Current understanding of an Emerging Coronavirus using in silico approach: Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2).

Novel coronavirus (nCoV) namely "SARS-CoV-2" is being found responsible for current PANDEMIC commenced from Wuhan (China) since December 2019 and has been described with epidemiological linkage to China in about 221 countries and territories until now. In this study we have characterized the genetic lineage of SARS-CoV-2 and report the recombination within the genus and subgenus of coronaviruses. Phylogenetic relationship of thirty nine coronaviruses belonging to its four genera and five subgenera was analyzed by using the Neighbor-joining method using MEGA 6.0. Phylogenetic trees of full length genome, various proteins (spike, envelope, membrane and nucleocapsid) nucleotide sequences were constructed separately. Putative recombination was probed via RDP4. Our analysis describes that the "SARS-CoV-2" although shows great similarity to Bat-SARS-CoVs sequences through whole genome (giving sequence similarity 89%), exhibits conflicting grouping with the Bat-SARS-like coronavirus sequences (MG772933 and MG772934). Furthermore, seven recombination events were observed in SARS-CoV-2 (NC_045512) by RDP4. But not a single recombination event fulfills the high level of certainty. Recombination mostly housed in spike protein genes than rest of the genome indicating breakpoint cluster arises beyond the 95% and 99% breakpoint density intervals. Genetic similarity levels observed among "SARS-CoV-2" and Bat-SARS-CoVs advocated that the latter did not exhibit the specific variant that cause outbreak in humans, proposing a suggestion that "SARS-CoV-2" has originated possibly from bats. These genomic features and their probable association with virus characteristics along with virulence in humans require further consideration.

The Impact of COVID-19 National Lockdown on Myocardial Infarction (MI) Hospitalizations in Northern Jordan.

Background: During COVID-19 lockdown periods, several studies reported decreased numbers of myocardial infarction (MI) admissions. The lockdown impact has not yet been determined in developing countries. The aim of this study was to investigate the impact that of the lockdown measures might have had on the mean number of MI hospital admissions in Northern Jordan. Methodology: A single-center study examined consecutive admissions of MI patients during COVID-19 outbreak. Participants' data was abstracted from the medical records of King Abdullah University Hospital between 2018 and 2020. Mean and percentages of monthly admissions were compared by year and by lockdown status (pre-lockdown, lockdown, and post-lockdown time intervals). Results: A total of 1380 participants were admitted with acute MI symptoms: 59.2% of which were STEMI. A decrease in number of MI admissions was observed in 2020, from 43.1 (SD: 8.017) cases per month in 2019 to 40.59 (SD: 10.763) in 2020 (P < 0.0001) while an increase in the numbers during the lockdown was observed. The mean number during the pre-lockdown period was 40.51 (SD: 8.883), the lockdown period was 44.74 (SD: 5.689) and the post-lockdown was 34.66 (SD: 6.026) (P < 0.0001 for all comparisons). Similar patterns were observed when percentages of admissions were used. Conclusion: Upon comparing the lockdown period both to the pre- and post-lockdown periods separately, we found a significant increase in MI admissions during the lockdown period. This suggests that lockdown-related stress may have increased the risk of myocardial infarction.

The impact of partial and complete lockdown during the COVID-19 pandemic on acute surgical services: a retrospective cohort study.

PURPOSE: The burden of the coronavirus disease of 2019 (COVID-19) pandemic on the healthcare sector has been overwhelming, leading to drastic changes in access to healthcare for the public. We aimed to establish the impact of implemented government partial and complete lockdown policies on the volume of surgical patient admissions at a tertiary referral center during the pandemic. METHODS: A database was retrospectively created from records of patients admitted to the surgical ward through the emergency department. Three 6-week periods were examined: The complete lockdown period (CLP), which included a ban on the use of cars with the exception of health service providers and essential sector workers; A pre-COVID period (PCP) 1 year earlier (no lockdown); and a partial lockdown period (PLP) that involved a comprehensive curfew and implementing social distancing regulations and wear of personal protective equipment (e.g., masks) in public places. RESULTS: The number of patients admitted to the surgery ward was significantly higher in the PCP cohort compared to the CLP and PLP cohorts (p = 0.009), with a 42.1% and 37% decline in patients' admissions, respectively. Admission rates for patients with biliary pathologies and vascular thrombotic events increased. 30-day mortality rates did not differ significantly between the three periods (p = 0.378). CONCLUSIONS: While COVID-19 lockdown regulations had a significant impact on patient admission rates, surgical outcomes were not affected and the standards of care were maintained. Future protocols should strive to improve access to healthcare to avoid complications caused by delayed diagnosis and treatment.

