Vaccines: immunology, regulation and clinical management

The pandemic has facilitated an explosion in the development of new platforms for vaccines and rapid regulatory approval systems. The COVID-19 vaccines have been produced in record time and have proved far more effective than expected. In many countries, the roll out of vaccination initially proved effective in reducing severe disease, but there are major concerns following the emergence of SARS-CoV-2 variants, especially omicron, where vaccine boosting is required to maximise effect. Vaccine hesitancy, the spread of disinformation and the equitable delivery of vaccines worldwide remain significant challenges.Copyright © ERS 2021.

Occlusive Explosion

Clinical Information Patient Initials or Identifier Number: A Relevant Clinical History and Physical Exam: 47yr old man, suffered a blast injury at the workplace after an O2 tank exploded while he was transferring liquid gas into a tank for welding purposes. The impact has caused him to temporary loss of consciousness. Upon awakening, he had severe chest pain associated with shortness of breath. On examination, superficial partial thickness injury on the chest wall, and lungs: reduced breath sound bi-basally, no murmur heard. BP:106/77mmHg, HR:100/min, SPO2 100% on HFM 15L/min. [Formula presented] [Formula presented] [Formula presented] Relevant Test Results Prior to Catheterization: Serial ECGs were done and showed dynamic changes in the anterior leads Bedside echo before invasive coronary angiograms shows mild LVSD, normal valves, and no pericardial effusion [Formula presented] [Formula presented] Relevant Catheterization Findings: Right radial approach 6F system Opitorque catheter for diagnostic angiogram LMS: smooth LAD: ATO mid LAD, DG1 prox ATO LCx: smooth RCA: smooth Impression: ATO to LAD and Diagonal 1 ( Dual ATO) [Formula presented] [Formula presented] [Formula presented] Interventional Management Procedural Step: Right radial coronary angiogram via 6F system EBU 3.0 engaged with good support Sion blue wired into LAD, export catheter delivered, and aspirated red thrombus Pre-dilated with Sapphire 3 SC 2.5x15mm @ 6-10ATM Flow established in LAD, however, decided to interrogate DG1 as it shows ATO BMW wired into the DG1 and pre-dilated with Sapphire 3 SC 2.0x15mm Noted nonflow limiting dissection and decided to stent DG1 with 2.25x34mm@12ATM, dissection sealed and TIMI III flow established Stented mid LAD with 2.5x30mm @12ATM just before LAD/DG1 bifurcation, then stented proximal LAD with 2.5x 26mm@ 12ATM. Post-dilated LAD with 2.75x15mm@ 14-20ATM TIMI II-III flow IV Tirofiban has been given a loading dose due to a high thrombus burden and sluggish flow [Formula presented] [Formula presented] [Formula presented] Conclusion(s): Myocardial infarction is a rare complication of blunt chest trauma. This case demonstrates how blast shock waves result in the dissection of the coronary vessel leading to total occlusion of the two vessels. It also promotes red thrombus within the coronary vessels. Percutaneous coronary intervention is the most suitable way to treat this condition. Intravascular imaging such as IVUS or OCT would be beneficial to demonstrate the physiology behind this MI and would also be helpful in planning and optimizing the lesions. Unfortunately, intravascular imaging was not used for this patient to reduce procedural time as he was treated during the height of the COVID pandemic.Copyright © 2023

Anxiety, depression and post-traumatic stress disorder in patients on hemodialysis in the setting of the pandemic, inflation, and the Beirut blast: a cross-sectional study.

