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1.
Singapore Medical Journal ; 62(1):S39-S42, 2022.
Article in English | EMBASE | ID: covidwho-1822609

ABSTRACT

COVID-19 significantly impacted the teaching-learning-assessment activities in many medical schools. In this article, we discuss the impact of COVID-19 on the Yong Loo Lin School of Medicine, National University of Singapore, focusing on paediatric training and the adaptations of the system and the people. The school developed strategies to promptly disseminate information and safety measures to protect all its staff and students. By leveraging on the school’s infrastructure for technology-enabled learning, good-quality medical training and reliable assessments were able to be carried out swiftly. The paediatric curriculum was crafted based on these principles, and it provided distance-based learning with live and interactive sessions to teach core clinical skills. The faculty also tapped on standardised patients to provide consistent and life-like scenarios. Measures were implemented to minimise challenges with technology-enabled learning. Collectively, efforts from the staff, support from the leadership and students’ adaptations tremendously helped to ease the transition.

2.
International Journal of Public Health ; 67:1604497, 2022.
Article in English | MEDLINE | ID: covidwho-1818034

ABSTRACT

Objective: We examined whether pre-pandemic mental health and sociodemographic characteristics increased the susceptibility of pregnant women and mothers of young children to stress in the early months of the COVID-19 pandemic.

3.
Aids ; 2022.
Article in English | PubMed | ID: covidwho-1806746

ABSTRACT

OBJECTIVE: People living with HIV (PLHIV) co-infected with SARS-CoV-2 are at higher odds of severe diseases. Whereas the immunogenicity of mRNA vaccine and adenovirus-vectored vaccine was similar between PLHIV in stable condition and healthy adults, the effects of inactivated vaccines are not known. DESIGN: Prospective longitudinal observational study in real-world setting. METHODS: Adult PLHIV in care and planning to receive either inactivated (Day 0 and 28) or mRNA-based (Day 0 and Day 21) vaccine against SARS-CoV-2 were recruited, with blood samples collected over 6 months for surrogate virus neutralisation test (sVNT). Demographic and clinical data including age, gender, CD4 count, and suppressed viral load (SVL) status were transcribed for analyses, by simple and multivariable linear regression models, and multivariable linear generalised estimating equations (GEE). RESULTS: A total of 611 HIV patients, 91% male, were recruited, of whom 423 and 184 have received mRNA-based and inactivated vaccine respectively. The seroconversion rate was 99% for mRNA-based vs 86% for inactivated vaccine (OR = 21.56, p = 0.004). At 6 months, mRNA-based vaccine continued to give a higher response (94% vs 57%, p < 0.001). The temporal pattern varied between the 2 vaccines. By GEE, mRNA-based vaccine (B = 40.59, p < 0.001) and latest SVL status (B = 10.76, p = 0.01) were positively associated with sVNT level, but not latest CD4 count. CONCLUSIONS: In HIV patients, inactivated vaccine gave a lower peak and shorter duration of sVNT responses compared to mRNA vaccine. The results suggested that different strategies may be needed in boosting the immunity in anticipation of the emergence of variants in the community.