Magnetic Iron-Improved Growth, Leaf Chemical Content, Yield, and Fruit Quality of Chinese Mandarin Trees Grown under Soil Salinity Stress.

Chinese mandarin fruits are an inexpensive and rich source of vitamin C. They have potential benefits in treating acute respiratory infections and mitigating inflammation in critical patients with COVID-19. In Egypt, citrus is the most important fruit tree but is sensitive to salinity stress, resulting in poor vegetative tree growth and reductions in productivity and fruit quality. Magnetic iron has emerged as a promising approach in the citrus tree industry, since it improves vegetative growth, yield, and fruit quality and alleviates salinity stress in Chinese mandarin trees grown in soils suffering from high salt stress. This research is aimed at studying the influence of adding magnetic iron (as soil treatment) on tree canopy growth, yield, and fruit quality of 'Chinese' mandarin trees. Therefore, the treatments were as follows: 0, 250, 500, and or 750 g of magnetic iron.tree-1. Our results indicated that all applications of magnetic iron significantly improved tree canopy volume, leaf total chlorophyll, relative water content, yield (kg.tree-1), and the fruit physical and chemical characteristics of Chinese mandarin. In contrast, leaf Na and Cl content, (%), proline, and total phenolic content were decreased by magnetic iron soil treatments. In respect to vegetative growth, our results indicated that adding magnetic iron at the concentration 750 g.tree-1 caused the best values of tree canopy volume. A similar trend was noticed regarding yield. The increase in yield attained was nearly 19%; the best values were obtained when magnetic iron were used at 750 g.tree-1. In conclusion, the application of magnetic iron can lead to improved fruit production and fruit quality of Chinese mandarin trees grown in salinity stress conditions.

Differential upregulation of AU-rich element-containing mRNAs in COVID-19.

BACKGROUND: AU-rich elements (AREs) are located in the 3'UTRs of 22% of human mRNAs, including most transiently expressed inflammatory mediators. By default, AREs mark mRNAs for decay and translational inhibition, but this activity can be temporarily inhibited in case of infection to allow the onset of inflammation. Morbidity and mortality in COVID-19 patients have been associated with dysregulated inflammation, a process that may include aberrant ARE activity. RESULTS: RNA-seq data from available transcriptomic studies were analyzed to investigate a possible differential expression of mRNAs that contain AREs in the context of SARS-CoV-2 infections. ARE-mRNAs turned out to be significantly overrepresented among the upregulated mRNAs after SARS-CoV-2 infection (up to 42%). In contrast, ARE-mRNAs were underrepresented (16%) in the downregulated group. Consequently, at a global scale, ARE-mRNAs are significantly more upregulated after SARS-CoV-2 infection compared to non-ARE mRNAs. This observation was apparent in lung cell line models such as A549 and Calu-3 and with infections with other respiratory viruses and cell lines. Most importantly, at the clinical level, the elevated ARE-mRNA response appeared strongest in blood cells of COVID-19 patients with mild disease. It diminished with disease severity and was least apparent in patients in need of intubation and respiratory-related death. Gene function and clustering analysis suggest that the ARE-response is rather global and the upregulated ARE-mRNAs in patients with mild disease do not particularly cluster in specific functional groups. CONCLUSIONS: Compared to the rest of the transcriptome, ARE-containing mRNAs are preferentially upregulated in response to viral infections at a global level. In the context of COVID-19, they are most upregulated in mild disease. Due to their large number, their levels measured by RNA-seq may provide a reliable indication of COVID-19 severity.

