Immunogenicity, effectiveness and safety of COVID-19 vaccine in older adults living in nursing homes: A real-life study.

INTRODUCTION: BNT162b2 (BioNTech and Pfizer) is a nucleoside-modified mRNA vaccine that provides protection against SARS-CoV-2 infection and is generally well tolerated. However, data about its efficacy, immunogenicity and safety in people of old age or with underlying chronic conditions are scarce. PURPOSE: To describe BNT162b2 (BioNTech and Pfizer) COVID-19 vaccine immunogenicity, effectiveness and reactogenicity after complete vaccination (two doses), and immunogenicity and reactogenicity after one booster, in elders residing in nursing homes (NH) and healthy NH workers in real-life conditions. METHODS: Observational, ambispective, multicenter study. Older adults and health workers were recruited from three nursing homes of a private hospital corporation located in three Spanish cities. The primary vaccination was carried out between January and March 2021. The follow-up was 13 months. Humoral immunity, adverse events, SARS-CoV-2 infections, hospitalizations and deaths were evaluated. Cellular immunity was assessed in a participant subset. RESULTS: A total of 181 residents (mean age 84.1 years; 89.9% females, Charlson index ≥2: 45%) and 148 members of staff (mean age 45.2 years; 70.2% females) were surveyed (n:329). After primary vaccination of 327 participants, vaccine response in both groups was similar; ≈70% of participants, regardless of the group, had an antibody titer above the cut-off considered currently protective (260BAU/ml). This proportion increased significantly to ≈ 98% after the booster (p<0.0001 in both groups). Immunogenicity was largely determined by a prior history of COVID-19 infection. Twenty residents and 3 workers were tested for cellular immunity. There was evidence of cellular immunity after primary vaccination and after booster. During the study, one resident was hospitalized for SARS-CoV-2. No SARS-CoV-2-related deaths were reported and most adverse events were mild. CONCLUSIONS: Our results suggest that the BNT162b2 mRNA COVID-19 vaccine is immunogenic, effective and safe in elderly NH residents with underlying chronic conditions.

Social service providers under COVID-19 duress: adaptation, burnout, and resilience

Summary : This article examines the response of social services organizations and their workers to the COVID-19 pandemic in a northeastern U.S. state. Using an exploratory, cross-sectional survey design with a convenience sample (N = 1472), we ask: (1) how did agencies and social service workers manage service disruptions associated with COVID-19;(2) how did social service workers perceive shifts in clients' needs;(3) how did social service workers experience the transition to remote interactions with clients;and (4) how did social service workers cope with COVID-related transitions and demands. Findings : Our findings tell a story of unprecedented crises alongside powerful attempts at adaptation, innovation, and resilience. Faced with extraordinary need among their clients, fears for their own health, and a breakdown of organizational and community functioning and guidance, social workers were able to learn and implement new technologies, adapt to increasing demands, manage new work-life boundaries, and find ways to address gaps in service while experiencing symptoms of burnout. Application : The impact of supervisory and administrative fragmentation and communication breakdowns in the face of crisis put social workers in an untenable position despite surprising abilities to adapt, innovate, and manage their professional lives while under duress. Assuring better supervisory/administrative infrastructure to support workers as they deliver services during crises will help in future crises.

COVID-19 job and income loss and mental health: the mediating roles of financial assets and well-being and the moderating role of race/ethnicity

Prior research shows unemployment has a negative effect on mental health, yet whether this relationship is affected by financial factors is unknown. For example, having money in savings may mitigate the impact of job loss on mental health. We use structural equation modeling with data from the Socio-Economic Impacts of COVID-19 Survey with a nationally representative sample (N = 3,341) to examine COVID-19 related job loss and mental health as partially mediated by liquid assets and Financial Well-Being (FWB) and moderated by race and ethnicity as moderators. More than a quarter (28.34%) of participants said they experienced a job or income loss due to COVID-19, which was associated with greater psychological distress as measured by the PHQ-4. The structural model had excellent fit (RMSEA = 0.021);FWB partially mediated the relationship between job/income loss and mental health (p <.001), accounting for 49% of the total effect. However, liquid financial assets did not partially mediate this relationship. Black participants experienced very different direct and indirect effects. Social workers should assess and intervene concerning financial factors when individuals experience job loss. Job loss is different among Black individuals who face greater challenges related to structural racism yet also have greater resilience.

