ABSTRACT
During the COVID-19 pandemic, technology stocks, such as FAANG stocks (Facebook, Amazon, Apple, Netflix, and Google), attracted the attention of global investors due to the vast use of technology in daily business. However, technology stocks are generally considered risky stocks;hence, efficient risk management is required to construct an optimal portfolio. In this study, we investigate the volatility spillovers and dynamic conditional correlations among the daily returns of FAANG company stocks, gold, and sharia-compliant equity to construct the optimal portfolio weights and hedge ratios during the COVID-19 pandemic period by utilizing a multivariate GARCH framework. The dynamic conditional correlations reveal that both gold and sharia-compliant equities exhibit lower correlations with FAANG stocks during the COVID-19 pandemic, implying opportunities for portfolio diversification. The findings indicate that gold and shariah-compliant equity are good candidates to hedge FAANG stocks. These findings are highly relevant for international investors, asset managers, hedgers, and portfolio managers.
ABSTRACT
Objective: Primary care is the first line of defense during a pandemic. It can assist patients manage at home, reinforce public health messaging, and pinpoint individuals who require hospital treatment. Primary care struggled to quickly adapt in order to safeguard doctors, staff, and patients during the COVID-19 outbreak and maintain patient relationships. We outline the steps primary care has to follow in a pandemic using the existing public health framework for doing so. Study Design: It was a review. The authors' primary care practices and networks' observed experiences are used to guide the recommended activities. During the early stages of the COVID-19 pandemic, efforts were concentrated on encouraging physical separation and urging patients who had a suspected sickness or exposure to self-quarantine. Both testing and contract tracing were not accessible. Place and Duration: It was conducted at services hospital Lahore and duration was 07 months. Telehealth was used to transform in-person treatment into virtual care as the epidemic progressed. By utilizing registries to connect with people who were socially vulnerable, at risk for infection, or had chronic diseases that were not under control, practices maintained contact with their patients. Most individuals with probable COVID-19 were treated by practices at home. Result(s): Practices are currently getting ready to deal with the direct and indirect effects of the pandemic, including complications from COVID-19 infections, missed treatment for acute issues, insufficient prevention, uncontrolled chronic disease, mental illness, and increased social requirements. Conclusion(s): Throughout, practices suffered from severe financial strain, firing employees or sometimes shutting down when it was most required. In order to prepare for the upcoming pandemic, primary care must draw lessons from this experience. Primary care cannot be neglected by payers or policymakers in their time of need. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Various case reports have associated transient sinus bradycardia with Remdesivir (RDV) therapy for SARS-CoV2 infection. Pallotto et al., Gubitosa et al., and Touafchia et al. all reported the association of Remdesivir with increased risk of bradycardia in small samples of patients treated with RDV for COVID-19. To our knowledge, no large studies looked at this side effect of RDV therapy. We aimed to analyze the association between sinus bradycardia and Remdesivir therapy for COVID-19. METHODS: A retrospective case-control analysis was done for 1535 patients with SARS-CoV2 infection who were admitted to four teaching hospitals in an urban area in 2020. The mean age was 66 years (SD of 16.7, range 18-99), with 774 males (50.4%). Patients were divided into cases (treated with RDV) and controls (not treated with RDV). Multivariate logistic regression methods were used to analyze the associations between independent variables and outcomes. Pulse rate variables were recorded as pulse rate at day-0, day-3, day-7, and incidence of bradycardia on three consecutive days during admission. Other variables recorded were age, gender, comorbidities, prior history of cardiac disease/arrhythmias, concomitant medications (including AV nodal blockers, dexamethasone, Albuterol, and Lasix), and ICU admission. Survival analysis was run for 7-day and 30-day mortality, as well as survival to hospital discharge. RESULTS: 1415 patients were included in the final analysis, after the exclusion of 120 patients with previous heart blocks. 