ABSTRACT
BackgroundThe COVID-19 pandemic triggered serious challenges in the treatment of chronic diseases due to the lack of access to medical attention. Patients with rheumatic diseases (RD) must have adequate treatment compliance in order to reach and maintain remission or low activity of their diseases. Treatment suspension because of non-medical reasons might lead to disease activation and organ damage.ObjectivesIdentify the frequency of biologic treatment (bDMARD) suspension in patients with RD during the COVID-19 pandemic and determine the associated factors for suspension.MethodsIn this study we included all patients registered in the Mexican Biologics Adverse Events Registry (BIOBADAMEX), that started bDMARD before March 2019 and suspended treatment during the COVID-19 pandemic. We used descriptive statistic to analyze baseline characteristics and main treatment suspension causes. We used Chi[2] and Kruskal Wallis tests to analyze differences between groups.ResultsA total of 832 patients patients registered in BIOBADAMEX were included in this study, 143 (17%) suspended bDMARD during the COVID-19 pandemic. The main causes of suspension were inefficacy in 54 (38%) patients, followed by other motives in 49 (34%) patients from which 7 (5%) was loss of medical coverage. Adverse events and loss of patients to follow up were the motive in 16 (11%) and 15 (11%) patients respectively.When we compared the group that suspended bDMARD with the non-suspenders (Table 1), we found statistical differences in patient gender, with 125 (87%) female patients that suspended bDMARD, with a median age of 52 (42-60) years, and a treatment duration of 3.8 years.ConclusionIn our study we found that 17% of patients with RD suspended bDMARD treatment during the COVID-19 pandemic and that non-medical motives such as lack of patients follow up and loss of medical coverage due to unemployment were important motives. These results are related to the effect of the pandemic on other chronic diseases.Table 1.Patients baseline characteristicsPatients that did not suspended bDMARD during pandemic (n = 689)Patients that suspended bDMARD during pandemic (n = 143)pFemale gender, n(%)549 (79.7)125 (87.4)0.02Age, median (IQR)55 (45 – 63)52 (42 – 60)0.04Body mass index, median (IQR)26.4 (23 – 30.4)27.23 (24.2 – 30.46)0.13Social security, n(%)589 (85.5)128 (89.5)0.2Diagnosis0.7- Rheumatoid arthritis444 (64.4)97 (67.8)- Juvenil idiopathic athritis29 (4.2)2 (1.4)- Ankyosing sponylitis93 (13.5)19 (13.3)- Psoriasic arthritis43 (6.2)6 (4.2)- Systemic lupus erithematosus32 (4.6)9 (6.3)- Others48 (6.9)10 (6.9)Disease duration, median (IQR)11 (7 – 19.5)12 (6 - 18)0.95Comorbidities, n(%)305 (44.3)73 (51)0.08Previos biologic, n(%)249 (36.1)60 (42)0.1Treatment at pandemic iniciation, n(%)0.8 - Etanercept a34 (4.9)5 (3.5)- Infliximab a24 (3.5)5 (3.5)- Adalimumab130 (18.9)22 (15.4)- Rituximab a61 (8.9)25 (17.5)- Abatacept76 (11)20 (14)- Tocilizumab82 (11.9)18 (12.6)- Certolizumab92 (13.4)28 (19.6)- Rituximab b7 (1)0- Golimumab36 (5.2)5 (3.5)- Tofacitinib14 (2)1 (0.7)- Infliximab b4 (0.5)2 (1.4)- Etanercept b31 (4.5)6 (4.2)- Baricitinib12 (1.7)1 (0.7)- Belimumab5 (0.7)1 (0.7)- Secukinumb8 (1.2)3 (2.1)Steroids use, n(%):254 (36.9)57 (39.9)0.2Steroids dose (mg), median (IQR)6 (5 – 10)6 (5 – 10)0.47DMARD use, n(%):538 (78.1)118 (82.5)0.1Treatment duration, median (IQR)5.06 (4.04 – 5.78)3.82 (3.35 – 4.95)0.001Suspension motive, n(%)NA- Inefficacy-54 (37.8)- Adverse event-16 (11.2)- Pregnancy-2 (1.4)- Loss of patient-15 (10.5)- Remission-7 (4.9)- Others-49 (34.2)Adverse events, n(%):102 (14.8)24 (16.8)0.3- Severe, n(%)13 (1.9)5 (3.5)0.4a original, b biosimilarREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsVijaya Rivera Teran: None declared, Daniel Xavier Xibille Friedmann: None declared, David Vega-Morales: None declared, Sandra Sicsik: None declared, Angel Castillo Ortiz: None declared, Fedra Irazoque-Palazuelos: None declared, Dafhne Miranda: None declared, Iris Jazmin Colunga-Pedraza: None declared, Julio Cesar Casasola: None declared, Omar Elo Muñoz-Monroy: None declared, Sandra Carrilo: None declared, Angélica Peña: None declared, Sergio Duran Barragan: None declared, Luis Francisco Valdés Corona: None declared, Estefanía Torres Valdéz: None declared, Azucena Ramos: None declared, Aleni Paz: None declared, ERICK ADRIAN ZAMORA-TEHOZOL: None declared, Deshire Alpizar-Rodriguez Employee of: Scientific Advisor in GSK México.