A bleeding tumor on the scalp

A 83-year-old man presented with a large tumour on his head. He had been postponing his visit due to COVID. Physical examination revealed an ulcerating, bleeding tumour of 5.5x5x3 cm. Histologic analyses showed a poorly differentiated squamous cell carcinoma. Additional imaging displayed damage of the tabula externa without pathological lymph nodes.

Patient satisfaction with a virtual multidisciplinary team balance clinic: a pilot study

Background/Aims: The COVID-19 pandemic led to many services being conducted remotely, including ear, nose and throat services. Although much in-person activity has now resumed, some services are still being provided remotely. This pilot study explored patients' satisfaction with the virtual multidisciplinary team balance clinics established at the authors' practice, looking at the feasibility of continuing this model of service delivery in the future. Methods: Self-administered questionnaires were posted to the 56 patients who had received a virtual consultation with the service between March and September 2020, of which 22 were returned. The questionnaire presented respondents with 14 items, with which they rated their agreement on a 6-point Likert scale. Correlations between the final item (which measured overall satisfaction) and the other items were analysed using Spearman's rho. Results: Overall, respondents were satisfied with the virtual consultations. Respondents either agreed or strongly agreed with 13 of the 14 items;the only exception was 'I obtained better access to healthcare services by use of telemedicine'. Most respondents were happy with the quality of communication and valued the time saved on travel, although one pointed out that this may not be an appropriate mode of service delivery for patients who are deaf. Conclusions: Virtual clinics can be an acceptable adjunct to traditional clinical consultations in an ear, nose and throat outpatient department for balance disorders and should be continued in future.

