ABSTRACT
Organizations confront falling demand and, as a result, operational and financial restrictions during difficult economic times. The purpose of this case study is to examine the influence of COVID-19 on the SC of a steel fabrication manufacturer in Egypt, named Ghazala Steel Fabrication Company, as the massive dispersion of COVID-19 is seen as a global shock. Furthermore, the pandemic effects are being felt globally in various ways, including all SC operations, manufacturing costs, and logistical activities. The case study used primary data collection methods to investigate and analyze the impact of COVID-19 on SC performance on Ghazala's SC performance. Semi-structured interviews and site observations were used to analyze and discuss the impact of COVID-19 on the steel industry SCs and how it affected all relevant stakeholders. © 2023 by IGI Global. All rights reserved.
ABSTRACT
Background: The coronavirus, COVID-19, has caused a global pandemic of an unprecedented scale. The efficacy of antivirals and other drugs, considered for repurposing, is assessed in clinical trials. It is not clear, however, whether these treatments, when available, will be cost effective. Purpose(s): To systematically review published economic evaluations of antivirals for the management of pandemic influenza. Method(s): The following databases were searched from inception to 26 March 2020: Medline (EBSCO HOST), EMBASE (OVID), EconLit (OVID), NHS EED (OVID) and HTA (OVID). Citation tracking and reference checking were also used. Only full economic evaluations published in the last ten years were included. Studies were quality assessed using NICE economic evaluation checklist. Data were extracted into standard data extraction tables and narratively summarised. Result(s): Of 709 records identified, 14 studies were included. These were mostly conducted in high income countries. They were seven (50.0%) cost-utility analyses, four (28.6%) cost-effectiveness analyses, two (14.3%) cost-consequences analyses, and one (7.1%) cost-benefit analysis. Antiviral treatment-containing strategies were found to be either cost saving or cost effective. Empirical treatment was more cost effective than test-guided treatment for young adults but less for older adults. Infection rate, prevalence, antiviral efficacy and costs were the key drivers of cost effectiveness Conclusion(s): Antiviral treatment for managing pandemic influenza viruses that have high case fatality rate, similar to the COVID-19 pandemic, has shown to be cost effective, either as standalone intervention or part of a multifaceted strategy.
ABSTRACT
Purpose: COVID pandemic has posed a significant challenge among kidney transplant recipients (KTR) due to their immunocompromised state. There is uncertainty on immunosuppression (IS) management among those who have COVID infection. We sought to better understand the clinical course, management, and outcomes of our KTR who developed COVID infection during the period when COVID vaccine was more readily available. We also investigated the impact of vaccination status on COVID infection. Method(s): Single-center experience of COVID infected KTR. Baseline demographics, clinical data, COVID vaccination status, management, and outcomes were obtained by manual chart ion of the EMR. Result(s): 83 KTR had COVID infection. Mean age was 54 years;57% were males and 53% were African American. 47% of the patients were >3 years post-transplant. Interestingly, the proportion of COVID-infected patients who were unvaccinated and vaccinated with 2 doses were similar (42% vs 39%;p=NS) and the proportion of asymptomatic patients who were unvaccinated and vaccinated were also similar (47% vs. 53%;p=NS). Respiratory symptom was the most common manifestation (69%);49 patients (59%) required hospitalization. Mean length of stay was 15 days;19 (23%) required ICU admission and 14 (17%) required mechanical ventilation;26 developed AKI with about half requiring RRT;only 2 (18%) patients requiring RRT had renal recovery. The majority of admitted patients received dexamethasone and antibiotics. For IS management, 53% had MMF held or reduced while only 11% had CNI dose reduced;17 patients (20%) died. In multivariable modeling, only age (OR 1.1, 1.02-1.19;p=0.020) and AA race (OR 5.4, 0.73-40.2;p=0.097) were associated with risk of death. Induction, sex, BMI, and vaccination status were not significant predictors. There were no subsequent acute rejections or graft losses in those who recovered. Conclusion(s): KTR represent a vulnerable patient population for COVID infection. Due to their immunocompromised state and often more severe clinical presentation, with majority requiring hospitalization, ICU admission, and mechanical ventilation. In this single center study, COVID vaccination did not seem to have an appreciable impact on the incidence of COVID infection and presentation. It is unclear what impact immunosuppression dose reductions had on the COVID clinical course, but these reductions did not appear to increase risk of rejection or graft loss.
