Demographic Characteristics, Clinical Features, Laboratory, and Radiological Findings in Children Admitted to COVID19 Center in Amara City, Misan Province, Iraq

Background: Most pediatric patients with covid 19 had mild to moderate infection and some had severe challenging infection. Generally, they had variable signs and symptoms, laboratory, and radiological findings correlated with the patient age, the involved system, disease severity and probably any underlying disease. Aim: To identify the most common clinical features, the frequency of positive radiological findings, and laboratory results of the infected children hospitalized in Misan COVID-19 Center. Materials and method: A retrospective descriptive with some analytic study applied on 100 pediatric patients in the age range of (0-16) years, diagnosed with COVID-19 or were highly suspected cases, depending on clinical findings, laboratory tests, COVID-19 RT-PCR and/or chest (X-ray + CT), whom were admitted to the Pediatric Covid -19 Center in Amara City, Iraq during the time period of (February-June, 2021). Their medical records were reviewed for demographic information, (gender, age, and residence), medical history, clinical examination, laboratory and imaging studies, (X-ray + CT), O saturation, the duration of illness before admission of any underlying chronic diseases as well as the most common presenting signs and symptoms. Results: Children infected slightly more in the age range of (5-10 years), boys slightly more infected than girls as (54%) and (46%), respectively. The urban residents suffered more than the rural ones, 4% of all cases had low O2 saturation. Fever and malaise were the most common presenting symptoms as (93%) and (68%), respectively. The illness duration before hospitalization commonly was (<5days), (RT-PCR) was negative in 45% of patients, 54% had anemia with or without leukopenia and lymphopenia, CTs were positive in (62%) and CXR was positive in (53%), while the underlying chronic diseases were found in (23%) of the cases. Conclusion: Children of ages between (5-<10 years) were slightly more infected than others, fever, malaise, and cough were the most common manifestations, the urban predominance is high, and half of patients had anemia about one third and had lymphopenia. Likewise, one forth had thrombocytopenia, negative Covid-19 (RT-PCR), and/or CXR. The CT results did not exclude infection. Thus, we need further local studies to support our results. © 2023 by SPC (Sami Publishing Company)

Why do ventilation strategies matter in controlling infectious airborne particles? A comprehensive numerical analysis in isolation ward

A proper ventilation strategy in an isolation ward could promote better indoor air quality for the occupants. This could also reduce the risk of immunocompromised patients contracting healthcare-associated infections (HAI) or airborne diseases such as COVID-19, tuberculosis, and measles among others. This study aims to propose and examine appropriate ventilation strategies in a single-patient isolation ward that can reduce particle settlement in patients. A simplified CFD model of the isolation ward was developed and well-validated against established data. An RNG k-ε model and discrete phase model (DPM) were used to simulate airflow and particle transportation. The study examined the airflow and particle dispersion under a baseline case and four proposed ventilation strategies. Results showed that the baseline case study, which used the ceiling-mounted air curtain was insufficient to prevent the particles from dispersing into the vicinity of the patient. Likewise, the dilution effect under the baseline case and case 4 (wall-mounted air supply diffuser) were relatively weak due to the low air change rate (ACH) of 4/hr and 9/hr respectively. The ventilation strategy in case 4 has a negligible effect on reducing the particles (14%) settling on the patient although the ACH in case 4 was 2-times the baseline case. The present finding ascertains that utilising the combination of ceiling-mounted air diffuser and air curtain jet (case 3) results in zero particle settlement on both patient's and the patient's bed. It also reduced 57% of particles in the vicinity of the medical staff's breathing zone compared to the baseline case. © 2023 Elsevier Ltd

Improved Outpatient Medical Visit Compliance with Sociodemographic Discrepancies in Vascular Telehealth Evaluations.