4.
Emerg Microbes Infect ; : 1-37, 2022.
Article in English | PubMed | ID: covidwho-1806182

ABSTRACT

Fully vaccinated people remain at risk of Coronavirus Disease 2019 (COVID-19). We examined association between prior vaccination and clinical outcomes in patients with COVID-19. Overall, 387 patients with mild-to-severe COVID-19 were enrolled. Patients were considered fully vaccinated at least 14, 7, and 14 days after receiving the second dose of ChAdOx1 nCoV-19 or mRNA-1273, second dose of BNT162b2, or single dose of Ad26.COV2.S, respectively. The primary outcomes (risk of pneumonia, requirement of supplemental oxygen, and progression to respiratory failure) were compared between vaccinated and unvaccinated patients. Logistic regression analysis was performed to identify factors associated with the outcomes. There were 204 and 183 patients in the vaccinated and unvaccinated groups, respectively. The vaccinated group was significantly older and had more comorbidities than the unvaccinated group. Patients in the unvaccinated group were significantly more likely to develop pneumonia (65.6% vs. 36.8%) or require supplemental oxygen (29.0 vs. 15.7%) than the vaccinated group. The vaccinated group had a significantly shorter time from symptom onset to hospital discharge than the unvaccinated group (10 vs. 11 days;p<0.001). The proportion of patients who progressed to respiratory failure did not differ significantly between groups. In multivariable analyses, vaccination was associated with an approximately 70% and 82% lower likelihood of pneumonia and supplemental oxygen requirement, respectively. Being vaccinated was associated with a significantly lower risk of pneumonia and severe disease when breakthrough infection developed. Our findings support continuous efforts to increase vaccine coverage in populations.

5.
Int J Environ Health Res ; : 1-13, 2022.
Article in English | PubMed | ID: covidwho-1795528

ABSTRACT

Exposure setting is crucial in the formation and propagation of SARS-CoV-2 transmission clusters. In this cohort study, transmission networks of 2 waves were differentiated by exposure setting using territory-wide surveillance data with clinical and laboratory records in Hong Kong. Characteristically, the first wave had resulted from imported cases followed by local transmissions, while the second wave was constituted primarily by local infections. With a 4-fold higher caseload, the second wave featured predominance of epidemiologically linked, local, older and asymptomatic patients with higher viral loads and shorter inpatient days. The 1028 transmission clusters formed 155 cascades composing at least two clusters. Daily and social activities were exposure settings that bridged clusters while residences usually terminated transmission cascades. Regulatory restrictions on social activities extinguished cluster formation in bars, but shifted to private parties in the second wave. The results confirmed that strategic interventions targeting exposure settings could achieve effective epidemic control.

6.
J Travel Med ; 2022.
Article in English | PubMed | ID: covidwho-1795212

ABSTRACT

Using two early transmission chains in Hong Kong, the estimated R and k were 1.34 (95%CrI: 0.94-2.19) and 0.33 (95%CrI: 0.17-0.62) respectively, inferring 20.3% (95%CrI: 12.7%-29.6%) cases were responsible for 80% of the transmissions of the Omicron epidemic. Compared with Omicron BA.1, Omicron BA.2 had a greater superspreading potential.

7.
Journal of the Architectural Institute of Korea ; 37(12):329-338, 2021.
Article in Korean | Scopus | ID: covidwho-1776536

ABSTRACT

Recently, as non-face-to-face culture spreads to COVID-19, the time spent indoors is increasing. Accordingly, indoor air quality management has become an important factor. Therefore, the purpose of this study is to evaluate the possibility that chitosan may exist as a building material for reducing air pollutants such as heavy metals and formaldehyde. As a result of the experiment, cement cured binder are better in terms of strength than non-cement cured binder, and as the chitosan substitution rate increases, flexural strength increases and compressive strength decreases. Chitosan has a similar structure to fiber, and chitosan powder has a dispersion-enhancing effect, which is considered to help increase flexural strength. The concentrations of heavy metals and formaldehyde tend to decrease. It is estimated that Chitosan adsorbed fine dust by attracting negative fine dust according to the principle of charge. In addition, it is estimated that heavy metals and formaldehyde were adsorbed due to its excellent chelate properties of chitosan. As a result of the board experiment mixed with chitosan, the durability of the board is excellent as the PVA fiber incorporation rate increases. Therefore, it is judged that this study can be used as basic data for the development of multifunctional building materials by utilizing Kitosan Mountain, which lacks research in the field of building materials. © 2021 Architectural Institute of Korea.

