ABSTRACT
BackgroundUpadacitinib (UPA) is an oral JAK inhibitor (JAKi) approved for the treatment of RA. JAKi have been associated with an elevated risk of herpes zoster (HZ) in patients (pts) with RA. The adjuvanted recombinant zoster vaccine (RZV, Shingrix) was shown to be well-tolerated and effective in preventing HZ in adults aged ≥ 50 years.[1] The efficacy and safety of RZV have not been studied in pts with RA while on UPA in combination with MTX.ObjectivesTo assess the immunogenicity of RZV in pts with RA receiving UPA 15 mg once daily (QD) with background MTX.MethodsEligible adults aged ≥ 50 years with RA enrolled in the ongoing SELECT-COMPARE phase 3 trial (NCT02629159) received two RZV doses, administered at the baseline and week (wk) 12 visits. Pts should have been on stable doses of UPA 15 mg QD and background MTX for ≥ 8 wks before the first vaccination and ≥ 4 wks after the second vaccination. Antibody titers were collected pre-vaccination (baseline), 4 wks post-dose 1 vaccination (wk 4), and 4 wks post-dose 2 vaccination (wk 16). The primary endpoint was the proportion of pts with a humoral response to RZV defined as ≥ 4-fold increase in pre-vaccination concentration of anti-glycoprotein E [gE] titer levels at wk 16. Secondary endpoints included humoral response to RZV at wk 4 and the geometric mean fold rise (GMFR) in anti-gE antibody levels at wks 4 and 16. Cell-mediated immunogenicity to RZV was an exploratory endpoint evaluated by the frequencies of gE-specific CD4+ [2+] T cells (CD4+ T cells expressing ≥ 2 of 4 activation markers: IFN-γ, IL-2, TNF-α, and CD40 ligand) measured by flow cytometry at wks 4 and 16 in a sub-cohort of pts.ResultsOf the 95 pts who received ≥ 1 RZV dose, 93 (98%) received both RZV doses. Pts had a mean (standard deviation) age of 62.4 (7.5) years. The median (range) disease duration was 11.7 (4.9–41.6) years and duration of UPA exposure was 3.9 (2.9–5.8) years. At baseline, all but 2 pts were receiving concomitant MTX and half (50%) were taking an oral corticosteroid (CS) at a median daily dose of 5.0 mg. One pt discontinued UPA by wk 16. Blood samples were available from 90/93 pts. Satisfactory humoral responses to RZV occurred in 64% (95% confidence interval [CI]: 55–74) of pts at wk 4 and 88% (81–95) at wk 16 (Figure 1). Age (50–< 65 years: 85% [95% CI: 75–94];≥ 65 years: 94% [85–100]) and concomitant CS (yes: 87% [77–97];no: 89% [80–98]) use at baseline did not affect humoral responses at wk 16. GMFR in anti-gE antibody levels compared with baseline values were observed at wks 4 (10.2 [95% CI: 7.3–14.3]) and 16 (22.6 [15.9–32.2]). Among the sub-cohort of pts, nearly two-thirds achieved a cell-mediated immune response to RZV (wk 4: n = 21/34, 62% [95% CI: 45–78];wk 16: n = 25/38;66% [51–81]). Within 30 days post-vaccination of either RZV dose, no serious adverse events (AEs) (Table 1) or HZ were reported. AEs that were possibly related to RZV were reported in 17% of pts. One death occurred more than 30 days after wk 16 due to COVID-19 pneumonia.ConclusionMore than three-quarters (88%) of pts with RA receiving UPA 15 mg QD on background MTX achieved a satisfactory humoral response to RZV at wk 16. In a subgroup of pts, two-thirds (66%) achieved a cell-mediated immune response to RZV at wk 16. Age and concomitant CS use did not negatively affect RZV response.Reference[1]Syed YY. Drugs Aging. 