BACKGROUND: In 2020, Lebanon has witnessed its worst economic crisis, exacerbated by the COVID-19 pandemic and a massive explosion of its capital. Amidst these stressors, this study aims at assessing the prevalence of depression, anxiety, suicidality, post-traumatic stress disorder (PTSD) and cognitive impairment in patients undergoing hemodialysis in an academic hospital destroyed by the explosion. METHODS: This cross-sectional study conducted 6 months after the blast included adults on hemodialysis, with no previous diagnoses of dementia or intellectual disability. It explores prevalence rates of psychiatric disorders, in addition to other medical and psychosocial variables such as frailty, malnutrition, sarcopenia, quality of life and religiosity. RESULTS: Forty two patients (mean age 66.1; SD: 11.2 years) undergoing hemodialysis for 6.12 years (SD:7.22 years) were included. Anxiety and depression rates reached 54.8% and 57.1% using cut-offs of 6 and 7 respectively on the Hospital Anxiety and Depression rating Scale. 9.5% of the patients reported being in the hospital at the time of the blast and 7.1% reported being injured. 33.3% screened positively for PTSD using a cut-off of 23 on the PCL-5. 26.2% had passive death wishes and 7.1% had suicide plans, however no one had attempted it. 23.8% were found cognitively impaired as shown by the Mini-Cog (<3). Around two-third of participants were moderately to severely malnourished per the GLIM criteria. One third suffered from frailty, according to the FRAIL screening tool. Around 60% suffered from sarcopenia, based on handgrip strength measures. These findings contrast with "acceptable to good" quality of life subjectively reported by participants on the Short Form 36 (SF-36) Health Survey. While one-third of participants participated in organizational religious activities, 88% reported significant subjective meaning of religion in their heart. CONCLUSIONS: Rates of depression, anxiety, PTSD, suicidality, and cognitive impairment were found to be alarming in the setting of an urban dialysis unit following a major explosion. Psychiatric disorders were found to be compounded with increased prevalence of malnutrition, frailty, and sarcopenia. These findings urge healthcare providers to implement early diagnostic and intervention strategies to improve both mental and physical wellbeing of this vulnerable population, in similar settings.

A scoping review to identify the teaching methods that are employed in the education of telemedicine

Telemedicine is increasingly being used as a means of triaging referrals, educating primary care physicians and - in some circumstances - replacing face-to-face appointments. Since the start of the COVID-19 pandemic, its use has exponentially risen. It is vital to consider how clinicians are taught to practice this form of medicine, as it is significantly different from 'routine clinical practice'. This review aimed to consider the current evidence for the methods used when teaching telemedicine and, more specifically, teledermatology and the effectiveness of these methods. Database searches were conducted in MEDLINE, Embase, Web of Science and Education Research Complete. Search terms related to telemedicine/teledermatology and education/learning were used. Titles and s were independently screened by two reviewers according to the eligibility criteria, followed by the full texts. Results were extracted and analysed thematically. Critical appraisal was undertaken. Eleven studies were included in the review from the 451 identified. Some studies were poorly designed and open to sources of bias, confounding factors and limited reliability. Teaching methods identified included continuous feedback to trainees, training via an online platform, reviewing prior exposure to telemedicine and different telemedicine modalities (still photographs vs. videos). Four themes were identified in the results of the papers: concordance rates between clinicians, knowledge acquisition, clinician confidence and its use as an educational tool. Multiple methods of telemedicine education are used. Generally, trainees that have more exposure to it are more confident in undertaking it in ongoing clinical practice. There is evidence that there is an element of knowledge acquisition associated with tele-education, but that it is not necessarily sustained long term. The use of videos to supplement still images in consultations appears to be superior. Future work to assess the effectiveness of different teaching methods should be considered a priority with the explosion of telemedicine undertaken since the start of the COVID-19 pandemic.

Role of vitamin D, folic acid, ferritin, inflammation and oxidative stress in the pathogenesis of COVID-19

The COVID-19 pandemic is one of the most devastating and significant events of recent times. COVID-19 has so far become one of the worst infectious disease outbreaks of recent times, with more than 635 million cases and more than 6.6 million deaths. Viruses cause an explosion of inflammatory cytokines and reactive oxygen types. Oxidative stress is thought to have a key role in COVID-19. vitamin D, folic acid, calcium (Ca), magnesium (Mg) and ferritin levels are thought to be associated with COVID-19. This study aims to investigate the role of oxidative stress, inflammation, vitamin D and folic acid, ferritin, Ca and Mg in the pathogenesis of COVID-19. Material(s) and Method(s): 45 patients diagnosed with COVID-19 and 45 healthy persons (control group) were included in the study. Vitamin D, ferritin, folic acid, CRP, Ca, Mg and Phosphorus were measured in an autoanalyzer, and SOD, GSH-Px and MDA were spectrophotometrically measured in the serum of the participants. TNF-alpha, IL-1beta and IL6 levels were studied by the ELISA method. Result(s): The activity of SOD, GSH-px, antioxidant enzymes, Serum vitamin D, folic acid, Ca and Mg of the COVID-19 group was found to be significantly lower than the control group (p<0.05). Conclusion(s): Again, the levels of MDA, TNF-alpha, IL-1beta, IL-6, CRP and ferritin in the Covid-19 group were found to be significantly higher than in the control group (p<0.05).Antioxidant enzyme activities were low and oxidative stress was high in patients with COVID-19. At the same time, the levels of serum ferritin, CRP, TNF-alpha, IL-1beta and IL6 were high, and levels of Ca and Mg were low in patients with COVID-19.According to these results, we hypothesize think that the level of oxidative stress, inflammation, vitamin D, and serum ferritin, Ca, and Mg levels play a role in the pathogenesis of COVID-19. Future clinical trials should be conducted to further clarify the pathogenesis in patients with COVID-19.Copyright © 2022 Mattioli 1885. All rights reserved.