ABSTRACT
BackgroundSjögren's syndrome (SS) is a chronic, systemic autoimmune disease affecting exocrine glands, primarily the salivary and tear glands, with potentially severe manifestations in multiple organs. No approved disease-modifying therapies exist. Dazodalibep (DAZ) is a biologic antagonist of CD40L.ObjectivesThe objective of this study was to evaluate the efficacy and safety of DAZ therapy in adult SS subjects with moderate-to-high systemic disease activity (NCT04129164).MethodsWe conducted a randomized, double-blind, placebo-controlled, crossover study to evaluate DAZ therapy in adult SS subjects with moderate-to-high systemic disease activity, as defined by a EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) score ≥ 5. Eligible subjects were randomized 1:1 to receive intravenous DAZ 1500 mg or placebo (PBO) Q2W x 3 doses, then Q4W x 4 additional doses. Starting on Day 169, subjects initially randomized to DAZ received PBO Q4W x 5 doses and subjects randomized to PBO received DAZ Q4W x 5 doses and were then followed for 12 weeks. The primary endpoint was the change from Baseline in ESSDAI at Day 169. Safety assessments included the incidence of adverse (AEs), serious AEs (SAEs), and AEs of special interest (AESIs).ResultsThe 74 randomized subjects all received ≥1 dose of study medication (DAZ, N=36;PBO, N=38). The baseline demographics and disease characteristics were balanced between the two groups. The change from Baseline to Day 169 in ESSDAI score (LS mean ± SE), was -6.3 ± 0.6 in DAZ-treated subjects compared to -4.1 ± 0.6 in the PBO group, a difference of -2.2 (p = 0.0167). Compared to the PBO group, the DAZ group showed positive trends in the EULAR Sjögren's Syndrome Patient Reported Index score, and Functional Assessment of Chronic Illness Therapy-Fatigue score at Day 169. A post-hoc responder analysis of subjects achieving high levels (5 and 6 points) of improvement on ESSDAI favored DAZ (61.1% and 60.0%) over PBO (35.1% and 34.3%).The reported AEs were generally mild through Day 169 and similar in frequency between treatment groups. The most frequently reported AEs occurring in ≥5% of DAZ-treated subjects and >PBO were COVID-19, diarrhea, dizziness, ligament sprain, upper respiratory tract infection, contusion, device allergy, fatigue, hypertension, and oropharyngeal pain. Two SAEs were reported in a single DAZ-treated subject: this subject was a 59-year-old female who experienced a grade 3 SAE of COVID-19 infection and later died of unknown cause 46 days after last administration of DAZ (12 days after COVID-19 diagnosis). There was a single AESI of herpes zoster in a DAZ-treated subject.ConclusionDAZ is a potential new therapy for the treatment of systemic disease activity in patients with SS. SS subjects with moderate-to-high systemic disease receiving DAZ experienced a statistically significant reduction in disease activity relative to PBO as measured by the improvement in ESSDAI score. Except for a case of severe COVID-19 infection, DAZ therapy in SS subjects appeared to be well tolerated. Larger controlled trials of DAZ therapy for SS are warranted to further explore its safety profile and confirm its clinical efficacy.Table 1.Efficacy and Safety DataPBO N=38DAZ 1500 mg N=36EfficacyΔESSDAI, LS mean (SE) †-4.1 (0.6)-6.3 (0.6)*ΔESSPRI, LS mean (SE) †-1.12 (0.29)-1.80 (0.31)ΔFACIT-Fatigue, LS mean (SE) †5.8 (1.6)8.1 (1.6)AE Summary, n (%)≥1 AE23 (60.5)28 (77.8)≥1 related AE8 (21)10 (27.8)≥1 SAE01 (2.8)≥1 related SAE00≥1 AE leading to discontinuation00≥1 AESI01 (2.8)≥1 Death01 (2.8)Efficacy endpoints as of Day 169;† Analyzed using MMRM;Comparisons vs PBO;*p<0.05;AE summaries based on AEs that occurred through Day 169;AE, adverse event;AESI, adverse