DIFFUSE ALVEOLAR HEMORRHAGE SECONDARY TO IMMUNE THROMBOCYTOPENIA FOLLOWING SARS-COV-2 VACCINATION: A CASE REPORT

SESSION TITLE: COVID-Related Critical Care Cases SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm INTRODUCTION: We present a case of diffuse alveolar hemorrhage (DAH) secondary to Immune Thrombocytopenia (ITP) temporally related to SARS-CoV-2 (CoV) vaccine. CASE PRESENTATION: An 80-year-old female presented with dyspnea, hemoptysis, diffuse petechiae, and ecchymosis;no focal neurological deficits or hepatosplenomegaly. She had no history of bleeding or autoimmune disorders;no recent respiratory or gastrointestinal infections;but received Moderna CoV vaccine 4 weeks prior to presentation. Chest X-ray (CXR) and CTA of chest demonstrated multifocal bilateral patchy airspace opacities. Initial platelet was 1 x 109/L with normal morphology of platelet and WBC, and no schistocytes. Coagulation panel, LDH, haptoglobin, and bilirubin were all normal. CoV NAAT was negative. Dexamethasone and IVIG for high suspicion of ITP was initiated. Supportive care including platelet transfusion and oxygen via nasal cannula was maintained. Platelets were severely consumed in spite of treatment with platelets undetectable at nadir and rapid decrease of hemoglobin, approximately 6 g/dL, within 24 hours of admission. IgM and IgG plasma platelet autoantibodies returned positive, confirming ITP diagnosis. Additional workup was unremarkable for infections, rheumatologic disorders, and malignancy. Respiratory state rapidly declined with worsening hemoptysis and significant increase of bilateral airspace opacities on repeat CXR, indicative of DAH. Lung protective mechanical ventilation protocol was initiated on day 2 with medically induced deep sedation and paralysis to minimize hemorrhage exacerbation. Rituximab, romiplostim, and nebulized tranexamic acid were added for severe and refractory ITP, which eventually slowed platelet consumption, reduced pulmonary hemorrhage, and stabilized hemoglobin. Platelets recovered above 30 x 109/L on day 9, and subsequent bronchoscopy showed persistent blood on bronchoalveolar lavage. She was successfully extubated after prolonged 14-day intubation. Platelet normalized before discharge. DISCUSSION: Incidence of ITP related to CoV vaccine is approximately 0.8-0.9 case per million vaccinated. Most cases present with superficial bleeding and respond to first-line agents with rapid recovery. GI bleeding and intracranial hemorrhage, but not DAH, have been reported in several cases, requiring third-line agents to promote platelets recovery and achieve hemostasis. We report a case of DAH secondary to ITP following CoV vaccine. Temporal relationship and severe presentation are consistent with other reports of ITP with life-threatening internal bleeding probably secondary to CoV vaccine. CONCLUSIONS: When DAH is suspected, rapid escalation of treatment to include third-line agents is desired. If intubated, lung protective ventilation with paralysis is preferred to minimize further lung injury due to DAH. Reference #1: Lee EJ, Cines DB, Gernsheimer T, et al. Thrombocytopenia following Pfizer and Moderna SARS-CoV-2 vaccination. Am J Hematol. 2021;96(5):534-537. doi:10.1002/ajh.26132 doi:10.1016/J.VACCINE.2021.04.054 Reference #2: Welsh KJ, Baumblatt J, Chege W, Goud R, Nair N. Thrombocytopenia including immune thrombocytopenia after receipt of mRNA COVID-19 vaccines reported to the Vaccine Adverse Event Reporting System (VAERS). Vaccine. 2021;39(25):3329-3332. Reference #3: Tarawneh O, Tarawneh H. Immune thrombocytopenia in a 22-year-old post Covid-19 vaccine. Am J Hematol. 2021;96(5):E133-E134. doi:10.1002/ajh.26106 DISCLOSURES: No relevant relationships by Timothy Barreiro No relevant relationships by Tiewei Cheng No relevant relationships by Zeina El Amil No relevant relationships by Jin Huang No relevant relationships by Sanaullah Khalid

Learners' engagement assessment in e-learning during the COVID-19 pandemic: nation-wide exploration.