2018;35:1031–40.Table 1. Safety Results Through 30-Days Post-RZV Vaccination in UPA-Treated PatientsEvent, n (%)UPA 15 mg QD (N = 95)Any AE38 (40%)AE with reasonable possibility of being related to UPAa13 (14%)AE with reasonable possibility of being related to RZVa16 (17%)Severe AEb1 (1%)Serious AE0AE leading to discontinuation of UPA0Death0AE, adverse event;QD, once daily;RZV, adjuvanted recombinant zoster vaccine;UPA, upadacitinib.aAs assessed by the investigator.bHypersensitivity.AcknowledgementsAbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, review, and approval of the . All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship. Medical writing support was provided by Julia Zolotarjova, MSc, MWC, of AbbVie.Disclosure of InterestsKevin Winthrop Consultant of: AbbVie, AstraZeneca, BMS, Eli Lilly, Galapagos, Gilead, GSK, Novartis, Pfizer, Regeneron, Roche, Sanofi, and UCB, Grant/research support from: AbbVie, AstraZeneca, BMS, Eli Lilly, Galapagos, Gilead, GSK, Novartis, Pfizer, Regeneron, Roche, Sanofi, and UCB, Justin Klaff Shareholder of: AbbVie, Employee of: AbbVie, Yanxi Liu Shareholder of: AbbVie, Employee of: AbbVie, CONRADO GARCIA GARCIA: None declared, Eduardo Mysler Speakers bureau: AbbVie, Amgen, AstraZeneca, BMS, Eli Lilly, GlaxoSmithKline, Pfizer, Roche, and Sandoz, Consultant of: AbbVie, Amgen, AstraZeneca, BMS, Eli Lilly, GlaxoSmithKline, Pfizer, Roche, and Sandoz, Alvin F. Wells Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Novartis, Pfizer, and Sanofi, Xianwei Bu Shareholder of: AbbVie, Employee of: AbbVie, Nasser Khan Shareholder of: AbbVie, Employee of: AbbVie, Michael Chen Shareholder of: AbbVie, Employee of: AbbVie, Heidi Camp Shareholder of: AbbVie, Employee of: AbbVie, Anthony Cunningham Consultant of: GSK, Merck Sharp & Dohme, and BioCSL/Sequirus.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is a fatal pandemic viral disease caused by the severe acute respiratory syndrome corona virus type-2 (SARS-CoV-2). The aim of this study is to observe the associations of IL-6, SARS-COV-2 viral load (RNAemia), IL- 6 gene polymorphism and lymphocytes and monocytes in peripheral blood with disease severity in COVID-19 patients. This study was carried out from March 2021 to January 2022. RT-PCR positive 84 COVID-19 patients and 28 healthy subjects were enrolled. Blood was collected to detect SARS-COV-2 viral RNA (RNAemia) by rRT-PCR, serum IL-6 level by chemiluminescence method, SNPs of IL-6 by SSP-PCR, immunophenotyping of lymphocytes and monocyte by flow cytometry. Serum IL-6 level (pg/ml) was considerably high among critical patients (102.02 +/- 149.7) compared to severe (67.20 +/- 129.5) and moderate patients (47.04 +/- 106.5) and healthy controls (3.5 +/- 1.8). Serum SARS-CoV-2 nucleic acid positive cases detected mostly in critical patients (39.28%) and was correlated with extremely high IL-6 level and high mortality (R =.912, P < 0.001). Correlation between IL-6 and monocyte was statistically significant with disease severity (severe group, p < 0.001, and 0.867*** and critical group p < 0.001 and 0.887***). In healthy controls, moderate, severe and critically ill COVID-19 patients, IL-6 174G/C (rs 1800795) GG genotype was 82.14%, 89.20%, 67.85% and 53.57% respectively. CC and GC genotype had strong association with severity of COVID-19 when compared with GG genotype. Significant statistical difference found in genotypes between critical and moderate groups (p < 0.001, OR-10.316, CI-3.22-23.86), where CC genotype was associated with COVID-19 severity and mortality. The absolute count of T cell, B cell, NK cell, CD4+ T cells and CD8+ T cells were significantly decreased in critical group compared to healthy, moderate and severe group (P < 0.001). Exhaustion marker CD94/NKG2A was increased on NK cells and CD8+ cytotoxic T cell among critical and severe group. Absolute count of monocyte was significantly increased in critical group (P < 0.001). Serum IL-6, IL-6 174 G/C gene and SARS-CoV-2 RNAaemia can be used in clinical practice for risk assessment;T cell subsets and monocyte as biomarkers for monitoring COVID-19 severity. Monoclonal antibody targeting IL-6 receptor and NKG2A for therapeutics may prevent disease progression and decrease morbidity and mortality.Copyright © 2023 Elsevier Inc.
