacts as well as which organizations provide advocacy services in support to PWD from survey data collected from 1,582 US participants in 2010 (N = 866) and 2015 (N = 716).Findings>Results suggest that the ADA has had a positive impact on PWD, yet this law favorably affects people of certain demographics more than others. Moreover, people with and without disabilities have differing opinions on the impact of the ADA, suggesting that what is conveyed to the public and the impact of the ADA on real-life outcomes of PWD are sometimes misaligned.Originality/value>The present study helps add to the current body of knowledge on the impact of the ADA by providing perspectives on advocacy services and impacts from a diverse set of PWD and their counterparts without disabilities.

The Determinants of the Usage of Accounting Information Systems toward Operational Efficiency in Industrial Revolution 4.0: Evidence from an Emerging Economy

The purpose of this study is to determine the factors affecting the application of accounting information systems (AIS) in small and medium enterprises (SMEs) in Vietnam. Drawing upon the Technology–Organization–Environment (TOE) theoretical framework, Diffusion of Innovations theory (DOI), and Resource-based theory (RBV), we proposed a research model to investigate the antecedents and influence of AIS usage in Vietnamese SMEs. This study used an online survey of individuals who work in Vietnamese SMEs for data collection. The result was assembled by applying the PLS-SEM model to test the proposed hypotheses based on 132 valid responses. First, the factors that have a significant impact on AIS usage are as follows: relative advantage;owner/manager commitment;and impact of COVID-19. Second, the research results also confirm that there is a positive relationship between AIS usage and AIS effectiveness;AIS performance has a positive impact on business performance. Research implications are to help business owners and leaders decide whether to use AIS to strengthen the company's position and reduce the burden on departments, particularly the accounting department.

The perceptions of social media users of digital detox apps considering personality traits.

The purpose of this study was to investigate the perceptions of users about using digital detox applications and to display relationships among personality traits and technology-related variables. This study was designed using survey approach and employed Generalized Structured Component Analysis (GSCA). As such, 11 hypotheses were constructed and tested. The study recruited 263 participants who utilize detox applications to avoid social media distractions. Data were collected through Google Form and analyzed using GSCA Pro 1.1 to better understand whether the proposed conceptual model fits the data. The results of the study indicated that behavioral intention predicted usage behavior significantly; performance expectancy, effort expectancy, and social influence positively affected behavioral intention; in turn, agreeableness and extroversion positively influenced performance expectancy, and extroversion affected effort expectancy; finally, neuroticism had a statistically significant and negatively associated with effort expectancy of using social media detox apps. The significant exceptions were that facilitating conditions were not predictive of behavioral intention, openness to experience did not influence performance expectancy, and conscientiousness was not linked to effort expectancy. The proposed conceptual model explained 56.68% of the amount of variation, indicating that instructors, policy makers and software designers should consider personal factors for preparing practical intervention approaches to mitigate learning issues related to social media distraction.

Fibrin clot characteristics and anticoagulant response in a SARS-CoV-2-infected endothelial model.

Coronavirus disease 2019 (COVID-19) patients have increased thrombosis risk. With increasing age, there is an increase in COVID-19 severity. Additionally, adults with a history of vasculopathy have the highest thrombotic risk in COVID-19. The mechanisms of these clinical differences in risk remain unclear. Human umbilical vein endothelial cells (HUVECs) were infected with SARS-CoV-2, influenza A/Singapore/6/86 (H1N1) or mock-infected prior to incubation with plasma from healthy children, healthy adults or vasculopathic adults. Fibrin on surface of cells was observed using scanning electron microscopy, and fibrin characteristics were quantified. This experiment was repeated in the presence of bivalirudin, defibrotide, low-molecular-weight-heparin (LMWH) and unfractionated heparin (UFH). Fibrin formed on SARS-CoV-2 infected HUVECs was densely packed and contained more fibrin compared to mock-infected cells. Fibrin generated from child plasma was the thicker than fibrin generated in vasculopathic adult plasma (p = 0.0165). Clot formation was inhibited by LMWH (0.5 U/ml) and UFH (0.1-0.7 U/ml). We show that in the context of the SARS-CoV-2 infection on an endothelial culture, plasma from vasculopathic adults produces fibrin clots with thinner fibrin, indicating that the plasma coagulation system may play a role in determining the thrombotic outcome of SARS-CoV-2 infection. Heparinoid anticoagulants were most effective at preventing clot formation.

