Evaluation of Vitamin D binding protein and 25-hydroxy Vitamin D metabolites in COVID-19 patients

Objectives: The immunomodulatory roles of Vitamin D and Vitamin D binding protein (VDBP) are in interest with incidence or outcome of coronavirus disease-2019 (COVID-19). This study aimed to investigate the association between the severity of COVID-19 with VDBP, total 25-hydroxy Vitamin D (25(OH)D), and its metabolites free Vitamin D (VDfree) and bioavailable Vitamin D (VDbio). Methods: Study group consisted of 68 COVID-19 patients and 20 healthy subjects. Patients were subgrouped as asymptotic, mild/moderately pneumonia, or severe pneumonia. Plasma total 25(OH)D was quantitated by liquid chromatography with mass spectrometry and serum VDBP by a polyclonal sandwich enzyme immunoassay. In addition, routinely used laboratory parameters in follow-up were recorded. VDfree and VDbio were calculated using total 25(OH)D, VDBP, and albumin levels. Results: Plasma total 25(OH)D (13.3±5.7 vs. 30.3±13.3 ng/dL), VDfree (2.18 [1.52–3.44] vs. 4.34 [3.74–6.48] pg/mL), and VDbio (1.86 [1.09–2.81] vs. 4.28 [3.45–6.34] nmol/L) levels were lower in COVID-19 patients (p<0.001). Despite the insignificance of 25(OH)D and metabolites between COVID-19 severity subgroups, serum VDBP was highest in mild/ moderately pneumonia (601.8±278.6 ng/mL) and lowest in severe pneumonia (427.9±147.2 ng/mL) (p<0.001). In addition, VDBP was positively correlated with lymphocyte counts (B:87.9, r2=0.068, p=0.031) and negatively correlated with D-Dimer levels (B:−0.024, r2=0.081, p=0.032). Conclusion: COVID-19 patients have lower plasma 25(OH)D levels and lower 25(OH)D metabolites VDfree, VDbio which are physiologically active. In addition, serum VDBP concentrations significantly decrease in critically ill patients which needs further studies to be associated in the etiopathogenesis of the disease severity. [ FROM AUTHOR] Copyright of International Journal of Medical Biochemistry is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Emotion Focused Therapy and Chinese American Clients: An Exploration Using the Cultural Lens Approach

Asian Americans are the fastest growing ethnic group in the United States and of this group, Chinese Americans represent the largest subgroup. Some scholars have speculated that more symptom-focused and directive psychotherapeutic approaches may be more congruent with Chinese Americans' conceptualization of treatment than traditional Western modalities. Although these approaches may be more culturally appropriate and efficacious for some Chinese American clients, they presuppose that Chinese American clients have difficulties or an inability to express or communicate underlying emotional distress. As a consequence of this generalization, mental health therapists may assume that emotion-oriented psychotherapeutic approaches such as Emotion Focused Therapy (EFT) will not benefit this population. Notwithstanding efforts to expand the relevance of EFT, there remains little research examining the cultural validity of EFT across cultural groups, particularly for Chinese American clients. In this article, we use the Cultural Lens Approach to assess the relevance and applicability of EFT for Chinese American individuals and couples. The aim of this article is to provide clinical direction for therapists using EFT with Chinese American clients and energize the field to conduct further research examining the relevance and applicability of psychotherapeutic approaches with this client group. Further, this article aims to combat stereotypes and Western notions of mental health, which may be limiting clinical and research perspectives on mental healthcare for Chinese Americans. This exploration comes at a time when Chinese Americans are at increased risk of adverse mental health outcomes due to race-based violence and discrimination observed during the COVID-19 pandemic.Copyright © 2023 Taylor & Francis Group, LLC.

Falls Prevention: Community Exercise Programme, Reducing Risk of Falls, Deconditioning and Loneliness in Frail Elderly Patients