event of special interest;ESSDAI, EULAR Sjögren's Syndrome Disease Activity Index;ESSPRI, EULAR Sjögren's Syndrome Patient Reported Index;FACIT-Fatigue, Functional Assessment of Chronic Illness Therapy-Fatigue;PBO, placebo;SAE, serious adverse eventFigure 1.AcknowledgementsFunded by Horizon herapeutics. Medical writing support provided by B Lujan, PhD, an employee of Horizon Therapeutics.Disclosure of InterestsE. William St. Clair Consultant of: Horizon Therapeutics, Bristol Myers Squibb, CSL Behring, Resolve Therapeutics, Sonoma Biotherapeutics. Royalties: UpToDate, Liangwei Wang Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Ilias Alevizos Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, William Rees Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Alan Baer Consultant of: Bristol Myers Squibb, Wan Fai Ng Consultant of: Novartis, GlaxoSmithKline, Abbvie, BMS, Sanofi, MedImmune, Janssen and UCB, Ghaith Noaiseh Consultant of: Novartis, Chiara Baldini Consultant of: GSK, and Sanofi.
ABSTRACT
The Coronavirus (COVID-19) disease is a global pandemic infectious disease caused by a novel coronavirus, which affects all age groups with a higher incidence in the geriatric population and people with chronic diseases. The outbreak of the virus is a serious public health challenge including to nurses at the various health care facilities around the world. The outbreak of the coronavirus has been a huge threat to nursing and nursing care globally. Nurses are experiencing a high level of daily emotional stress in their activities in preventing disease infections, promoting health, and saving lives. Many nurses have lost their lives to the deadly disease in their fight to save their patients, many feel stressed and burnout, and many feeling discouraged because of the protracted effects of the disease. The psychological health of the nurses as frontline health care workers should be safeguarded owing to their crucial roles in mitigating disease pandemics. Thus, adequate training of nurses would better equip them with the necessary information regarding the preventive measures, and management approaches to foster the mitigation of the disease, mitigate the disease burden on healthcare facilities, and enhance the recovery rate of the infected populations. Andfurther better prepare nurses on prioritizing personal psychological health.
ABSTRACT
In the new millennium, humanity has faced with a global challenge in the form of the novel coronavirus infection (COVID-19). In addition to systemic and respiratory symptoms, SARS-CoV-2 causes neurological disorders, as it is a neurotropic virus. Many scientists assume that SARS-CoV-2 can enter the nervous system through the functional receptor of angiotensin-converting enzyme 2, which is present in glial cells, neurons, skeletal muscles, and other organs. Neurological complications are manifested by damage to the central nervous system, peripheral nervous system, and cranial nerves, as well as by mental disorders. Mental illnesses develop due to neuroinflammation and neuronal death after brain infection with SARS-CoV-2. The article describes a clinical case of a 63-year-old man with the co-occurring novel coronavirus infection and obvious mental disorder who has never had any mental illnesses before. The given clinical example demonstrates the importance of studying the cause-and-effect relationship between COVID-19 and mental illness. In the medium- and long-term perspective, COVID-19 is expected to result in mental health disorders during COVID-19 recovery. Besides, an increase in the number of patients with mental disorders who were mentally healthy before COVID-19 infection is also expected. © 2023 Authors. All rights reserved.