Factors Affecting the Intention to Use Financial Technology among Vietnamese Youth: Research in the Time of COVID-19 and Beyond

This study focuses on understanding the factors that affect the intention of using financial technology among young Vietnamese in the context of the COVID-19 pandemic. Fintech studies are abundant in developed countries and mainly focus on consumers' conditions, awareness, habits, and capital. These are expected to differ significantly from the situation in developing countries. We have reviewed factors that can affect the user's intention, including the Perceived Benefit (PB), Perceived Risk (PR), Belief (B), and Social Influence (SI), and rely on the Technology Acceptance Model (TAM) and the Theory of Reasoned Action (TRA) model in this research. The survey sample comprises 161 Z-generation consumers with strong flexibility and knowledge about the use of Fintech. We use the PLS-SEM (partial least squares structural equation modeling) analysis method with the SmartPLS software (SmartPLS GmbH, Oststeinbek, Germany) to evaluate the research model. We find that the Perceived Benefit (PB) has the most significant impact on the intention to use Fintech, followed by Belief (B). However, in general, the factors are not significant, perhaps due to many reasons that are intrinsic in Vietnam. Based on this result, service providers, policymakers, and researchers can calibrate the development and research for the following stages. We offer findings different from the previous research, thus especially extending the literature on young people.

Earnings Management, Board Composition and Earnings Persistence in Emerging Market

Income data are useful for making economic decisions and anticipating future revenues. Earning quality, or the utility of earnings in making decisions, is determined by real economic performance. Firms with greater performance should, on average, have higher profits quality. Managers, investors, and scholars are interested in the influence of earnings management (EM) on earnings persistence (EP). This study evaluates the relationship between these variables in terms of accrual, real EM, board composition, and EP. We conducted quantitative research using GMM regression on a sample of 228 listed businesses in the Vietnamese stock market from 2014 to 2017. Our findings indicate that accrual earnings management (AEM) is associated with a negative connection with EP, but real earnings management (REM) is associated with a mixed association with EP. Additionally, the data indicate that board of directors (BODs) play a critical role in EP. Our research contributes to the existing body of knowledge by establishing a foundation for future research in this subject and by proposing some feasible options for functional government agencies and enterprise management interested in enhancing EP.

Modeling and Prediction of the Covid-19 Cases With Deep Assessment Methodology and Fractional Calculus.

This study focuses on modeling, prediction, and analysis of confirmed, recovered, and death cases of COVID-19 by using Fractional Calculus in comparison with other models for eight countries including China, France, Italy, Spain, Turkey, the UK, and the US. First, the dataset is modeled using our previously proposed approach Deep Assessment Methodology, next, one step prediction of the future is made using two methods: Deep Assessment Methodology and Long Short-Term Memory. Later, a Gaussian prediction model is proposed to predict the short-term (30 Days) future of the pandemic, and prediction performance is evaluated. The proposed Gaussian model is compared to a time-dependent susceptible-infected-recovered (SIR) model. Lastly, an analysis of understanding the effect of history is made on memory vectors using wavelet-based denoising and correlation coefficients. Results prove that Deep Assessment Methodology successfully models the dataset with 0.6671%, 0.6957%, and 0.5756% average errors for confirmed, recovered, and death cases, respectively. We found that using the proposed Gaussian approach underestimates the trend of the pandemic and the fastest increase is observed in the US while the slowest is observed in China and Spain. Analysis of the past showed that, for all countries except Turkey, the current time instant is mainly dependent on the past two weeks where countries like Germany, Italy, and the UK have a shorter average incubation period when compared to the US and France.

Disulfiram use is associated with lower risk of COVID-19: A retrospective cohort study.

Effective, low-cost therapeutics are needed to prevent and treat COVID-19. Severe COVID-19 disease is linked to excessive inflammation. Disulfiram is an approved oral drug used to treat alcohol use disorder that is a potent anti-inflammatory agent and an inhibitor of the viral proteases. We investigated the potential effects of disulfiram on SARS-CoV-2 infection and disease severity in an observational study using a large database of clinical records from the national US Veterans Affairs healthcare system. A multivariable Cox regression adjusted for demographic information and diagnosis of alcohol use disorder revealed a reduced risk of SARS-CoV-2 infection with disulfiram use at a hazard ratio of 0.66 (34% lower risk, 95% confidence interval 24-43%). There were no COVID-19 related deaths among the 188 SARS-CoV-2 positive patients treated with disulfiram, in contrast to 5-6 statistically expected deaths based on the untreated population (P = 0.03). Our epidemiological results suggest that disulfiram may contribute to the reduced incidence and severity of COVID-19. These results support carefully planned clinical trials to assess the potential therapeutic effects of disulfiram in COVID-19.