Introduction Covid has had a devastating effect on the Elderly, resulting in deconditioning, increased falls and loneliness. Tailored exercises can reduce falls in people aged over 65 by 54% and participation in physical activity reduces the risk of hip fractures by 50%, currently costing the NHS 1.7 billion per year in England. This 8-week intervention delivered by trained volunteers in patient's homes, aims to reduce deconditioning, loneliness and the risk, incidence and fear of falling (FOF) amongst frail patients post-discharge from hospital. Method A gap in service was identified in Frail patients discharged from hospital, at risk of falling and awaiting community physiotherapy. A steering group was set up including acute and community therapists, volunteers and carers to design a collaborative intervention to bridge the gap. At risk patients were identified and referred by ward therapists supported by the hospital volunteering team. Volunteers were trained to deliver an 8 weeks programme of progressive exercises in patients' homes with additional signposting to appropriate statutory and voluntary services. Qualitative and quantitative outcome measures were taken at week 1 and week 8 of the intervention Results 91.5% total health outcomes improved or maintained by average: - FOF reduced by 22.5% - 180 degree turn improved by 43% - 60 sec Sit to Stand improved by 14.75% - Timed Up And Go improved by 15.5% - Confidence to cope at home improved by 15% - Pain / discomfort (self-reported) improved by 18.75% - Overall health (self-reported) improved by 8.5% Conclusion(s) Targeted exercise at home with skilled volunteers can improve functional fitness and health outcomes in a frail elderly population at risk of falls when discharged home from hospital. The programme increases patients' connectivity to local voluntary and community sector services. Volunteers' mental health improves by engaging in meaningful service.

Telemedicine for Adolescent and Young Adult Long-acting Reversible Contraception Initial Follow-up Visit: Outcomes Over 1 Year

Background: Telemedicine for adolescent and young adult (AYA) long-acting reversible contraception (LARC) care is understudied, as telemedicine was quickly implemented in response to the COVID-19 pandemic. We compare outcomes of AYA LARC follow-up care via telemedicine vs. in-person visits over 1 year. Method(s): This cohort (IRBP00030775) includes patients who 1) had an intrauterine device (IUD) or implant inserted between 4/1/20-3/31/21 and 2) attended an initial LARC follow-up visit (defined as the first visit within 12 weeks of insertion) at 1 of 4 US Adolescent Medicine clinics. Eligible patients were 13-26 years old with a LARC method inserted without sedation and in situ for at least 12 weeks. We compared outcomes over 1 year between AYAs attending the initial follow-up visit via telemedicine (telemedicine attendees) to those who completed the visit in-person (in-person attendees). Outcomes included patient-reported symptoms, menstrual management, acne management, sexually transmitted infection (STI) testing and results, and LARC removal. Descriptive statistics described the sample and compared groups. Adjusted Poisson regression examined factors associated with number of visits and adjusted logistic regression models examined the association between initial visit modality and initiation of menstrual management. Result(s): Our study included 194 AYAs, ages 13.9-25.7 years, who attended an initial follow-up visit. Most AYAs (86.6%) attended only 1 visit in the first 12 weeks post-insertion. Telemedicine attendees comprised 40.2% of the sample. Telemedicine and in-person attendees were similar with regards to site, age, race/ethnicity, prior pregnancy, concurrent medical/mental health diagnoses, and reason for LARC (Table 1). In-person attendees were more likely to have the IUD than telemedicine attendees (Table 1). Patient-reported symptoms over 1 year were similar between groups (Table 2). Menstrual management (OR = 1.02, CI: 0.40-2.60), number of visits attended (RR = 1.08, CI: 0.99-1.19), acne management (p =.28), and LARC removal (p =.95) were similar between groups. In-person attendees were more likely to have STI testing than telemedicine attendees (p =.001). However, no positive STI tests were captured in either group. Conclusion(s): Approximately 40% of AYAs attended their LARC follow-up visit via telemedicine. LARC type may have influenced modality of visit. While in-person attendees were more likely to have STI testing, there were no positive STI tests detected in either group during the study period. More research is needed to determine if the decrease in STI testing is clinically significant. Other outcomes were similar between visit modalities, suggesting telemedicine may be useful for AYA LARC care. Supporting Figures or Tables: https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1370854-1-ANY.docx https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1370854-2-ANY.docxCopyright © 2023

