Covid-19 Vaccination Impact on Atrial Arrhythmias - Real-World Evidence from the Certitude Registry

Background: The COVID-19 vaccines were developed unprecedentedly and have proven safe and efficacious in reducing transmissibility and severe infection. The impact of mRNA-based COVID-19 vaccines on atrial arrhythmias (AA) incidence is unknown. Objective(s): To analyze the incidence of AA after COVID-19 vaccination in patients with a cardiac implantable electronic device (CIED). Method(s): BIOTRONIK Home Monitoring data and Medicare claims data from CERTITUDE patients implanted with a CIED between 2010-20 were utilized to identify recipients of one or more doses of the COVID-19 vaccine in 2021. Those who had influenza vaccination in 2020 were also identified in the same cohort as a control. From remote monitoring data, the number of atrial high rate events (AHR) and % burden of AA in the three months post-vaccination was compared to the preceding three months using Wilcoxon signed rank test. Kruskal-Wallis test was used for group difference comparisons. New AF diagnosis was determined from ICD-10 diagnosis codes in Medicare claims. Result(s): First and 2nd doses of COVID vaccine (50% Pfizer, 47% Moderna, and 3% J&J) were administered to 7757 and 6579 individuals with a CIED (age 76.2 (+/-9.0) y, 49% males), respectively. In the same cohort, 4723 (61%) individuals received the influenza vaccine. A statistically significant increase in the number of AHR episodes and % burden of AA was noted in the three months post-vaccination compared to the preceding three months after the 1st and 2nd doses of the COVID-19 vaccine (Figure). No such association was noted following influenza vaccination. In subgroup analysis, AHR episodes increased significantly in age groups >70 and men. Post-vaccination increase in AHR episodes was more significant in those without a pre-vaccination history of AHR episodes (mean increase of AHR 6.9+/-88.4, p<0.001) and was non-significant in those with a preceding history of AHR (p=0.8). Among the 764 patients with no AF diagnosis in claims preceding the first COVID-19 vaccine, 87 (11.4%) developed a new AF diagnosis or AHR event in the first three months post-vaccination. Conclusion(s): We report a small but significant increase in the number of CIED-detected atrial arrhythmias following vaccination for COVID-19 but not influenza, specifically in men and age >70 years. Acknowledging the immense public health benefit of COVID-19 vaccines, our results should prompt increased awareness of evaluating for AF in this high-risk group following vaccination. [Formula presented]Copyright © 2023

Fluid balance as an independent prognostic indicator of in-hospital mortality in heart failure patients with Covid19

Introduction: Fluid resuscitation confers protection against in-hospital mortality in heart failure (HF) patients with severe sepsis. SARS COV-2 infection leads to cytokine storm that is clinically similar to severe sepsis. We aim to evaluate if positive fluid balance is associated with in-hospital mortality in HF patients with Covid-19. Method(s): This single center retrospective cohort study was conducted in patients admitted in the ICU for Covid 19 from 10/2020 to 3/2021 in a community hospital in Newark. The primary outcome was survival to discharge. Clinical SAS 9.4 was used to obtain summary statistics, perform chi-squared test and multivariable logistic regression analysis. Result(s): We included 91 patients admitted in the ICU with covid 19, of which 33 were diagnosed with HF. Out of 33 people, majority were males. Most of the patients were hispanic. Diabetes and hypertension were the most common comorbidities. 60.61% of HF patients had multiple comorbidities. Odds of negative survival outcome in those with positive fluid balance after adjusting for HF as compared to those with negative fluid balance in patients of COVID 19 was 12.958 (P value= 0.0183). Conclusion(s): Positive fluid balance in HF patients admitted with Covid 19 may be associated with adverse outcomes. Larger, prospective studies are needed to investigate the correlation between covid 19 and fluid balance in HF patients.

