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Introduction: Enteral feeding is a physiologic process of providing adequate nutrition and has been shown to improve both mortality and quality of life in patients with inadequate oral intake. Improved critical care medicine and recent wave of Coronavirus Disease 2019 (COVID-19) has left us with a large proportion of patients needing alternative enteral nutrition. Although rare, intussusception is an important differential for patients presenting with acute abdominal pain post makeshift percutaneous endoscopic gastrostomy (PEG) tube placement. Case Description/Methods: A 58-year-old male was admitted to the hospital for coffee ground emesis over three days accompanied with epigastric pain. He had right sided hemiparesis secondary to cerebrovascular accident with PEG tube for enteral nutrition. Examination was significant for epigastric tenderness with normal bowel sounds. PEG tube aspiration revealed bile-tinged fluid. Significant labs included white blood cell count of 11,600 /mm3, hemoglobin 10.2 g/dL, and lactic acid of 2.3 mmol/L. A computerized tomography of the abdomen with IV contrast showed a small segment duodeno-duodenal intussusception at the horizontal segment around the distal end of the tube was noted (Figure A). An urgent esophagogastroduodenoscopy (EGD) revealed a Foley catheter acting as a makeshift PEG tube extending across the pylorus into the duodenum. The distal tip of the Foley catheter was visualized with an inflated balloon seen in the third portion of the duodenum (Figure B) The inflated catheter balloon acted as a lead point causing intussusception in a ball-valve effect. The balloon was deflated, and the catheter was replaced (Figure C) with a 20 Fr PEG tube. Discussion(s): Gastric outlet obstruction is an uncommon complication reported in few cases caused by migration of the gastrostomy tube. Rarely this migrating gastrostomy tube can invaginate the duodenum or the jejunum causing intussusception. Only handful of cases have been reported in the literature. Patients usually present with epigastric pain, vomiting or rarely hematemesis. CT scan of the abdomen is the investigation of choice. Amidst the pandemic and supply shortage, Foley catheters have been deemed as a viable alternative to gastrostomy tubes and are being used more often. It is important to recognize this rare complication and use of balloon catheter should raise further suspicion. Timely endoscopic intervention can help avoid bowel necrosis and surgical intervention.
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Objective: This is the first prospective cohort study in Singapore to investigate the COVID-19 vaccine-associated myocarditis to understand its pathophysiology. Introduction: Acute myocarditis and other cardiovascular symptoms have been observed to be associated with the two mRNA-based coronavirus disease 2019 (COVID-19) vaccines-namely Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273)-currently in-use in Singapore. The mechanisms through which myocarditis occurs are unknown, hence our study aims to understand the pathophysiology of myocarditis associated with COVID-19 vaccines. Method(s): Patients with onset of cardiac manifestations were recruited from multiple hospital outpatient clinics between November 2021 and September 2022. Clinical history and physical examination data was collected with blood sample collection, echocardiography, 12-lead electrocardiogram (ECG), coronary angiography and magnetic resonance imaging (MRI) at recruitment and 6-month follow-up. Analysis of biomarkers, genetic, serological and MRI data was conducted. Result(s): As of 6 September 2022, a total of 5 patients have been enrolled (4 males, 1 female). The most commonly reported symptoms across all patients were chest pain/discomfort (80%), followed by palpitations (40%). MRI evidence of myocarditis has been detected in 2 (50%) of the male patients, of which both reported two or more symptoms occurring 1-2 days post-vaccination. Both patients have each received at least two doses of either the Pfizer-BioNTech BNT162b2 vaccine or Moderna mRNA-1273 vaccine. Their MRI findings were consistent with myocarditis. On late gadolinium enhancement (LGE) imaging, epicardial enhancement at the basal inferolateral segment and mid-wall enhancement at the apical anterior, lateral and inferior walls were observed in one patient. Patchy, mid-wall LGE in the basal inferior/inferolateral wall was observed in the other patient. No MRI evidence of myocarditis was available for the sole female patient. Conclusion(s): While more data is needed to definitively prove the association of the two mRNA-based Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273 COVID-19 vaccines with post-vaccination myocarditis, we believe our findings may support further investigations to enable risk stratification for vaccine-associated myocarditis and identify potential preventative strategies accordingly.