ABSTRACT
BackgroundSome individuals may have persistent symptoms after COVID-19, a new condition known as long COVID-19. However, these complaints can be misunderstood with disease activity in patients with immune-mediated rheumatic diseases (IMRD), especially fatigue and mental distress.ObjectivesTo evaluate fatigue, depression, anxiety, and stress in IMRD patients after 6 months of COVID-19, compared with IMRD patients without COVID-19.MethodsThe ReumaCoV Brasil is a longitudinal study designed to follow-up IMRD patients for 6 months after COVID-19 diagnosis (cases) compared with IMRD patients no COVID-19 (controls). Clinical data, such as age, sex, comorbidities, as well as disease activity measurements and current treatment regarding IMRD, and COVID-19 outcomes were evaluated in all patients. The FACIT questionnaire (Functional Assessment of Chronic Illness Therapy) and the DASS 21 (Depression, Anxiety and Stress Scale - 21 Items) were applied at 6 months after COVID in both groups.ResultsA total of 606 IMRD patients were included, of whom 322 (53.1%) cases and 284 (46.9%) controls. Most patients were female (85.3%) with mean age 46.1 (13.0) years old. Specific disease activity were similar between cases and controls. There was a significant difference between FACIT scores and 3 domains of DASS-21 comparing cases and controls (Figure 1). The factors associated with FACIT were female gender, diabetes, obesity, no comorbidities, COVID manifestations (skin, joint pain, asthenia, diarrhea, and dyspnea), and chronic oral corticosteroid use. DASS-21 Depression was associated with these same factors. Female gender, COVID manifestations as skin, joint pain, asthenia, cough, dyspnea, and chronic oral corticosteroid use were associated with DASS-21-Anxiety. DASS-21 Stress was associated with female gender, asthenia, diarrhea, dyspnea, cough, chronic oral corticosteroid use, and hospitalization. Table 1 shows the variables that remained in the models after the univariate logistic analysis. A weak correlation between disease activity and FACIT was observed in rheumatoid arthritis (p=0.010;r2 = 0.035) and ankylosing spondylitis patients (p=0.010;r2 = 0.129). No other correlations were observed between the scores results and disease activity (patient's global assessment - PGA), medications or specific IMRD.ConclusionFatigue and mental changes such as depression, anxiety, and stress, occurred more frequently in IMRD patients who had COVID-19 than in those who did not have COVID-19, especially in women, regardless of disease activity score. Fatigue was more related to female gender, diabetes, obesity, and current joint pain. Mental impairment was more associated with severity of COVID-19, including respiratory and non-respiratory symptoms.Figure 1.Comparison between cases and controls of FACIT and DASS-21 depression, anxiety, and stress scoresFACIT (Functional Assessment of Chronic Illness Therapy);DASS-21 (Depression, Anxiety and Stress Scale - 21 Items):Table 1.Final model using binary Logistic Regression analysis to evaluate the preditive factors associated with FACIT and DASS-21 scoresFACIT Score ≤ 37 x score > 37§DASS-21-DEPRESSION Score ≤ 6 (normal/mild) x score > 6 (moderate/severeDASS-21-ANXIETY Score ≤ 5 (normal/mild) x score > 5 (moderate/severe)DASS-21-STRESS Score ≤ 9 (normal/mild) x score > 9 (moderate/severeVariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)Female0.151.83 (1.12-2.98)No comorbidities0.0290.66 (0.46-0.95)Joint pain0.0022.44 (1.39-4.26)Female0.0122.31 (1.20-4.46)Diabetes0.0062.35 (1.28-4.32)Joint pain**0.0012.58 (1.57-4.22)Dyspnea0.0013.61 (2.11-6.19)Dyspnea0.0013.69 (2.09-6.51)Dyspneia0.0012.00 (1.23-3.26)Dyspnea0.0012.82 (1.79-4.44)Oral CE0.0141.55 (1.09-2.21)Joint pain0.0052.20 (1.41-3.43)Oral CE0.0481.41 (1.00-1.99)§Lower scores mean worse fatigue;CE: corticosteroid;OR: odds ratio;CI: confiance intervalAcknowledgementsReumaCoV Brasil researchers, Brazilian Rheumatology Society and National Council for Scientific and Technological Deve opment.Disclosure of InterestsNone Declared.