CAREGIVING FOR PEOPLE WITH DEMENTIA DURING THE PANDEMIC: A SCOPING REVIEW

Background: The COVID-19 pandemic has had a large impact on the roles and responsibilities of caregivers for older adults with dementia. An increasing number of studies have examined the unique challenges faced by caregivers during this time, including extended work hours, anxiety around contracting COVID-19, and adhering to public health guidelines. Informal caregivers may also face greater strain on their personal lives during lockdown. Objective: To conduct a scoping review to examine factors impacting well-being of caregivers of older adults with dementia during the first year of the COVID-19 pandemic. Method: We conducted a PubMed search using the terms "COVID-19,” "older adults,” and "caregiving” or "caregiver.” Sixty-seven papers were identified published between June 2020 and December 2021. Results: All papers identified were cross-sectional and conducted after the pandemic began and prior to the availability of COVID-19 vaccines. Articles highlighted increasing burdens such as financial and physical stress, as well as worsened psychological wellbeing through increased anxiety and depression among caregivers during the pandemic. Additionally, themes of protective factors on wellbeing in the form of social connection and telehealth interventions emerged. Discussion: Limitations to our review include lack of longitudinal information on caregiver experience to better identify broad impacts on caregiver well-being. Studies not only identified new, pandemic-related risk factors for caregiver burden, but also a heightened effect of pre-existing risk factors (e.g. income, living situation, gender) on burden. Caregiver psychiatric outcomes reflect the overall population's increase in mental illness since the start of the pandemic.

Evaluation of thrombotic outcomes in patients in a large clinical enterprise following COVID-19 vaccination

Background: With widespread COVID-19 immunization efforts, reports of vaccine-induced thrombocytopenia and thrombosis (VITT) have emerged, particularly in association with adenoviral vector-based vaccines (ChAdOx1 nCoV-19 and Ad26.COV2.S). The incidence of VITT is considered to be extremely low, with the benefits of vaccination strongly outweighing associated risks. Despite the favorable safety profile of COVID-19 vaccines, VITT has garnered the attention of and likely contributes to vaccine hesitancy among a persistently unvaccinated portion of the United States population. Aim(s): We sought to characterize thrombotic events following COVID-19 vaccination in a large clinical enterprise where mRNA-based vaccines were mostly administered. Method(s): With institutional approval, medical records of 779,602 patients vaccinated against COVID-19 (2 mRNA-based vaccines: 61.2% BNT162b2, 36% mRNA-1273, and adenovirus-based Ad26. COV2.S, 2.7%) from 12/4/2020-6/ 6/2021 at Cleveland Clinic Enterprise locations in Ohio and Florida were queried. A baseline complete blood count was available for 223,345 patients, of which 663 (0.3%) demonstrated thrombocytopenia-defined as >=50% platelet decline 4-28 days post-vaccination- and were subject to chart review. Thrombotic events including deep vein thrombosis, pulmonary embolism, stroke/transient ischemic attack, myocardial infarction, cerebral venous sinus thrombosis, and splanchnic thrombosis were assessed. Thrombotic risk factors including medications, viruses, and malignancy, as well as platelet factor 4 antibody assays were recorded. Result(s): Of 76 patients with thrombosis, 63 (82.9%) demonstrated clear etiologies. Thirty (39.5%) had malignancies (24 treated with chemotherapy associated with thrombosis risk). Seven (9.2%) were considered hypercoagulable, six (7.9%) had catheter-related thrombosis, five (6.6%) had recent surgery, five (6.6%) had reduced mobility, five (6.6%) had cardiovascular risk factors, three (3.9%) had diagnosed/suspected immune thrombocytopenia, and two (2.6%) were septic. Of three patients with unprovoked thrombosis, one had findings concerning for VITT (Figure 1). Conclusion(s): 76/223,345 (0.03%) patients demonstrated thrombosis following COVID-19 vaccination, with one (0.0004%) case concerning for VITT. In a large clinical enterprise, VITT is exquisitely rare.

