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Inequalities exist in health literacy and engagement with healthcare [1]. We aim to offer trial participation equitably to our peri-operative population. Trials should represent the populations they aim to study and broadening access helps makes research relevant to all. Although there are many under-served groups in our communities, one type of disadvantage is socio-economic deprivation. This can be represented by the 'Index of Multiple Deprivation' (IMD) decile where decile 1 represents the most deprived and 10 the least. Relative deprivation is analysed by postcode [2] and includes a number of contributing domains. We ran a single-centre observational trial on post-COVID-19 peri-operative outcomes. We tried to broaden access by avoiding exclusions such as 'not able to read and understand English' and offering participation via a number of routes such as face to face, by post and by email. We aimed to find out whether we had enabled participation from a cross-section of the population. Methods Between January and June 2021, sequential patients listed for elective surgery were approached for consent prior to admission. IMD deciles were generated;postcodes are attributed to a decile of deprivation between 1 and 10. Results Of 515 patients approached, 410 participated. IMD deciles were available for 395 of the 410 and are shown with IMD deciles for Leeds City Council in Fig. 1. Discussion Our active peri-operative research team attempts to promote access to studies via a range of interactions, which do not all rely on technology and by offering e.g. questionnaires via an interpreter. This appears to have been successful in this example;however, there are a number of limitations and areas to address. We find that observational studies are easier to recruit to and representation may be poorer in more complex studies. We could not collect data on those who declined participation. Socio-economic deprivation is just one aspect of underserved communities. IMD deciles are compared to those of the city council, which may differ from the peri-operative population. We have ongoing project work with local communities to promote understanding and uptake of peri-operative research and we work to create more inclusive and representative trials, participation and outputs relevant to underserved groups. (Figure Presented).
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TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Vaccinations against Novel Coronavirus 2019 (COVID-19) for immunocompromised individuals have been increasingly prioritized to avoid severe infection. Here is a case of severe COVID-19 infection in a patient with malignant lymphoma who completed the vaccination course. CASE PRESENTATION: A 79-year-old male with malignant lymphoma on active Rituximab was diagnosed with COVID-19 two months after completing the Pfizer vaccination course. He presented with a worsening cough despite receiving monoclonal antibodies outpatient. On evaluation, his vitals were stable. Chest x-ray revealed bilateral pleural effusions with bibasilar opacities. During his hospitalization, he received a full course of dexamethasone, ivermectin, remdesivir and baricitinib. However, his cough and oxygenation progressively worsened, with eventual intubation and vasopressor support. Computed Tomography (CT) Chest showed progressive worsening of COVID-19 Pneumonia. Originally on admission he had tested negative for the IgM and IgG antibodies against the Nucleocapsid (N) Protein which raised the suspicion that he had not mounted an immune response to the vaccine. On further evaluation, he was found to have positive antibody titers against Spike (S) proteins which confirmed that he had mounted a response to the vaccine despite his immunocompromised status. DISCUSSION: Anti-CD20 therapy is one of the primary therapies for hematological malignancies. Despite T cell function being the primary role against COVID-19, there is increasing evidence that B-cell depletion may inhibit protective immunity following infection and vaccination. A two-dose regimen of BNT162b2 (Pfizer) conferred 95% protection against COVID-19 in persons 16 years of age or older, and decreased the rate of severe infection. However, only 4% of the vaccinated patients suffered from any malignancy;0.2% of them had metastatic solid tumors, leukemia, lymphoma and none were on chemotherapy. The efficacy of the vaccine was extrapolated to include the subset of individuals on active chemotherapy. Interestingly, despite having an active immunological response to the vaccine and normal T-cell function, the patient suffered from severe COVID pneumonia. CONCLUSIONS: Though widespread immunization against COVID-19 is underway, patients with hematological malignancies still remain a vulnerable population. The decision to halt immunomodulatory therapy to improve efficacy of the vaccine needs further investigation. REFERENCE #1: Baker D et al. (2020). COVID-19 vaccine-readiness for anti-CD20-depleting therapy in autoimmune diseases. Clinical & Experimental Immunology, 202(2), 149–161. https://doi.org/10.1111/cei.13495 DISCLOSURES: No relevant relationships by Luke Alessi, source=Web Response No relevant relationships by Louis Avvento, source=Web Response No relevant relationships by Abdul Qadeer, source=Web Response No relevant relationships by Kathryn Saxby, source=Web Response No relevant relationships by Howard Sklarek, source=Web Response No relevant relationships by LAKSHMI SUBRAMANIAN, source=Web Response No relevant relationships by Daisy Young, source=Web Response
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Increasing financialization of energy and commodity markets offer a variety of tradeoff for the investors and consumers. On the one hand, this increased financialization of the two markets helps investors design a well-diversified investment portfolio with assets from different asset categories. However, at the same time, this increases the connectedness between the two markets significantly, which may have strong implications for investors and consumers. In this paper, we examine the long-term connectedness and causality between Crude oil and agricultural commodity prices. The advantage of long-term time series is that we may be able to uncover the demand and supply shocks that originated in both markets during the tranquil period and the shocks during the volatile period such as the Global Financial Crisis of 2008 and COVID-19 pandemic. For this purpose, we employ the full bootstrap sample and rolling window causality tests primarily. Our results are surprisingly different from most of the studies that have held oil prices responsible for causing changes in agricultural commodity prices (ACP). In contrast, our results confirm the presence of bidirectional causality and show that Oil prices are as much affected by the ACP as vice versa. This significant reverse causality running from ACP to Oil prices can open up a completely new interpretation domain. Finally, it is surprisingly interesting that both ACP and Oil prices remain immune to the shocks that originated in both markets during the entire time period of the COVID-19 pandemic. © 2021 Elsevier Ltd
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COVID-19 pandemic has forced the emergency deployment of digital health technology (DHT) to provide remote care. DHT is a promising option to enable telehealth, and, by the same token, it contributes to the implementation of social distance measures. The objective of this scoping review is to investigate existing DHT solutions that have been put in place to enable remote care in response to the COVID-19 pandemic. Structured literature searches were performed in Medline (Ovid), Scopus and CINAHL with Full Text (EBSCOhost), with a mix of keywords and controlled vocabulary unique to each database. The librarian utilized the search strategy on respiratory pandemics created in April 2020 for Medline (Ovid) by Canadian Agency for Drugs and Technology in Health (CADTH). An additional search for grey literature was performed including pre-prints and reports in Google Advanced, LitCovid and MedRx. Two independent reviewers assessed the articles retrieved from the databases (n=131) based on pre-established inclusion criteria and included six articles. Analysis of the results revealed six different types of DHT, including 5 dedicated to telemedicine and one used to track activity of people who were confined to their homes. The results showed positive health-related outcomes and user behavior outcomes. This review revealed that there is limited literature on the use of DHT to enable remote care in response to a pandemic and therefore calls for more documentation of the ongoing deployment of DHTs to support patient safety and the delivery of quality care during the COVID-19 pandemic and beyond.
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Up to now, no vaccine has been developed for COVID-19 treatment. Although many scientists are working for the rapid development of a vaccine to control this pandemic, nonetheless, it will take time. If the vaccine will be developed soon, it will not be available to the entire world instantly since the mass production of the vaccine will take time. In this scenario, we will have to take alternative measures to control the COVID-19 pandemic. These alternative approaches include the stimulation of the immune system to fight against viral infections. Among the different approaches to strengthen the immune system, the use of probiotics is the best one. Probiotics can help the body to fight against COVID-19 directly and indirectly. In this review, we comprehensively discuss the use of probiotics for the prevention and control of COVID-19.