ABSTRACT
Os desafios enfrentados por pacientes e suas famílias para terem acesso a cuidados médicos referentes a condições de saúde crônicas fazem com que os profissionais de saúde responsáveis por seu atendimento médico se sintam, com elevada frequência, impotentes. Às vezes convém atribuir a reponsabilidade por esses desafios a um ou mais grupos específicos, tais como os formuladores de políticas ou o sistema de seguro-saúde. No entanto, as verdadeiras razões desses desafios são bem mais complexas, existindo múltiplos fatores presentes, com interrelação. Torna-se necessário realizar uma análise sistêmica mais ampla, bem como ter uma visão mais abrangente, de forma a integrar o contexto sociocultural, focando particularmente as populações vulneráveis e aquelas precariamente atendidas, incluindo-se os adultos mais idosos, a população de áreas densamente povoadas e os indivíduos com status socioeconômico de nível inferior, assim como os migrantes e as minorias1. Neste contexto, a equidade e a justiça social constituem fundamentos aplicáveis essencialmente em um estado de utopia, mas estes fundamentos são indispensáveis à implementação de mudanças futuras.A justiça social constitui um apelo bastante significativo como conceito, a ser plenamente reconhecido em todas as profissões relacionadas aos cuidados de saúde2. O conceito afirma que todos devem, independentemente das circunstâncias legais, políticas, econômicas ou outras3, ter acesso igual à riqueza, ao bem-estar, aos privilégios e às oportunidades, bem como à saúde. Além disso, esse conceito é dirigido para dimensões que vão além dos princípios do direito civil ou penal e transcendem, entre os indivíduos e a sociedade, a relação cujo propósito é ter e manter uma vida gratificante. Portanto, a justiça social é de aplicação universal, devendo ser relacionada a propósitos sociais em todas as regiões do mundo.Como região, a América Latina tem muitos países e com numerosos pontos em comum. Antes da pandemia do coronavírus de 2019 (COVID-19), existiam desafios significativos com relação à saúde na América Latina, incluindo a escassez de medicamentos, a falta de acesso a alimentos saudáveis ou a cuidados primários, seja para migrantes ou pessoas desabrigadas. De acordo com o Índice de GINI, a América Latina é a região mais injusta do planeta, com 185 milhões de pessoas auferindo uma renda abaixo do limiar de pobreza, o equivalente a 66 milhões de indivíduos em estado de pobreza extrema4. Para superar essas deficiências, as comunidades precariamente atendidas se apoiam mutuamente, trabalhando em projetos locais, bancos de alimentos e organizações religiosas, mas desafios significativos continuam existindo.A abordagem atual, com respeito aos cuidados de saúde para indivíduos fragilmente representados e que vivem em comunidades mal atendidas, não é mais sustentável. O caminho a adotar deve incluir como base a medicina para uma vida saudável (HLM, na sigla em inglês), promovendo em sua essência atividades físicas, boa alimentação, ter um peso corporal mediano e abster-se de fumar. Em nível sistêmico, essa mudança cultural diz respeito ao estabelecimento de políticas e práticas.Apromessa ou possibilidade de ter uma existência gratificante encontra-se aqui, na América Latina. Essa abordagem precisa abraçar o conceito de justiça social para que todos tenham oportunidades semelhantes com relação a ter um estilo de vida saudável, minimizando-se os efeitos deletérios das doenças crônicas.Alternate :The challenges that patients and their families experience to access care for chronic health conditions often make the health professionals responsible for their care feel powerless. At times, it may be convenient to lay the blame for these challenges on a singular group, such as policymakers or the health insurance system. However, the true reasons such challenges exist are much more complex, multifactorial, and interrelated. A broader systemic analysis and broader visio is needed to integrate the sociocultural context and place a particular focus on vulnerable, underserved populations, including older adults, people living in densely populated areas, people with lower socioeconomic status, migrants, and minorities11 Shadmi E, Chen Y, Dourado I, Faran-Perach I, Furler J, Hangoma P, Hanvoravongchai P, Obando C, Petrosyan V, Rao KD, Ruano AL, Shi L, de Souza LE, Spitzer-Shohat S, Sturgiss E, Suphanchaimat R, Uribe MV, Willems S. Health equity and COVID-19: global perspectives. Int J Equity Health 2020;19(1):104.. In this context, equity and social justice are constructs that may only feasible in a Utopia but are essential to effect change moving forward.Social justice as a concept is quite appealing and should be fully embraced by all health care professions22 Arena R, Laddu D, Severin R, Hall G, Bond S, HL-PIVOT Network. Healthy living and social justice: addressing the current syndemic in underserved communities. J Cardiopulm Rehabil Prev 2021;41(3):E5-E6.. The concept professes that all people should have equal access to wealth, well-being, privilege, opportunity, and health regardless of legal, political, economic, or other circumstances33 Braveman PA, Kumanyika S, Fielding J, Laveist T, Borrell LN., Manderscheid R, Troutman A. Health disparities and health equity: the issue is justice. Am J Public Health 2011, 101(Suppl. 