Genotyping of Corona virus infections in Baghdad city

Background: The discovery of genotypes linked to geographic and temporal infectious clusters suggests that genotyping analysis can be used to track and monitor the transmission of corona virus. Objective: To explore the clinical value of causative agent for corona virus infection (CoVI) by using different genes (SARS-HCoV2 ORFlab JINZA1 and JINZA2 gene and HCoV NL63, HCoV OC43 and HCoV 229E in the diagnosis of causative agent for corona virus disease and severity of infection to know speed transmission this pandemic and control of disease. Patients and methods: Different types from human samples included nasal swabs, throat swabs and blood samples(plasma) from patients with CoVI and pneumonia. To diagnosis SARS-HCoV2 ORFlab JINZA1 and JINZA2 gene, and HCoV NL63 gene, HCoV OC43 gene and HCoV 229E gene. The positive ratio of SARS-HCoV2 ORFlab gene in the diagnosis of COVID-19 pneumonia confirmed by conventional PCR then gene sequencing by sanger method by using PCR product were sent for Sanger sequencing using ABI3730XL, automated DNA sequences, by Macrogen Corporation Korea. The results were received by email then analyzed using geneious software. Results: Assay for CoV the results shown P = 0.001 Highly sign. (P<0.01) within NL63 gene from nasal and throat swab positive n = 2 (10.53%) while negative n =17 (89.47 %) and P = 0.00 Highly sign. (P<0.01) within CT for NL63 gene positive n = 2 (4 %) while negative n = 48 (96 %). In addition to CoV result by PCR were P = 0.033 Sign. (P<0.05), positive n =17 (34%) and negative n =33 (66 %) from total n =50, and P = 0.019 Sign. (P<0.05) within SARSHCOV2 ORFlab gene from nasal swab by PCR positive n =4(21.05%), negative n = 15(78.95%) from total n =19 and P = 0.648 Non sign. (P>0.05) 229E gene from nasal and throat swab positive n =11(57.9%), negative n =8 (42.1%) from total n=19 (100%). While undetectable from OC43HCOV gene by real time PCR and by conventional PCR that indicated all results were negative for blood samples and from nasal and throat swab: Conclusion: Genotyping very important to know type of gene caused corona virus infection by using PCR real time PCR and conventional PCR indicated the study on the present other types of corona virus were HCOV 229E and NL63 HCOV and PCR product confirmed by Sanger sequencing using ABI3730XL, automated DNA sequences, the results concluded discovery two new isolates called SARSHCOV2ORF1ab JINZA1 gene and SARSHCOV2ORF1ab JINZA2 gene in Baghdad/Iraq patients and submitted in National Center for Biotechnology Information. SARSHCOV2ORF1ab JINZA1 OK486620 gene and JINZA2 OK586822 gene. The names of both genes according to name of PhD student Jnan Jafar Baksh, Supervisal Prof. Dr. Nazar Shiyaa Mohammed and Assist prof. Dr. Ahmed Saadi Hassan. BLAST results indicated because transmission by travel between Iraq and USA. Both of two patient's loss of their life due to severity of infection for JINZA1 and JINZA2 and were critical class for this pandemic.Recommendation: 1) Chosen specific primers for specific gene to avoid coinfection with other viruses and using confirmed tests include real time PCR or conventional PCR and gene sequencing for genotyping for corona virus to know speed viral transmission and control of disease: 2) Nasal swab and throat swab for detection from corona virus mostly greatest than blood samples because viral load higher and development molecular techniques and instruments for detection from virus when very low viral load.

Study of Adhesion Molecules' (ICAM-1 and VCAM-1) Effects on Immunothrombosis in Severe and Critical COVID-19 Infections in Comparison with Mild Cases

Background: The study aimed to evaluate the association among the adhesion molecules (ICAM1 and VCAM-1) with immunothrombosis in severe and critical COVID-19 patients in comparison with mild cases. Materials and Methods: A cross sectional study was conducted. From 1 October 2021 to 30 May 2022, a total of 82 COVID-19 patients were recruited at the hospital in Imam AL-Hussein Medical City/Kerbala, consisting of 44 males and 38 females, and their ages ranged from 25 to 85 years old. All participants were hospitalized after testing positive for the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). 27 of those were diagnosed with mild COVID-19 and 27 with severe cases, while 28 patients had critical diseases. Results: In mild cases, ICAM-1 adhesion molecule level increased approximately more than four folds over the normal range, and dramatically elevated with COVID-19 progression (p= < 0.001). VCAM-1 level also significantly elevated (p = 0.002), but his elevation was slower than ICAM-1 elevation. Conclusion: There is a more significant correlation among immunothrombosis, cellular adhesion molecules (ICAM-1, VCAM-1) elevation and COVID-19 severity.

Dementia Analytics Research User Group (DARUG) - A Model for meaningful stakeholder engagement in dementia research

BACKGROUND: The importance of involving stakeholders in research is widely recognised but few studies provide details to implementation in practice. The use of real-time technology involving patients, carers and professionals in project design, monitoring, delivery and reporting could maximise contribution. Stakeholder engagement was included as part of a Dementia Analytics Research User Group project which applied machine learning to the Trinity-Ulster-Department of Agriculture (TUDA) data set, identifying clinical and lifestyle factors associated with cognitive health in 5000 community-dwelling older Irish adults.

