An eco-friendly strategy for recovery of H-2-CH4-rich syngas, benzene-rich tar and carbon nanoparticles from surgical mask waste using an updraft gasifier system

The COVID-19 pandemic has created a new type of waste (surgical mask waste "WMs") that presents a major challenge now and in the future, given the strong possibilities of similar epidemics to reoccur. In order to find an effective industrial solution to the millions of WMs produced daily, this research aims to develop a new eco-friendly strategy to convert WMs into H-2-CH4-rich syngas, carbon nanoparticles (CNPs), and benzene-rich tar using an updraft gasifier system. The experiments started with the preparation of WM granules using shredding followed by granulation processes. Subsequently, the granules were processed in a lab-scale reactor with a capacity of 0.9-1 kg/h and consisted of a continuous WM feed system, a gasifier, a sampling system for syngas and tar, a ceramic filtration unit for separating the CNPs against the synthesis gas, and a burner. The gasification experiments were performed in ambient air with different air-fuel equivalence ratios (ER: 0.21, 0.25, and 0.29) and temperatures (700 degrees C, 800 degrees C, and 900 degrees C) to determine the optimal conditions that yield the maximum amount of H-2-CH4-rich syngas and CNPs with less impurities. The chemical composition and morphology of the obtained gasification products (syngas, tar, and CNPs) were observed using GC-FID, FTIR, and SEM. The results showed that the maximum production of syngas (4.29 +/- 0.16 kg/h with HHV of 3804 kJ/kg) and CNPs (0.14 +/- 0.011 kg/h) accompanied by a moderate tar rate (0.123 +/- 0.009 kg/h with HHV of 41,139.88 kJ/kg) could be obtained at 900 degrees C and ER = 0.29, while the highest H-2 (16.93 +/- 1.7 vol.%) and CH4 (10.44 +/- 0.85 vol.%) contents in syngas product were synthesized at 900 degrees C and ER = 0.19. Benzene and toluene were the major GC-FID compounds in the formulated tar product with abundance up to 25.6% and 11%, respectively. Meanwhile, gasification conditions of 900 degrees C and ER = 0.24 allowed the best morphology to be formulated for spherical-shaped CNPs with a diameter of less than 200 nm.

Workplace policies and quality of working life (QoWL) during the COVID-19 pandemic in Jordanian hospitals.

BACKGROUND: Many healthcare organizations place a high value on quality of work-life (QoWL). The healthcare system's long-term sustainability and capability to offer high-quality services to patients depend on improving QoWL for their healthcare workers. OBJECTIVE: The study aimed to explore the impact of Jordanian hospitals' workplace policies and measures in three main domains: (I) Infection prevention and control (IPC) measures, (II) Supply of personal protective equipment (PPE), and (III) COVID-19 precautionary measures on the QoWL among healthcare workers during the COVID-19 pandemic. METHODS: A cross-sectional survey was conducted from May to June 2021 through an online self-reported questionnaire (Google Form) targeting hospital healthcare professionals working at Jordanian hospitals (public, private, military, and university). The study used a valid work-related quality of life (WRQoL) scale to study the QoWL. RESULTS: A total of 484 HCWs in Jordanian hospitals participated in the study with a mean age of (34.8 ± 8.28 years). 57.6% of the respondents were females. 66.1% were married, with 61.6% having children at home. An average QoWL among healthcare workers in Jordanian hospitals during the pandemic was observed. The study results also showed a significant positive correlation between workplace policies (IPC measures, supply of PPE, and COVID-19 preventive measures) and the WRQoL among healthcare workers. CONCLUSION: Our findings highlighted the vital need for QoWL and psychological well-being support services for healthcare staff during pandemics. Improved IPC systems and other precautionary measures at the national and hospital management levels are required to help minimize the stress and fear that healthcare workers experience and lower the risk of COVID-19 and future pandemics.

Incidence and Clinical Outcomes of New-Onset Atrial Fibrillation in Critically lll Patients with COVID-19: A Multicenter Cohort Study - New-Onset Atrial Fibrillation and COVID-19.