8.
JAMS Journal of Acupuncture and Meridian Studies ; 15(1):37-42, 2022.
Article in English | EMBASE | ID: covidwho-1772266

ABSTRACT

Background: The primo vascular system can be viewed as a circulatory system that plays a therapeutic function in regenerating the body tissue. The anti-CD3 monoclonal antibody was used as an immunotherapeutic agent to treat the novel coronavirus infection (COVID-19). Objectives: In this study, we observed the effect of injecting lymph nodes with Foralumab, an anti- human CD3 epsilon therapeutic monoclonal antibody, on primo vessels. Methods: The structure and atomic stoichiometry of the antibody were determined by transmission electron microscopy and energy dispersive spectroscopy. Alcian blue dying solution was injected into the lymph nodes of the abdominal vena cava of rabbits, and the solution further flowed into the lymph vessels. Results: A primo vessel with primo nodes stained with Alcian blue was clearly visible in the lymph vessel. By injecting Foralumab into lymph nodes of rabbits with lipopolysaccharide-induced inflammation, the floating primo vessel in the lymph vessel appeared thicker and was distinctly visible. Conclusion: The observation of the primo vessel post-treated with Foralumab in the inflamed lymphatic system suggests the possibility of a functional role of the primo vascular circulatory system in pathophysiological conditions

9.
Canadian Liver Journal ; : 11, 2021.
Article in English | Web of Science | ID: covidwho-1581428

ABSTRACT

BACKGROUND: Indigenous populations experience higher rates of hepatitis C virus (HCV) infections in Canada. The Extension for Community Health Outcomes+ (ECHO+) telehealth model was implemented in Alberta to support HCV screening and treatment, using Zoom technology to support Indigenous patient access to specialist care closer to home. Our goal was to expand this program to more Indigenous communities in Alberta, using various Indigenous-led or co-designed methods. METHODS: The ECHO+ team implemented a Two-Eyed Seeing framework, incorporating Indigenous wholistic approaches alongside Western treatment. This approach works with principles of respect, reciprocity, and relationality. The ECHO+ team identified Indigenous-specific challenges, including access to liver specialist care, HCV awareness, stigma, barriers to screening and lack of culturally relevant approaches. RESULTS: Access to HCV care via this program significantly increased HCV antiviral use in the past 5 years. Key lessons learned include Indigenous-led relationship building and development of project outputs in response to community needs influences impact and increases relevant changes increasing access to HCV care. Implementation of ECHO+ through biweekly telehealth sessions, problem solving in partnership with Indigenous communities, increased HCV awareness, and flexibility resulting from the impacts of COVID-19.CONCLUSION: Improving Indigenous patient lives and reducing inequity requires supporting local primary health care providers to create and sustain integrated HCV prevention, diagnosis, treatment, and support services within a culturally safe and reciprocal model. ECHO+ uses telehealth and culturally appropriate methodology and interventions alongside multiple stakeholder collaborations to improve health outcomes for HCV.