ABSTRACT
Background: The recent pandemic prompted a number of clinical trials to assess the efficacy and safety of medication use for the treatment for COVID-19. As pregnant women are excluded or vastly underrepresented in clinical research, there is a paucity of data on how pregnancy and perinatal outcomes are impacted by such medications. Considering that pregnant women are at increased risk for COVID-19 infection and that pregnancy is also associated with an increased risk of developing severe COVID-19, it is of utmost importance to assess the effect of gestational medications use for COVID-19 on pregnancy outcomes. Objective(s): The aims of this systematic review were to (1) determine and quantify COVID-19-specific and repurposed medication use during pregnancy, and (2) provide an overview of the pregnancy and neonatal outcomes that have occurred in COVID-19-positive pregnant women exposed to COVID-19-specific or repurposed medications compared to use in pregnant women without COVID-19;neonatal outcomes compared between COVID-19 positive pregnant women treated and untreated with these medications. Method(s): A systematic literature search was conducted in Ovid and executed in the following databases: MEDLINE, Embase, and Global Health. Search strategies applied combined database-specific subject headings and keywords relevant to the topic. Some subject headings used in databases were pregnancy outcome, COVID-19, SARS-CoV-2, pharmaceutical preparations, drugs, and prescription. Some keywords used for the searches were pregnancy outcome, neonatal outcome, coronavirus disease 2019, drug, medication, and treatment. For each database, keywords were searched within the , keyword heading word or heading words, and title fields. Restrictions were applied regarding the date of publication and searches were limited to English publications. Study selection was accomplished by two independent investigators (NSK, NAB). Only original research articles were considered for inclusion. Included studies investigated pregnancy or neonatal outcomes in women with COVID-19 receiving medication to treat COVID-19. A standardized extraction form was used to independently extract relevant information. Result(s): The literature search yielded a total of 344 records. After deduplication, 69 records were removed. The title and of 275 publications were screened.
ABSTRACT
COVID-19 is a multisystem disease that requires holistic management. Most patients will experience mild symptoms including cough, fever and mild dyspnoea. A small proportion of patients will have severe manifestations including respiratory failure, ARDS and multiorgan failure. Extrapulmonary features are common and include gastrointestinal, thromboembolic, neurological, cardiac, renal, endocrine and dermatological manifestations. The care of COVID-19 patients requires close attention to these features. This includes respiratory support (such as supplemental oxygen, NIV and awake proning);fluid, electrolyte and nutrition management;prevention, detection and treatment of thrombotic events;management of diabetic complications;review of medications;appropriate use of antibiotics;and evidence-based use of therapeutic agents such as corticosteroids, antivirals such as remdesivir and other emerging therapies such as immunomodulating agents. Early planning for treatment escalation and decision making around the appropriateness of cardiopulmonary resuscitation are crucial as deterioration can be rapid. Prolonged symptoms occur in a minority of patients and longitudinal follow-up is required.Copyright © ERS 2021.
