ABSTRACT
Purpose In 2018, a US-based consortium implemented the first accredited IR training program in East Africa at a quaternary care hospital. Training is performed by visiting teams comprising an IR physician, nurse, and technologist, traveling to Tanzania on a 2-weeks-on, 2-weeks-off schedule. In March 2020, Covid- related restrictions halted academic travel. Herein, we describe the successful adaptation of a novel IR teaching program in a resource-limited setting during Covid-19. Materials and Methods IR procedures occurring between January 2019 - October 2021 were recorded and analyzed, including during academic travel bans. During this time focus was placed on virtual teaching, recruitment, supply procurement, and industry support. Monthly in-person teaching trips resumed in late 2020. Results In the latter half of 2019, 124 primary procedures were performed. In the first half of 2021, a total of 254 primary procedures were performed, increased from an average of 120.5 per half-year, pre- restrictions. Expanded virtual teaching resulted in lectures and journal clubs beyond the main teaching site, such as Rwanda, Uganda, and Nigeria. Despite widespread travel restrictions in 2020, supply, research, and recruitment operations increased. As a result, once travel resumed, attending visits increased compared to pre-pandemic times from 14 (1.17 +/- 0.37 per month) to 20 (1.82 +/- 1.74 per month). In September 2021, the program graduated the first three fully-trained IR faculty in East Africa. Conclusion Maintaining a highly functional IR training program is feasible in a resource-limited setting, despite the pandemic. Future work will focus on increasing efficiency, longitudinal sustainability, and Pan- African expansion.
ABSTRACT
;INTRODUCTION: Mobile video gaming among university students has increased rapidly, more than before the COVID-19 pandemic. This is very concerning as this could spark various problems, such as musculoskeletal pain and gaming disorders. OBJECTIVES: The present study is to identify the predictors of mobile video gaming on musculoskeletal pain among university students in Selangor, Malaysia. PARTICIPANTS AND METHODS: This study was conducted online using a self-reported online questionnaire via Google Form and sent to university students in Selangor, Malaysia. Participants' gaming addiction was measured using the Ten Item Internet Gaming Disorder Test (IGDT-10) questionnaire, and the prevalence of musculoskeletal pain was assessed by the Modified Nordic Musculoskeletal Questionnaire (MNMQ). The data was analyzed using SPSS version 25. A descriptive and binomial linear regression test was used to predict the variables. The statistical significance was set at p < 0.05, and odds ratios were calculated with confidence intervals of 95%. RESULTS: The prevalence of Internet Gaming Disorder among university students in Selangor, Malaysia is 1.8% (n=3). The neck region (74.2%) was the most commonly reported body region with musculoskeletal pain, followed by the shoulder region (60.7 %), lower back region (55.8 %), and upper back region (50.9 %). The body position was the only predictor of mobile video gaming with musculoskeletal pain (p = 0.002) in the lower back region. CONCLUSION: According to the findings of this study, the prevalence of Internet Gaming Disorder (IGD) among university students was low and not addicted to gaming in the Covid-19 lockdown. We also found that participants who sat while playing mobile video games were more likely to develop low back pain. However, one of the limiting factors could be prolonged sitting in virtual classes during the lockdown, which causes low back pain. © 2021, BAHIANA - School of Medicine and Public Health. All rights reserved.
ABSTRACT
Introduction: Acute fibrinous and organizing pneumonia (AFOP) is a rare histological pattern of lung injury. Organizing Pneumonia (OP) may be occurring more frequently than realized in patients with lung injury from COVID-19. This case report reviews the presentation and disease course of AFOP in a patient with COVID-19. Case description:A 49-year-old male with a history of Diabetes Mellitus and Chronic Lymphocytic Lymphoma on Venetoclax and Obinutuzumab presented with fever, exertional dyspnea, and dry cough and was diagnosed with COVID-19. His CT scan showed extensive peripheral predominant patchy and heterogenous ground glass opacities with mediastinal lymphadenopathy (Image A). His serum aspergillus galactomannan index was 4.37 and he was started on voriconazole. He however remained febrile;so, he had a transbronchial cryobiopsy. His pathology revealed marked interstitial T-cell lymphocytic inflammatory infiltrate with fibrinous and organizing pneumonia. There was proliferative bronchiolitis and evidence of acute pulmonary hemorrhage, without features of vasculitis/capillaritis. No evidence of malignancy or organisms were identified. He was started on methylprednisolone daily and he initially improved, however, his fever returned and his oxygen requirements increased rapidly with steroid taper. His repeat chest CT scan showed a marked increase in bilateral patchy areas of consolidation with surrounding areas of ground glass opacity and intralobular septal thickening ("crazy paving") Image B. His infectious work up was extensive but negative. At this point, he required invasive mechanical ventilation;after which he received pulse dose steroids for three days followed by high dose maintenance. He improved and was extubated. However, he required high flow supplemental oxygen and was unable to be weaned past 100% fraction of inspired oxygen;as a result, Ruxolitinib was added. Unfortunately, his hypoxemia remained refractory and he developed sudden cardiovascular collapse which led to his demise. The patient died 40 days after admission. Discussion: Understanding the histopathology, disease course, and sequelae of COVID-19 is of paramount importance, because AFOP in COVID-19 adds complexity to management. Our patient's antemortem biopsy was performed prior to acute respiratory distress syndrome and mechanical ventilation as opposed to previous case reports with post mortem findings of AFOP after prolonged mechanical ventilation. Notably, 30% - 60% of intensive care patients with SARS CoV 1 had OP and AFOP. Additionally, the CT findings of COVID-19 are similar to OP and this lends support to the possibility that OP is an underlying pattern of lung injury in COVID-19.