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Background: Our study aimed to explore the experiences of stakeholders from local government units, health facilities and higher education institutions on the delivery of non-COVID-19 health services after the initial wave of the pandemic. Methods: Twenty-nine public health workers, thirteen university staff, and four hospital administrators in the Philippines participated. Using a descriptive phenomenological approach, we analysed transcripts from six focus group discussions conducted online between March and June 2021. Findings: The COVID-19 pandemic made the routine health programs inaccessible due to hesitancy among patients to visit health facilities, a shift in public health priorities, and lack of students to augment the existing workforce. Public health workers reported stress and mental health exhaustion. Apart from fear of infection during service provision, public health workers and university staff experienced work overload, pressure to learn new technology, and webinar fatigue. Mental health problems have surfaced as health workers and young people have become more affected while support services remain insufficient. Public health workers have reported actions to maintain service delivery in the new normal such as use of telehealth and social media. However, issues on workforce wellbeing and digital equity posed adaptation challenges. Participants suggested partnership with higher education institutions as pivotal to position local health systems towards recovery. Interpretation: The rapid change in the service landscape highlights the importance of sustainable partnerships, effective workforce management, equitable digital innovations, and promoting mental wellbeing to preserve community, school, and occupational health and rebuild resilient local health systems in low-resourced areas. Funding: This research is proudly supported by the Australia-ASEAN Council, Australian Government Department of Foreign Affairs and Trade. © 2022 The Author(s)
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Purpose: This study aims to investigate technology-based health and safety (H&S) management to control the spread of disease on construction sites using a partial least squares structural equation modelling (PLS-SEM) approach. Design/methodology/approach: An extensive literature review is conducted to develop a conceptual framework. The variables identified from the literature review are included in a cross-sectional survey which gathered a total of 203 valid feedback. The variables for challenges are grouped under their relevant construct using exploratory factor analysis. Then, a hypothesized model is developed for PLS-SEM analysis using Smart PLS software. Later, the outcome of the model is further validated by nine construction experts using a semi-structured questionnaire survey. Findings: The results rationalized the relationships between the COVID-19 H&S measures, challenges in implementing COVID-19 H&S measures on construction sites and the innovative technologies in transforming construction H&S management during the COVID-19 pandemic. The possible challenges that obstruct the implementation of H&S measures are highlighted. The potential technologies which can significantly transform H&S management by reducing the impact of challenges are presented. Practical implications: The findings benefited the industry practitioners who are suffering disruption in construction operations due to the pneumonic plague. Originality/value: By developing a conceptual model, this study reveals the contribution of technology-based H&S management for construction projects during the COVID-19 pandemic, which remains under-studied, especially in the context of the developing world. © 2022, Emerald Publishing Limited.
