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Patients with psoriasis experience impaired health-related quality of life (HRQoL) and are at risk of depression and anxiety. Although treatment with biological agents reportedly improves HRQoL, there is limited evidence on the impact of biological treatment failure on HRQoL and other aspects of psychosocial well-being. This study aims to evaluate psychosocial wellbeing outcomes in UK patients with moderate-to-severe plaque psoriasis who experience biological treatment failure and those with an adequate treatment response. This ongoing multicentre, noninterventional study involves adults (aged >= 18 years) with a confirmed diagnosis of moderate-to-severe plaque psoriasis, currently undergoing treatment with biological therapy within UK practice (target sample: 270 patients). Demographic, clinicopathological and treatment data are obtained from medical records. Patient-reported outcome data are collected prospectively via validated and bespoke questionnaires assessing dimensions of psychosocial wellbeing at baseline and at the closest consultation to months 3, 6, 9, 12 (+/- 6 weeks). Here, we describe interim results for patients enrolled prior to the COVID-19 pandemic. Twenty patients were enrolled between 10 January 2020 and 28 March 2020 [mean (SD) age 52 (14.3) years;70% male]. The Table summarizes the interim scores at baseline and month 3 (where available);two patients experienced treatment failure at month 3. Overall, patients reported high levels of anxiety and depression at baseline. Conversely, other aspects of wellbeing were less affected (e.g. HRQoL), while treatment satisfaction and trust levels in healthcare providers were relatively high. Similar trends were observed at month 3, although sample sizes were insufficient to detect any statistical differences between groups. These interim results provide novel insight into the psychosocial wellbeing of patients at the start of the COVID-19 pandemic. The additional data will improve understanding of patients' wellbeing throughout the pandemic, including real-world outcomes of patients experiencing treatment failure. (Table Presented).
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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-COV2) infection has been associated with the development and persistence of various neurological symptoms in some patients. There have been few prior case reports of small fiber neuropathy (SFN) associated with this infection. However, literature is limited, and the etiology of these symptoms is unclear. Some reports suggested neuroinflammation. Objective(s): To present case series of 3 patients who developed small fiber neuropathy after SARS-COV2 infection. Method(s): We identified patients with SFN after SARSCOV2 infection from our neuromuscular database. We performed chart review and obtained clinical, demographic and, outcomes information of these patients. Result(s): The age of patients was 46, 56 and 71 years. Two female and one male. Time to neuropathy symptom evaluation in clinic from positive COVID19 test was 4 months, 6 months, and 10 months, respectively. None of the patients were hospitalized or given additional medications for COVID treatment. Patients 1& 3 had mild respiratory symptoms. Patient 2 had no symptoms, just a routine pre-op test was positive. All patients had numbness, tingling and painful paresthesias as the main symptoms. The second patient reported autonomic symptoms of heart racing and temperature dysregulation. Nerve conduction studies did not show large fiber peripheral neuropathy in any of the patients. Skin biopsy was performed at 7 months, 8 months and 13 months respectively post COVID infection and was positive in all 3 patients. There was no other etiology identified for the neuropathy Treatment included gabapentin for the first patient, the second patient received narcotic medication for a surgery and continued this for her neuropathic symptomsand the third patient is not on any medications for SFN. Conclusion(s): SFN can be associated with prior SARSCOV infection. There is need for further research to determine possible underlying neuropathological mechanisms and find effective treatments in COVID-related SFN.
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Most people preferred e-commerce ensuing the Coronavirus Disease-2019 (COVID-19) outbreak, resulting in delivery companies receiving large quantities of parcels to be delivered to clients. Hurdle emerges when delivery person needs to convey items to a large number of households in a single journey as they never face this situation before. As a result, they seek the quickest way during the trip to reduce delivery costs and time. Since the delivery challenge has been classified as an NP-hard (non-deterministic polynomial-time hard)) problem, this study aims to search the shortest distance, including the runtime for the real case study located in Melaka, Malaysia. Hence, two metaheuristic approaches are compared in this study namely, Ant-Colony Optimization (ACO) and Genetic Algorithm (GA). The results show that the GA strategy outperforms the ACO technique in terms of distance, price, and runtime for moderate data sizes that is less than 90 locations. © 2022, International Journal of Advanced Computer Science and Applications. All Rights Reserved.