CROI 2022: Summary of Basic Science Research in HIV and SARS-CoV-2

The Conference on Retroviruses and Opportunistic Infections (CROI) 2022, which was held as a virtual conference, continues to serve as the preeminent forum that features research advances in HIV-1 and its associated coinfections. The conference has extended its area of coverage to include research advances in SARS-CoV-2. As pointed out in the presentation from Hatziioannou in the New Investigators workshop, there has been an explosion in research activity on SARS-CoV-2 that has eclipsed that for HIV-1. In the past 12 months, there were approximately 6600 publications on HIV-1 and approximately 64, 000 on SARS-CoV-2. Although these numbers include review articles, they reveal the tremendous response by researchers to the existential threats posed by lentiviruses and coronaviruses. This poses challenges for any conference committee tasked with selecting abstracts for presentation from the large number submitted for consideration. CROI organizers have consistently been able to assemble a program that, through invited presentations, abstract-driven talks, posters, interactive sessions, workshops, and symposia, showcases the most recent research advances.Copyright © 2022, IAS-USA. All rights reserved.

A novel ensemble deep learning model for covid-19 Twitter sentiment analysis

Recent years have seen a rise in the significance of sentiment analysis as a direct result of the explosion in the amount of material available online. The practice of analyzing textual data created on social media sites such as Facebook and Twitter using a natural language processing approachis called sentiment analysis. Since the beginning of the COVID-19 pandemic, several postings, including videos and text messages, have been uploaded on the social media platform in order to provide real-time updates on the progression of the pandemic across the world's nations. The term refers to the practice of analyzing the word-based data created by social media platforms, which can be accessed, retrieved, and evaluated with relative ease. Most of the published research relating to COVID-19 issue theories were surveys of people's thoughts and ideas, and they explored the influence that the pandemic had on their life. This was because COVID-19 became prevalent after it was discovered. A very small number of researchers used a machine learning strategy for the task of analyzing the sentiment of social media. The rapid spread of the illness has resulted in a significant rise in the number of posts and comments made by users of social media, and these expressions of opinion cover a wide range of topics. The topic of sentiment analysis is discussed in this article, with the primary emphasis being placed on the categorization of the feelings sent by users in tweets originating from Twitter that are associated with COVID-19. Using deep learning techniques (CNN, LSTM, CNN + Bi-LSTM), as well as CNN + Bi-LSTM +CNN (CBC) a deep learning-based ensemble model, we were able to categorize the attitudes as positive, neutral, or negative. In comparison to the typical machine learning models, the BiLSTM technique has obtained more accuracy (0.98), when it comes to the categorization of Twitter sentiment. Based on the findings of the investigation as a whole, we are able to draw the conclusion that individuals have higher levels of optimism and confidence toward the recovery from the COVID-19 pandemic. A study of this kind will assist those responsible for making policies and decisions in meeting the requirements of the public in an acceptable manner. Copyright © 2022 Ubiquity Press. All rights reserved.

Emergenza Esplosione, veridizione, normalizzazione

Emergency has two areas of meaning the one derived from the Anglism emergency, the other that includes all meanings connectable to what emerges. COVID19 emergency is exemplary of both areas. A semiotics of emergence observes the process of explosion, veridification and normalization of phenomena that burst into cultural systems. The analysis of social discourses on the pandemic has provided elements to identify semantic oppositions, through which we have outlined a system of meaning relations. © 2022 The Author.