Сравнительный анализ данных амбулаторных электронных медицинских карт пациентов с хронической сердечной недостаточностью разных возрастов: результаты и проблемы

Цель. Определить клинические особенности и тактику ведения пациентов с хронической сердечной недостаточностью (ХСН) трех возрастных групп на основании анализа электронных медицинских карт (ЭМК). Материал и методы. Проанализированы 683 ЭМК пациентов из медицинских учреждений городских округов Московской области, обратившихся за медицинской помощью в 2021 г, у которых в качестве одного из кодов диагноза (осложнений) был указан код I50 (сердечная недостаточность). Для анализа сформированы 3 возрастные группы пациентов: 18-59 лет;60-70 лет;старше 71 года. Результаты. Выявлены статистически значимые различия в частоте регистрации артериальной гипертензии (85;90 и 94% соответственно), кардиомиопатии (5,6;0,8 и 0,4%), перенесенного COVID-19 (78;26 и 17%), госпитализаций по любой причине (52;43 и 63%). При этом различий в частоте госпитализаций с диагнозом COVID-19 не выявлено (4,4;4,5 и 4,6% соответственно). Доля женщин в выборке значимо увеличивалась с возрастом (32;49 и 65%)...

[Haute-Marne (France) experience during the 5th COVID-19 epidemic wave in a geriatric short-stay unit]

OBJECTIVE: The objective is to study the contribution of vaccination against COVID-19 in elderly subjects infected with COVID-19.

Visual impairment service review

Aims: To assess the quality of documentation of patients with a visual impairment within a neurosurgery department to see if they have a corresponding vision alert within their medical notes. Methods: Retrospective case note analysis over 3 years of neurosurgical patients diagnosed with a space occupying lesion involving the anterior fossa near the optic apparatus was conducted. Post-surgical clinical assessment validated by formal visual assessment revealed 56 patients had a visual impairment diagnosis. Visual acuity and visual field mean deviations in the best eye were studied, along with the documentation of a vision alert. A total of nine patients did not meet the inclusion criteria and were removed from the study. Results: Out of 47 patients, four were found to have a severe sight impairment. Only 11 (23.40%) patients had a vision alert on their medical records. Out of the 47 patients with a visual impairment, three patients certified as sight impaired and severely sight impaired (75%) did not have a vision alert on their medical record. Conclusions: Although visual impairment was common in this study population, most patients had useful vision. Documentation to alert clinicians and carers about visual impairment was poor and needs improvement.

Physical Activity in Older Adults With Visual Impairment

Visual impairment presents challenges for older adults to participate in physical activity or exercise. The purpose of this collective case study is to explore how older adults with visual impairment participate in physical activity. Four older adults with visual impairment were recruited to participate in the study. Three out of the 4 participants were able to complete all rounds of the study prior to COVID-19 pandemic halting the study. Five themes emerged from the study: exercise to enhance health and well-being, occupations as activity, loss of participation, adaptation to vision loss, and motivation to stay healthy. The findings support the use physical activity to enhance overall health and well-being.

COVID-19 and psychological distress: Lessons for India

Purpose: The COVID-19 pandemic has undoubtedly altered the routine of life and caused unanticipated changes resulting in severe psychological responses and mental health crisis. The study aimed to identify psycho-social factors that predicted distress among Indian population during the spread of novel Coronavirus. Method: An online survey was conducted to assess the predictors of distress. A global logistic regression model was built, by identifying significant factors from individual logistic regression models built on various groups of independent variables. The prediction capability of the model was compared with the random forest classifier. Results: The respondents (N = 1060) who are more likely to be distressed, are in the age group of 21-35 years, are females (OR = 1.425), those working on site (OR = 1.592), have pre-existing medical conditions (OR = 1.682), do not have health insurance policy covering COVID-19 (OR = 1.884), have perceived seriousness of COVID-19 (OR = 1.239), have lack of trust in government (OR = 1.246) and whose basic needs' fulfillment are unsatisfactory (OR = 1.592). The ones who are less likely to be distressed, have higher social support and psychological capital. Random forest classifier correctly classified 2.3% and 17.1% of people under lower and higher distress respectively, with respect to logistic regression. Conclusions: This study confirms the prevalence of high distress experienced by Indians at the time of COVID-19 and provides pragmatic implications for psychological health at macro and micro levels during an epidemiological crisis. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