Racial Disparities in Emergency Restraint Use for Agitated Patients

Background: The COVID 19 pandemic and the murder of George Floyd have prompted healthcare organizations to reexamine racial inequities in their care, challenging us to produce lasting, fundamental change. Mental health disorders, both diagnosed and undiagnosed, have increased in volume and developed new challenges for acute care practitioners during the pandemic. Additionally previous research has suggested that there are intrinsic and extrinsic biases that affect how care is delivered to patients presenting with mental health crises. Method(s): Through nominal group technique, we identified topics for equitable-care-oriented QI in the emergency department (ED) of our Level-1 Trauma center. Initial review of triage, left-without-being-seen, and fast-track data did not demonstrate significant racial disparities in standard benchmarks. We therefore focused on behavioral codes and restraint use. We prospectively collected data on all behavioral codes over a 3-month period, including demographics, visit characteristics, and certain aspects of restraint use including type of restraint, length of restraints, medication use, and reinitiation of restraints. In addition to tracking these metrics, employee perceptions of the psychiatric mental health emergencies were polled and evaluated. Result(s): Our QI process identified varying levels of disparities in care. Over the study period, white, non-white, and black patients comprised 50.5%, 49.5%, and 28.7% of the ED patient population, respectively, and 50%, 50%, and 44% of the patients who were subject to behavioral codes. Of those patients who had behavioral codes called, restraints were used for 64.8% of white patients, 64.3% of non-white patients, and 67.2% of black patients. Of those arriving by ambulance or police, 20% arrived with pre-hospital restraints or handcuffs, and of those, 90.9% were placed in restraints on arrival to the ED. Of those patients who had restraints placed, 4-points were used for 34.1%, 26.1%, and 25.5% of white, non-white, and black patients, respectively, and the restraint chair was used for 30.7%, 38,6%, and 41.8% of those same groups. Medications were given to 80.7%, 88.7%, and 91.4% of white, non-white, and black patients who were placed in restraints, respectively, and to 77.4%, 80.6%, and 83.3% of those same groups of patients who were not placed in restraints. None of the differences were statistically significant. Of those patients who had restraints placed and then discontinued, 13% were re-restrained at some other point during their visit. Among other responses, nearly half of all ED employees thought that patients should ideally not be restrained during behavioral codes and that, if necessary, the restraint chair provides a better experience than 4-point restraints. Conclusion(s): Continuous QI around a variety of measures can identify disparities and targets for sustained anti-racist improvements in emergency department care. This study will guide further intervention and education around inequities in care in our department and has prompted further consideration of, when restraints are deemed necessary, preferentially using less invasive measures like the restraint chair over 4-point restraints. Although decision-making around chemical and physical restraints for mental health emergencies is complex and difficult to study, EDs should carefully examine their use through continuous QI in order to optimize patient-centered outcomes.

Analysis of the interferon lambda 3 and 4 gene single nucleotide polymorphisms and vaccine response against COVID-19

Introduction: Assessing how various COVID-19 vaccines work against SARS-CoV-2 in different individuals is pivotal to planning better management and coping with the pandemic. Single nucleotide polymorphisms (SNPs) are one of the contributing factors to the immune response. This study investigated interferon lambda 3 and 4 (IFNL3/4) gene polymorphism and their association with an individual's immune response after receiving COVID-19 vaccines. Materials and Methods: An exploratory laboratory study to identify SNPs rs1297860 and rs368234815 in IFNL3/4 genes in Indonesian who have received two shots of CoronaVac and further evaluate its association with the COVID-19 vaccine response. The immune response was reflected from the serum titres of SARS-CoV-2 IgG (anti-spike IgG level), quantified using the SARS-CoV-2 IgG II Quant assay, where the IFNL3/IFNL4 SNPs identified using polymerase chain reaction restriction fragment length polymorphism. Results: From March to August 2021, this study recruited 46 eligible and healthy persons. None of the subjects in this study have the assumed associated genotypes (TT in IFNL3 or DG/DG in IFNL4). There was also no significant difference in the Mean Fold Rise of anti-spike IgG level between individuals with IFNL3 rs12979860 C/T polymorphism (CT genotype) and those with the homozygous common (wild-type) genotype (TT genotype) (U = 358;P > 0.05). Conclusion: The frequency of IFNL3/4 polymorphisms in this study population was low. Furthermore, the IFNL3/4 polymorphisms do not affect immune response (anti-spike IgG level) in individuals receiving two shots of the COVID-19 vaccine in this study. [ FROM AUTHOR]

Frozen Shoulder in Patients with COVID-19

Introduction: Because COVID-19 with extrapulmonary manifestations is likely to lead to the development of musculoskeletal disorders in susceptible individuals due to immunological mechanisms, it is possible to see more frozen shoulder cases during the COVID-19 pandemic. Therefore, this study was performed to evaluate the relationship of frozen shoulder and COVID-19. Materials and Methods: This study was a cross-sectional study from September 2020 to February 2021;patients who were referred to our shoulder clinic with stiffness and shoulder pain and diagnosed with adhesive capsulitis (AC) were evaluated for COVID-19 involvement. Shoulder range of motion was assessed as passive range of motion of forwarding flexion, internal rotation and external rotation in the arm at the side and 90° abduction. The visual analogue scale was also used to assess pain intensity. SPSS software was used for analysis, and Chi-square test was used for qualitative data analysis and a t-test was used for quantitative data. Results: Seventy-two patients with frozen shoulders were included in the study;the results showed that AC occurs at a younger age in patients with COVID-19 infection (P < 0.039);the mean age of all patients was 52.73 ± 8.68. The severity of pain was higher in patients with COVID-19 (P = 0.012). Furthermore, regarding the duration of referral in terms of months, it was shown that people with COVID-19 were referred in a shorter period after the onset of shoulder symptoms and there was a significant difference in terms of referral time and pain between the two groups (P < 0.01). Regular activity had a lower rate in patients with COVID-19 infection and the difference was significant in patients with and without COVID-19 (P < 0.029). Conclusion: Due to younger age, greater pain and faster visit of patients with a frozen shoulder after COVID-19, it is recommended to look for frozen shoulder in all COVID-19-infected patients by a complete clinical examination. This is more important in patients without regular physical activity. [ FROM AUTHOR]