Atrial fibrillation (Afib) can contribute to a significant increase in mortality and morbidity in critically ill patients. Thus, our study aims to investigate the incidence and clinical outcomes associated with the new-onset Afib in critically ill patients with COVID-19. A multicenter, retrospective cohort study includes critically ill adult patients with COVID-19 admitted to the intensive care units (ICUs) from March, 2020 to July, 2021. Patients were categorized into two groups (new-onset Afib vs control). The primary outcome was the in-hospital mortality. Other outcomes were secondary, such as mechanical ventilation (MV) duration, 30-day mortality, ICU length of stay (LOS), hospital LOS, and complications during stay. After propensity score matching (3:1 ratio), 400 patients were included in the final analysis. Patients who developed new-onset Afib had higher odds of in-hospital mortality (OR 2.76; 95% CI: 1.49-5.11, P = .001). However, there was no significant differences in the 30-day mortality. The MV duration, ICU LOS, and hospital LOS were longer in patients who developed new-onset Afib (beta coefficient 0.52; 95% CI: 0.28-0.77; P < .0001,beta coefficient 0.29; 95% CI: 0.12-0.46; P < .001, and beta coefficient 0.35; 95% CI: 0.18-0.52; P < .0001; respectively). Moreover, the control group had significantly lower odds of major bleeding, liver injury, and respiratory failure that required MV. New-onset Afib is a common complication among critically ill patients with COVID-19 that might be associated with poor clinical outcomes; further studies are needed to confirm these findings.

Diverging levels of COVID-19 governmental response satisfaction across middle eastern Arab countries: a multinational study.

BACKGROUND: Public acceptance of governmental measures are key to controlling the spread of infectious diseases. The COVID-19 pandemic has placed a significant burden on healthcare systems for high-income countries as well as low- and middle-income countries (LMICs). The ability of LMICs to respond to the challenge of the COVID-19 pandemic has been limited and may have affected the impact of governmental strategies to control the spread of COVID-19. This study aimed to evaluate and compare public opinion on the governmental COVID-19 response of high and LMICs in the Middle East and benchmark it to international countries. METHODS: An online, self-administered questionnaire was distributed among different Middle Eastern Arab countries. Participants' demographics and level of satisfaction with governmental responses to COVID-19 were analyzed and reported. Scores were benchmarked against 19 international values. RESULTS: A total of 7395 responses were included. Bahrain scored highest for satisfaction with the governmental response with 38.29 ± 2.93 on a scale of 40, followed by the Kingdom of Saudi Arabia (37.13 ± 3.27), United Arab Emirates (36.56 ± 3.44), Kuwait (35.74 ± 4.85), Jordan (23.08 ± 6.41), and Lebanon (15.39 ± 5.28). Participants' country of residence was a significant predictor of the satisfaction score (P < 0.001), and participants who suffered income reduction due to the pandemic, had a history of SARS-CoV-2 infection, and held higher educational degrees had significantly lower satisfaction scores (P < 0.001). When benchmarked with other international publics, countries from the Gulf Cooperation Council had the highest satisfaction level, Jordan had an average score, and Lebanon had one of the lowest satisfaction scores. CONCLUSION: The political crisis in Lebanon merged with the existing corruption were associated with the lowest public satisfaction score whereas the economical instability of Jordan placed the country just before the lowest position. On the other hand, the solid economy plus good planning and public trust in the government placed the other countries of the Gulf Cooperation Council on top of the scale. Further investigation is necessary to find out how the governments of other low-income countries may have handled the situation wisely and gained the trust of their publics. This may help convey a clearer picture to Arab governments that have suffered during the pandemic.

Atypical Eclampsia in a Pregnant Woman Infected by COVID-19.

The coronavirus disease 2019, also called (COVID-19), is an infectious disease which is caused by a virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first report was in December 2019, and on March 12, 2020, the World Health Organization (WHO) declared this disease a pandemic. COVID-19 targets many major organs causing life-threatening systemic complications. It can cause lung damage and respiratory failure in addition to systemic inflammation and immune dysregulation. Hypercoagulable state and numerous neurological abnormalities also have been reported due to this condition. Going through the literature review, we found some cases of pregnant women with novel coronavirus infection, being mostly mild illnesses, and most of these cases were focused on maternal-fetal transmission and neonatal outcomes. In this case report, we present the case of a COVID-19 positive woman who came to our emergency department at 34 weeks of gestation with tonic-clonic seizures. This case was a challenge for us because we faced a new an unknown manifestation of both COVID and eclampsia.

