ABSTRACT
Introduction: Numerous studies have shown both hyponatremia and hypernatremia to be independently associated with mortality. Patients infected with Covid-19 infection can develop severe life threatening pneumonia and the mortality in these patients can be as high as 20.3% to 27.9%. While respiratory tract involvement is one of the main manifestation of Covid -19 infection, many patients also have associated dysnatremias. The reported prevalence of hyponatremia and hypernatremia in Covid -19 patients has been 25%-45% and 3% to 7% respectively. Recently, it has also been observed that patients with covid-19 infection develop severe treatment resistant hypernatremia > 150 mEq/L, which is difficult to correct. In patients with Covid-19 infection, dysnatremia is a frequent occurrence, although its relationship with mortality needs to be established. We aimed to study the frequency of dysnatremia in patients with Covid -19 infection at different stages of admission. Method(s): This retrospective analysis was conducted at Aga Khan University Hospital, Karachi, Pakistan over a period of twelve weeks. All admitted adult patients with covid -19 were included. Three levels of serum sodium were recorded: on admission, maximum level anytime during hospital stay and at the time of discharge or death (+/- 48 hours). Based on the serum level of sodium, three definitions were used: hyponatremia, hypernatremia and normonatremia. Hypernatremia was further categorized into mild, moderate and severe. Patients developing acute kidney injury (AKI) was also recorded. The main outcome measure was inpatient mortality. Result(s): The study included 574 patients;median age was 55.6 +/-14.4 years. On admission, the mean sodium was 135.9 +/- 6.4 mEq/L, 39% patients had hyponatremia and 4.7% had hypernatremia. During hospital admission, the percentage of hypernatremia increased to 18.8%: 12.7% had mild, 4.5% had moderate and 1.6% had severe hypernatremia. The mean serum sodium, during hospital stay, in patients who survived was around 140.6 +/- 5 as compared to 151 +/- 9.9 mEq/L in those who died with p value <0.001. The last mean serum sodium checked before death or discharge (+/- 48 hours) was 145.4 +/- 9.4 mEq/L as opposed to 137.7 +/- 3.7 mEq/L with p value of <0.001 in patients who died and survived respectively. The mean serum creatinine on admission was 1.3 +/-1.3 mg/dl;200 (34.8%) patients developed AKI;100 (50%) patients developed stage 1 AKI, 49 (24.5%) had stage 2 and 50 (25%) had stage 3 AKI. Around 36 (6.3%) required renal replacement therapy. The predictors of AKI included severity of Covid-19 [p = 0.001], age [p = <0.001], hypertension [p = 0.04] and invasive ventilation [p = 0.01]. Overall, mortality was 10.97%. Conclusion(s): Hyponatremia on admission is commonly seen in patients admitted with Covid -19 infection, whereas hypernatremia is a frequent finding in patients who could not survive, however their association with mortality needs to be established. No conflict of interestCopyright © 2023
ABSTRACT
Background: Older patients with cancer remain at high risk for negative outcomes from COVID-19 infection, particularly those who have multimorbidities and on immunosuppressive therapy. These patients have been excluded or underrepresented in pivotal COVID-19 vaccine clinical trials and there are ongoing concerns that they may not acquire the same level of protection from the available vaccines as the immunocompetent adults. Moreover, the level of protection wanes over time making them more susceptible to emerging COVID-19 novel variants of concern. Despite the implementation of global vaccination campaigns which have successfully reduced COVID-related hospitalisations and deaths in many parts of the world, there remains many unresolved issues and challenges to address as the pandemic ensues. With aging, concerns for age-related dysregulation and immune dysfunctions called immunosenescence may lead to potentially lower immunogenicity to vaccines. Despite receiving the primary vaccination, real-world evidence showed that both patients aged > 65 years and those with cancer have a higher risk of developing breakthrough COVID-19 infections and related complications. Subsequent booster doses are found to be effective at improving immune response, particularly against the novel variants, and the vulnerable population should be given the priority in booster campaigns. Method(s): Since the beginning of the pandemic in 2020, The International Society of Geriatric Oncology set up a COVID-19 Working Group comprised of multidisciplinary specialists by developing recommendations, advocacy, and action plans based on expert opinion and evidence related to older adults with cancer. Result(s): The table below summarises the updated recommendations from the SIOG COVID-19 Working Group. Conclusion(s): The SIOG COVID-19 Working Group supports ongoing public health interventions, continued mass immunisations, and booster campaigns targeting the most vulnerable members of the society, including older adults with cancer (Table Presented).