Impact of Vipassana Meditation on Ability to Cope with COVID-19 Pandemic

The upheaval caused by this pandemic and the uncertainty about life has triggered problems related to the psychological health of the community including healthcare professionals and simultaneously worsened the mental condition of those already suffering from psychiatric issues (Du et al., General Hospital Psychiatry 67:144–145, 2020;Fusar-Poli et al., Journal of Affective Disorders 275:78–79, 2020). A global effort is required to manage the mental health issues triggered by COVID-19. It is important to explore the resources that are conducive to mental health. One such tool is the ancient meditation technique, Vipassana Meditation (VM) taught by the Buddha to overcome universal ills. In this study, an attempt has been made to show case the impact of VM practice in coping with the current unprecedented situation by managing the stress effectively. For this purpose, the Stress Coping Behaviour Scale (SCBS) (Janghel, G. & Srivastava, The International Journal of Indian Psychology 4(3), No. 100, DIP 18.01.077/2017040) was administered online to 462 Vipassana meditators (Male 67%, Female 33%;Ages 20–65 years) who practised Vipassana regularly at least for one year. The responses were analysed by using ANOVA (SPSS v22.0) to highlight the variation in coping with stress due to regularity of practice and number of years of practice. The maladaptive and adaptive coping styles measured by SCBS indicated better coping results for meditators who meditated regularly. It indicated that they don’t get swayed by the external catastrophic situation and are able to remain equanimous. This empirical study showcases that VM can be practised as a measure to promote well-being by managing and preventing mental and psychological issues arising in a pandemic situation. In future, VM practice can be adopted to manage uncertainties created by COVID-19 or any other unprecedented stressful situation to help bring about a “New Normal”. One of the limitations of this study is that the conclusions could not be corroborated by conducting personal interviews with some of the meditator respondents. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

FLUID BALANCE AS AN INDEPENDENT PROGNOSTIC INDICATOR OF IN-HOSPITAL MORTALITY IN PATIENTS WITH HEART FAILURE AND COVID-19

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Fluid resuscitation confers protection against in-hospital mortality in heart failure (HF) patients with severe sepsis. SARS COV-2 infection can lead to a cytokine storm that is clinically similar to severe sepsis. Little is known about fluid balance in patients with HF admitted for covid 19. We aim to evaluate whether positive fluid balance is associated with in-hospital mortality in HF patients admitted for Covid-19. METHODS: This single center retrospective cohort study was conducted in patients admitted in the ICU for confirmed Covid 19 from 10/2020 to 3/2021 in a community hospital in Newark. The primary outcome was survival to discharge. Clinical SAS 9.4 was used to obtain summary statistics, perform chi-squared test and multivariable logistic regression analysis. RESULTS: We included 91 patients admitted in the ICU with covid 19. Out of these 33 patients were diagnosed with heart failure. Out of 33 people with HF 23 (69.70%) were male, 10 (30.3%) were females. Of the 33, 17(56.67%) were latino, 5(16.67%) were caucasian and 6(20%) were african-american. Mean age of population with and without Heart Failure was 70.78 yrs(?12.52) and 58.57 yrs(?13.37) respectively. Amongst them 18(54.55%) had DM, 27(81.82%) had HTN, 5 (15.15%) had chronic respiratory disease and 7(21.21%) had CKD. Amongst those with Heart Failure, 20(60.61%) had multiple comorbidities. The odds for negative survival are shown in table 1. Odds of negative survival outcome in those with positive fluid balance after adjusting for heart failure as compared to those with negative fluid balance in patients of COVID 19 was 12.958 (P value= 0.0183). CONCLUSIONS: Positive fluid balance in HF patients admitted with Covid 19 may be associated with adverse outcomes. Larger, prospective studies are needed to investigate the correlation between covid 19 and fluid balance in HF patients. CLINICAL IMPLICATIONS: This study creates awareness on the need of caution while fluid resuscitation in heart failure patients with Covid-19 as a positive fluid balance might be associated with unfavorable outcomes DISCLOSURES: No relevant relationships by Ruhma Ali no disclosure on file for Joaquim Correia;No relevant relationships by Neev Mehta No relevant relationships by Aditya Patel No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim

Mutational analysis of ORF-8 of SARS-CoV-2 -a window to immunotherapy

Background: TGF-Beta plays an important role in immune evasion in oncology. Similarly, SARSCov-2, the causal agent of the COVID-19 pandemic, also has an immune evasion function. This is mediated by ORF-8 through its interaction with multiple immune regulatory elements, including TGF-beta. This is a mutational analysis of ORF-8. Methods: We took advantage of the database of millions of SARS-CoV-2 genomes are archived and organized in phylogenetic relationships to show the evolution of ORF-8. Site numbering and genome structure use Wuhan-Hu-1/2019 as reference. The phylogeny is rooted relative to early samples from Wuhan. Temporal resolution assumes a nucleotide substitution rate of 8 × 10-4 subs per site per year. ( https://nextstrain.org/). The epidemiological data provided at https://ourworldindata.org/coronavirus was used to determine the property of the variants using mortality and infectivity data at the site. Results: Scan of ORF-8 revealed a high rate of mutation at aa119 and aa120. More importantly, the mutation at 120 or 119 that resulted in null ORF8 clearly delineates the pre-Delta and Delta SARSCov-2. In fact, all the delta lineages exhibited the null mutation at 119/120. This region is important for the dimerization of ORF-8 and possibly its interaction with host TGF-beta. All other variants, including the alpha variants, are wild type (aa120 = F). Monitoring the mutations over the last several months indicated that the delta variants have now picked up the wild type F at aa120 (Faa120) in Egypt or the L at aa 120 (Laa120) in India. The epidemiology of Egypt and India indicates that the Faa120 is more immune evasive and suggestive that more infectious but not more lethal. Conclusions: This is an opportunity to monitor in real-time the evolution of ORF-8 and how it is interacting with the host immune system. Additionally, since our current clinical trial on TGF-beta inhibitors is in India and Latin America, it is an opportunity to correlate clinical findings to molecular and epidemiological data for these variants. If we are correct, the Faa120 will emerge as the dominant variant in the next wave of COVID-19.

Quadruplet loss and SqueezeNets for Covid-19 detection from Chest-X rays

The Coronavirus Pandemic triggered by SARS-CoV-2 has wreaked havoc on the planet and is expanding exponentially. While scanning methods, including CT scans and chest X-rays, are commonly used, artificial intelligence implementations are also deployed for COVID-based pneumonia detection. Due to image biases in X-ray data, bilateral filtration and Histogram Equalization are used followed by lung segmentation by a U-Net, which successfully segmented 83.2% of the collected dataset. The segmented lungs are fed into a Quadruplet Network with SqueezeNet encoders for increased computational efficiency and high-level embeddings generation. The embeddings are computed using a Multi-Layer Perceptron and visualized by T-SNE (T-Distributed Stochastic Neighbor Embedding) scatterplots. The proposed research results in a 94.6% classifying accuracy which is 2% more than the baseline Convolutional Neural Network and a 90.2% decrease in prediction time. © 2022 by CSJM;Pranshav Gajjar, Naishadh Mehta, Pooja Shah

House prices and COVID-19 pandemic shocks in India: a nonlinear ARDL analysis

Purpose: India is one of those countries that are severely affected by the COVID-19 pandemic. With the upsurge in the cases, the country recorded high unemployment rates, economic uncertainties and slugging growth rates. This adversely affected the real estate sector in India. As the relation of the housing market with the gross domestic product is quite lasting thus, the decline in housing prices has severely impacted the economic growth of the nation. Hence, the purpose of this paper is to gauge the asymmetric impact of COVID-19 shocks on housing prices in India. Design/methodology/approach: Studies revealed the symmetric impact of macroeconomic variables, and contingencies on housing prices dominate the literature. However, the assumption of linearity fails to apprehend the asymmetric dynamics of the housing sector. Thus, the author uses a nonlinear autoregressive distributed lag model to address this limitation and test the existence of short- and long-run asymmetry. Findings: The findings revealed the long- and short-run asymmetric impact of the COVID-19 outbreak and the peak of the COVID-19 on housing prices. The results indicate that the peak of COVID-19 had a greater impact on housing prices in comparison to the outbreak of COVID-19. This can be explained as prices will revert to normal at a speed of 0.978% with the decline in the number of COVID-19 cases. Whereas the housing prices rise at a rate of 0.714 as a result of government intervention to deal with the ill effects of the COVID-19 outbreak. Moreover, it can be inferred that both the outbreak and peak of COVID-19 will lead to a minimal decline in housing prices, while with the decline in the number of cases and reduction in the impact of the outbreak of COVID, the housing prices will rise at an increasing rate. Originality/value: To the best of the authors’ knowledge, this is the first study to understand the impact of the outbreak and peak of COVID-19 on the housing prices separately. © 2020, Emerald Publishing Limited.