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Purpose: It has been proposed that patients with intestinal failure (IF) and intestine transplant (IT) are at higher risk of severe complications of COVID-19 due to weakened immunity and comorbidities. Multidisciplinary teams had to adapt their clinical approaches in order to keep these patients as safe as possible during the pandemic. Data is lacking. Method(s): Retrospective, observational, multicenter study performed with 3 surveys to assess COVID-19 practice changes in IF and IT patients. Result(s): 17 centers were included in the analysis;six had a 3 (+/- 4) months moratorium on performing transplant. Nine delayed their routine follow up including "protocol" biopsies. Nine reported decrease in new referrals. Sixteen incorporated telemedicine. Two reported rehabilitation services (home health, PN deliveries) being affected. In the first survey, 10 centers (59%) reported having IF and IT patients with COVID-19. In the other 2 surveys, a total of 25 IF and IT patients were reported positive for COVID-19. Of the 11 IF patients, 8 were male;7 were adults, with a mean age of 60 (+/- 8) years. Nine of them were symptomatic at presentation, with the most prevalent symptoms being fever/chills, cough and sore throat;hospitalization was required in 45.5%, all patients survived. A total of 14 IT patients were positive;8 were female;all of them were adults, mean age: 47 (+/- 16) years. All of them were symptomatic at presentation, with the most prevalent symptoms being fever/chills, dyspnea and cough. Hospitalization was required in 50%. Immunosuppression was discontinued in 1 patient, decreased in 5 (all on tacrolimus), and left unchanged in 8 cases;3 patients (21%) died. Conclusion(s): Many aspects of healthcare have been impacted by the COVID-19 pandemic. Centers adapted to new paradigms in patient care. Despite the availability of telemedicine, hospitals that treat IF and IT patients have found difficulties to sustain an appropriate home care regimen and referrals. IF patients did not have increased mortality, but IT recipients did, with similar results to those reported for other solid organs.
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Introduction: The multidisciplinary model of management for fragility hip fractures has only been recently introduced in the Philippines. Its development at the national and local level is made more difficult by the COVID-19 pandemic. To our knowledge, this is the first study to provide a comprehensive report on the clinical characteristics, current management and early outcomes of fragility hip fracture patients admitted during the COVID-19 pandemic in the setting of a country with an emerging economy. Methods: A multicenter prospective cohort study was conducted in the Philippines involving 12 hospitals from June 16, 2020 to February 28, 2021 during the Extended Community Quarantine Period during the COVID-19 pandemic. The clinico-demographic characteristics, treatments, and follow-up data at 30 days post-injury were gathered using the Research Electronic Data Capture (REDCAP) database system, using a minimum common data (MCD) which was adopted from the FFN MCD. Results: A total of 158 elderly patients (>60 years old) with fragility hip fractures were eligible for the study. 9 patients (5.7%) were confirmed or suspected to have COVID-19 infection. The median time of injury-to-admission was at least 3 (IQR: 1.0-13.7) days. 80% of the patients underwent surgical intervention with a median time from admission-to-surgery of at least 5 (IQR: 2.5-13.6) days. Notably, all non-COVID admitted patients had not been reported to have contracted the virus during their hospital stay. The 30-day mortality and morbidity rate for acute fragility fractures were 3.7%. Only the presence of a COVID-19 infection was found to be an independent and poor predictor for early mortality (P = 0.010). Conservatively managed patients had a significantly higher morbidity rate than surgically treated patients (13.6% vs 1.8%;P = 0.031). All five deaths occurred in non-surgical patients with an ASA grade of at least III. Conclusion: We recommend prompt admission and multidisciplinary care for elderly hip fracture patients even during the COVID-19 pandemic. Short-term outcomes remain favorable for non-COVID patients with acute fragility fractures treated with surgery. While a suspected or confirmed COVID-19 infection was the only significant and independent pre-operative risk factor for early mortality, there is evidence in the literature as well as in this study that the benefit of surgery may well outweigh the risk of conservatively treating COVID-19 patients provided that they can be optimized appropriately for surgery.
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Objective. This survey research intends to understand how people from a fourth-class municipality of Cavite made their decision to be vaccinated in spite of false information circulating within family, friends, and neighbors. Methods. The study employed survey research and gathered data using voluntary sampling from a pool of citizens with an appointment schedule in the vaccination site located in Magallanes, Cavite. Results. The pandemic saw a rise in the spread of information disorders. The proliferation of fake news and misinformation affect our lives as they disrupt relationships with family members and friends. Trust is being questioned as people believe in contrasting medical opinions. The overload of information sharing is a challenge for individuals to evaluate news sources coming from multiple platforms. As the status of inoculation in the Philippines is ongoing, citizens who want protection took time to get vaccinated. The impact of traditional and social media continues to be powerful influencers in information dissemination. As we deal with overabundance of information, librarians have an emerging role to play. Conclusions. Librarians are seen as partners of a local government unit in promoting citizens' well-being, providing credible sources of health information vital for an individual to help them arrive at an informed decision, and showcase advantages of vaccines as evidenced by scientific publications. © J. Yap, D. Tafalla, 2021.