Sleep Quality, Insomnia, Anxiety, Fatigue, Stress, Memory and Active Coping during the COVID-19 Pandemic.

BACKGROUND: The current study aimed to evaluate the impact of the coronavirus (COVID-19) pandemic on sleep quality, insomnia, anxiety, stress, fatigue and active coping in the United States. METHODS: This was a cross-sectional study using a publicly available database taken from the Boston College COVID-19 Sleep and Well-Being Dataset. We have selected the most recent data that included information about sleep quality and other measures, including insomnia, anxiety, stress, fatigue and coping, collected between 22 February-8 March 2021. RESULTS: A total of 476 subjects were included in the analysis. The mean (SD) age of the study population was 38.8 (17.8) years, and there were more females (85%) than males. The population had a mean (SD) score of the Pittsburgh Sleep Quality Index (PSQI) of 6 (3.2), with 65% having the prevalence of poor sleep quality (defined as PSQ ≥ 5; n = 311). The mean (SD) score for Insomnia Severity Index (ISI) was 6.9 (5.2), with 55 subjects (11.5%) having clinical insomnia (defined as ISI ≥ 15); of whom 9% had severe clinical insomnia. There were positive correlations between PSQI and ISI (r = 0.76, p < 0.001), PROMIS fatigue scale (r = 0.53, p < 0.001), Generalized Anxiety Disorder-7 (GAD-7) (r = 0.46, p < 0.001), and Perceived Stress Scale (PSS) (r = 0.44, p < 0.001). The PSQI was inversely correlated with the John Henryism Active Coping Scale (JHACS) and memory scale. In the multivariate regression model, JHACS, ISI, fatigue, PSS and GAD-7 were significant predictors of PSQI, and these variables accounted for 62% of the variance of PSQI, adjusted for age and gender. CONCLUSION: An important contribution to the literature is made by this research, which demonstrates the significant prevalence of poor sleep quality and its association with insomnia and other mental and physical well-being. It also underlines the need to prioritise policy and public health efforts to address sleep issues that have substantial health and economic effects for both individuals and the population at large.

Public health workers' knowledge, attitude and practice regarding COVID-19: the impact of Field Epidemiology Training Program in the Eastern Mediterranean Region.

BACKGROUND: This study aimed to compare knowledge, attitude and practice (KAP) regarding COVID-19 between public health workers (PHWs) attended field epidemiology training program (FETP-trained) and those who did not attend FETP (non-FETP trained). METHODS: Multi-country cross-sectional survey was conducted among PHWs who participated in COVID-19 pandemic in 10 countries at EMR. Online questionnaire that included demographic information, KAP regarding COVID-19 pandemic was distributed among HCWs. Scoring system was used to quantify the answers, bivariate and Multivariate analysis performed to compare FETP-trained with non-FETP trained PHWs. RESULTS: Overall, 1337 PHWs participated, with 835 (62.4%) < 40 years of age, and 851 (63.6%) males. Of them, 423 (31.6%) had FETP, including that 189 (44.7%) had advanced level, 155 (36.6%) intermediate and 79 (18.7%) basic level training. Compared with non-FETP trained, FETP trained were older, having higher KAP scores. FETP participation was low in infection control, and PH laboratories. KAP mean scores for intermediate level attendees are comparable to advanced level. CONCLUSIONS: FETP-trained are having better KAP than non-FETP PHWs. Expanding the intermediate level, maintain the Rapid Response training and introduce the laboratory component are recommended to maximize the benefit from FETP. Infection control, antimicrobial resistance and coordination are areas where training should include.

Mental health impacts of COVID-19 on healthcare workers in the Eastern Mediterranean Region: a multi-country study.