ABSTRACT
Society must understand, model, and forecast infectious disease transmission patterns in order to prevent pandemics. Mathematical models and computer technology may help us better understand the pandemic and create more systematic and effective infection management strategies. This study offers a novel perspective through a compartmental model that incorporates fractional calculus. The first scenario is based on proportional fractional definitions, considering compartmental individuals of susceptible, moving susceptible, exposed, infected, hospitalized, and recovered. Through an extension of this derivative, they decimated the model to integer order. We extended the deterministic model to a stochastic extension to capture the uncertainty or variance in disease transmission. It can develop an appropriate Lyapunov function to detect the presence and uniqueness of positive global solutions. Next, we discuss how the epidemic model might have become extinct. In our theoretical study, we demonstrated that a sufficiently outrageous amount of noise can cause a disease to become extinct. A modest level of noise, on the other hand, promotes the persistence of diseases and their stationary distribution. The Khasminskii method was used to determine the stationary distribution and ergodicity of the model.
ABSTRACT
Background: COVID-19 pandemic has influenced health care delivery. We conducted an observational study to understand how obstetric medicine (ObM) physicians utilized home blood pressure monitoring (HBPM) to manage hypertension in pregnancy. Method(s): Pregnant participants with risk factors or diagnosis of hypertensive disorders of pregnancy (HDP) were enrolled, May 2020-December 2021, and provided with validated home blood pressure (BP) monitor. ObM physicians completed questionnaires to elicit how home BP readings were interpreted to manage HDP. Result(s): We enrolled 103 people: 44 antepartum patients (33.5 +/- 5 years, gestational age of 24 +/- 5 weeks);59 postpartum patients (35 +/- 6 years, enrolled 6 +/- 4 days post-partum). ObM physicians used range of home BP readings (70%) for management of HDP. Conclusion(s): HBPM to manage HDP is acceptable and can be used to manage hypertension during pregnancy. Further studies are needed to assess the generalizability of our findings and the safety of HBPM reliance alone in management of HDP.Copyright © The Author(s) 2023.
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With an increase in teledermatology, accelerated by the Covid-19 pandemic, leaders at Penn Medicine recognized a need to improve the value of videoconference-based visits by developing an innovative process to simplify the method by which patients can share photos in advance of the visit while automating instructions and reminders for patients to reduce the burden on staff. The process enables patients to submit photos via cell phone text attachments rather than using the traditional patient portal, if they prefer. Initial results show improvements in patient compliance and engagement, photo quality, and teledermatology encounters. Copyright © 2022 Massachusetts Medical Society.
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A novel method for assessing the effectiveness of enrichment evaluations PROMETHEE combining pentagonal intuitionistic fuzzy numbers (PIFNs) and preference rank-ing organization is presented in the present paper. PIFN suggests a new technique for multi -criteria group decision making (MCGDM) in which two characteristic values of membership and non-membership functions are involved. The key practicality of incorporating PIFN in decision -making is its effective capability of managing the vagueness and uncertainties of linguistic terms used during discussions. The designed algorithm is then applied to get an appropriate, cost-effective, and publicly accepted awareness campaign to be used to forewarn populaces about any virulent disease, which has not been studied before. Importantly, it is the only way to protect any huge population of a country from any fatal disease, i.e. to be timely aware of the disease's transmissibility, severity, and precautionary measures through any effectively ap-proachable source. Here, we consider alternative sources of campaigns, such as commercial advertisement on television, on social media, on bills /other government circulars, billboards, and door-to-door volunteering for guidance. These alternative campaigns are based on five generalized criteria, where the weight of each criterion is evaluated via the fuzzy analytical hier-archy process (F-AHP). After using the F-AHP for complex decisions based on acceptance and effectiveness, the F-PROMETHEE algorithm is applied to achieve the closest ideal alternative.