OBJECTIVE: The coronavirus pandemic has led to a rapid expansion in telemedicine across all medical fields but has also exposed tele-healthcare disparities with differing access to technology across racial and ethnic groups. The objective of our study was to investigate the impact of telehealth on vascular visit compliance and to explore the effect of sociodemographic factors on vascular surgery outpatient telehealth utilization during the COVID-19 pandemic. METHODS: Consecutive patients undergoing outpatient vascular surgery evaluation between February 24, 2020 (the launch of our telemedicine program) and December 31, 2020, were reviewed. Baseline demographic and outcomes were obtained from the electronic medical record. Telehealth or in-person evaluations were defined according to the patient's index visit during this period. Medical visit compliance was established upon completion of the telehealth or in-person encounter. Chi square tests and logistic regression analyses were used. RESULTS: There were 23,553 scheduled outpatient visits for 10,587 patients during the study period. 1,559 of those were scheduled telehealth encounters compared to 21,994 scheduled in-persons encounters. Out of the total scheduled outpatient encounters, 13,900 medical visits (59.0%) were completed: 1,183 telehealth visits and 12,717 in-person visits. The mean travel distance saved for telehealth visits were 22.1±27.1 miles and the mean travel time saved was 46.3±41.47 minutes. We noted no sociodemographic differences between patients scheduled for telehealth vs. in-person visits. There was a trend towards a lower proportion of African American patients among the telehealth group vs. in-person group (7.8% vs. 10.6%, P=.116) respectively; however, this did not reach statistical significance. There was a significantly higher rate of medical visit completion among the telehealth group compared to the in-person group (79.5% vs. 59.4%, P<.001). Among patients who were scheduled for an outpatient medical visit, having a scheduled telemedicine evaluation (vs. in-person) was associated with 2.3 times the odds of completing the medical visit (Odds Ratio (OR)=2.31, 95% Confidence Interval (CI): 2.05-2.61) adjusting for age, sex, race, ethnicity, language and the distance between the patient's home zip code and the outpatient vascular center zip code. Selecting for scheduled telemedicine visits, African American patients were associated with decreased odds of telemedicine utilization (OR=0.73, 95%CI:0.59-0.90) after adjusting for age, sex, ethnicity, language and visit type. CONCLUSIONS: The vascular surgery outpatient telehealth evaluation appears to improve medical visit completion in our region with apparent sociodemographic disparities. Further studies are needed to confirm if telemedicine expansion has improved access to care in other geographical areas.

High Seroprevalence of SARS-CoV-2 IgG and RNA among Asymptomatic Blood Donors in Makkah Region, Saudi Arabia.

The gold-standard approach for diagnosing and confirming Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) infection is reverse transcription-polymerase chain reaction (RT-PCR). This method, however, is inefficient in detecting previous or dormant viral infections. The presence of antigen-specific antibodies is the fingerprint and cardinal sign for diagnosis and determination of exposure to infectious agents including Corona virus disease-2019 (COVID-19). This cross-sectional study examined the presence of SARS-CoV-2 spike-specific immunoglobulin G (IgG) among asymptomatic blood donors in Makkah region. A total of 4368 asymptomatic blood donors were enrolled. They were screened for spike-specific IgG using ELISA and COVID-19 RNA by real-time PCR. COVID-19 IgG was detected among 2248 subjects (51.5%) while COVID-19-RNA was detected among 473 (10.8%) subjects. The IgG frequency was significantly higher among males and non-Saudi residents (p < 0.001 each) with no significant variation in IgG positivity among blood donors with different blood groups. In addition, COVID-19 RNA frequency was significantly higher among donors below 40-years old (p = 0.047, χ2 = 3.95), and non-Saudi residents (p = 0.001, χ2 = 304.5). The COVID-19 IgG levels were significantly higher among the RNA-positive donors (p = 001), and non-Saudi residents (p = 0.041), with no variations with age or blood group (p > 0.05). This study reveals a very high prevalence of COVID-19 IgG and RNA among asymptomatic blood donors in Makkah, Saudi Arabia indicating a high exposure rate of the general population to COVID-19; particularly foreign residents. It sheds light on the spread on COVID-19 among apparently healthy individuals at the beginning of the pandemic and could help in designing various control measures to minimize viral spread.

Inequities in the deployment of COVID-19 vaccine in the WHO Eastern Mediterranean Region, 2020-2021.