[Therapeutic effect of a nasal swab: an accidental vagal manoeuvre in a patient with supraventricular tachycardia]

BACKGROUND: The case gives the reader a valuable insight in pathophysiology and treatment in atrioventricular nodal re-entry tachycardia (AVNRT) and vagal manoeuvres available to treat this phenomenon. CASE DESCRIPTION: A 85-year-old woman with a medical history of heart failure and aortic valve stenosis presents herself on the Emergency Department with cardiac shock and cardiac asthma. The ECG showed an AVNRT with 170 beats per minute (bpm) and a left bundle branch block (LBBB). After nasal swab for COVID-19 cardiac rhythm converted to a sinus or atrial tachycardia with 116bpm. The patients circulatory status improved and could then be treated with diuretics. Nasal swabs can lead to stimulation of the glossopharyngeal nerve with increase parasympathetic activity leading to a remission of atrioventricular re-entry tachycardia. CONCLUSION: Nasal swabs can lead to increased parasympathetic activity in the atrioventricular node and cause conversion of supraventricular tachycardia to sinus rhythm.

Digitalization and Tele-Health Care Concept of Complementary of Traditional Medical practices by Using BIOCERAMIC Technique

Objective: Tele-health care service of alternative practice for chronic pain disease is worthwhile of developing, especially in the period of COVID- 19 pandemic. Targeting on myofascial trigger points, this study was performed to assess the possible short-term pain relief and functional improvement in patients by applying the device of BIOCERAMIC material enhanced by frequencies of tempo sound and visible light spectrum (BioS & L). Methods: Fourteen patients who participated in the procedure for the selection of trigger points for the BioS &L treatment, assessment of pain levels using a visual analog scale (VAS) analysis, and detection of abnormal resonance of 12 harmonic frequencies using a quantum resonance spectrometer (QRS). Results: Comparing the pre- and post-treatment of BioS &L on pain score of 12 HFs (V1-V12) as measured by VAS estimated by mixed model showed 91.7% (11/12) improvement with statistically significant results. The distribution of differences in the QRS score estimated by the mixed model among participants with pre-test QRS level ≥ 2 showed 83.3% (15/16) of HFs with statistically significant results. Conclusion: Treatment of BioS &L at trigger points providing pain relief is explained by the hypothesis of microvascular physiology and physics of wave propagation. This study provides a workshop with a concept of digitalization of complementarity and traditional medical service and tele-health care, which fulfills distant data connection and remote practice. In the period of epidemic spread, it helps to decrease close contact on both health care providers and patients.

État des connaissances - Organisation des soins et services médicaux en milieu d’hébergement et de soins de longue durée