ABSTRACT
The current global health crisis is a consequence of the pandemic caused by COVID-19. It has impacted the lives of people from all factions of society. The re-emergence of new variants is threatening the world, which urges the development of new methods to prevent rapid spread. Places with more extensive social dealings, such as offices, organizations, and educational institutes, have a greater tendency to escalate the viral spread. This research focuses on developing a strategy to find out the key transmitters of the virus, particularly at educational institutes. The reason for considering educational institutions is the severity of the educational needs and the high risk of rapid spread. Educational institutions offer an environment where students come from different regions and communicate with each other at close distances. To slow down the virus's spread rate, a method is proposed in this paper that differs from vaccinating the entire population or complete lockdown. In the present research, we identified a few key spreaders, which can be isolated and can slow down the transmission rate of the contagion. The present study creates a student communication network, and virus transmission is modeled over the predicted network. Using student-to-student communication data, three distinct networks are generated to analyze the roles of nodes responsible for the spread of this contagion. Intra-class and inter-class networks are generated, and the contagion spread was observed on them. Using social network strategies, we can decrease the maximum number of infections from 200 to 70 individuals, with contagion lasting in the network for 60 days.
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The COVID-19 pandemic has spurred extensive vaccine research worldwide. One crucial part of vaccine development is the phase III clinical trial that assesses the vaccine for safety and efficacy in the prevention of COVID-19. In this work, we enumerate the first successful implementation of using machine learning models to accelerate phase III vaccine trials, working with the single-dose Johnson & Johnson vaccine to predictively select trial sites with naturally high incidence rates ("hotspots"). We develop DELPHI, a novel, accurate, policy-driven machine learning model that serves as the basis of our predictions. During the second half of 2020, the DELPHI-driven site selection identified hotspots with more than 90% accuracy, shortened trial duration by six to eight weeks (approximately 33%), and reduced enrollment by 15,000 (approximately 25%). In turn, this accelerated time to market enabled Janssen's vaccine to receive its emergency use authorization and realize its public health impact earlier than expected. Several geographies identified by DELPHI have since been the first areas to report variants of concern (e.g., Omicron in South Africa), and thus DELPHI's choice of these areas also produced early data on how the vaccine responds to new threats. Johnson & Johnson has also implemented a similar approach across its business including supporting trial site selection for other vaccine programs, modeling surgical procedure demand for its Medical Device unit, and providing guidance on return-to-work programs for its 130,000 employees. Continued application of this methodology can help shorten clinical development and change the economics of drug development by reducing the level of risk and cost associated with investing in novel therapies. This will allow Johnson & Johnson and others to enable more effective delivery of medicines to patients.
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The novel coronavirus (COVID-19) has become a global concern due to the unprecedented catastrophe it has brought about. Social stigma around COVID-19 has become another concern in many areas. This study employs a qualitative approach in analyzing and discussing cultural perceptions and experiences of social stigma and suffering around COVID-19 in Bangladesh. This paper argues that socio-cultural and religious practices and various new metaphors in day-to-day linguistic usage around COVID-19 created and shaped social stigma with social suffering for the suspected, infected, associated, and even recovered individuals and groups. The findings show that stigmatization around COVID-19 takes place due to fear of infection, perceived loss of social status, discrimination in social life, and exclusion from standard health services, all of which need to be addressed in health and related policies in the future. © OpenEditions Journals. All Rights Reserved.
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A new coronavirus that caused the Covid-19 sickness, has already elevated the threat to humans. The virus is quickly spreading around the planet. Therefore, in order to detect sick individuals and stop the infection from spreading, it is vital that we develop fast diagnostic tests. The advancement of machine learning would make it possible to implement pre- ventative actions as soon as possible by enabling early detection of Covid19. However, insufficient sample sizes, particularly chestX-ray pictures, has made it more challenging to diagnose this ailment. In this study, we examined a number of these recently created transfer learning-based CNN models that can identify COVID-19 in lung CT or images of X-ray to diagnose Covid-19 using images of X-ray. We gathered data on the research resources that are readily available. We looked into and examined datasets, pre-processing methods, segmentation approaches, extraction of features, classification, and experimentation outcomes that could be useful for determining future research paths in the area of applying transfer learning based CNN models to diagnose COVID-19 disease. We have analyzed various models such as ResNet50, DenseNet-21, VGG-16, ImageNet, and some hybrid models and evaluated their performance matrix with a particular set of data used in their research work. Additionally, in orderfor a model to perform at its best, it is observed that there aren't enough data sets of COVID-19-infected individuals. This calls for augmentation, segmentation, and domain adaptation in transfer learning. © 2022 IEEE.