BACKGROUND: Healthcare workers (HCWs) fighting against the COVID-19 pandemic are under incredible pressure, which puts them at risk of developing mental health problems. This study aimed to determine the prevalence of depression, anxiety, and stress among HCWs responding to COVID-19 and its associated factors. METHODS: A multi-country cross-sectional study was conducted during July-August 2020 among HCWs responding to COVID-19 in nine Eastern Mediterranean Region (EMR) countries. Data were collected using an online questionnaire administered using KoBo Toolbox. Mental problems were assessed using the Depression, Anxiety, and Stress Scale (DASS-21). RESULTS: A total of 1448 HCWs from nine EMR countries participated in this study. About 51.2% were male and 52.7% aged ≤ 30 years. Of all HCWs, 57.5% had depression, 42.0% had stress, and 59.1% had anxiety. Considering the severity, 19.2%, 16.1%, 26.6% of patients had severe to extremely severe depression, stress, and anxiety, respectively. Depression, stress, anxiety, and distress scores were significantly associated with participants' residency, having children, preexisting psychiatric illness, and being isolated for COVID-19. Furthermore, females, those working in a teaching hospital, and specialists had significantly higher depression and stress scores. Married status, current smoking, diabetes mellitus, having a friend who died with COVID-19, and high COVID-19 worry scores were significantly associated with higher distress scores. CONCLUSIONS: Mental problems were prevalent among HCWs responding to COVID-19 in EMR. Therefore, special interventions to promote mental well-being among HCWs responding to COVID-19 need to be immediately implemented.

Scaling the Children Immunization App (CIMA) to Support Child Refugees and Parents in the Time of the COVID-19 Pandemic: A Social Capital Approach to Scale a Smartphone Application in Zaatari Camp, Jordan.

BACKGROUND: Children vaccination is a key intervention for their survival, especially among refugees. Yet, children vaccination registration is done manually in refugees camps and there is no possibility to send reminders to parents to come back on time. We aimed to boost the parental registration of children's vaccination records on a Children Immunization app (CIMA) while also availing the parents with useful parenting skills under COVID-19-related stress. METHODS: We incorporated United Nations Office on Drugs and Crime (UNODC) Parenting Skills under COVID-19 information material, through CIMA in Arabic and English languages. We recruited 1100 children in February-March 2021, through a community health promotion dissemination approach. A team of two nurses from the local population and two volunteers (one trained nurse and one trained social worker), from the camp, was formed. They promoted the CIMA app at two clinics and through households visits in Zaatari refugee camp. Qualitative data on impressions and observations of the interactions with the Zaatari camp community were also collected. RESULTS: A total of 1100 children, up to 15 months of age, eligible for vaccination were enrolled in CIMA, whereby the staff explained the content of the app in terms of vaccination schedule, health promotion materials for vaccination and parenting skills to their caregivers. During the household visits, the volunteers identified a total of 70 children that have incomplete history of vaccination records (n = 42/70 girls, 60%). Also, opportunities and challenges for scaling the app were documented. CONCLUSION: The scaling of CIMA as an innovative means of dissemination of risk and health information in challenging context such as refugee camps was feasible. In the context of vaccination needs for children, in refugee settings, such a need is more eminent, particularly in the context of COVID-19.

Compliance with safety measures and risk of COVID-19 transmission among healthcare workers.

AIM: This study aimed to determine the compliance of healthcare workers (HCWs) with the hospital safety measures and the prevalence of hospital-acquired COVID-19 infection among them. METHODOLOGY: HCWs at King Abdullah University Hospital (KAUH) assigned for COVID-19 patients between 18 March and 10 June 2020 were tested for past infection using total anti-SARS-CoV-2 immunoglobulin assay, demographic data and compliance with safety measures were assessed using a questionnaire. RESULTS: A total of 340 HCWs participated in the study, 260 were close direct care. Three HCWs tested positive for total anti-SARS-CoV-2 immunoglobulin. Close direct care were more compliant with personal protective guidelines than those providing direct care. CONCLUSION: HCWs compliance with personal protective guidelines might explain the low prevalence of COVID-19 infection in hospital settings.