The purpose of this study is to determine how learners feel about distance learning as a substitute for face-to-face learning. A nationwide survey of over 11,000 students was conducted during the covid-19 outbreak to evaluate how students in grades 8-12 responded to and viewed full-time e-learning practices. Two-thirds of students had negative attitudes toward e-learning, according to the findings of the survey in the five selected issues of effectiveness, ease of use, interactivity, motivation, and academic assessment of the e-learning platform. Regardless of the students' age, gender, grade, branch, or technology used, they all had a negative opinion regarding e-learning. In addition to technological issues, the majority of students cited psychological and social factors as reasons for their negative attitudes toward e-learning, such as a lack of readiness and ability to adapt to a new style of education, ineffectiveness of the means and methods used, and poor communication with teachers and other classmate learners. On the practical side, the study's findings point to the necessity to adapt the teaching style via the electronic platform to be more acceptable to students, particularly in terms of engagement and providing a stimulating learning environment.

Progressive Multifocal Leukoencephalopathy in immunocompetent a case report and review of literature

Objective: NA Background: Progressive multifocal leukoencephalopathy, (PML) a demyelinating disease of the brain, caused by the John Cunningham (JC Virus) is usually seen in patients who are immunocompromised. Here, we describe a case of an immunocompetent patient diagnosed with PML and a comprehensive literature review. Case Description: A 64-year-old Caucasian male presented with acute worsening of progressive neurological decline with difficulty in vision and reading. The patient was diagnosed with Coronavirus disease 2019 (COVID-19). Following COVID-19 infection he started to have difficulty in maintaining balance, poor attention span and expressive aphasia. Based on history, examination, CSF markers, histopathology, and T2/FLAIR MRI Brain at the time of presentation the patient was diagnosed with PML in a setting of no immunosuppression disorder. Results: In our literature review, it was seen that the average age of symptom presentation was 57.5 with predominance in males. Most of the patients presented with progressive neurological deficits with symptomology ranging from mild confusion, aphasia, anxiety to sensory disturbances with numbness, hemiparesis and hemianopsia. Out of the 21 cases, patients responded to mirtazapine and intravenous pulse methylprednisolone (IVMP). The mortality rate was close to 50% with 11 fatal cases and 10 non-fatal cases. None of the cases had any immunosuppressive conditions or underlying HIV, malignancy, solids organ or stem cell transplants and were not on immunosuppressive medications. Conclusions: Our case and literature review demonstrate the possibility that PML may very rarely occur in patients that are immunocompetent. Furthermore, our review showed that patients responded well to mirtazapine and IVMP. In our case, the patient was treated with Pelfilgrastim with encouraging results and could be explored as a possible treatment option. We also want to highlight that mortality rate was lower in this review and was only compared to mortality in PML associated with immunocompromised status.

Role of adenosine receptors in cardiovascular disorders and novel corona virus infection

Objective: To assess the importance of adenosine signaling in cardiovascular disorders (thrombosis, ischemia) and novel corona virus infection. Methodology: A specified web search was done to gather the relevant information using different scientific research forums and databases like WHO database, Pubmed and Google Scholar etc. Results: Adenosine receptors are P1 type of purinergic receptors and belong to G protein-coupled receptors (GPCRs), which is the largest family of integral membrane bound proteins receptors. Adenosine receptors are further classified into four subclasses known as A1, A2A, A2B, and A3. All four subclasses are being mediated by extracellular adenosine and perform a key role in a wide range of physiological functions such as immune system modulation, angiogenesis and sleep regulation. Adenosine receptors are thought to play a significant role in many pathophysiological conditions including cardiovascular disorders such as ischemia and thrombosis and novel corona virus infection making it a key target against these disorders. Conclusion: We suggest that modulation of adenosine receptor activity could increase the regenerative phase in these disorders by increasing the proliferation and differentiation rates of damaged tissue.