Efficacy of lopinavir/ritonavir plus interferon beta compared to hydroxychloroquine in the treatment of COVID-19: A retrospective observational study

Introduction: Although a long time past since COVID-19 was broken out, it is hard to determine which pharmacological combination regimen is more efficacious. The present study aimed to evaluate the efficacy of lopinavir/ritonavir (LPV/r) plus interferon (IFN) beta-1a regimen compared to the hydroxychloroquine (HCQ) regimen in moderately ill patients with COVID-19. Methods: A multiple-centre retrospective observational case-controlled study was performed between March and September 2020, including adults with confirmed COVID-19. The patients were categorised into age- and sex-matched two groups;LPV/r plus IFN beta-1a (n = 102) and HCQ (n = 298) regimens. Clinical outcomes and mortality rates were compared between the groups. Results: LPV/r plus interferon (INF) beta-1a regimen had improved none of the clinical outcomes and mortality rate compared to the HCQ regimen. The length of stay (LOS) in the hospital and the need for oxygen therapy were slightly worse in the LPV/r plus INF beta-1a regimen (4.73 ± 2.93 days, 63%) than in the HCQ group (3.74 ± 3.30 days, 48.3%). No statistically significant difference was observed between the two groups in care of intensive care unit (ICU) admission, LOS in ICU, the need for non-invasive ventilation and the need for invasive mechanical ventilation as well as in-hospital mortality rate. Conclusions: LPV/r plus IFN beta-1a regimen did not show any meaningful improvement in clinical outcomes or mortality compared to the HCQ regimen. Larger randomised controlled trials are needed to assess the efficacy of this combination further. [ FROM AUTHOR]

The clinical manifestations and outcomes in neonates infected with COVID-19 in the West of Iran

Introduction: So far, no study has been conducted in Iran on the effect of COVID-19 on neonates. Therefore, the present cross-sectional study has been evaluated to determine the clinical manifestations and outcomes in neonates infected with COVID-19 in the west of Iran. Materials and Methods: The present cross-sectional study was conducted among neonates infected with COVID-19 in six provinces of Hamadan, Kermanshah, Kurdistan, Ilam, Zanjan and Lorestan, located in the west of Iran, from 1 March to 1 July 2020. In these neonates, the polymerase chain reaction test was positive. The data were collected by a checklist and were analysed using SPSS Statistics Software. Result: During the study period, 16 neonates infected with COVID-19 were identified including Kurdistan Province with five cases, Hamadan Province four cases, Kermanshah with three cases, and Lorestan and Zanjan provinces with two cases. Neonate gender of them had equal distribution. Two (15.38%) of them needed CPR after delivery. The delivery method for 9 (56.25%) was vaginal, and one of them died during the study period. The medical care used for these neonates was as follows: 87.5% were hospitalized in the intensive care unit and antibiotics were used for 68.75%. 12.5% underwent COVID-19-specific treatment, and for 25%, a ventilator was used. The laboratory findings in neonates infected with COVID-19 showed that in 18.75%, blood urea nitrogen has increased. 46.15% of neonates reported lymphocytopenia. The blood haematocrit and haemoglobin decreased by 31.35% and 56.25%, respectively. Conclusion: The coronavirus disease 2019 has occurred among neonates, but they seemed to have a milder disease course and better prognosis than adults. Findings showed that there is a possibility of vertical intrauterine transmission from pregnant mothers to newborns. [ FROM AUTHOR]

ADMINISTERING COMPLEX COGNITIVE TESTS REMOTELY IN THE COGNITIVELY-IMPAIRED

The article reports that While the COVID-19 pandemic has undoubtedly catalyzed the adoption of more flexible datacollection approaches within clinical trials, this has been the direction of travel for some time. Rather than bringing participants into sites, allowing them to participate from the safety of their own homes by leveraging remote datacollection methods placed participant preference at the center of the research effort and positively impacted participant engagement.