DELAYED PRESENTATION OF CHEMICAL PNEUMONITIS AND RELATED RESEMBLANCE TO COVID-19 ASSOCIATED PNEUMONIA IN CT IMAGING: A CASE REPORT

SESSION TITLE: Imaging, ECMO, and other Procedures in the ICU Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Inhalation of various organic and non-organic compounds like toxic fumes, batteries, and dust can result in lung irritation called chemical pneumonitis (1). Chemical Pneumonitis can cause acute complications like secondary pneumonia or long-term complications like bronchiectasis or lung destruction (2). Classical radiograph findings of chemical pneumonitis show pulmonary edema or radiographic opacities (3). This type of injury can initially present as no damage in radiograph scans, and the extent of damage can be difficult to determine initially. Chemical pneumonitis can also be difficult to distinguish from pneumonia caused by bacteria or a virus. CASE PRESENTATION: A 40-year-old male presented to the emergency department with an 18% total body surface area burn to his upper extremities from an oil pump battery explosion that released chemicals he likely aspirated. The patient was intubated and transferred to the Burn ICU where a bedside bronchoscopy was performed. It revealed no soot or signs of inhalation injury. On the day of admission, he had a 100% oxygen dependence. A CT scan was done and showed no lung damage. The patient was extubated and moved to a high-flow nasal cannula of 40 liters per minute. A repeat CT scan was performed of his chest on hospital day 4. The results appeared to be multifocal pneumonia eliciting a possible diagnosis of Covid 19 pneumonia. This delayed his excision and grafting by 5 days. Through aggressive respiratory therapy intervention, oxygen dependence was reduced until the patient was on room air. The patient was discharged to inpatient rehab on hospital day 21. DISCUSSION: There are several factors presented in this case that should be kept in mind when treating a patient exposed to compounds that can cause chemical pneumonitis. Chemical pneumonitis likely has no findings on bronchoscopy. Furthermore, previous literature has suggested that CT chest scans of chemical pneumonitis may initially present with no apparent injury. Regardless of these initial findings, it is important that patients receive intense pulmonary hygiene to avoid delays in other interventions. Chemical pneumonitis injuries can be associated with chemical burns, and it is imperative to avoid delays in interventions including excision and skin grafting. Findings from a chemical pneumonitis injury may present on a CT scan later in a patient's course of injury. The findings of the CT scan could resemble multifocal pneumonia. This may complicate treatment plans as SARS-CoV-2 is also known to cause multifocal pneumonia. CONCLUSIONS: This case highlights the complexity that chemical pneumonitis traumatic injury may present, and the various factors providers should keep in mind. In the aftermath of the COVID-19 pandemic, another factor has emerged: the resemblance of chemical pneumonitis to SARS-CoV-2 multifocal pneumonia. Reference #1: Andujar, P., & Nemery, B. (2009). Pathologies respiratoires aiguës et subaiguës d'origine toxique [Acute and subacute chemical pneumonitis]. Revue des maladies respiratoires, 26(8), 867–885. https://doi.org/10.1016/s0761-8425(09)73682-4 Reference #2: Neill, S., & Dean, N. (2019). Aspiration pneumonia and pneumonitis: a spectrum of infectious/noninfectious diseases affecting the lung. Current opinion in infectious diseases, 32(2), 152–157. https://doi.org/10.1097/QCO.0000000000000524 Reference #3:.White, C. S., & Templeton, P. A. (1992). Chemical pneumonitis. Radiologic clinics of North America, 30(6), 1231–1243. DISCLOSURES: No relevant relationships by Genesy Aickareth No relevant relationships by Deepak Bharadia No relevant relationships by John Griswold No relevant relationships by Alan Pang No relevant relationships by Jad Zeitouni

Combining cell therapy and extracorporeal membrane oxygenation for Acute Respiratory Distress Syndrome: Back to no future?