COVID-19 Diagnosis from CXR images through pre-trained Deep Visual Embeddings

COVID-19 is an acute respiratory syndrome that affects the host's breathing and respiratory system. The novel disease's first case was reported in 2019 and has created a state of emergency in the whole world and declared a global pandemic within months after the first case. The disease created elements of socioeconomic crisis globally. The emergency has made it imperative for professionals to take the necessary measures to make early diagnoses of the disease. The conventional diagnosis for COVID19 is through Polymerase Chain Reaction (PCR) testing. However, in a lot of rural societies, these tests are not available or take a lot of time to provide results. Hence, we propose a COVID-19 classification system by means of machine learning and transfer learning models. The proposed approach identifies individuals with COVID-19 and distinguishes them from those who are healthy with the help of Deep Visual Embeddings Inceptionv3, MobileNetv3, and EfficientNetB7, were used in this study along with five different pooling schemes to perform deep feature extraction. In addition, the features are normalized using standard scaling, and 4-fold cross-validation is used to validate the performance over multiple versions of the validation data. The best results of 88.86% UAR, 88.27% Specificity, 89.44% Sensitivity, 88.62% Accuracy, 89.06% Precision, and 87.52% F1-score were obtained using ResNet-50 with Average Pooling and Logistic regression with class weight as the classifier.

The Increasing Prevalence of DM in COVID-19 Patients in North Sudan: Is it a Matter of Diabetogenicity?

Background: COVID-19 had made more than 197 million infections and 4 million death. Therefore, we need to assess the prevalence of DM among COVID-19 patients and its effect on the outcome. Objectives: We aim to assess the prevalence, risk factors and outcome of diabetes among COVID-19 patients. Methods: This was a prospective, cross-sectional, hospital-based study enrolled 400 COVID-19 patients and was conducted in COVID-19 isolation centres in North Sudan. Results: Males constituted 275 (68.9%) of the study participants, and the majority of participants were aged between 40 and 60 years 150(37.4%). The prevalence of DM was found to be 49.25% in the study participants. Diabetics were significantly more likely to have a respiratory rate higher than 30 (P=0.012), and oxygen saturation less than 93% (P<0.001), to develop shock (P=0.004), to require oxygen therapy (P<0.001), to be intubated (P<0.001), to develop respiratory failure and organ failure (P<0.001), and to have a poorer outcome (P<0.001). New-onset diabetes occurred in 20 (5%) participants and their mortality was higher compared to non-patients with diabetes (P=0.04). The total mortality of participants was 15.8%. Factors associated with poorer outcome were older age (P<0.001), and having type 1 diabetes (P=0.025).Conclusion: The prevalence of diabetes is very high among COVID-19 patients, and is associated with a more severe disease and a poorer outcome. New onset diabetes was associated with poorer outcome compared to non-diabetics.

The Increasing Prevalence of Diabetes Mellitus in COVID-19 Patients: Why?

Coronavirus infection disease 2019 (COVID-19) is caused by SARS COV-2 and it has been increasing continuously in a number of cases and mortalities. COVID-19 had caused more than 197 million infections and 4 million deaths. This study aimed to assess the prevalence, risk factors and outcome of Diabetes Meletus (DM) among COVID-19 patients. Prospective, cross-sectional, hospital-based study conducted in which 400 COVID-19 patients enrolled in COVID-19 isolation centers in North Sudan. In this study, we noticed that most of the participants were males and constituted 275 (68.9%) of the study participants, the majority of participants' ages ranged were between 40 to 60 years and was 150 (37.4%). The prevalence of DM was found to be 49.25% among the study participants. Diabetics were significantly more likely to have a respiratory rate higher than 30 (P=0.012), and oxygen saturation less than 93% (P<0.001), to develop shock (P=0.004), to require oxygen therapy (P<0.001), to be intubated (P<0.001), to develop respiratory failure and organ failure (P<0.001), and to have a poorer outcome (P<0.001). New-onset diabetes occurred in 20 (5%) participants and their mortality was higher compared to non-patients with diabetes (P=0.04). The total mortality of participants was 15.8%, factors associated with poorer outcomes were older age (P<0.001), and having type I diabetes (P=0.025). The prevalence of diabetes is very high among COVID-19 patients, and is associated with a more severe disease and a poorer outcome. New onset diabetes was associated with poorer outcomes compared to non-diabetics. More researches requested to discover more risk factors and complications associated with Covid-19.