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Objective: The current study was conducted to determine whether people will keep practicing physical distancing behavior as part of their daily lives after the end of the COVID-19 pandemic. Material(s) and Method(s): A structured questionnaire was prepared online using "Question Pro" software for surveys, and the study was conducted electronically. The questionnaire for the study had two components, the first was related to the partic-ipant's demographics, and the other was about physical distancing questions. There were 16 questions in total. Result(s): Women were more fearful/careful and would want to limit socializing than men. The religious aspect is one primary reason people will be willing to avoid physical distancing. Physical distancing was more acceptable to people with higher education levels. This physical distancing trend might affect the public transportation and tourism industry. Conclusion(s): This study showed that the female gender and population with higher education are willing to follow better ad-herence to SOPs of the COVID-19 pandemic.Copyright © 2023, Khyber Medical College. All rights reserved.
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Purpose: Working remotely in a COVID-19-induced lockdown has been challenging for both organisations and their employees;studies report that job demands changed, and teleworkers experienced increased burnout. This paper explores the negative employee outcomes that this work arrangement brings along and offers possible solutions to counter such negative outcomes since they could be detrimental to the much-touted future of work. Design/methodology/approach: The study adopted a time-lagged longitudinal design and collected two-waved data from 403 quaternary sector employees. The data were analysed using structural equation modelling and model-21 in PROCESS macro for SPSS. Findings: Findings affirm that employees experienced increased job demands during this crisis. Employees reported an increase in turnover intention because of burnout caused by increased job demands. However, increased task interdependence alone did not have any effect on turnover intention. The perceived organisational task support (POTS) was found to forestall the negative effect of job demands on burnout, and employee resilience (ER) buffered the burnout and turnover intention relationship. Practical implications: Providing remote work task support and boosting resilience among employees will help in doing away with the negative effects of teleworking. However, managers shall prioritise reducing job demands for teleworkers. Originality/value: The linkage between work factors and turnover intention is well established. Drawing on the event system theory and using the COVID-19 context, the present study added to the existing knowledge by studying the role of job demands (workload pressure and task interdependence) on turnover intention through the mediation of burnout. The study goes beyond the existing literature by accounting for POTS as a first-level moderator between job demands and burnout relationship, and ER as a second-level moderator between burnout and turnover intention relationship. © 2023, Emerald Publishing Limited.
ABSTRACT
There have been 6,566,610 fatalities and 626,337,158 reported cases of COVID-19 worldwide. Pakistan presently has over 1,573,922 confirmed cases and 30,625 deaths. A survey-based study was performed from January to September 2022 among different university communities to find out their KAP level. Data was collected in Google Forms through a questionnaire. The Independent t-test, Multinomial regressions, and Non-parametric Mann-Whitney test were used to assess the level of significance (p-value ≤0.05). 317 out of 605 participants were male (52.5 %), the majority of participants were 15-29 years old (72.7 %), unmarried/divorced (71.6 %), have no children (82.1 %), residing in the urban area (54.9 %) and possess a college/university degree (59.5 %). The majority of participants correctly answered five out of six knowledge questions (M = 4.96, SD = 1.03) and correctly identified the primary symptoms of COVID-19 (94.4 %) along with the proper identification of mode of transmission (95.2 %) while 1.8% wrongly replied and 2.1 % did not reply. A knowledge test revealed the significant frequency of misconception, with nearly half of the respondents (46.3 %) assuming that illness might be contracted by eating or coming into touch with wild animals. Wearing a facial mask is highly practiced (M = 3.59, SD = 0.91), followed by avoiding crowded places (M = 3.44, SD = 0.95) and practicing hand hygiene (M = 3.36, SD = 1.04). Females, the elderly, and the less educated, on the other hand, have less understanding of COVID-19, making them especially susceptible to the pandemic. It is proposed that further awareness might contribute to a favorable attitude and practice. © Pakistan Academy of Sciences.