The WHO Eastern Mediterranean Region (EMR) is characterised by a large range in routine immunisation coverage. We reviewed progress in access, deployment efforts, and use of COVID-19 vaccines in the EMR to identify bottlenecks and propose recommendations. We compiled and analysed data reported to WHO regarding the number of vaccines provided emergency use authorisation (EUA) in each country, the number of vaccine doses allocated and delivered by COVAX, the number of vaccine doses received bilaterally, the date of initiation of vaccination, vaccine usage rate and overall vaccination coverage. In June-July and October-November 2021, we conducted two rounds of a regional survey to assess vaccine acceptance and calculated the weighted proportion of individuals who would get vaccinated once a vaccine is available and recommended. We stratified the analysis according to four groups based on their participation status in COVAX, from the highest to lowest income, that is, (1) fully self-financing high-income countries (group 1), (2) fully self-financing upper middle-income countries (group 2), (3) Advance Market Commitment (AMC) countries not eligible to receive Gavi support (group 3) and (4) AMC countries eligible for Gavi support (group 4). As of 31 December 2021, the median number of vaccines provided with EUA was 6 for group 1, 11 for group 2, 8 for group 3 and 9 for group 4. On the same date, COVAX had delivered 179 793 310 doses to EMR countries. Vaccination started on 10 December 2020 in group 1, on 13 December 2020 in group 2, on 30 December 2020 in group 3 and on 20 January 2021 in group 4. The regional acceptance survey (first round) pointed to higher vaccine acceptance in group 1 (96%), than in others, including group 2 (73.9%), group 3 (78.8%) and group 4 (79.3%), with identical patterns in the second round (98%, 78%, 84% and 76%), respectively. Usage of vaccine allocated by COVAX to participating countries was 89% in group 1, 75% in group 2, 78% in group 3 and 42% in group 4. The full dose and partial dose coverage decreased with the income groups of countries, from 70% and 6% in group 1, to 43% and 8% in group 2, to 33% and 11% in group 3, and 20% and 8% in group 4. All 22 EMR countries introduced COVID-19 vaccines by 21 April 2021, but with major inequities in coverage. Additional efforts are needed to address the determinants of unequal vaccine coverage at all stages of the result chain to improve vaccine equity.

Learning anatomy before and during COVID-19 pandemic: Students' perceptions and exam performance.

The objective of our study was to explore the impact of COVID-19 pandemic on learning anatomy and to compare the students' perceptions of "face-to-face" and "online" anatomy teaching, and to assess their impact on student's performance. We used a descriptive, cross-sectional, questionnaire-based study that focused on a single cohort of undergraduate medial students who attended anatomy demonstrations, at the College of Medicine and Medical Sciences, Arabian Gulf University (CMMS-AGU), both pre-pandemic (face-to-face) during 2019-2020 and the pandemic (online) during 2020-2021. Students who participated in this study responded in favor of face-to-face demonstrations for better understanding of the spatial orientation of body organs and systems, the visualization of the anatomical relations between structures, understanding the difficult anatomical structures, understanding the clinical correlations, and making them more confident about their practical exams. On the other hand, students were in favor of online demonstrations for retaining key information, confidence levels on discussing anatomy learning needs, effective utilization of demonstration time, and lower stress associated with the online learning. Regarding anatomy exam scores, statistically significant difference was found between mean scores of online and onsite exams in one of the two analyzed multiple choice questions tests. However, there was a statistically significant difference between the mean scores of objective structured practical examination of online and onsite exams in the two analyzed tests. Furthermore, the majority of the students who participated in the survey prefer a mixture of both face-to-face and online anatomy demonstrations during the pandemic and also in the post-COVID-19 era.

Sustainable and fast saliva-based COVID-19 virus diagnosis kit using a novel GO-decorated Au/FBG sensor.

Monitoring the COVID-19 virus through patients' saliva is a favorable non-invasive specimen for diagnosis and infection control. In this study, salivary samples of COVID-19 patients collected from 6 patients with the median age of 58.5 years, ranging from 34 to 72 years (2 females and 4 males) were analyzed using an Au/fiber Bragg grating (FBG) probe decorated with GO. The probe measures the prevalence of positivity in saliva and the association between the virus density and changes to sensing elements. When the probe is immersed in patients' saliva, deviation of the detected light wavelength and intensity from healthy saliva indicate the presence of the virus and confirms infection. For a patient in the hyperinflammatory phase of desease, who has virus density of 1.2 × 108 copies/mL in saliva, the maximum wavelength shift and intensity changes after 1600 s were shown to be 1.12 nm and 2.01 dB, respectively. While for a patient in the early infection phase with 1.6 × 103 copies/mL, these values were 0.98 nm and 1.32 dB. The precise and highly sensitive FBG probe proposed in this study was found a reliable tool for quick detection of the COVID-19 virus within 10 s after exposure to patients' saliva in any stage of the disease.