ABSTRACT
Purpose: The COVID pandemic has posed a significant challenge among kidney transplant recipients (KTR) due to their immunocompromised states. The effects of COVID vaccination on KTRs are uncertain. We sought to better understand the clinical course, management, and outcomes of KTRs who developed COVID infection during the pre-and post-COVID vaccine rollout periods. We also compared whether there was a difference in patient outcomes or management of COVID infection between the two groups. Method(s): This was a single-center study of KTRs who were infected with COVID. Baseline demographics, clinical parameters, COVID vaccination status, management, and outcomes were obtained by manual chart ion of the electronic medical records. Result(s): We studied a total of 134 KTRs in the pre-vaccination era and 83 KTRs after vaccination rollout who had COVID infections. The mean age of the patients was 54 years in both groups, and there was a greater proportion of African American KTRs in the pre-vaccination rollout era (70% vs. 53%, P=.02). No statistically significant differences were found among sex, BMI, or induction agents. In the pre-vaccination era, KTRs were more likely to present with fever (71% vs. 51%, P<.001). No statistically significant differences were observed in the onset of COVID infection after transplant, ICU admission, the requirement of mechanical ventilation therapy, incidence of AKI (acute kidney injury), requirement of renal replacement therapy (RRT), or incidence of acute rejection. For COVID infection management, KTRs in the post-vaccination rollout era were more likely to be treated with dexamethasone (47% vs. 32%, P=.035) . No statistically significant difference was found in the proportion of patients who required reduction or discontinuation of immunosuppressive agents. In the pre-vaccination era, KTRs were more likely to recover from acute kidney injury (57% vs, 25%, P=.01). No statistically significant difference was found in mortality between groups, but the risk of death was almost twice a high in the post-vaccination rollout era (21% vs. 12%). Conclusion(s): In this single-center case-control study, COVID vaccination rollout did not seem to have an appreciable impact on the incidence of hospitalization, ICU admission, AKI, RRT requirement, or mortality. Mortality risk among KTRs in the post-vaccination rollout era was almost twice as high as it was in the pre-vaccination rollout era, although there was no statistically significant difference, which might be due to low statistical power. The lack of improved outcomes of KTRs in the postvaccination rollout remains unclear. A combination of suboptimal immunogenic response to vaccination and the Delta variant surge could be a possibility.
ABSTRACT
Purpose: COVID pandemic has posed a significant challenge among kidney transplant recipients (KTR) due to their immunocompromised state. There is uncertainty on immunosuppression management among those who have COVID infection. We sought to better understand the clinical course, management, and outcomes of our KTR who developed COVID infection. Methods: Single-center experience of COVID infected KTR. Baseline demographics, clinical data, management, and outcomes were obtained by manual chart abstraction of the EMR. Results: 50 KTR had COVID infection. Mean age was 53;50% males;74% African-Americans. Fever was the most common symptom (71%);36 patients (71%) required hospitalization;11 (22%) required ICU admission and 8 (16%) required mechanical ventilation. 23 developed AKI with one-third requiring RRT;50% of patients requiring RRT eventually had renal recovery. Majority of admitted patients received dexamethasone, remdesivir, and convalescent plasma. In terms of immunosuppression, 28 of 49 (57%) had their MMF held while 8% had MMF dose reductions;one had everolimus held and one had AZA held;7 (14%) had CNI dose reductions with none held. Six patients (12%) died. Those who died were significantly more likely to receive dexamethasone (42% vs 2%;p=0.002), remdesivir (33% vs 7%;p=0.027), and convalescent plasma (40% vs 0%;p=0.001). Mortality rates were similar across those who had immunosuppressive agents dose reduced vs held vs not adjusted (11% vs 17% vs 12%, respectively;p=0.919). CNI dose reductions tended to be more common in those who died (43% vs 7%;p=0.122). There were no subsequent acute rejections or graft losses in those who recovered. Conclusions: KTR represent a vulnerable patient population during COVID. Due to their immunocompromised state and often more severe clinical presentation, the majority require hospitalization, with a significant number needing ICU admission and mechanical ventilation. Severe illness led to higher use of dexamethasone, remdesivir and covalescent plasma in those who ultimately died of COVID. It is unclear what impact immunosuppression dose reductions had on the COVID clinical course, but these reductions did not appear to increase risk of rejection or graft loss.
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Background: The effect of angiotensin-receptor blockers (ARBs) and angiotensinconverting enzyme inhibitors (ACEi) on outcome and severity in COVID-19 patients has been postulated. Methods: We performed a systematic review in different databases to identify studies and research work that assessed the association of ACEi/ARBs on the severity of illness and mortality in COVID-19 subjects. Inclusion criteria for our meta-analysis were all studies that included human subjects with COVID-19 infection, reported mortality and severity of the disease, and described ACEi/ARB treatment. The data collected were the name of the first author, journal title, the country of the study, sample size, relative risk and confidence intervals for association of ACEi/ARB treatment and mortality and severity. We used the random-effects model for the meta-analysis and the funnel plot analysis to assess potential publication bias. Results: Out of 4,702 records reviewed in different databases, 11 papers were included in our meta-analysis. Altogether, 8,643 patients were included in the final analysis. Random effects model (REM) for the relationship between ACEi/ARB and survival showed that ACEi/ARB does not affect survival (relative risk [RR]=0.81, confidence interval ranges [CIR] from 0.53 to 1.23). There was no evidence of heterogeneity with I-squared =25.5% and p<0.235. By applying Egger's test, there was no evidence of small studies effect with P=0.64. REM for the relationship between ACEi/ARB and disease severity showed that ACEi/ARB are not related to disease severity (RR=0.90, CIR from 0.70 to 1.15). There was evidence of heterogeneity with I-squared =56.2% and p=0.01. By applying Egger's test, there was no evidence of small studies effect with P=0.93. Conclusions: Based on the results of this meta-analysis, ACEi/ARB are not associated with increased mortality or severity in COVID-19 subjects.