600 patients (39.1%) were in the Remdesivir group, and 935 patients (60.9%) were in the control group. Between both groups, a total of 454 patients (29.6%) had transient bradycardia on three consecutive days during hospitalization. A multivariate regression analysis was done after adjusting for all confounding variables (age, gender, history of cardiac diseases, AV-nodal blocking drugs, dexamethasone, furosemide, and albuterol therapy). It was seen that there was no statistically significant association between RDV therapy and persistent transient bradycardia (transient bradycardic events on three consecutive days) (Odds Ratio 0.823, 95% confidence interval (CI) 0.594-1.134, p=0.236). There was no statistically significant association of RDV therapy with patients having any bradycardia event during hospitalization in a sub-analysis (Odds Ratio 0.888, 95% confidence interval (CI) 0.665-1.184, p=0.419). Also, RDV failed to show any statistically significant mortality benefit (OR 1.1, CI 0.75-1.62, p=0.6). CONCLUSIONS: Our findings indicate that although transient sinus bradycardia in patients with COVID-19, can be triggered by severe hypoxia, inflammatory damage to AV-nodal cells, or exaggerated response to medications, there was no statistically significant association of RDV therapy with the risk of developing bradycardia. RDV therapy should not be withheld in patients at risk of developing bradycardia. CLINICAL IMPLICATIONS: Remdesivir therapy did not increase the risk of developing bradycardia in our patient population. RDV therapy should not be withheld in patients at risk of developing bradycardia. Larger RCTs are needed to validate these findings. DISCLOSURES: No relevant relationships by Rahul Bollam, source=Web Response No relevant relationships by Bhagat Kondaveeti, source=Web Response No relevant relationships by Florencio Mamauag, source=Web Response No relevant relationships by Kainat Saleem, source=Web Response No relevant relationships by Manasi Sejpal, source=Web Response No relevant relationships by Megha Sood, source=Web Response No relevant relationships by Morgan Stalder, source=Web Response No relevant relationships by Rosalie Traficante, source=Web Response No relevant relationships by Syed Arsalan Zaidi, source=Web Response
ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Various cardiac manifestations of the COVID-19 virus have been reported since early 2020, including a range of arrhythmias, but to our knowledge, only 2 case reports exist describing new bradycardia in patients with COVID-19 infection. We aimed to analyze the association between sinus bradycardia and severity of covid-19 infection, including survival outcomes. METHODS: A retrospective analysis was done for 1535 patients with SARS-CoV2 infection who were admitted to four teaching hospitals in an urban area in 2020. The mean age was 66 years (SD of 16.7, range 18-99), with 774 males (50.4%). Multivariate logistic regression methods were used to analyze the associations between independent variables and outcomes. Pulse rate variables were recorded as pulse rate at day-0, day-3, day-7, and incidence of bradycardia on 3 consecutive days during admission. Other variables recorded were age, gender, comorbidities, prior history of cardiac disease/arrhythmias, concomitant medications (including AV nodal blockers, dexamethasone, Remdesivir, Albuterol, and Lasix), and ICU admission. The severity of COVID-19 infection was graded by the need for ICU admission vs. no ICU admission. Survival analysis was run for 7-day and 30-day mortality, as well as survival to hospital discharge. RESULTS: 1415 patients were included in the final analysis, as 120 patients with prior heart block were excluded. 508 patients (33.1%) required ICU admission due to severe hypoxia, 708 patients (46.2%) had at least one episode of significant bradycardia. Our sample population had an inpatient all-cause mortality of 18.1%. After adjusting for confounding variables, it was seen that patients with incident bradycardia on 3 consecutive days were more likely to require ICU admission than patients without these bradycardia events (Odds Ratio 1.58, p=0.001). There was no significant association of bradycardia with survival to hospital discharge (p=0.761). It was also seen in a sub-analysis that tachycardia on day-3 is statistically significantly associated with 7-day mortality, such that patients with tachycardia on day 3 had 2.9 (p<0.001) times the odds of 7-day mortality compared to those with normal heart rate. We also tested the overall significance of pulse rate at day-0, day 3, day 7, and persistent bradycardia and found that pulse at day 3 was a statistically significant predictor of 7-day mortality (p=0.001). CONCLUSIONS: Our findings suggest a possible correlation between bradycardia and the severity of COVID-19 symptoms;more severe COVID-19 cases were associated with a higher incidence of new bradycardia events. Transient sinus bradycardia can be triggered by severe hypoxia, inflammatory damage to AV-nodal cells, or exaggerated response to medications, but the exact etiology is still unknown. Bradycardia might be a warning sign of possible acute worsening of symptoms and should be monitored closely. Further studies are warranted to confirm these findings. CLINICAL IMPLICATIONS: Transient sinus bradycardia is possibly associated with a higher likelihood of ICU admission due to the severity of COVID-19 symptoms, and these patients should be monitored closely. DISCLOSURES: No relevant relationships by Firas Abdulmajeed, source=Web Response No relevant relationships by Abasin Amanzai, source=Web Response No relevant relationships by Rahul Bollam, source=Web Response No relevant relationships by Florencio Mamauag, source=Web Response No relevant relationships by Kainat Saleem, source=Web Response No relevant relationships by Morgan Stalder, source=Web Response No relevant relationships by Syed Arsalan Zaidi, source=Web Response