Interleukin-6 as a predictor of cytokine storm and response to tocilizumab in a tertiary care designated COVID Hospital in Jharkhand

Objective Release of Interleukin -6 a pro- inflammatory cytokine in Acute respiratory distress syndrome (ARDS) related to SARS- CoV-2 has been found .The aim of the study was to study the clinical and biochemical effects of IL-6 blockade using a humanized anti-IL-6 receptor antibody, tocilizumab (TCZ) . Methodology Retrospective analysis of 66 patients with COVID -19 ARDS evidenced by RTPCR and lung CT scan was done. Patients with increasing oxygen requirements, rising inflammatory markers suggesting cytokine storm were treated with TCZ. Demographic and clinical data were collected from the electronic medical records and case sheets. Serum levels of CRP, ferritin, Interleukin -6, lymphocytes, platelets, creatinine, liver enzymes were assayed before and after the TCZ administration. Results Patient treated with TCZ had comorbidities, along with hematological and biochemical abnormalities. 12 patients (18%) benefited from TCZ and 54 patients died. There was significant lymphopenia on the day of TCZ administration - average 5.6% (2-9%) but the average TLC was within normal range In the survivors, CRP decreased dramatically 60.3 % (10-90%) within 2-4 days of TCZ administration. There was a marked decrease in Ferritin and IL-6 also, 20.5% (9.7 - 40%) and 25.5% ( 6- 42%) respectively. Conclusion: Blocking excessive IL-6 production might be the key to the COVID -19 ARDS treatment. In our study, treatment with TCZ resulted in favorable evolution in only 18%of cases. Inflammatory biomarkers decreased in survivors as early as 4th day after TCZ administration. The low favorable outcome could be because of the comorbidities.

Women’s Employment and Digital Technology: A Regional Analysis in India

The article explores women’s employment and the future of work due to the changing nature of jobs as a result of the onslaught of new technologies. Adoption of new digital technologies, industry 4.0 technologies and the increasing influence of platform or gig economy has had intense effects on the ‘future of work’, causing dramatic changes. Further, COVID-19 has severely impacted the economy, especially women, reflected in the consistent fall in female labour force participation across states. The unemployment rate (UR) is significantly higher among urban women. A large proportion of woman workers are vulnerable from automation because of their low-skill and the unskilled and routine nature of their work. The risk of automation is much higher in the case of women working in manufacturing and modern services. Women in India are engaged largely in traditional jobs with low level of education and skill, and having limited or negligible social security, particularly in the unorganised sector. The article is based on the secondary data provided by the National Sample Survey Organisation (NSSO) and uses the International Labour Organization (ILO) skill framework. The analysis clearly shows that skill sets among women is abysmally low. Noticeably, enhancing skill development as per the emerging market demand, including digital literacy, will go a long way to expand job opportunities for women. © 2021 Institute for Human Development.

"It's second best": A mixed-methods evaluation of the experiences and attitudes of people with musculoskeletal pain towards physiotherapist delivered telehealth during the COVID-19 pandemic.

BACKGROUND: Musculoskeletal physiotherapy practice rapidly adopted telehealth during the COVID-19 pandemic, providing a unique opportunity to evaluate the experiences and attitudes of people who would not usually engage with these services. METHODS: A sequential mixed-methods study recruited people with musculoskeletal pain conditions accessing Australian private practice physiotherapist services. Part 1 involved an online survey of telehealth services accessed, treatments and resources provided, self-reported global change in condition, and attitudes toward telehealth. Part 2 involved semi-structured interviews with a subset of survey participants, exploring experiences and attitudes towards telehealth. Quantitative data was reported descriptively. Qualitative data was evaluated using inductive thematic analysis. RESULTS: 172 participants responded to the survey, and 19 were interviewed. 95% accessed video-based telehealth, and 85% reported condition improvement. 84% agreed it was an efficient use of their time, 75% agreed it was financially viable, and 73% agreed their condition was accurately diagnosed. 62% percent believed telehealth should be less expensive than in-person services. Qualitative analysis revealed four themes (17 subthemes), including (i) telehealth had value, but generally perceived as inferior to in-person care; (ii) challenges related to assessment, diagnosis, 'hands on' treatment, observation, communication, and technology; (iii) advantages to access safe, expert, and convenient care; and (iv) importance of supportive technology, including video and supplementary resources. CONCLUSION: Physiotherapist telehealth services provided to people with musculoskeletal pain during the pandemic was valued. However, telehealth was generally perceived as inferior to traditional in-person care, and may be best used as part of a hybrid model of care.