COVID-19-related job insecurity and employees’ behavioral outcomes: mediating role of emotional exhaustion and moderating role of symmetrical internal communication

Purpose: This study aims to examine the impact of COVID-19-related job insecurity on two types of employees’ behaviors: family undermining and withdrawal. This study also proposes emotional exhaustion as a mediator and symmetrical internal communication as a moderator in the relationship between COVID-19-related job insecurity and employees’ behaviors. Design/methodology/approach: Using a time-lagged design, data were gathered from 193 employees working in Pakistan’s hospitality sector. Structural equation modeling in AMOS and PROCESS Macro were used to test the hypotheses. Findings: The results show that COVID-19-related job insecurity is positively related to family undermining and withdrawal behaviors, and these associations are mediated by emotional exhaustion. Furthermore, symmetrical internal communication weakens the positive influence of COVID-19-related job insecurity on emotional exhaustion. Additionally, the indirect impact of COVID-19-related job insecurity on employees’ behavioral outcomes via emotional exhaustion is stronger for employees with low symmetrical internal communication than for those with high levels of symmetrical internal communication. Practical implications: Hospitality management needs to focus on transparent and horizontal communication patterns to reduce the ensuing negative behaviors from COVID-19-related job insecurity. Originality/value: To the best of the authors’ knowledge, this is the first study to examine the impact of COVID-19-related job insecurity on two types of employees’ behaviors: family undermining and withdrawal. This study also offers new insights via mediating mechanisms and moderators associated with the relationship between COVID-19-related job insecurity and employees’ behavioral reactions. © 2022, Emerald Publishing Limited.

Does Bacillus Calmette-Guerin vaccination protects from COVID-19? A Uni-center Study

Bacillus Calmette-Guerin (BCG) is a vaccine for tuberculosis and is administered at birth in several countries, however there are many countries that have no BCG vaccination policy and coincidently they are worst hit by Covid-19 pandemic in terms of disease severity and mortality.The study was conducted to determine the association between BCG vaccine and COVID-19 severity. Study included total 150 participants visiting Department of Medicine, Mayo Hospital, Lahore, Pakistan. Data regarding BCG vaccination, comorbidity, demographics, disease severity were collected through self-structured questionnaire using non-probability convenient sampling. Prior written informed consents were taken from the participants. Male and female were in equal proportion. 68.6% were married, only 3.9% were smokers. Analysis revealed that only 10 (6.5%) were hypertensive and10 (6.5%) were diabetic. There was no BCG vaccine protection against Covid-19 in the current study. Severity of disease was similar in vaccinated and non-vaccinated patients. But it can not be applicable to whole population. Another fact is that most of Pakistani population is BCG vaccinated due to national policy and coincidently Pakistan suffered less as compared to high hit countries. There maybe some association between BCG vaccination and Covid-19 or some other environmental factor and genetics that need to be explored.

Artificial intelligence in COVID-19 evidence syntheses was underutilized, but impactful: a methodological study.

OBJECTIVES: A rapidly developing scenario like a pandemic requires the prompt production of high-quality systematic reviews, which can be automated using artificial intelligence (AI) techniques. We evaluated the application of AI tools in COVID-19 evidence syntheses. STUDY DESIGN: After prospective registration of the review protocol, we automated the download of all open-access COVID-19 systematic reviews in the COVID-19 Living Overview of Evidence database, indexed them for AI-related keywords, and located those that used AI tools. We compared their journals' JCR Impact Factor, citations per month, screening workloads, completion times (from pre-registration to preprint or submission to a journal) and AMSTAR-2 methodology assessments (maximum score 13 points) with a set of publication date matched control reviews without AI. RESULTS: Of the 3,999 COVID-19 reviews, 28 (0.7%, 95% CI 0.47-1.03%) made use of AI. On average, compared to controls (n = 64), AI reviews were published in journals with higher Impact Factors (median 8.9 vs. 3.5, P < 0.001), and screened more abstracts per author (302.2 vs. 140.3, P = 0.009) and per included study (189.0 vs. 365.8, P < 0.001) while inspecting less full texts per author (5.3 vs. 14.0, P = 0.005). No differences were found in citation counts (0.5 vs. 0.6, P = 0.600), inspected full texts per included study (3.8 vs. 3.4, P = 0.481), completion times (74.0 vs. 123.0, P = 0.205) or AMSTAR-2 (7.5 vs. 6.3, P = 0.119). CONCLUSION: AI was an underutilized tool in COVID-19 systematic reviews. Its usage, compared to reviews without AI, was associated with more efficient screening of literature and higher publication impact. There is scope for the application of AI in automating systematic reviews.