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Background & Purpose: Home blood pressure monitoring (HBPM) in pregnant women is common, but uncertainty exists on utilization of home blood pressure (BP) readings for management of hypertensive disorders of pregnancy (HDP). We conducted a qualitative improvement study to understand how physicians utilize HBPM for pregnant patients and patient acceptability. Method(s): Pregnant patients with risk factors for HDP were recruited. Participants were provided with a validated home BP monitor (Microlife Watch BP) and monitored their BP two times in the morning/evening and manually entered data into a paper diary. Obstetrical Medicine physicians completed written survey after each clinic visit to understand how they used HBPM. Surveys were sent to all participants to assess acceptability of HBPM. Result(s): In total, 103 women were recruited for the study, of which, 43% were enrolled antepartum (mean age 34+/-5 years;mean gestation 171+/-61 days) and 57% postpartum (mean age 35+/-6 years;mean days postpartum 6+/-4 days). Median compliance with home BP readings was 0.94 (IQR 0.57, 1.00). Obstetrical Medicine physicians relied on the range of HBPM readings (70%) to make clinical decisions for management of HDP. Antepartum, 13% of clinic visits resulted in an increase of antihypertensive medications, and 82% required no change in medication. Post-partum, 44% of visits required a decrease anti-hypertensive medication. 98% of participants found HBPM easy to do, and 51% were able to strictly adhere to their measurement schedule. Barriers to HBPM included newborn care (57%), forgetting to check (39%), and lack of time in the mornings (35%). Conclusion(s): HBPM to manage HDP is acceptable to patients and can be safely used to manage HDP ante-partum and post-partum. In light of the COVID-19 pandemic and increasing demand for virtual healthcare visits, further studies are need to assess the effectiveness of HBPM on management of HDP.
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Objective: To determine prevalence of online fatigue among academicians and to analyse factors associated with online fatigue. Study Design: Analytical, cross-sectional study. Place and During of Study: The study was conducted online from Nov 2021 to Apr 2022 on academicians belonging to educational institutions and teaching hospitals of Rawalpindi Pakistan. Methodology: One hundred fifty academicians, aged 20-75 years, belonging to Rawalpindi were enrolled through snowball sampling. Data was collected online by using google forms. A validated questionnaire having an online fatigue scale was used. Partial responses were excluded. Qualitative variables were expressed as frequency and percentage while quantitative variables were expressed as mean and S.D. Chi-square test was applied. Results: Out of 150 academics, 72(48%) were males and 78(52%) were females. Mean age of participants was 32±9.4 years. Amongst the study participants 27(18%), 67(44.7%), 50(33.3%) and 6(4%) suffered from mild, moderate, severe and extreme online fatigue respectively. The degree of online fatigue was found to be significantly associated with female gender (p=0.000), older age (p=0.005) and higher level of education (p=0.002). Association of online fatigue with factors such as workplace (p=0.054), residence (p=0.129) and amount of technology usage (p=0.995) was found to be statistically insignificant. Conclusions: Our study showed that online fatigue was prevalent among the academic community of Rawalpindi, especially females. Online fatigue can be reduced by training the academicians about work-life balance and updating their knowledge on practical technology. © 2022, Army Medical College. All rights reserved.