10.
European Heart Journal ; 42(SUPPL 1):833, 2021.
Article in English | EMBASE | ID: covidwho-1554549

ABSTRACT

Introduction: COVID 19 is a global pandemic that has stretched healthcare resources. We explored the shift in patient demographics and clinical management of systolic heart failure (HF) patients during the COVID 19 outbreak. Purpose: To examine the impact of COVID 19 on the hospitalization rates of decompensated systolic HF patients in a tertiary hospital in Asia and delineate differences in the clinical characteristics and management of these patients. Methods: Data was extracted from the admission registry for systolic HF patients admitted to the tertiary hospital from January to June 2019 (pre- COVID) and the corresponding time period in 2020 during the COVID outbreak. We compared the demographics, clinical management and outcomes of these patients. Results: There was a significant reduction in patients admitted for systolic HF during the COVID period, 174 (6.3%) compared to 240 (8.5%) pre- COVID (p=0.001). The baseline demographics were similar except for the age of patients admitted during the COVID 19 period, which were younger at 66.1±13.5 compared to 69.9±13.9 pre-COVID (p=0.007). The mean left ventricular ejection fraction (LVEF) was lower during the COVID period (22.9±10.1% vs 24.9±10.1%;p=0.032). More patients during the COVID period were placed on mineralocorticoid receptor antagonists (p=0.001) and SGLT2 inhibitors (p<0.001). For those with recurrent admission for systolic HF, the number for HF admissions in the preceding one year was lower during COVID period compared to pre-COVID (0.2±0.5 vs 0.5±1.0 readmissions, p<0.001). There was no COVID 19 infection among those admitted for systolic HF. The 30-day all-cause mortality and readmission rates were comparable between both groups. Cardiac related mortalities were higher during the COVID 19 period compared to the pre-COVID period (77.8% vs 100.0%, p=1.000). No difference was observed in the length of stay nor proportion of patients who required a higher level of care in high dependency or intensive care unit during the COVID outbreak. Those who were admitted during the COVID period were more likely first presentation of decompensated systolic HF, 119 (68.4%) compared to 135 (56.3%) pre-COVID (p=0.014). Conclusion: Similar to the existing publications, there was a reduction in patients admitted for HF during the COVID period. However, for those who were admitted, these patients were younger and had lower LVEF. Most of them were first diagnosed with systolic HF during the hospitalizations. For those who had previous history of systolic HF, they had a lower number of HF admissions in the preceding one year compared to those who were admitted during the pre-COVID period. There was no difference in the 30-day mortality and utilization of high dependency or intensive care unit during the COVID outbreak.

11.
Eur Rev Med Pharmacol Sci ; 25(21): 6719-6730, 2021 11.
Article in English | MEDLINE | ID: covidwho-1524860

ABSTRACT

OBJECTIVE: COVID-19 vaccines have developed quickly, and vaccination programs have started in most countries to fight the pandemic. The aging population is vulnerable to different diseases, also including the COVID-19. A high death rate of COVID-19 was noted from the vulnerable aging population. A present scenario regarding COVID-19 vaccines and vaccination program foraging adults had been discussed. MATERIALS AND METHODS: This paper reviews the current status and future projections till 2050 of the aging population worldwide. It also discusses the immunosenescence and inflammaging issues facing elderly adults and how it affects the vaccinations such as influenza, pneumococcal, and herpes zoster. RESULTS: This paper recommends clinical trials for all approved COVID-19 vaccines targeting the elderly adult population and to project a plan to develop a next-generation COVID-19 vaccine. CONCLUSIONS: The review has mapped the COVID-19 vaccination status from the developed and developing countries for the elderly population. Finally, strategies to vaccinate all elderly adults globally against COVID-19 to enhance longevity has been suggested.


Subject(s)
Aging , COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , COVID-19/immunology , COVID-19/virology , COVID-19 Vaccines/immunology , Humans , Immunization Programs , Immunosenescence , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purification , Treatment Outcome
12.
International Journal of Antimicrobial Agents ; 58:N.PAG-N.PAG, 2021.
Article in English | Academic Search Complete | ID: covidwho-1440078
13.
International Journal of Infectious Diseases ; 94:41-43, 2020.
Article in English | CAB Abstracts | ID: covidwho-1409649

ABSTRACT

Failure of pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine may occur despite perfect adherence, although this is uncommon. Failure results in breakthrough HIV infection. Delayed seroconversion associated with antiretroviral use may complicate the picture, causing uncertainties in interpreting adherence patterns for establishing the true cause of PrEP failure.

