Use of Vascularized, Denervated Muscle Targets for Prevention and Treatment of Upper-Extremity Neuromas.

Purpose: Neuroma formation following upper-extremity peripheral nerve injury often results in persistent, debilitating neuropathic pain with a limited response to medical management. Vascularized, denervated muscle targets (VDMTs) offer a newly described surgical approach to address this challenging problem. Like targeted muscle reinnervation and regenerative peripheral nerve targets, VDMTs are used to redirect regenerating axons from an injured nerve into denervated muscle to prevent neuroma formation. By providing a vascularized muscle target that is reinnervated via direct neurotization, VDMTs offer some theoretical advantages in comparison with the other contemporary surgical options. In this study, we followed the short-term pain outcomes of patients who underwent VDMT surgery for neuroma prevention or treatment. Methods: We performed a retrospective chart review of 9 patients (2 pediatric and 7 adult) who underwent VDMTs either for symptomatic upper-extremity neuromas or as a prophylactic measure to prevent primary neuroma formation. In-person and/or telephone interviews were conducted to assess their postoperative clinical outcomes, including the visual analog pain scale simple pain score. Results: Of the 9 patients included in this study, 7 underwent VDMT surgery as a prophylactic measure against neuroma formation, and 2 presented with symptomatic neuromas that were treated with VDMTs. The average follow-up was 5.6 ± 4.1 months (range, 0.5-13.2 months). The average postoperative pain score of the 7 adult patients was 1.1 (range, 0-8). Conclusions: This study demonstrated favorable short-term outcomes in a small cohort of patients treated with VDMTs in the upper extremity. Larger, prospective, and comparative studies with validated patient-reported and objective outcome measures and longer-term follow-ups are needed to further evaluate the benefits of VDMTs in upper-extremity neuroma management and prevention. Type of study/level of evidence: Therapeutic III.

Comparison of knowledge, attitude, anxiety, and behaviours in medical and non-medical students towards COVID-19 vaccination: A need for concern amidst the pandemic

Purpose: COVID-19, a pandemic declared on March 11th, 2020, makes it crucial for the whole world to control and ensure safety measures to control such infections in the future. Fear, worry, and panic remain widespread, especially among healthcare workers. We aimed to compare the knowledge, attitude, anxiety, and behaviours of medical and non-medical students towards vaccination against COVID-19. Material and Methods: We conducted a cross-sectional study for one month on the MBBS/BDS and undergraduate nonmedical students through an online questionnaire which consisted of a multiple choice KAP questionnaire consisting of four sections (i.e., socio-demographic details, knowledge, attitudes, and behavior). Multiple linear regression was performed to determine the variables predicting knowledge and attitudes towards COVID-19 vaccination. Results: Vaccine hesitancy was detected in 17% of Undergraduate Medical Students, while the same was noted in 45% of non-medical students. 48.7% of medical students knew about different vaccines available in India for COVID-19 viz a viz the same in non-medical students was 49.5%. The majority of the students (35.8% medical and 48.6% non-medical) considered Covishield the best currently available vaccine in India. The majority of the students (Medical 86.5% and non-medical 75.2%) thought that the COVID-19 vaccine could reduce the spread of the disease in the community. In the multiple regression model, better socioeconomic status, holding nuclear families, and having a history of essential vaccinations uptake were linked with knowledge, while attitudes were substantially associated with being female and having previous history of vital vaccines uptake.Conclusion: The results showed that medical students had sufficient knowledge, an optimistic attitude, and moderate levels of concern towards COVID-19. Vaccine hesitancy was much less among medical when compared to non¬medical students. Expanding knowledge and regulatory oversight of vaccine research and the public release of safety data may lessen vaccine reluctance among students. © 2021, Arabian Gulf University. All rights reserved.

Effect of sample pooling on the Cycle threshold value of RT-PCR testing for Covid-19 and logistic savings

Background:This ongoing coronavirus disease 2019 (Covid-19) pandemic is a great challenge for our health-care systems and their infrastructure. Diagnostic confirmation of infected individuals based on RT-PCR is important for the contain- ment of viral spread because despite high viral loads, infection can be asymptomatic. To come up with the limited sup- plies in low socio economic countries like ours, pooling of specimens was proposed as a method to screen large number of patients. To analyse the effect of pooling of samples on the sensitivity of RT-PCR, we compared Cycle threshold (Ct) values of pools with those of the deconvulated (individual) samples. Methods:From March 2020 to October 2020, we performed Covid-19 testing by RT-PCR from areas with varying preva- lence of population referred to VRDL, JNMCH, Aligarh. To circumvent the limited availability of RNA extraction and PCR reagents, pool testing was started. 5 samples were pooled together and these pools were tested by RT-PCR. Negative pools were reported as negative whereas positive pools were deconvoluted and each sample was tested individually. In this study, 408 pools i.e 2040 samples were analysed. Results:In our study, a ΔCt value of 0.96 (i.e. an increase in Ct value in the pooled sample as compared to individual sample) was found that shows a slight loss of PCR sensitivity in pooled samples which is relatively small compared to the inherent clinical sensitivity of the standard assay. But the gains in cost effectivity and savings of resources are considera- bly high. Conclusions: As pooling of samples is a cost effective way for Covid-19 testing, the slight loss in the sensitivity of PCR can be overcomed by considering the Ct cut-off value for positive pools slightly above the kit cut off value to circumvent the dilution effect.