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Objectives: To determine the level of depression, anxiety and stress in pathologists due to the Covid-19 pandemic. Materials and methods: It was a Cross-sectional Analytical Multicenter Questionnaire-based study conducted from April 2020 to June 2020 including Pathologists working in Khyber Teaching Hospital and Pakistan Institute of Medical Sciences, Islam-abad. Informed written consent was obtained and DASS-21 Questionnaire was administered. Data were analysed by SPSS. Levels of depression, anxiety and stress were determined and analysed by multiple regression mothod to predict depression anxiety and stress levels from demographics. Results: Mean age of the study sample was 25-63 (37±8.75). There were 13(22.4%) males and 45(77.6%) females. Overall DAS score, mean depression, anxiety and stress score were 31.5±22, 8.7±9.1, 7.4±7.1 and 15.3±9 respectively. Females had a higher overall DAS score (U=156.5, p=.011), depression score (U=178.5, p=.032) and anxiety score (U=168.5, p=.029) as compared to males. Anxiety scores were highest in pathologists working in the microbiology section and lowest in those of the chemical pathology section (χ2=8.13, p=.043). Multiple regression analysis showed that the female gender was significantly associated with a higher overall DAS score (β=13.69, p=.047) and stress score (β=6.10, p=.031) as compared to the male gender. Conclusion: Pathologists working in the Covid-19 pandemic have a high level of mental distress and females have a higher level of psychological distress as compared to males. Implementation of mental support programmes for health care workers during pandemic situations is required to provide psychological support to health care workers.
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In this study a rapid and short Strategic environmental assessment (SEA) conducted to find the existing policy and legal gaps of biomedical waste management regulations during the COVID-19.15 Key Informant Interviews (KIIs) were taken from the regulatory bodies, public and private medical college hospitals, corporations, civil societies, and the third-party organization involved in medical waste management. A DPSIR framework and SWOT analysis shows that the existing biomedical waste management suffers from institutional conflicts, lack of monitoring, and environmental regulations. The revised rules must be implementable with “3-R policy”, and “polluter pays principle,” and environmental impact assessment guided by SEA.
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Introduction: The COVID-19 pandemic greatly affected the capacity to perform standard endoscopic procedures. Due to government mandate, practice shifted to performing only urgent procedures at the beginning of the pandemic followed by gradual resumption of elective procedures. We evaluated the impact of deferred colorectal cancer screening from March to December 2020 at a large academic cancer center. Methods: We performed a retrospective cohort study among adults aged 18 years and older who had an endoscopy procedure performed between January 2019 to December 2020 at the University of Texas MD Anderson Cancer Center. In March 2020, elective procedures were suspended, then resumed in June 2020, with close to full capacity achieved by September 2020. There was no suspension during the 2020 winter COVID-19 surge. Clinical data were obtained via extraction of electronic health records. Data were aggregated and analyzed by the Syntropy platform: Palantir Foundry (Foundry). Basic statistics were performed, including student's t-test and Chi-squared analysis. Results: We identified 12444 endoscopy procedures performed on 9993 patients in 2019 and 9993 endoscopy procedures on 8138 patients in 2020 (Table 1). Between March and December 2020, 8756 COVID tests were performed pre-endoscopy, with an average positivity rate of 4.8%. In Texas, the average COVID positivity rate was 8.9%. Total endoscopy volume declined by 19.7% in 2020 compared to 2019 (P-value = 0.02). The sharpest declines in endoscopy were in April 2020, with EGD volume falling by 76%, colonoscopy volume by 78%, and ERCP volume by 16% compared to respective averages in April 2019. By the end of 2020, case volume returned to 2019 levels. From March 2020 to December 2020, 850 colonoscopies were cancelled;average adenoma detection rates (ADR) were 27.0 and average carcinoma detection rates (CDR) were 10.7, compared to ADR of 34.5 (P-value = 0.004) and CDR of 12.6 (P=0.71) for the same time period in 2019. See Figure 1. Conclusion: Total endoscopy volume declined by 19.7% in 2020 due to the impact of COVID-19 related changes in endoscopy practice. This impacted elective procedures such as screening colonoscopy procedures. The ADR was significantly lower in 2020 compared to 2019. There was not a significant change in CDR. These findings highlight the importance of increased routine endoscopic procedures, as the burden of COVID-19 diminishes. (Table Presented).