14.
Annals of the Academy of Medicine, Singapore ; 50(8):638-642, 2021.
Article in English | MEDLINE | ID: covidwho-1391248

ABSTRACT

The COVID-19 pandemic has significantly disrupted medical education, particularly affecting clinical-year students. Educational institutions often had to halt, shorten or impose significant restrictions on their hospital rotations due to strict infection control and social-distancing guidelines implemented in tertiary healthcare institutions, as well as manpower and logistical constraints amid the pandemic. Thus, distance-based learning platforms such as online lectures and case-based teaching were increasingly adopted in place of bedside and face-to-face tutorials. While interactive virtual case-based discussions are generally useful in imparting clinical reasoning skills to medical students, they are unfortunately not able to fully replicate the experience of clerking, examining and managing real patients in the wards, which is a quintessential process towards building clinical acumen and attaining core clinical competencies. Therefore, for final year medical students who are preparing for their Bachelor of Medicine and Bachelor of Surgery (MBBS) examinations, many are naturally concerned by how learning in this "new normal" may affect their ability to make the transition to become competent junior doctors. As such, we seek to share our learning experiences as the first batch of medical students to have completed our entire final year of clinical education amid the COVID-19 pandemic, and offer 4 practical suggestions to future batches of students on how to adapt and optimise clinical learning under these circumstances: actively engaging in virtual learning, making the most of every clinical encounter, learning how to construct peer teaching/practice sessions, and maintaining physical and psychological well-being.

15.
Canadian Liver Journal ; 4(2):79-81, 2021.
Article in English | EMBASE | ID: covidwho-1256336
18.
Infezioni in Medicina ; 29(1):165-166, 2021.
Article in English | Scopus | ID: covidwho-1148493
19.
American Journal of Obstetrics and Gynecology ; 224(2):S649-S649, 2021.
Article in English | Web of Science | ID: covidwho-1141083
20.
Eur Rev Med Pharmacol Sci ; 25(3): 1708-1723, 2021 02.
Article in English | MEDLINE | ID: covidwho-1102757

ABSTRACT

OBJECTIVE: Recent pandemic virus SARS-CoV-2 is a global warning for the healthcare system. The spike protein of virus SARS-CoV-2 is significant because of two reasons. Firstly, the spike protein of this virus binds with the human ACE2 (hACE2) receptor. Secondly, it has several antigenic regions that might be targeted for vaccine development. However, the structural analytical data for the spike protein of this virus is not available. MATERIALS AND METHODS: Here, we performed an analysis to understand the structural two subunits of S glycoprotein (S gp) of SARS-CoV-2. Further, an analysis of secondary structure components and the tertiary structure analysis of RBD was carried out. We also performed molecular interaction analysis between S gp of this virus and hACE2 as well as between SARS-CoV S gp and hACE2 to compare the binding properties of these two viruses. RESULTS: We noted that the molecular interaction of SARS-CoV-2 S gp and hACE2 form eleven hydrogen bonds, while the molecular interaction of SARS-CoV S gp and hACE2 receptor form seven hydrogen bonds, indicating that the molecular interaction of SARS-CoV-2 S gp and hACE2 receptor is more stable than SARS-CoV S gp and hACE2 receptor. The pairwise sequence alignment of S gp SARS-CoV and SARS-CoV-2 shows several conserved residues of these two proteins. Besides, conserved pattern analysis of SARS-CoV-2 S gp and hACE2 revealed the presence of several highly conserved regions for these two proteins. The molecular dynamics simulation shows a stable interplay between SARS-CoV-2 S gp with the hACE2 receptor. CONCLUSIONS: The present study might help determine the SARS-CoV-2 virus entrance mechanism into the human cell. Moreover, the understanding of the conserved regions may help in the process of therapeutic development from the infection of the deadly virus.


Subject(s)
Angiotensin-Converting Enzyme 2/chemistry , COVID-19/virology , SARS-CoV-2/chemistry , Spike Glycoprotein, Coronavirus/chemistry , Computer Simulation , Conserved Sequence , Glycosylation , Humans , Hydrogen Bonding , Hydrophobic and Hydrophilic Interactions , Molecular Dynamics Simulation , Protein Interaction Domains and Motifs , Protein Structure, Secondary , Protein Structure, Tertiary , Protein Subunits
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