Low clinical utility of testing for anti-platelet factor 4 in asymptomatic individuals after ChAdOx1 nCoV-19 vaccine.

INTRODUCTION: The development of anti-platelet factor 4 (PF4) antibodies is linked to a rare thrombotic complication described now as vaccine-induced immune thrombotic thrombocytopenia (VITT). This clinical syndrome with thrombosis and thrombocytopenia was reported after exposure to the Oxford-AstraZeneca COVID-19 vaccine, ChAdOx1 nCoV-19 vaccine (AZD1222), and Ad26.COV2.S vaccine (Janssen/Johnson & Johnson). In the absence of the clinical features, the incidence of positive anti-PF4 antibodies in asymptomatic individuals post-vaccination is unclear. METHODS: The aim of this study was to evaluate the development of anti-PF4 antibodies in asymptomatic individuals 14-21 days after receiving the first dose of ChAdOx1 nCoV-19 vaccine (AZD1222) and BNT162b2 vaccine. Prospectively, we collected serum from individuals before and after ChAdOx1 nCoV-19 vaccine and BNT162b2 vaccine and measured anti-PF4 antibodies using the Asserachrom HPIA IgG ELISA (Stago, Asnieres, France). RESULTS: We detected positive anti-PF4 antibodies in 5 of 94 asymptomatic individuals post-vaccine with a rate of 5.3% with low titers (OD 0.3-0.7). Four of 5 individuals who tested positive after the vaccine had also positive anti-PF4 antibodies before the vaccine, which indicates that a majority of the positive results are due to preexisting anti-PF4 antibodies. We did not find a relation between the development of anti-PF4 antibodies and the immune response to the vaccine, status of prior COVID-19 infection, and baseline characteristics of participants. None of the participants developed thrombosis nor thrombocytopenia. CONCLUSION: Our results provide new evidence to guide the diagnostic algorithm of suspected cases of VITT. In the absence of thrombosis and thrombocytopenia, there is a low utility of testing for anti-PF4 antibodies.

Attitudes toward the SARS-CoV-2 Vaccine: Results from the Saudi Residents' Intention to Get Vaccinated against COVID-19 (SRIGVAC) Study.

Vaccine uptake could influence vaccination efforts to control the widespread COVID-19 pandemic; however, little is known about vaccine acceptance in Saudi Arabia. The present study aimed to assess the Saudi public's intent to get vaccinated against COVID-19 and explore the associated demographic determinants of their intentions as well as the reasons for vaccine hesitancy. A cross-sectional, web-based survey was distributed to public individuals in Saudi Arabia between 25 December 2020 and 15 February 2021. Participants were asked if they were willing to get vaccinated, and the responses, along with demographic data were entered into a multinomial logistic regression model to assess the relative risk ratio (RRR) for responding "no" or "unsure" versus "yes". Among 3048 participants (60.1% female, 89.5% Saudi), 52.9% intend to get vaccinated, 26.8% were unsure, and 20.3% refused vaccination. Vaccine hesitancy was significantly higher among females (RRR = 2.70, p < 0.0001) and those who had not been recently vaccinated for influenza (RRR = 2.63, p < 0.0001). The likelihood was lower among Saudis (RRR = 0.49, p < 0.0001), those with less than a secondary education (RRR = 0.16, p < 0.0001), perceived risks of COVID-19, and residents of the southern region (RRR = 0.46, p < 0.0001). The most often cited reasons for hesitancy were short clinical testing periods and concerns about adverse events or effectiveness. Vaccine hesitancy is mediated by many demographic factors and personal beliefs. To address vaccine-related concerns and amend deeply rooted health beliefs, communication should provide transparent information.

Cardiac Injury Biomarkers and the Risk of Death in Patients with COVID-19: A Systematic Review and Meta-Analysis.