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Objectives: To assess perceptions of parents regarding vaccinating their children against COVID-19 and to assess the prevalence of COVID-19 vaccine hesitancy as compared to routine childhood vaccinations. Study Design: Analytical, cross-sectional, quantitative study Place and Duration of Study: Study was conducted in Rawalpindi/Islamabad Pakistan, from Nov 2021 to Apr 2022. Methodology: Parents having children of either gender, 12 to 18 years of age, residents of Rawalpindi/Islamabad Pakistan were included in the study. Study was conducted online using Google forms. Sample size of 303 was taken and participants were enrolled through non probability convenience sampling. Modified Vaccine Hesitancy Scale (VHS) was used. Parental attitudes towards routine childhood vaccinations versus COVID-19 vaccines were compared using paired sample T test. Results: Among 303 parents, 196(64.5%) were willing to vaccinate their child with COVID-19 vaccine. Reasons for COVID-19 vaccine hesitancy included insufficient vaccine safety information (16.8%), avoidance of vaccines/ medications in general (8.9%), inconvenient / painful vaccine administration (7.9%), perceiving child as not at high risk of developing complications of he gets infected by COVID-19(6.3%) and concerns of getting COVID-19 through the vaccine (4.6%). An encouraging attitude was seen among parents for routine childhood vaccination as compared to COVID-19 vaccination with higher mean VHS 2.68±0.44 vs. 2.52±0.43 respectively (p<0.001). Conclusions: A large proportion of parents were hesitant regarding the COVID-19 vaccine as compared to routine childhood vaccines. Relying on the national authorities regarding the immunization information is a much better option to l imit hesitancy. © 2022, Army Medical College. All rights reserved.
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The COVID-19 series is obviously one of the most volatile time series with lots of spikes and oscillations. The conventional integer-valued auto-regressive time series models (INAR) may be limited to account for such features in COVID-19 series such as severe over-dispersion, excess of zeros, periodicity, harmonic shapes and oscillations. This paper proposes alternative formulations of the classical INAR process by considering the class of high-ordered INAR models with harmonic innovation distributions. Interestingly, the paper further explores the bivariate extension of these high-ordered INARs. South Africa and Mauritius' COVID-19 series are re-scrutinized under the optic of these new INAR processes. Some simulation experiments are also executed to validate the new models and their estimation procedures. © 2022 The Author(s)
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Background: With the ongoing SARS-CoV-2 pandemic there is concern for development of Long COVID in patients with immune-mediated diseases treated with immunosuppressive agents. We aimed to determine the incidence of Long COVID among Inflammatory Bowel Disease (IBD) patients and to identify associated risk factors. Our study also aimed at studying the differences in risk of Long COVID among different IBD medication exposures. Method(s): We conducted a retrospective cohort study utilizing a nationwide cohort of patients with IBD in the Veteran Affairs Healthcare System (VAHS). Patients diagnosed with SARS-COV-2 between March 10th, 2020, and January 24th, 2021, were included. All charts were reviewed to determine recent IBD hospitalization, hospitalization for SARS-CoV-2 infection, and stability of IBD control pre and post infection. COVID-19 hospitalizations were also reviewed for intensive care unit requirement (ICU). COVID-19 treatments including remdesivir, monoclonal antibody infusions, and corticosteroids were also ascertained. Primary outcome was development of Long COVID. Cox regression analysis was used to identify variables associated with Long COVID. Result(s): A total of 677 patients with SARS-CoV-2 infection were included, of which 49 (7.3%) were diagnosed with Long COVID (Table 1). No significant differences in IBD medication class between patients with and without Long COVID diagnoses were noted. In multivariable regression analysis, COVID-19 hospitalization (HR 3.56, 95% CI 1.80-7.09, p<0.001), ICU requirement (HR 2.20, 95% CI 1.18-4.08, p=0.01), and COPD (HR 2.41, 95% CI 1.03-5.64, p=0.04) were significantly associated with Long COVID (Table 2). Adjusted survival curves showed that relative to patients who were not hospitalized, patients hospitalized in the ICU had an 8.61-fold increased hazard of Long COVID (HR 8.61, 95% CI 3.98-18.65, p<0.001) (Figure 1). Conclusion(s): Hospitalization and ICU care for COVID-19, as well as pre-existing COPD, were associated with increased risk of developing Long COVID, suggesting that severity of infection with a vulnerable substrate are key drivers of risk. Medications used in the treatment of IBD did not impact the risk of Long COVID. These findings should help reassure and inform IBD patients about the risk of Long COVID.