Introduction: After more than 50 years of research we are yet to develop an effective treatment for the Acute Respiratory Distress Syndrome (ARDS). This stands in contrast to the advances made in supportive care, a prime example of which is the maturation of Extracorporeal Membrane Oxygenation (ECMO). While technologies such as ECMO 'buy time' for recovery, the identification of a therapy remains crucial to improving outcomes. Recently, mesenchymal stem cells (MSCs) have shown promise as a novel treatment.1 Importantly, cell therapy may represent a means to overcome the hurdles associated with successful pharmacological intervention in ARDS. Little is known about the interaction between cell therapy and ECMO. This is a deficiency, given that those receiving ECMO for ARDS are among the most severely ill and therefore most likely to benefit. This programme of work was designed to close that gap. Objectives: Using a translational pipeline, our objective was to assess the safety and efficacy of MSCs during ECMO for ARDS. Methods: We employed several diverse methods to address our objectives, including an ex-vivo ECMO simulation, complex sheep models of ARDS and ARDS and venovenous ECMO, systematic review methodology, and unsupervised machine learning techniques. Results: In our ex-vivo model, we were the first to demonstrate potential harms associated with MSC therapy during ECMO.2 When 40 × 10∧6 clinical-grade human MSCs (Cynata Therapeutics Ltd., Australia) were added to fresh whole human blood and subjected to extracorporeal circulation using commercial components, oxygenator and pump performance was severely impaired within 4 hours. These experiments also demonstrated benefits associated with MSCs, including trends toward lower inflammatory cytokine concentrations and less neutrophil activation.3 To validate our findings, we sought to test hMSCs in a clinicallyrelevant sheep model. At the outset we undertook a systematic review of existing pre-clinical models of ARDS and ECMO.4 This has since produced an international collaborative effort to characterise pre-clinical models of ECMO across a range of indications. We subsequently described a 'double-hit' model of ARDS which combines oleic acid and intra-tracheal E. coli lipopolysaccharide. Using cluster analysis, we showed that this model shares qualitative similarities with the 'hypo-inflammatory' phenotype identified in clinical cohorts [Millar JE et al. Physiological Reports 2021. In Press]. Finally, in a 24-hour model, combining our novel injury method, VV-ECMO, and best practice ventilatory and supportive care, we performed a controlled trial of intra-tracheal hMSC therapy5 [Editorial: Del Sorbo L, Fan E. AJRCCM 2020]. This study showed that hMSCs reduce histological evidence of lung injury and ameliorate shock. However, hMSC-mediated impairment of oxygenator function was evident again. Conclusion: This work addresses a gap in our understanding of cell therapy in critical illness. The findings are of direct clinical relevance, highlighting the potential harms of cell therapy during extracorporeal circulation. With a recent explosion in the number of registered clinical trials of MSCs for severe COVID-19 in mind, the use of MSCs during ECMO cannot be recommended.

Management of depression: A daily challenge in psychiatric emergencies

Depression is the most common psychiatric disorder in the general population, and emergency room visits for depression have been increasing for several years. In addition, the Covid-19 pandemic may lead to an explosion of psychiatric emergency room visits for this reason, with an overall prevalence of anxiety and depression that appears to be increasing since 2020. The Centre Psychiatrique d'Orientation et d'Accueil is a regional psychiatric emergency service located in Paris which records approximately 10,000 consultations per year. Among these consultations, the main symptoms are those of depression (depressive ideations, anxiety) and nearly 40 % are diagnosed with mood disorders, including depression. The management of the patient in the emergency room is based on a global evaluation, which should not be limited to the psychiatric interview. In the best case, and if compatible with the organization of the service, an initial evaluation by the nursing reception staff determines the context of the arrival of the patient, the reason and the degree of urgency of the consultation can thus be assessed from the outset. The request for care can come from the patient themself, but also from family and friends who are worried about a decline in the patient's previous condition. The consultation may also be triggered by the intervention of emergency services, particularly in the case of attempted suicide or agitation. The context of arrival, the environment, and the patient's entourage must be taken into account in order to achieve an optimal orientation. Particular attention must be paid to the first episodes (elimination of a differential diagnosis, screening for a possible bipolar disorder). The existence of an external causal factor or a comorbid personality disorder should not trivialize the consultation and lead to a faulty diagnosis of a characterized depressive episode. Drug treatment in the emergency room is usually symptomatic (anxiolytic treatment with benzodiazepines or neuroleptics, depending on the situation), and outpatient referral should always be preferred. Therapeutic adaptations can then be considered. The decision to hospitalize must always be justified, and consent for care must be rigorously evaluated. It is almost always necessary to take the patient's entourage into account as well as the potential support of the patient by the entourage. All these elements must be recorded in the file. Suicide risk assessment must be systematic for all patients consulting psychiatric emergencies, and the use of the RUD (Risk, Urgency, Dangerousness) grid can be useful. Any decision to release a patient with suicidal tendencies must be made strictly following certain conditions:a rapid psychiatric re-evaluation of the crisis, with for example the proposal of a post-emergency consultation, a supportive entourage, accepted symptomatic treatment. The registration of the suicidal patient in a monitoring system such as VigilanS can also be beneficial and reduce the risk of recidivism.