Potential immunomodulatory role of sesamin in combating immune dysregulation associated with COVID-19

The ongoing outbreak of novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused an unprecedented global health crisis. Development of a cure for this devastating disease is currently at full speed, with several vaccines against COVID-19 already authorized and administered. Currently, demand for these vaccines far exceeds supply. As such, boosting immunity represents a viable route to halt the rapid spread of SARS-CoV-2 and limit fatalities until vaccines become more readily and widely available. The use of phytochemicals appears to be a promising panacea. Sesamin, a lignan isolated from Sesamum indicum seeds, is known for its potent pharmacological properties, and is therefore hypothesized as a potential candidate in the therapeutic regimen against COVID-19. Herein, we highlight the confirmed therapeutic anti-inflammatory and immune-modulatory potential of sesamin against myriads of respiratory disorders, and tentatively suggest that sesamin may exert similar potent effects against COVID-19. Precisely, we speculate that sesamin may help alleviate COVID-19 via restoring Th1/Th2 balance and preventing inflammation and cytokine storm development. Additionally, we further support the promising role of sesamin against COVID-19 by underscoring the direct evidence, which suggests that sesamin may demonstrate promising inhibitory potential against three important SARS-CoV-2 targets, namely main protease, spike protein, and angiotensin-converting enzyme 2 receptor. Although preliminary, there is ample evidence to propose sesamin as a potential phytotherapeutic and prophylactic candidate against COVID-19. Further in vitro, in vivo, and preclinical studies are required to further substantiate the role of sesamin in the prevention and/or treatment of COVID-19.

Iraq experience in handling the COVID-19 pandemic: implications of public health challenges and lessons learned for future epidemic preparedness planning.

BACKGROUND: Iraq has been exceptionally challenged by the COVID-19 pandemic due to the already exhausted healthcare system. OBJECTIVES: To describe the epidemiological situation of COVID-19 in Iraq, the government's response to the pandemic, and provide recommendations for further action. METHODS: A desk review of secondary data using the available reports on the epidemiological situation in Iraq as well as official governmental sources was conducted. RESULTS: The major surge in the number of COVID-19 cases occurred in the first week of June and continued to increase dramatically until mid-October when a significant decrease happened. With a few exceptions, the reproductive number R has been consistently above 1. Patients aged 30-39 years (25.6%) were the most affected, while those aged 60-69 years (26.7%) had the highest deaths rates. Iraq tried to contain the pandemic through several regulations: border control, enforcing curfew, mask-wearing, and social distancing, COVID-19 isolation centers, expanding lab capacity, contact tracing, as well as several supportive economic measures. However, the extent of implementing these regulations is questionable. CONCLUSION: Additional administrative and scientific measures with special emphasis on handling mass gathering, coordination with media and better training of healthcare workers particularly on infection prevention and control.

Clinical Practice and Barriers of Ventilatory Support Management in COVID-19 Patients in Saudi Arabia: A Survey of Respiratory Therapists.

OBJECTIVE: This study was conducted to determine the clinical practice and barriers of ventilatory support management in COVID-19 patients in Saudi Arabia among respiratory therapists. METHODS: A validated questionnaire comprising three parts was distributed to all critical care respiratory therapists registered with the Saudi Society for Respiratory Care through the official social networks. RESULTS: A total of 74 respiratory therapists completed the survey. The mean (±standard deviation) of intensive care unit beds was 67 ± 79. Clinical presentation (54%) and arterial blood gas (38%) were the two main diagnostic tools used to initiate ventilatory support. While protocols for the initiation of invasive mechanical ventilation (IMV; 81%) were widely available, participants had limited availability of protocols for the use of non-invasive ventilation (NIV; 34%) and high-flow nasal cannula (HFNC; 34%). In mild cases of COVID-19, most respondents used HFNC (57%), while IMV was mostly used in moderate (43%) and severe (93%) cases. Regular ventilator check was mostly done every 4 h (57%). BiPAP (47.3%) and full-face masks (45.9%) were the most used mode and interface, respectively, while pressure-regulated volume control (55.4%) and pressure control (27%) were the most used mechanical ventilation modes for COVID-19 patients. In terms of use of proning, 62% used it on IMV, while 26% reported using awake proning. Staff shortage (51.4%), personal protective equipment (PPE) shortage (51.4%), increased workload (45.9%), inadequate training (43.2%) and lack of available protocols and policies (37.8%) were the main barriers. CONCLUSION: Ventilatory support management of COVID-19 in Saudi Arabia was inconsistent with the global practice, lacked uniformity, and there was limited use of standard protocols/treatment guidelines. Shortage of staff and PPE, increased workload and insufficient training were the most prevalent barriers.