Ethical decision-making and organisational evaluation of in-kind versus funding-based corporate social responsibility initiatives;COVID-19 context study of organizational egoism

Purpose: The purpose of this study is to comprehend how individuals analysed organisational initiatives while responding to the COVID-19 crisis through corporate social responsibility (CSR) initiatives through both in-kind and in cash (funding-based) forms. CSR actions manifested finally towards the achievement of organisational reputational and economic egoism. Design/methodology/approach: The study was conducted on 331 respondents during the period of the COVID-19 pandemic and the lockdown in India. Moderated mediation analysis was conducted for data analysis and hypothesis testing. Two models were tested. The research models were tested using a statistical package for the social sciences (SPSS) and AMOS. Findings: This study considered the evaluation of the in cash (funding-based) and in-kind CSR types of CSR initiatives by individuals with personal cultural characteristics of independence, interdependence and altruism. The results of the first model indicated a significant positive relationship between independence, utilitarian thinking (UT) and organisational economic egoism (OEE). The mediating effect of UT between the independence-OEE relationship was significant. The results of the second model also found a significant relationship between interdependence, deontological thinking (DT) and organisational reputational egoism (ORE). Similarly, there was a significant positive relationship between altruism, DT and ORE. The mediation effect of DT was significant for both the relationships. The moderated mediation relationship of both the first and second model has been found to be significant. Research limitations/implications: In the research integrated models were developed associating individual personal cultural characteristics of independence, interdependence and altruism with UT and DT and subsequently to organisational economic and reputational egoism. Practical implications: Managers undertaking CSR initiatives through both in-kind and in cash (funding-based) would be better able to understand based upon these study insights what nature of CSR initiatives (in-kind or in cash) are more appropriate for what kind of individual context (independence, interdependence and altruism) in decision-making (UT and DT) with organisational context (organisational economic and reputational egoism). Social implications: In the trying realities of the COVID-19 context, firms were contributing to society through CSR initiatives which were both in-kind and in cash (funding-based) in nature. This study emphasised what kind of CSR initiative was more appropriate for what kind of context for both enhanced social good and increased organisational gains. Originality/value: This was one of the first studies in the context of CSR initiatives during COVID-19 times that analysed evaluation of in cash (funding-based) and in-kind CSR actions. CSR initiatives by individuals with personal cultural characteristics of independence, interdependence and altruism were related to UT and DT and finally manifested towards organisational economic and reputational egoism. © 2021, Emerald Publishing Limited.

A record-based comparative study of the impact of covid-19 lockdown measures on the burden of maxillofacial trauma cases

Background: The Covid-19 pandemic had a complicated effect on the number of cases of maxillofacial trauma around the world. The precise impact of lockdown interventions on the number of cases of maxillofacial trauma in India is unclear. Aim and Objectives: The aim of this study was to see how Covid-19 lockdown steps affected the number of maxillofacial trauma cases reported to the emergency department. Methodology: From March 25 to May 31, 2020, a record-based comparative study was conducted to determine maxillofacial trauma cases among patients reported (Lockdown group/Study group) to the emergency department of Eklavya dental college & hospital. The results were compared to two control groups (pre-lockdown groups). Results: During the lockdown period, 170 (10.4 %) maxillofacial trauma cases were presented, 723 (44.1 %) cases during the pre-lockdown period, and 745 (45.5 %) cases the previous year (2019 period). As compared to the respective predecessors, the number of maxillofacial trauma cases decreased by 35.1 % and 33.7 % during the lockdown time. Conclusion: This study's findings will be used to prepare and enforce alternative procedures, define areas for development, and re-allocate resources and manpower in the event of potential epidemics or pandemics. © 2021 Universitatea de Vest Vasile Goldis din Arad. All rights reserved.