The Increasing Prevalence of DM in COVID-19 Patients: Is it a Matter of Diabetogenicity?

Background: COVID-19 had made more than 197 million infections and 4 million deaths. Therefore, we need to assess the prevalence of DM among COVID-19 patients and its effect on the outcome. Objectives: We aim to assess the prevalence, risk factors and outcome of diabetes among COVID-19 patients. Methods: This was a prospective, cross-sectional, hospital-based study enrolled 400 COVID-19 patients and was conducted in COVID-19 isolation centers in North Sudan. Results: Males constituted 275 (68.9%) of the study participants, and the majority of participants were aged between 40 and 60 years 150(37.4%). The prevalence of DM was found to be 49.25% in the study participants. Diabetics were significantly more likely to have a respiratory rate higher than 30 (P=0.012), and oxygen saturation less than 93% (P<0.001), to develop shock (P=0.004), to require oxygen therapy (P<0.001), to be in tubated (P<0.001), to develop respiratory failure and organ failure (P<0.001), and to have a poorer outcome (P<0.001). New-onset diabetes occurred in 20 (5%) participants and their mortality was higher compared to non-patients with diabetes (P=0.04). The total mortality of participants was 15.8%. Factors associated with poorer outcome were older age (P<0.001), and having type I diabetes (P=0.025). Conclusion: The prevalence of diabetes is very high among COVID-19 patients, and is associated with a more severe disease and a poorer outcome. New onset diabetes was associated with poorer outcome compared to non-diabetics.

The Impact of the Coronavirus (COVID-19) Pandemic on Access to Care and Basic Necessities of Emergency Department Patients With Opioid Use Disorders Who Are Linked to Treatment

Study Objective: COVID-19 has immensely impacted access to medical care for marginalized people, including people with substance use disorders. A needs assessment survey was created to assess the needs of patients enrolled in our emergency department’s (ED’s) peer navigator care linkage program for patients with opioid use disorder during COVID-19. The navigator program is a team of peer and student navigators at our ED that coordinates care for patients with opioid use disorder, to provide them with social support and links them to medications for opioid use disorder. We retrospectively reviewed the responses to the needs assessment survey to better understand the implications of COVID-19 on access to medical care and basic necessities for this vulnerable population. Methods: This was an IRB-approved, retrospective review of survey responses collected from April 2020 until April 2021. Patients surveyed were enrolled in our departmental peer navigator program as they presented to the ED with opioid-related complications (such as opioid overdose);the program started within the last two years. The survey consisted of questions that addressed how the pandemic impacted their ability to access medical care, inclination to seek medical care, and access to basic necessities such as housing and food. Participation was voluntary and the survey was administered by phone by the peer navigators and student volunteers. All survey responses were summarized using descriptive statistics. Results: A total 181 patients were contacted, 69 of whom responded (38.1%). During the pandemic, 27.5% of respondents did not feel comfortable going to the ED for medical or psychiatric care, 21.7% had no alternative care site, and 20.3% were unable to access other addiction treatment services. Although telehealth was an alternative, 39.1% of the subjects did not have access to an appropriate device (eg, smartphone) and 37.7% did not have reliable internet access. During the pandemic, 33.3% (23) of respondents lost employment, and of that population, only 47.8% (11) qualified for unemployment assistance. Meals were often skipped by 20.1% of respondents and 42.0% reported not living in stable housing. Conclusion: This survey illuminates the barriers to medical care and basic necessities for our substance using patient population, many of which may have been present before the COVID-19 pandemic. The results provide direction for resource allocation both currently and in the future. For example, to assist those who were unable to participate in a telehealth appointment, we are considering expansion of an existing program to provide patients with internet-capable cell phones. Future research should explore which interventions are most effective under similar circumstances.