Pulmonary thromboembolic disease associated with COVID-19 infection: a comparison between geriatric and non-geriatric populations.

INTRODUCTION: The magnitude of Coronavirus Disease 2019 (COVID-19) infection among the elderly population is expected to rise. Our study compares the clinical and computed tomographical (CT) features of pulmonary thromboembolic (PTE) disease associated with COVID-19 infection in geriatric and non-geriatric cases, and explores the 60-day mortality rate in these two groups. MATERIALS AND METHODS: We conducted this retrospective cross-sectional study in Hospital Tengku Ampuan Rahimah, Selangor, Malaysia. Patients admitted in April 2021 and May 2021 with concomitant COVID-19 infection and PTE disease were included. Demographic, clinical and laboratory data were retrieved, whilst CTPA images were analysed by a senior radiologist. RESULTS: A total of 150 patients were recruited, comprising 45 geriatric patients and 105 non-geriatric patients. The prevalence rate of hypertension, diabetes mellitus and dyslipidaemia were higher among the geriatric cohort. Evidently, the percentage of patients with fever and diarrhoea were significantly higher among the non-geriatric cohort. The geriatric cohort also recorded a significantly lower absolute lymphocyte count at presentation and albumin level during admission. Despite earlier presentation, the geriatric cohort suffered from more severe diseases. Analysis of the CT features demonstrated that the most proximal pulmonary thrombosis specifically limited to the segmental and subsegmental pulmonary arteries in both cohorts. The elderly suffered from a significantly higher inhospital mortality rate and their cumulative probability of survival was significantly lower. CONCLUSION: Typical COVID-19 symptoms may be absent among the elderly, prompting a lower threshold of suspicion during the COVID-19 pandemic. Additionally, the elderly demonstrated a higher probability of adverse outcomes despite earlier presentation and treatment.

Mask Wear Detection Algorithm Based on YOLOv5m

Wearing a mask during the COVID-19 epidemic can effectively prevent the spread of the virus. In view of the problems of small target size, crowd blocking each other and dense arrangement of targets in crowded places, a target detection algorithm based on the improved YOLOv5m model is proposed to achieve efficient detection of whether a mask is worn or not. This paper introduces four attention mechanisms in the feature extraction network based on the YOLOv5m model to suppress irrelevant information, enhance the information representation of the feature map, and improve the detection capability of the model for small-scale targets. The experimental results showed that the introduction of the SE module increased the mAP value of the original network by 9.3 percentage points, the most significant increase among the four attention mechanisms. And then a dual-scale feature fusion network is used in the Neck layer, giving different weights to the feature layers to convey more effective feature information. In the image pre-processing, the Mosaic method was used for data enhancement, and the CIoU loss function was used for coordinate frame positioning in the prediction layer. Experiments on the improved YOLOv5m algorithm demonstrate that the mean recognition accuracy of the method improves by 10.7 percentage points over the original method while maintaining the original model size and detection speed, and better solves the problems of small scale, dense arrangement and mutual occlusion of targets in mask wearing detection tasks in crowded places. © 2023 IEEE.

Clinical characteristics and computed tomographical features of pulmonary thromboembolic disease associated with COVID-19 infection: A tertiary hospital analysis.

INTRODUCTION: The co-existence of coronavirus disease 2019 (COVID-19) and pulmonary thromboembolic (PTE) disease poses a great clinical challenge. To date, few researches have addressed this important clinical issue among the South-East Asian populations. The objectives of this study were as follow: (1) to describe the clinical characteristics and computed tomographical (CT) features of patients with PTE disease associated with COVID-19 infection and (2) to compare these parameters with those COVID-19 patients without PTE disease. MATERIALS AND METHODS: This cross-sectional study with retrospective record review was conducted in Hospital Tengku Ampuan Rahimah, Selangor, Malaysia. We included all hospitalised patients with confirmed COVID-19 infection who had undergone CT pulmonary angiogram (CTPA) examinations for suspected PTE disease between April 2021 and May 2021. Clinical data and laboratory data were extracted by trained data collectors, whilst CT images retrieved were analysed by a senior radiologist. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20. RESULTS: We studied 184 COVID-19 patients who were suspected to have PTE disease. CTPA examinations revealed a total of 150 patients (81.5%) suffered from concomitant PTE disease. Among the PTE cohort, the commonest comorbidities were diabetes mellitus (n=78, 52.0%), hypertension (n=66, 44.0%) and dyslipidaemia (n=25, 16.7%). They were generally more ill than the non-PTE cohort as they reported a significantly higher COVID-19 disease category during CTPA examination with p=0.042. Expectedly, their length of both intensive care unit stays (median number of days 8 vs. 3; p=0.021) and hospital stays (median number of days 14.5 vs. 12; p=0.006) were significantly longer. Intriguingly, almost all the subjects had received either therapeutic anticoagulation or thromboprophylactic therapy prior to CTPA examination (n=173, 94.0%). Besides, laboratory data analysis identified a significantly higher peak C-reactive protein (median 124.1 vs. 82.1; p=0.027) and ferritin levels (median 1469 vs. 1229; p=0.024) among them. Evaluation of CT features showed that COVID-19 pneumonia pattern (p<0.001) and pulmonary angiopathy (p<0.001) were significantly more profound among the PTE cohort. To note, the most proximal pulmonary thrombosis was located in the segmental (n=3, 2.0%) and subsegmental pulmonary arteries (n=147, 98.0%). Also, the thrombosis predominantly occurred in bilateral lungs with multilobar involvement (n=95, 63.3%). CONCLUSION: Overall, PTE disease remains prevalent among COVID-19 patients despite timely administration of thromboprophylactic therapy. The presence of hyperinflammatory activities, unique thrombotic locations as well as concurrent pulmonary parenchyma and vasculature aberrations in our PTE cohort implicate immunothrombosis as the principal mechanism of this novel phenomenon. We strongly recommend future researchers to elucidate this important clinical disease among our post- COVID vaccination populations.