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INTRODUCTION: Despite reports suggesting an association between COVID-19 mRNA vaccination and pericarditis and myocarditis, detailed nationwide population-based data are sparsely available. We describe the incidence of pericarditis and myocarditis by age categories and sex after COVID-19 mRNA vaccination from a nationwide mass vaccination programme in Singapore. METHODS: The incidence of adjudicated cases of pericarditis and myocarditis following COVID-19 mRNA vaccination that were reported to the vaccine safety committee between January to July 2021 was compared with the background incidence of myocarditis in Singapore. RESULTS: As of end July 2021, a total of 34 cases were reported (9 pericarditis only, 14 myocarditis only, and 11 concomitant pericarditis and myocarditis) with 7,183,889 doses of COVID-19 mRNA vaccine administered. Of the 9 cases of pericarditis only, all were male except one. The highest incidence of pericarditis was in males aged 12-19 years with an incidence of 1.11 cases per 100,000 doses. Of the 25 cases of myocarditis, 80% (20 cases) were male and the median age was 23 years (range 12-55 years) with 16 cases after the second dose. A higher-than-expected number of cases were seen in males aged 12-19 and 20-29 years, with incidence rates of 3.72 and 0.98 case per 100,000 doses, respectively. CONCLUSION: Data from the national registry in Singapore indicate an increased incidence of pericarditis and myocarditis in younger men after COVID-19 mRNA vaccination.
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Objectives. In these trying times due to the global effect of pandemic, what social media accounts do academic libraries in Kazakhstan maintain and how can they improve their social media engagement to continuously connect with their stakeholders? This report provides an overview of the current status of social media engagement of selected academic libraries in Kazakhstan during the COVID-19 crises. This paper will give us a picture about the kinds of online postings shared by these libraries particularly with the use of Facebook. Methods. The top two universities ranked by Independent Quality Assurance Agency (IQAA) were considered in this report to be compared with the only autonomous organization of education in Kazakhstan. The library social media accounts of these three organizations were investigated to review the number of followers, frequency of posting, and its overall social media engagement. Data collected is publicly available to all potential users, followers, or subscribers. Using the post engagement rate (PER) formula introduced by Socialbakers (2013) and adapted by Peñaflor (2018) and Magno (2016), this report identifies and analyzes the average PER Facebook pages maintained by academic libraries. The engagement metrics looked into the number of interactions and the widest reach possible in every post. All three academic libraries investigated maintain a Facebook page. The other account was just created last February 2020. To compare Facebook data during the pandemic times, public information available from June – August 2020 was measured. Results. The social media platforms operated by the academic libraries in Kazakhstan are Facebook, Twitter, Instagram, VK, and YouTube. One of the earliest academic library Facebook accounts established in Kazakhstan started in 2010 with less than 3,000 accumulated followers after ten years. This shows a very slow rise in the number of followers considering an academic population of more than 5, 000 people in 2020. Data revealed that Eurasian National University Library’s Facebook account had a higher PER of 0.83 even if it only debut in 2020 compared to the Facebook page of Nazarbayev University which garnered 0.22 PER. KAZNU Library’s Facebook page had the highest PER of 1.02. Conclusions. Facebook is the most popular social media platform across the globe but it is not the case in Kazakhstan. Library marketing and promotion in Kazakhstan needs to be addressed as public relations is not the primary focus. The utilization of social media as a tool for user engagement is not fully developed. One way to look at it is to consider library staffing and identify their marketing background. The pandemic situation must be the turning point of academic libraries to enhance their reach with their stakeholders. It was a test to know the readiness of the library in terms of online communication and interaction. © J. M. Yap, 2020.