Sero-Prevalence of SARS-CoV-2 Antibodies in High-Risk Populations in Vietnam.

As a response to the coronavirus disease 2019 (COVID-19) pandemic, Vietnam enforced strict quarantine, contact tracing and physical distancing policies resulting in one of the lowest numbers of individuals infected with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) globally. This study aimed to determine the prevalence of SARS-CoV-2 antibody positivity among high-risk populations in Vietnam. A prevalence survey was undertaken within four communities in Vietnam, where at least two COVID-19 cases had been confirmed. Participants were classified according to the location of exposure: household contacts, close contacts, community members, and healthcare workers (HCWs) responsible for treating COVID-19 cases. Participants completed a baseline questionnaire and SARS-CoV-2 IgG antibodies were quantified using a commercial assay. A total of 3049 community members and 149 health care workers consented to the study. Among 13 individuals who were seropositive (0.4%), five household contacts (5/27, 18.5%), one close contact (1/53, 1.9%), and seven community members (7/2954, 0.2%) had detectable SARS-CoV-2 antibodies. All HCWs were negative for SARS-CoV-2 antibodies. Participants were tested a median of 15.1 (interquartile range from 14.9 to 15.2) weeks after exposure. Our study found a low prevalence of SARS-CoV-2 antibodies in high-risk communities and healthcare workers in communities in Vietnam with known COVID-19 cases.

Early Essential Newborn Care can still be used with mothers who have COVID-19 if effective infection control measures are applied.

We describe the first infant born to a woman with COVID-19 in Vietnam, by Caesarean section at 36 weeks and 5 days of gestation. The mother and baby remained together during their hospital stay and prolonged skin-to-skin contact and early and exclusive breastfeeding were achieved. This was in line with the World Health Organization's Early Essential Newborn Care (EENC) recommendations, the national Vietnamese standard of care since 2014. The baby remained virus-free throughout the 34-day postpartum follow-up. CONCLUSION: The EENC approach can still be used with mothers who have COVID-19 if effective infection control measures are applied.

Suspected heparin-induced thrombocytopenia in a COVID-19 patient on extracorporeal membrane oxygenation support: a case report.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) support can be life-saving in critically ill COVID-19 patients. However, there are many complications associated with this procedure, including Heparin-induced thrombocytopenia (HIT.) Despite its rarity in ECMO cases, HIT can lead to devastating consequences and is difficult to manage. CASE PRESENTATION: In this report, we present a case of a COVID-19 patient on ECMO support who was diagnosed with HIT and required intensive treatment. Initially, HIT was only suspected due to newly-developed thrombocytopenia and oxygenator dysfunction, with thrombi observed later. Regarding his treatment, since there was no recommended replacement to heparin available to us at the time of diagnosis, we decided to use rivaroxaban temporarily. No adverse events were recorded during that period. The patient was able to make a full recovery. CONCLUSION: HIT may jeopardize patient's care during ECMO. As COVID-19 may bring about a surge in the number of patients requiring ECMO support, we need consented guidance to optimize treatment in this specific situation.

An application to support COVID-19 occupational health and patient tracking at a Veterans Affairs medical center.

OBJECTIVE: Reducing risk of coronavirus disease 2019 (COVID-19) infection among healthcare personnel requires a robust occupational health response involving multiple disciplines. We describe a flexible informatics solution to enable such coordination, and we make it available as open-source software. MATERIALS AND METHODS: We developed a stand-alone application that integrates data from several sources, including electronic health record data and data captured outside the electronic health record. RESULTS: The application facilitates workflows from different hospital departments, including Occupational Health and Infection Control, and has been used extensively. As of June 2020, 4629 employees and 7768 patients and have been added for tracking by the application, and the application has been accessed over 46 000 times. DISCUSSION: Data captured by the application provides both a historical and real-time view into the operational impact of COVID-19 within the hospital, enabling aggregate and patient-level reporting to support identification of new cases, contact tracing, outbreak investigations, and employee workforce management. CONCLUSIONS: We have developed an open-source application that facilitates communication and workflow across multiple disciplines to manage hospital employees impacted by the COVID-19 pandemic.