ABSTRACT
The outbreak of COVID-19, a highly infectious respiratory disease from a novel coronavirus that was first detected in Wuhan city, Hubei Province, China, in December 2019, has since caused a severe outbreak worldwide, prompting WHO to declare the COVID-19 as a pandemic on March 11, 2020. While the impact of the COVID-19 pandemic will be global, both the World Bank and Asian Development Bank assess the Maldives as one of the worst-hit in the world given the high exposure of the Maldivian economy to external shocks, which shares relatively similar conditions like other small island states. This chapter includes the measures taken to control and contain the outbreak, including the establishment of NEOC and its transition to HEOC. It also highlights the key legal frameworks governing response to public health emergencies, the socioeconomic impacts, the effects on the education and public health sector, climate change and environmental challenges, the migrant's situation, and a review of the foreign aid received. This chapter concludes with brief suggestions to strengthen the COVID-19 response in the Maldives. © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
Background: Falls are a major issue among older patients with cancer and can lead to interruption in cancer treatment. Ample evidence shows resistance and balance training can prevent falls in older adults;however, there is a paucity of evidence regarding exercise on fall prevention in the older cancer population, who often have unique risk factors for falls. Given the new reality of the COVID-19 pandemic, minimizing group gatherings and its associated risks is imperative for older patients, who are a vulnerable population. This study sought to investigate the feasibility of an 8-week, virtual exercise program and its preliminary effects on lower body strength and balance in community-dwelling cancer patients. Methods: Study participants were recruited for this pretest-posttest intervention study using consecutive sampling over a one-year period from the Cross Cancer Institute in Edmonton, Alberta. The intervention entailed leg muscle strengthening and balance training exercises that progressed in difficulty as outlined by the Otago program, and involved a virtual component (facilitated live by a certified exercise physiologist via Zoom meeting platform once a week) and independent at-home training component (twice a week). Lower body strength and balance were assessed using the 5-times chair-stand and the 4- stage balance test, respectively, and were analyzed using the Wilcoxon Signed Rank test. Results: Twenty-seven older patients (mean age 70.1, range 65-76) participated. The most common cancer sites were breast (48%) and prostate (41%). One participant withdrew due to personal reasons unrelated to the program. The remaining 26 participants completed the intervention. Attendance rate for the virtual component was 97.6% and independent component 84.7%. Participants perceived the program as rewarding and enjoyable (100%), felt this program prepared them to exercise on their own (92%), were confident to continue exercising on their own (81%), and would recommend the program to other patients (100%). At baseline, 33% (n = 9) ≥1 fall over the past 6 months. A statistically significant improvement in lower body strength was detected post-intervention (p =.001), whereas no difference was detected in balance (p =.059). Conclusions: This virtual, hybrid resistance and balance training program was feasible, overwhelmingly accepted by our older participants, and appeared effective in improving lower body strength. Findings from this study may have potential to inform design of a larger, randomized multi-site study.
ABSTRACT
The present study analyses the case of urban sustainability in Mumbai in the context of the COVID-19 pandemic and aims to identify the relationship between the existing sustainability issues and the spread of the pandemic across the administrative wards of the Municipal Corporation of Greater Mumbai. It also tries to delve into the reasons behind the observed relationships to establish the patterns created by the COVID-19 pandemic in Mumbai by the end of August 2020. The study relies on secondary sources of data, that include reports published by government agencies, news articles, journals and websites. The study comprises a large amount of quantitative data that were analyzed using ArcGIS 10.4.1 and SPSS 23. The qualitative data collected through an extensive literature review was used alongside the quantitative data to support the study. The findings reveal that the COVID-19 pandemic had a varied impact across the wards of Mumbai, which was found to be associated with the unequal socio-economic conditions that prevail across the city. This inequality has contributed to Mumbai’s reduced resilience, for building which the Sustainable Development Goals (SDGs) have to be achieved. © 2021, Russian Geographical Society. All rights reserved.