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Multifaceted international and national collaborative responses and progress have sustained the world's largest densely populated refugee camps in the Cox's Bazar district, Bangladesh. Yet, the Rohingyas remain in an extremely precarious situation during the COVID-19 pandemic. The refugees are living in highly challenging circumstances of water, sanitation, and hygiene (WASH), natural disasters of the monsoon season as well as existing health and educational challenges of HIV, malnutrition and other diseases. Particulate matter PM2.5 in the sampling camps varied from 44 µg/m3 to 546 µg/m3, whereas PM10 in the sampling camps varied from 125 µg/m3 to 1122 µg/m3. Due to lock-down of Cox's Bazar, aid workers in and out of the camps were restrained with the only continuation of emergency food and medical service supplies. Largely dependent on aid during the ongoing pandemic, an investigation of the socio-environmental challenges of the refugee camps will identify the anticipatory impacts and needs.
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Novel coronavirus (COVID-19) has spread rapidly, forcing changes to health care systems across the globe. COVID-19 outbreak in Qatar has led to the application of preventive measures and cutting of face-to-face outpatient services across Hamad Medical Corporation, the main provider of primary and tertiary health care, aiming to reduce the risk of transmission. The disruption of face-to-face management of patients with cancer and primary lymphedema added to the lack of literature, specifically on its rehabilitation, during such unprecedented crisis and raised the need to quickly modulate our lymphedema outpatient physiotherapy services to ensure the continuity of care. This article describes how our team redesigned its lymphedema management approach through rapid development of online educational treatment resources and implementation of telerehabilitation to patients with lymphedema for the first time in Qatar. Unforeseen challenges were addressed in a 4-phased plan comprising operational, telephonic, virtual, and face-to-face phases, with a descriptive statistical analysis of data and the outpatient activity recorded throughout the phases. Evaluating the efficacy of such program in future research may open up windows for telerehabilitation to become a cornerstone in lymphedema care even after the pandemic.
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Purpose Amidst the one year of COVID-19 the amount of healthcare waste generation manifolds in Bangladesh. This article aims to rapidly assess the knowledge, attitude, practice, and perception (KAPP) towards COVID-19 related healthcare wastes among Bangladeshi healthcare professionals.Methods This research was conducted following a multi-stage methodological approaches to achieve the desired objectives. A total of 300 (= 300) responses were collected from the healthcare professionals, including doctors, nurses, and relevant staff from the public and private medical hospitals and clinics.Results It was found that most of the respondents (83.7%) know about the concerning issues of medical wastes and their types. Almost 90.0% (n = 270) respondents agreed with the statement KS3, mentioned as ‘medical waste of COVID-19 patients can be considered as infectious waste’ and they are aware about the potential threat from the waste. It was also found that nearly 76.0% (n = 228) of the respondents know about color coding for the segregation of medical waste. However, interestingly, 68.3% and 43.6% professionals have knowledge about the guidelines of medical waste management. Surprisingly, around 57.0% (n = 171) respondents think that medical waste management adds an extra burden to their work. T-test indicates that demographic characteristics e.g., respondents’ gender, age, occupation/job responsibility, work experience, and level of education, have a significant effect on the safe handling and disposal of biomedical waste.Conclusion Despite of having good knowledge about importance of safe handling and management of healthcare wastes Bangladeshi medical professionls have negative attitude and practices in the management of healthcare wastes.
Subject(s)
COVID-19ABSTRACT
As COVID-19 spreads quickly across the whole of Bangladesh, the increased uses of Personal Protective Equipment (PPE) could lead to secondary environmental catastrophes. It is urgent for respective authority to maintain a safe waste disposal system to save the environment and protect public health from impending health threats.
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The global pandemic COVID-19 culminated in escalating biomedical waste (BMW) worldwide, and the management authorities are struggling with waste treatment. Bangladesh and India are two densely populated South Asian developing countries with limited resources. Both countries face mass community transmission of the disease, with India facing severe infections and deaths. Predictably, a large population might sum up to a large amount of COVID-19-related BMW. There is also the question of capacity, whether the existing BMW policies and regulations of the regions can manage the BMW strategically driven by the pressure of the pandemic. Here, we have shown a framework leading to further environmental and community transmission of the COVID-19 pandemic if the BMW generated at healthcare facilities and homes is not appropriately managed. The BMW, such as safety suits or personal protective equipment (PPE), masks, gloves, and shields, would likely damage the environment in the long run by creating microplastic pollution. Modification and modernization of the existing policies, plans, and guidelines on the proper management of the hospital and household infectious waste is suggested. Moreover, occupational health and safety assessments for waste management workers at the hospitals are recommended. Installing suitable capacity incinerators and related infrastructures are recommended for appropriate waste management. In the absence of incinerators, the existing industrial furnaces, cement kilns, and mobile incinerators can be used with a rapid impact assessment adhering to the appropriate implementations of the policies and guidelines.