Public knowledge and perception of COVID-19 and its preventive measures

As research on the COVID-19 virus, symptoms, and preventive measures progressed, the information has been disseminated through public service announcements, mass media, and social media. This chapter reports a study which investigated perceived knowledge of COVID-19 disease and perceived effectiveness of preventive measures among Malaysians. The questionnaire data were collected from 230 respondents on 1-15 July 2020 during the Recovery Movement Control Order (RMCO) period when COVID-19 cases were low. The results showed that the public believed that they have moderate knowledge of COVID-19 disease. Their main sources of information were the mass media and internet sources and daily reports of the disease incidence. They also believed that they could understand the disease, including medical findings. Among the preventive measures, the respondents believed that the most effective measure was avoiding crowded places, followed by practice of personal hygiene. Personal initiatives (staying at home and wearing face masks) were perceived as more effective than Movement Control Order (MCO) and Standard Operating Procedures (SOP) at premises (temperature checks and contact tracing applications). The findings suggest that to stem subsequent waves of COVID-19 infection, health messages should be framed to convince the public to internalise disease prevention and control measures instead of displaying superficial compliance to avoid being caught for SOP violation. © 2022 selection and editorial matter, Edmund Ui-Hang Sim and Su-Hie Ting.

Utilization of the Youth Quitline as an opportunity for an undergraduate nursing students to deliver smoking cessation counseling as their clinical placement: An implementation of a service-learning model.

BACKGROUND: Smoking is an important modifiable risk factor of morbidities and mortality. Although healthcare professionals play an important role in smoking cessation, their adoption of such practices is relatively low because of inadequate training. To address this issue, we incorporated a service-learning model to operate the Youth Quitline. Undergraduate nursing students were trained and received supervision while delivering smoking cessation counseling through the Youth Quitline as their clinical placement. OBJECTIVES: We evaluated the effectiveness of the placement by assessing students' knowledge, attitudes and practices regarding smoking cessation and tobacco control. DESIGN: One-group pretest-posttest design. SETTING: Youth Quitline. PARTICIPANTS: A total of 61 third-year students in a mental health nursing program. METHODS: Students were required to complete 80 h at the Youth Quitline. The 80 h were divided into 20 sessions; students used four sessions to approach and recruit youth smokers in the community, then provided them with telephone counseling for the rest of the time. Prior to the placement, students attended a 2-day workshop. The outcomes were changes in students' knowledge, attitudes and practices regarding smoking cessation and tobacco control 3 months after the placement compared with baseline. RESULTS: From January-June 2021, students conducted 105 outreach activities to identify 3142 smokers in the community, and provided telephone counseling for 336 smokers via Youth Quitline. Compared with baseline, significant improvements were observed in students' knowledge, attitudes and practices regarding smoking cessation and tobacco control at 3-month follow-up. CONCLUSIONS: The clinical placement improved students' knowledge, attitudes and practices regarding smoking cessation and tobacco control, enhancing their competency in providing support to assist smokers to quit in their future practice. Incorporating the service-learning model in existing community-based services can provide additional venues for nursing students to practice. This is particularly important because many venues have restricted access during the COVID-19 pandemic.