A FRAMEWORK FOR DIGITAL HEALTH EQUITY

BACKGROUND: The COVID-19 pandemic highlighted both the continued impact of long-standing systemic oppression on disparate health outcomes as well as the growing importance of healthcare provided through digital means. For example, an explosion in the use of telehealth for remote care noted significant disparities in use by minority groups. There is a growing recognition of the crucial importance of determinants in the digital environment and their impact on health outcomes. These digital determinants of health (DDoH) function independently as barriers to and facilitators of health as well as interact with social determinants of health (SDoH) to impact outcomes. A framework for digital health equity, detailing key DDoHs, is needed to support the work of developers in industry, health systems operations and academia. METHODS: The framework for digital health equity is an adaptation of the NIMHD Research Framework, which is the culmination of decades of work in the field of health disparities. The NIMHD framework is organized into several domains, including biological, behavioral, physical/built environment, sociocultural environment, and the health care system. Because of its particular importance at this time -we incorporate a digital environment domain with key DDoHs. RESULTS: Determinants at the individual level include digital literacy, readiness, interest, and self-efficacy. Readiness describes necessary technological equipment availability. Interest is used here to describe an individual's desire and willingness to use and trust in digital tools. Determinants at the interpersonal level include bias, interdependence, and relationship disruption. We use the term bias to describe the impact perceptions about an individual's digital literacy, readiness and interest have on clinician willingness to enroll and engage individuals with digital healthcare tools. Relationship disruption describes the complex cultural transformation encouraged by digital technologies. For disparity populations this has the potential to impact well documented relational determinants including medical mistrust and poor-quality communication. Determinants at the community level include cellular wireless and broadband access, quality and affordability as well as health system infrastructure. Determinants at the societal level include the impact of policy, data and design standards, algorithmic bias as well as social norms and ideologies in technical industry. Key examples of facilitators of positive health outcomes are provided at all levels. CONCLUSIONS: By adapting the leading health disparities research framework for digital health equity, we hope developers will benefit from decades of progress in the field of health disparities as well as see their work in the larger context of SDoHs so that we might work together towards meaningful progress in using digital means to achieve health equity for all.

Development and remodeling of point-of-care ultrasound education for emergency medicine residents in resource-limited countries during the COVID-19 pandemic

Background: The administration of an accurate and effective point-of-care ultrasound (POCUS) course is a crucial tool in improving health education and thus the healthcare system in low-to middle-income countries. The development of the ultrasound curriculum in these countries during the pandemic era is a major challenge for medical educators. Objective: This study aims to survey the learner experience after implementing the POCUS curriculum for first-year emergency medicine residents. Method: A cross-sectional 10-question survey study was conducted at Srinagarind Hospital, Department of Emergency Medicine, Thailand, from July 2019 to July 2021 to determine the experience of POCUS learning by using the 5-point Likert-type scale after first-year emergency residents finishing the ultrasound rotation. Results: All learners responded to the survey. Our results demonstrated that the ultrasound rotation and our ultrasound learning materials were useful tools that showed a positive impact on POCUS knowledge for our learners. However, some obstacles of POCUS learning were identified to assist in closing faculty development gaps: the availability of handheld devices as well as the remodeling of the ultrasound rotation course should be managed according to the feedback we received. This study demonstrated a clear need for constant updates in higher education, medical program development, the accuracy of local learning materials, and the explosion of virtual and online learning platforms during this decade. Conclusion: Our results demonstrated that all academic activities employed and the ultrasound learning materials were useful in improving POCUS knowledge. However, we found some obstacles of POCUS learning that needed to be improved, mainly the length of time of training.

The current situation of physiotherapists in Lebanon

The aim of this article is to establish an overview of the current socio-economic and professional situation of physiotherapists in Lebanon, which deteriorated considerably after the great explosion in Beirut in August 2020, and which exacerbated the problems that occurred after the revolution and popular protests that erupted in October 2019, and the Covid-19 pandemic that began to spread in February 2020. What happened between 2019 and 2021, despite its importance, cannot be considered as the only reasons responsible for the deterioration of the socio-economic and professional situation of physiotherapists in Lebanon. Many factors from several sources occurred before or after 2019, exacerbated things such as: • The general Lebanese situation, • The glut of the number of physiotherapy graduates, • The lack of official protection for the physiotherapy profession, • The labour market and unfair fees for physiotherapy sessions, • The collapse of the national currency, • The accumulation of professional projects and the decline in the level of the National Order Professional performance since 2015. The current situation of physiotherapists in Lebanon is very dangerous and requires a lot of attention and work on the part of the National Professional Order, the State and everyone else to revive a new Lebanon and to achieve a good organization for all the issues of the physiotherapy profession.