Objectives:The Ministère de la Santé et des Services sociaux (MSSS) would like the medical management arrangements and multidisciplinary care models used in long-term care facilities in other countries to be explored. The objectives of this report are, therefore, to document, in Canada and other OECD (Organisation for Economic Co-operation and Development) member countries, i) the offer of medical care and services and how medical care is provided, ii) the composition of medical care and services teams and the roles and responsibilities of their members (physicians, nurses, specialized nurse practitioners and pharmacists), and iii) physician involvement in the facilities’ management. Conclusions:RESULTS: The availability of physicians in long-term care facilities varies around the world. Some countries and provinces (e.g., the U.S., Ontario and British Columbia) have standards or legislation governing how care is provided. The implementation of standards appears to create value by clarifying medical expectations and providing more medical care and services in a timely fashion. Physician involvement outside of normal work hours varies as well (i.e., daytime from Monday to Friday). To meet the needs of residents outside these hours, access to telephone support and telemedicine between the facility’s care team and a physician seem to be methods used in some provinces and countries (e.g., Ontario, France, Norway and Australia). As for the number of medical visits per 2 year per resident, it seems to vary between 7 and 10, according to information from British Columbia, Manitoba and the United States. In the United States in 2015, there was the equivalent of 1.37 full-time equivalent (FTE) physicians per 1,000 occupied nursing home beds. This is far from the ratio recommended by U.S. experts of one FTE physician per 10 skilled nursing facility beds (facilities with, among other things, temporary physical rehabilitation beds) and 100 nursing facility beds. In Ontario, it is recommended that 4 hours per week be spent on medical practice in long-term care facilities for every 25 to 30 residents. Different practices and types of collaboration are used among different professionals working in long-term care facilities in order to optimize the provision of care for the residents. The three main types of skill mix described in the literature are (1) delegation (the physician assigns a task to another health care professional but remains responsible for it), (2) substitution (expanding the responsibilities of a health care professional, who may then provide some of the same services as the physician and becomes responsible and autonomous in performing these tasks), and (3) supplementation (increasing the scope of a health care professional’s work by allowing them to provide additional services that complement or extend those provided by the physician). Although a combination of all three types is reported in practice, physician substitution with different professionals, such as specialized nurse practitioners (SNPs) and physician assistants, is the one most documented in the publications reviewed. CONCLUSION: The results presented in this state-of-knowledge report provide relevant avenues for reflection on the organization of medical care and services in long-term care facilities. The topics discussed include the different staffing models in place across the OECD countries, the variability in the level of physician involvement in the management of these facilities (and the form of this involvement), and the several forms of skill mix. These results provide insight on the organization of care and services and the sharing of responsibilities among the various members of the care team. Given the aging of the population, the increasing complexity of the residents’ profile, and the difficulties recruiting qualified workers, efforts will certainly have to be made to adjust the way things are done and to continue to offer quality care and services. This reflective work is all the more necessary given the significant impact the COVID-19 pandemic has had on the health and social services system. Lastly, there are several tensions in the mission of long-term care facilities, which is to offer quality care and services in a quality living environment. The combination of these two goals in the reflection on the organization of medical care and services is essential for ensuring residents’ well-being. Methods:The Institut national d'excellence en santé et en services sociaux (INESSS) has prepared a state-of-knowledge report based on the scientific literature and websites of organizations, learned societies and government bodies. A total of 58 primary studies, 9 reviews, 9 expert opinions published in a scientific journal, reports from 7 governments and 23 organizations were examined.

Performance Accuracy of a Laboratory-Developed Real-Time RT-PCR Method for Detection of SARS-CoV-2 in Self-Collected Saliva Specimens

OBJECTIVE: The ongoing COVID-19 pandemic caused by SARS-CoV-2 has challenged diagnostic laboratories to re-examine traditional methods for collecting specimens and sample types used in molecular testing. Our goal was to demonstrate that saliva can be used for detecting SARS-CoV-2 and correlates well with established molecular methods using nasopharyngeal (NP) swabs. METHODS: We examined use of a saliva collection device in conjunction with a laboratory-developed real-time reverse transcription-polymerase chain reaction (LDPCR) method for detecting SARS-CoV-2 in a symptomatic population and compared results with 2 US Food and Drug Administration (FDA)-approved methods (emergency use authorization [EUA]) that use specimens from NP swabs. RESULTS: The sensitivity of LDPCR compared with the reference methods was 75.0% (21/28);specificity, 98.1% (104/106). When cycle threshold values were compared between paired specimens using the LDPCR and a EUA reverse transcription PCR method, both targeting the open-reading frame gene, the mean value for saliva was 4.66 cycles higher than for NP specimens. CONCLUSION: Use of self-collected saliva in conjunction with an LDPCR for SARS-CoV-2 compared favorably with 2 FDA EUA methods using NP swabs. The use of an alternative sample type and assay method will aid in expanding the availability of testing during the ongoing COVID-19 pandemic.