Mobility indicators and COVID-19 growth ratio in Iraq: a correlation study.

BACKGROUND: There is no prior study of the effect of mobility-limiting measures on the occurrence of COVID-19 in Iraq. OBJECTIVES: To determine the relationship between publicly available mobility index data and the growth ratio (GR) of COVID-19. METHOD: We used Google COVID-19 Community Mobility Reports to extract Iraq's mobility data and the official Ministry of Health COVID-19 statements. We used the data to calculate the Pearson's correlation coefficient and fit a linear regression model to determine the relationship between percentage change from the baseline in the mobility indices and the GR of COVID-19 in Iraq. RESULTS: There was a moderate positive correlation between each of the mobility indices except the residential index and COVID-19 GR in Iraq. The general linear model indicated that as each of the mobility indices increases by one unit, the GR of COVID19 increases by 0.002-0.003 except for the residential index. As the residential mobility index increases by one unit, the GR decreases by 0.009. All the findings were statistically significant (P-value < 0.0001). CONCLUSION: Mobility-limiting measures may be able to reduce the growth rate of COVID-19 moderately. Accordingly, mobility-limiting measures should be combined with other public control measures particularly mass mask use.

Delayed admissions and efficacy of steroid use in patients with critical and severe COVID-19: an apprehensive approach.

BACKGROUND: Inadvertent delays in access to appropriate therapeutic interventions in high-risk group coronavirus disease 2019 (COVID-19) patients contribute to mortality in patients with severe/critical disease presentation. OBJECTIVES: The aim of this study was to determine the effect of timely admission to the hospital on mortality of patients with severe/critical COVID-19. Another secondary aspect of this study was to observe the efficacy of time-dependent use of corticosteroids on mortality of critical/severe COVID-19 patients. METHODS: Clinical data of 659 patients with severe/critical COVID-19, admitted to four major tertiary care hospitals from the Islamabad-Rawalpindi region of Pakistan was retrospectively collected from a period February-August 2020. Multivariate logistic regression analysis was carried out to determine the predictors of mortality in severe/critical COVID-19 patients. RESULTS: Out of a total of 659 patients, 469 (71.2%) patients died. Age > 60 years, presence of hypertension, heart disease and kidney disease along with late admission (>5 days) were significant predictors of mortality in patients with severe/critical COVID-19. CONCLUSIONS: The study highlights the importance of well-timed provision of appropriate medical interventions control COVID-19-associated mortality.

Myocardial perfusion after COVID-19 infection: No persisting impaired myocardial blood flow in surviving patients