The Lebanese Healthcare Crisis: An Infinite Calamity.

In the past, a number of events rocked Lebanon, a small region of the previously prestigious Phoenician civilization. Whether it was mandates, wars, or economic compromises, the country always seemed to rise up again to a prominent stature in the Middle East. Once known as Switzerland of the East, Lebanon was torn apart by the works of sectarian battles during the civil war from 1975 to 1990. Since then, the country has never been the same with the turmoil left and right. Despite all of that, the healthcare sector has been one of the most prominent in the Middle East and the entire Arab world with accomplished physicians returning from immigration to serve their country. Lebanon excelled in holding first-time international conferences, performing medical interventions, and offering one of the best healthcare education and training to its juniors. The most recent setbacks since late 2019 have, however, held Lebanon back and subsequently handcuffed the healthcare system, leading to the impactful demise of the once glorious care. Nevertheless, the healthcare system remains one of the top-tier domains fighting against the coronavirus disease 2019 (COVID-19) pandemic and the failings of the rocked state.

Challenges of Emergency Medical Teams and Deploying a Field Hospital in the Aftermath of the Beirut Blast: A Qualitative Study.

OBJECTIVE: The huge explosion that occurred at Beirut Port led to a high number of casualties. Consequently, 7 field hospitals (FHs) were deployed in Lebanon. The purpose of this study is to explore the challenges that emergency medical teams (EMTs) faced and explain the gaps at the national level related to deploying a FH. METHODS: A qualitative study was conducted. To collect the data, semi-structured interviews were done with 8 key informants (5 from the FHs, 2 from Lebanese Army Forces, and 1 from Ministry of Public Health). In this study, purposive sampling was used and data were analyzed using Braun and Clarke (2006) thematic analysis and MAXQDA software. RESULTS: Three major themes (logistical challenges, staff challenges, and coronavirus disease [COVID-19] pandemic) and 10 subthemes emerged for the challenges that EMTs faced. The gaps at the national level were categorized into 2 themes (absence of needs-based response and limited effective coordination between the host country and donor countries) and 5 sub-themes. CONCLUSION: Lebanon focuses on response rather than preparedness for disasters. EMTs that arrived didn't meet the medical needs. Hence, there is a need to strengthen the national capacities and to ensure better communication and coordination between the disaster-affected country and the EMTs.

Unusual neurological manifestations in children during the COVID-19 pandemic

Objective: To present paediatric cases of unusual neuroinflammatory conditions encountered during the COVID-19 pandemic in Trinidad & Tobago. Methods: Retrospective study design. Inpatient paediatric patients (aged 0-16 years) hospitalized for neurological complaints from June 2020 - August 2021 at EWMSC. Outcome measures were age at presentation, sex, ethnicity, diagnosis, radiological findings, blood/CSF findings, COVID-19 PCR and antibodies testing, treatment, outcomes and other systems involved. Results: Twenty (20) patients (aged 4-months-old to 15-years-old) had documented neurological involvement. 50% had a diagnosis of ADEM/ADS/AHNE;45% had a diagnosis of either CNS vasculitis (n=3), autoimmune encephalitis (n=3) or GBS (n=3);5% had a diagnosis of acute COVID-19 encephalitis. 70% were of African descent. The youngest age group (0-4 years) (n=11) constituted more males (82%) whereas the eldest age group (10-15 years) (n=3) were all females. Neuroimaging findings were corpus callosal lesions;deep white matter T2 hyperintensities;cerebellar involvement;area postrema and brainstem/C-spine involvement;microhaemorrhages and necrotizing/haemorrhagic lesions (peripheral/central). 70% of patients were either SARS-CoV-2 PCR or COVID-19 antibodies positive. Other systems were involved in 40% to 62.5% (n=5) had cardiac involvement (myocarditis, coronary arteries dilatation, valve regurgitation) and 37.5% (n=3) had pancreatic involvement (autoimmune pancreatitis, type 1 diabetes mellitus). Treatment modalities for CNS manifestations (n=17) were clinically based - 24% (n=4) 3rd line treatment, 29% (n=5) 2nd line treatment, 41% (n=7) 1st line treatment and 6% (n=1) requiring no treatment. All 3 patients with a diagnosis of GBS responded appropriately to IVIG. Developmental outcomes were worst in patients with a diagnosis of autoimmune encephalitis. Conclusion: We have had an explosion of neuro-inflammatory cases since the COVID-19 pandemic began. The range of neuroradiological diagnoses and other systemic involvement (including criteria for PIMS) are interesting, alluding to a neuroinflammatory mechanism. Effects on long-term sequelae and developmental outcomes are concerning in some cases, however, still unknown at this stage.