BACKGROUND: Cardiac complications may develop in a proportion of patients with the novel coronavirus disease (COVID-19), which may influence their prognosis. OBJECTIVES: To assess the role of cardiac injury biomarkers measured on admission and during hospitalization as risk factors for subsequent death in COVID-19 patients. METHODS: A systematic review and meta-analysis was carried out involving cohort studies that compared the levels of cardiac injury biomarkers in surviving and dead COVID-19 patients. Cardiac injury is defined as an elevation of the definitive markers (cardiac troponin (cTnI and cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)) above the 99th percentile upper reference limit. Secondary markers included creatine kinase-myocardial bound (CK-MB), myoglobin, interleukin-6 (IL-6), and C-reactive protein (CRP). The risk of death and the differences in marker concentrations were analyzed using risk ratios (RRs) and standardized mean differences (SMDs), respectively. RESULTS: Nine studies met the inclusion criteria (1799 patients, 53.36% males, 20.62% with cardiac injury). The risk of death was significantly higher in patients with elevated cTn than those with normal biomarker levels (RR = 5.28, P < 0.0001). Compared to survivors, dead patients had higher levels of cTn (SMD = 2.15, P=0.001), IL-6 (SMD = 3.13, P=0.03), hs-CRP (SMD = 2.78, P < 0.0001), and CK-MB (SMD = 0.97, P < 0.0001) on admission and a significant rise of plasma cTnT during hospitalization. CONCLUSION: COVID-19 patients with elevated cTn on admission, possibly due to immune-mediated myocardial injury, are at increased risk for mortality. This requires further radiographic investigations, close monitoring, and aggressive care to reduce the risk of severe complications and death.

Predictors of misconceptions, knowledge, attitudes, and practices of COVID-19 pandemic among a sample of Saudi population.

This study intends to explore the predictors of misconceptions, knowledge, attitudes, and practices concerning the COVID-19 pandemic among a sample of the Saudi population and we also assessed their approaches toward its overall impact. This online cross-sectional survey was conducted at the Faculty of Medicine, Rabigh, King Abdulaziz University (KAU) in Jeddah, Saudi Arabia (SA). Participants were approached via social media (SM), and 2006 participants (953 [47.5%] females and 1053 [52.5%] males) were included in this study. SM was the leading source of information for 43.9% of the study participants. Most of the participants had various misconceptions such as "females are more vulnerable to develop this infection, rinsing the nose with saline and sipping water every 15 minutes protects against Coronavirus, flu and pneumonia vaccines protect against this virus." About one-third of participants (31.7%) had self-reported disturbed social, mental, and psychological wellbeing due to the pandemic. Many participants became more religious during this pandemic. Two-thirds of the study participants (68.1%) had good knowledge scores. Attitudes were highly positive in 93.1%, and practice scores were adequate in 97.7% of the participants. Participants' educational status was a predictor of high knowledge scores. Male gender and divorced status were predictors of low practice scores, and aged 51-61 years, private-sector jobs, and student status were predictors of high practice scores. Being Saudi was a predictor of a positive attitude, while the male gender and divorced status were predictors of a negative attitude. Higher education was a predictor of good concepts, while the older age and businessmen were predictors of misconceptions. Overall, our study participants had good knowledge, positive attitudes, and good practices, but several myths were also prevalent. Being a PhD and a Saudi national predicted high knowledge scores and positive attitudes, respectively. A higher education level was a predictor of good concepts, and students, private-sector jobs, and aged 51-61 years were predictors of high practice scores. Study participants had good understanding of the effects of this pandemic.

Predictors of misconceptions, knowledge, attitudes, and practices of COVID-19 pandemic among a sample of Saudi population and its impact: a cross-sectional study (preprint)

ObjectivesTo explore the predictors of misconceptions, knowledge, attitudes, and practices of the COVID-19 pandemic among a sample of the Saudi population and its impact. DesignAn online cross-sectional study. SettingJeddah, Saudi Arabia. ParticipantsA total of 2006 participants [953(47.5%) females, and 1053(52.5%) males], and more than 18 years of age were included in the study. Data collection and analysisThis cross-sectional survey was conducted at the Faculty of Medicine, Rabigh, King Abdulaziz University (KAU). The participants were approached by social media (SM). An online questionnaire was administered, and the data were analyzed on SPSS-26. ResultsThe SM was the leading source of information 889(43.9%). Two-thirds of the participants, 1250(66.9%) had various misconceptions, and about one-third of the study participants 637(31.7%) had disturbed social, mental, and psychological wellbeing, and many participants became more religious. Two-thirds of the study participants, 1292(68.1%) had good knowledge score. The attitude was highly positive in 1867(93.1%) participants, and the practice score was adequate in 1939(97.7%). The participants educational status was the predictor of good knowledge. Male gender and divorced ones were the predictor of poor practice scores and age 51-60 years, private jobholders, and students were the predictors of the good practice scores. The Saudi nationality was the predictor of participants positive attitude, while the male gender and divorced ones were predictors of a negative attitude. The male gender and higher education status were the predictors of good concepts, while the older age and job (own business) were the predictors of misconceptions. ConclusionOur study observed several predictors of misconceptions, knowledge, attitudes, and practices among the Saudi population. Our participants had a good realization of the impact of this pandemic. Strengths and limitationsO_LIOurs is the first study involving the general population of Saudi Arabia at a time when COVID-19 has tremendously affected the society. C_LIO_LIThe use of a validated questionnaire has strengthened the study results. C_LIO_LIThe sample size is adequate and representing different segments of society. C_LIO_LIOne of the limitations is the convenience sampling method. C_LIO_LIBesides, the study used an online questionnaire, so we could not reach the section of society that is not using the internet. C_LI