Background: Acute myocardial damage is common in hospitalized patients with severe COVID-19, with evidence of myocardial infarction and myocarditis demonstrated on cardiovascular magnetic resonance (CMR). Post-mortem studies have also implicated microvascular thrombosis, which may cause persistent microvascular disease. Purpose: To determine the long-term coronary sequelae in recovered COVID-19 using multiparametric CMR including state-of-the-art inline quantitative stress myocardial blood flow (sMBF) mapping to assess global and regional sMBF. Methods: Prospective, multicentre observational study of recovered COVID-19 patients scanned at three London CMR units. Results were compared to a propensity-matched, pre-COVID chest pain cohort (104 patients referred for perfusion CMR, with subsequently demonstrated unobstructed coronary arteries) and 27 healthy volunteers (HV). Perfusion image analysis was performed using a novel artificial intelligence approach deriving global and regional stress and rest MBF with a cut-off of >2.25mL/g/min signifying normal sMBF and <1.82mL/g/min abnormal sMBF (Kotecha JCVI 2019). Results: 104 recovered, post-COVID patients (median age 62 years, 76% male;89[87%] hospitalised, 41/89[46%] requiring ICU) underwent adenosine-stress perfusion CMR at a median 131(IQR 43-179) days from COVID-19 diagnosis. Median LVEF was 67% (IQR 60-71%;12 (11.5%) with impaired LVEF), 51 patients (49%) had late gadolinium enhancement (LGE);18% infarct-pattern and 33% non-ischaemic LGE. Global stress MBF in post-COVID patients was no different to age-, sex-and co-morbidities-matched controls (2.57 ± 0.77 vs. 2.40 ± 0.75 ml/g/min, p = 0.11, Figure 1), though lower than HV (3.00 ± 0.76 ml/g/min, p = 0.001). Post-COVID, multivariate predictors of low sMBF were male sex (OR 0.57, 95%CI 0.41-0.80, p = 0.001) and hypertension (OR 0.67, 95%CI 0.51-0.88, p = 0.004), but not COVID-19 disease severity (ICU admission) or presence of scar (ischemic/non-ischemic). 21/42 with reduced sMBF (<2.25mL/g/min) had regional perfusion defects consistent with epicardial coronary disease. Conclusions: COVID-19 survivors do not demonstrate evidence of reduced global MBF by CMR compared to risk factor matched controls. Stress perfusion CMR identifies etiology of acute myocardial damage (infarction/myocarditis) and presence of occult coronary ischemia.

Changes in Behavior Management and Treatment Modalities in Pediatric Dentistry during COVID-19 Pandemic.

OBJECTIVE: This study aims to assess the knowledge and confidence of dentists related to behavior management with extra personal protective equipment (PPE), non-aerosol-generating dental procedures in the course of the coronavirus disease-2019 (COVID-19) pandemic. MATERIALS AND METHODS: A cross-sectional online survey was conducted among a sample of dentists who worked in Jordan and India in June 2020 during the COVID-19 pandemic. RESULTS: This study included a total of 177 dentists in Jordan and India that were practicing during the early months of the pandemic. Most dentists were seeing <6 patients per day. The most common emergency treatments during the pandemic by Jordanian dentists were abscesses (51.8%) and cellulitis (44.6%) vs (44.6%) abscesses and (35.5%) pulpitis in India. There was a high adoption of all elements of the PPE protocol. Most participants never or rarely used N2O sedation to manage their patients in Jordan and India (80.4 and 71.1%), respectively. Participants in Jordan and India that considered treatment non-aerosol-generating procedures (non-AGP) were (82.1 vs 97.5%, p = 0.000), respectively. CONCLUSION: Most of the surveyed dentists believe the extra PPE acts as a barrier to patient communication and child behavior management and would consider modifying the PPE to be more child-friendly. Most dentists consider non-AGP procedures and silver diamine fluoride (SDF) to be practical ways to practice safer dentistry, yet more training and information is needed for dentists treating children to provide a more confident safe environment for both dentists and their patients. HOW TO CITE THIS ARTICLE: Alsaleh MM, Sabbarini JM, Al-Batayneh OB, et al. Changes in Behavior Management and Treatment Modalities in Pediatric Dentistry during COVID-19 Pandemic. Int J Clin Pediatr Dent 2020;13(S-1):S125-S131.

An Overview of the Treatment Options Used for the Management of COVID-19 in Pakistan: Retrospective Observational Study.

BACKGROUND: Since the first reports of COVID-19 infection, the foremost requirement has been to identify a treatment regimen that not only fights the causative agent but also controls the associated complications of the infection. Due to the time-consuming process of drug discovery, physicians have used readily available drugs and therapies for treatment of infections to minimize the death toll. OBJECTIVE: The aim of this study is to provide a snapshot analysis of the major drugs used in a cohort of 1562 Pakistani patients during the period from May to July 2020, when the first wave of COVID-19 peaked in Pakistan. METHODS: A retrospective observational study was performed to provide an overview of the major drugs used in a cohort of 1562 patients with COVID-19 admitted to the four major tertiary-care hospitals in the Rawalpindi-Islamabad region of Pakistan during the peak of the first wave of COVID-19 in the country (May-July 2020). RESULTS: Antibiotics were the most common choice out of all the therapies employed, and they were used as first line of treatment for COVID-19. Azithromycin was the most prescribed drug for treatment. No monthly trend was observed in the choice of antibiotics, and these drugs appeared to be a random but favored choice throughout the months of the study. It was also noted that even antibiotics used for multidrug resistant infections were prescribed irrespective of the severity or progression of the infection. The results of the analysis are alarming, as this approach may lead to antibiotic resistance and complications in immunocompromised patients with COVID-19. A total of 1562 patients (1064 male, 68.1%, and 498 female, 31.9%) with a mean age of 47.35 years (SD 17.03) were included in the study. The highest frequency of patient hospitalizations occurred in June (846/1562, 54.2%). CONCLUSIONS: Guidelines for a targeted treatment regime are needed to control related complications and to limit the misuse of antibiotics in the management of COVID-19.