POS-738 ASSESSMENT OF DEPRESSION, ANXIETY, SUICIDALITY AND POST-TRAUMATIC STRESS DISORDER IN LEBANESE PATIENTS ON HEMODIALYSIS FOLLOWING THE BEIRUT EXPLOSION

Introduction: On the 4thof August 2020, Beirut witnessed a major blast in its port that led to 214 dead and more than 6500 injured. Saint George Hospital University Medical Center (SGHUMC) facing the port was subject to severe damage and was non-functional for around a month after the explosion. A considerable number of patients, and staff members present in the hospital at the time of the explosion were injured and subject to physical and psychological trauma, including patients who were undergoing their hemodialysis shift at the time of the blast. The purpose of this study was to assess the prevalence of depression, anxiety, suicidality, and post-traumatic stress disorder (PTSD) in this vulnerable population of end-stage renal disease patients. Methods: A cross-sectional study was conducted in March and April 2021 among patients aged 18 years and older, undergoing hemodialysis on a chronic basis at the outpatient unit of SGHUMC. The Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety and depressive disorders, while the PTSD Checklist for DSM-5 (PCL-5) was used to screen for PTSD. Suicidality was assessed by direct questions about passive death wishes, suicidal thoughts, plans and attempts. Other measures included age, sex, marital status, education, socioeconomic status, smoking, alcohol and substance use, malnutrition risk assessment, comorbid medical diseases, past psychiatric history, history of severe COVID-19 infection and assessment of the exposure to the Beirut blast. Results: 42 patients (mean age 66.1;SD: 11.2 years) were included in the assessment of whom 45.2% were female. 69% were married, 31% had a high school level of education or above while 16.6% had earned a university degree. 59.5% were smokers and 40.5% were alcohol users while 2.4% reported alcohol misuse. In addition, 2.4% reported active drug use. 66.7% belonged to a middle socioeconomic status (SES) and 9.5% to a high SES. Around 7% were hospitalized for COVID-19 infection. Two thirds suffered from moderate to severe malnutrition according to the GLIM criteria. Around 40% had cardiovascular disease and one fourth had thyroid problems. Only 12% had previously consulted a mental health professional. Anxiety and depression screening rates were found to be significantly high, reaching 54.8% and 57.1% using cut-offs of 6 and 7 respectively on the HADS. 9.5% of the patients reported being in the hospital at the time of the blast and 7.1% reported being injured. In addition, 23.8% had a close family member either injured or deceased because of the blast. 33.3% of our population screened positively for PTSD using a cut-off of 23 on the PCL-5. 26.2% had passive death wishes and 7.1% had suicide plans, however no one had attempted it. Conclusions: In an urban dialysis unit, affected by a major blast and the COVID-19 pandemic, depression, anxiety, and PTSD were found to be highly prevalent (figure 1), urging the need for a prompt psychiatric evaluation in similar settings and early intervention strategies aiming at improving the physical and mental well-being in this vulnerable population. No conflict of interest

Analysis of COVID-19 Misinformation in Social Media using Transfer Learning

Most major events are often accompanied by misinformation on online Social Networking platforms. Due to its nature, the COVID-19 pandemic was bound to lead to an explosion of information online, much of it false or misleading. This information explosion, termed "infodemic"by the World Health Organization (WHO), has revealed the need for automatic fake news detection to help with the exponentially growing flow of unverified information. The objective of this study is to explore combinations of different supervised classification models trained on different general and domain-specific embeddings, and compare the effects of the iterations on the results. We also analyze the results to determine whether the differences in weighted F1-score performance metrics are statistically significant. Ultimately, we demonstrate that concatenation of general and context-specific embeddings improves performance. Our research shows promise for health misinformation detection and formulation of effective public health responses. © 2021 IEEE.