A Data Aggregation Mechanism based on Spatial Correlation Chain-clustering for Wireless Sensor Networks

Wireless sensor networks (WSNs) are an emerging technology in the mobile ad hoc network as used for many different applications. It has several features, such as limited resources and features, smaller packet size, and dynamic multi-hop transmission. During the worldwide COVID-19 pandemic, WSNs have been used to measure social distancing/contact tracking among people. WSNs are also used to monitor the environment as a part of military applications. However, the major challenge that WSN protocols face lies in the limited battery energy for sensor networks. To effectively transfer data onto a base station (or 'sink') and achieve the efficiency of node energy saving, we group neighboring nodes into the same clusters with a K-means++ clustering and reduce the additional data sent to the sink. Therefore, this study proposes an energy-efficient data aggregation mechanism (EDAM) with a spatial correlation among sensor nodes to avoid high correlation among data and reduce node redundancy data transmission. The EDAM depends on the threshold of the first-order radio model's distance to divide the whole WSN area into several clusters. All cluster heads (CHs) construct a data relay transmission link in a WSN. The EDAM is based on the center of the whole sensing area and divides the WSN area into four quadrants. All data is transferred from all sensors to a CH in a quadrant. Then, the CH in each quadrant forwards the data it receives to its next quadrant. The EDAM adopts a quadrant rotation mechanism to aggregate the data in the four quadrants to the base station. The simulation results show that the EDAM reduces redundant data transmissions, averages the power consumption of nodes in the cluster, and obtains a better overall network lifetime than the LEACH, LEACH-C, and DEEC algorithms. © 2021 IEEE.

Getting the message across: Examining malaysia’s covid-19 public service announcement (psa) infographics

The current COVID-19 pandemic has become an unprecedented public health crisis and there is much ongoing research investigating its wide-ranging impacts on all areas of society and people's everyday lives. This article presents preliminary findings of an ongoing study that inquires into Malaysia's COVID-19 public service announcement (PSA) infographics and how they convey much-needed information to the general public during the pandemic period. Drawing upon research on infographics in healthcare and health risk communication, the article examines COVID-19 PSA infographics that have been produced in Malaysia and the ways they achieve what they are designed to do. The findings show that the infographics 1) are numerous and mostly presented in the informational and process-based types, 2) cover various topics related to the information on the novel virus, its risks, and recommended preventive and control measures, 3) possess key components of infographic and (4) adopt a three-way process of engaging the target audience. The findings also reveal several key points worth considering in thinking about the infographics, including whether they communicate the right message to the right audience at the right time and whether they are designed according to the principles of message design in health risk communication. © 2021, Universiti Malaysia Sarawak. All rights reserved.

Covid-19 in malaysia: Knowledge, threat perception, response efficacy and practice in precautionary behavior

Introduction: Susceptibility perceptions have been extensively studied but COVID-19 severity has been largely neglected. As susceptibility and severity may not co-occur, it is necessary to examine both components of disease threat. Objective: To examine the knowledge, threat perception, response efficacy, and associations with intended and concurrent COVID-19 preventive measures during a period of receding cases in Malaysia. Methods: An online survey of 230 respondents was conducted from 1 to Jul 15 2020 using a 50-item questionnaire to study intention for COVID-19 preventive measures. Snowball sampling technique and the 2-step factor analysis of data was done. Results: Good knowledge of the disease acquired mainly from the mass media and internet rather than family and friends were reported among the respondents. Severity of COVID-19 compared to other flu-like diseases was acknowledged, but a low perception of risk and likelihood of contracting the disease was observed. Beliefs in the efficacy of public preventive measures (quarantine, physical distancing, movement restriction and screening) were high. Face mask and personal hygiene ranked as the most effective individual preventive measures. Intentions for self-quarantine and testing were strong if flu symptoms were perceived. Perceived susceptibility is moderately associated with perceived severity and efficacy of recommended preventive measures. A stronger relationship was found between perceived efficacy of preventive measures and intended and concurrent health-protective measures. Conclusion: The findings suggest that perceptions of disease threat need to focus on susceptibility and severity, and perceptions of severity need to consider perceived severity for self and others. © IJCRR.

Repurposed Antiviral Drugs for Covid-19 - Interim WHO Solidarity Trial Results.

BACKGROUND: World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs - remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a - in patients hospitalized with coronavirus disease 2019 (Covid-19). METHODS: We randomly assigned inpatients with Covid-19 equally between one of the trial drug regimens that was locally available and open control (up to five options, four active and the local standard of care). The intention-to-treat primary analyses examined in-hospital mortality in the four pairwise comparisons of each trial drug and its control (drug available but patient assigned to the same care without that drug). Rate ratios for death were calculated with stratification according to age and status regarding mechanical ventilation at trial entry. RESULTS: At 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750 were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir (without interferon), 2063 to interferon (including 651 to interferon plus lopinavir), and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment, with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death, day 8; interquartile range, 4 to 14). The Kaplan-Meier 28-day mortality was 11.8% (39.0% if the patient was already receiving ventilation at randomization and 9.5% otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to 1.11; P = 0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P = 0.23), in 148 of 1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio, 1.00; 95% CI, 0.79 to 1.25; P = 0.97), and in 243 of 2050 patients receiving interferon and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39; P = 0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced initiation of ventilation or hospitalization duration. CONCLUSIONS: These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay. (Funded by the World Health Organization; ISRCTN Registry number, ISRCTN83971151; ClinicalTrials.gov number, NCT04315948.).