Notes From the Field: The Combined Effects of Tocilizumab and Remdesivir in a Patient With Severe COVID-19 and Cytokine Release Syndrome.

SARS-CoV-2 is known to cause severe bilateral pneumonia and acute respiratory distress syndrome or COVID-19 in patients, which can be debilitating and even fatal. With no drugs or vaccines available yet, a wide range of treatment regimens used are being repurposed. The need of the hour is to analyze various currently available regimens and devise a treatment plan that is most effective for COVID-19. Here we describe the case of a 68-year-old man with hypertension and diabetes, exhibiting symptoms of cough and shortness of breath, who presented at the emergency department of our hospital. Chest computed tomography revealed bilateral ground glass opacities that were indicative of COVID-19, and a computed tomography score of 24 was indicative of severe pulmonary pneumonia. He tested positive for COVID-19. His treatment regimen included the use of convalescent plasma, oxygen therapy, steroids, high-dose antibiotics, broad-spectrum antiviral remdesivir, and anti-interleukin-6 monoclonal antibody (Tocilizumab) at various stages of the disease. Oxygen supplementation was required at the time of admission. The patient initially developed a cytokine release storm, and oxygen supplementation was initiated to manage his condition. Supportive care and multiple treatment regimens were used to successfully recover the patient's health. With a rapid increase in number of confirmed cases worldwide, COVID-19 has become a major challenge to our health care system. With no available vaccines currently, the establishment of a combination of therapeutic drugs that effectively reduce disease progression is of utmost importance.

Real-Time Surveillance of Infectious Diseases, Injuries, and Chronic Conditions During the 2018 Iraq Arba'een Mass Gathering.

The Arba'een pilgrimage in Iraq is now the largest annual gathering in a single place worldwide. To monitor and address the health needs of pilgrims in field clinics near the pilgrimage route, a syndromic surveillance system was designed and implemented by Global Health Development/Eastern Mediterranean Public Health Network in collaboration with Iraq Ministry of Health. This study aimed to analyze the effectiveness of the surveillance system and the data it gathered in evaluating the burden of common acute and infectious conditions, chronic conditions, and trauma and injuries during the Arba'een pilgrimage in 2018. Data were collected at 152 field clinics located across 11 governorates in Iraq at strategic points along the Arba'een pilgrimage route from all governorates to Karbala between October 8 and November 3, 2018. A team of 24 surveillance supervisors trained, oversaw, and provided technical support for 304 data collectors. The data collectors recorded data from 338,399 patients (42.5% female and 57.5% male) in the span of 26 days. The vast majority of patients were from Iraq (n = 294,260, 87.6%) and Iran (n = 34,691, 10.3%). Of the 338,399 patients whose data were recorded by the surveillance system, 246,469 (72.8%) reported acute and infectious conditions, 202,032 (59.70%) reported chronic conditions, and 6,737 (2.0%) reported traumas and injuries. Many patients reported several conditions in multiple categories. The most prevalent acute condition treated was influenza-like illness, identified through patients exhibiting a combination of fever and cough symptoms. Findings from this study will help inform future planning efforts so healthcare workers can be better prepared for treating such cases at mass gatherings. With the latest challenges posed by the COVID-19 pandemic, preparations for a possible future outbreak of the novel coronavirus are also discussed. The information from this study serves as a foundation to inform and optimize future planning of wide-scale surveillance efforts and address challenges in health service delivery and health security.