1):S149-S155.. Moreover, this concept focuses on dimensions beyond civil or criminal law principles and the relationship between individuals and society to lead fulfilling lives. Therefore, social justice is relatable and universal for all regions in the world.Latin America as a region hosts many countries that share numerous commonalities. Prior to the coronavirus disease 2019 (COVID-19) pandemic, there were significant health related challenges in Latin America, including prescription drug shortages, lack of access to healthy food or primary care for migrants, and homelessness. According to the GINI Index, Latin America is the most inequitable region globally;185 million people's income is below the poverty threshold, of whom 66 million live in extreme poverty44 Garcia PJ, Alarcón A, Bayer A, Buss P, Guerra G, Ribeiro H, Rojas K, Saenz R, Salgado de Snyder N, Solimano G, Torres R, Tobar S, Tuesca R, Vargas G, Atun R. COVID-19 response in Latin America. Am J Trop Med Hyg 2020;103(5): 1765.. While these underserved communities support each other to supplement these shortcomings by working with local movements, food banks, and religious organizations, significant challenges remain. The current approach to health care in underrepresented individuals who live in underserved communities is no longer sustainable. The way forward must include healthy living medicine (HLM) as a foundation, at its core promoting physical activity, good nutrition, average body weight, and not smoking. On a systemic level, this cultural change refers to the establishment of policies and practices. The promise or possibility of being is here in Latin America. This approach needs to embrace the concept of social justice so that all individuals in the population have similar opportunities to embrace a healthy lifestyle and minimize the deleterious effects of chronic disease.
ABSTRACT
Background. Nurses' high workload can result in depressive symptoms. However, the research has underexplored the internal and external variables, such as organisational support, career identity, and burnout, which may predict depressive symptoms among Chinese nurses via machine learning (ML). Aim. To predict nurses' depressive symptoms and identify the relevant factors by machine learning (ML) algorithms. Methods. A self-administered smartphone questionnaire was delivered to nurses to evaluate their depressive symptoms;1,431 questionnaires and 28 internal and external features were collected. In the training set, the use of maximum relevance minimum redundancy ranked the features' importance. Five ML algorithms were used to establish models to identify nurses' depressive symptoms using different feature subsets, and the area under the curve (AUC) determined the optimal feature subset. Demographic characteristics were added to the optimal feature subset to establish the combined models. Each model's performance was evaluated using the test set. Results. The prevalence rate of depressive symptoms among Chinese nurses was 31.86%. The optimal feature subset comprised of sleep disturbance, chronic fatigue, physical fatigue, exhaustion, and perceived organisation support. The five models based on the optimal feature subset had good prediction performance on the test set (AUC: 0.871–0.895 and accuracy: 0.798–0.815). After adding the significant demographic characteristics, the performance of the five combined models slightly improved;the AUC and accuracy increased to 0.904 and 0.826 on the test set, respectively. The logistic regression analysis results showed the best and most stable performance while the univariate analysis results showed that external and internal personal features (AUC: 0.739–0.841) were more effective than demographic characteristics (AUC: 0.572–0.588) for predicting nurses' depressive symptoms. Conclusions. ML could effectively predict nurses' depressive symptoms. Interventions to manage physical fatigue, sleep disorders, burnout, and organisational support may prevent depressive symptoms.
ABSTRACT
As tuberculosis (TB) patients do not have lifetime immunity, environmental transmission is one of the key reasons why TB has not been entirely eradicated. In this study, an SVEIRB model of recurrent TB considering environmental transmission was developed to explore the transmission kinetics of recurrent TB in the setting of environmental transmission, exogenous infection, and prophylaxis. A more thorough explanation of the effect of environmental transmission on recurrent TB can be found in the model's underlying regeneration numbers. The global stability of disease-free and local equilibrium points can be discussed by looking at the relevant characteristic equations. The Lyapunov functions and the LaSalle invariance principle are used to show that the local equilibrium point is globally stable, and TB will persist if the basic reproduction number is larger. Conversely, the disease will disappear if the basic reproduction number is less than one. The impact of environmental transmission on the spread of tuberculosis was further demonstrated by numerical simulations, which also demonstrated that vaccination and reducing the presence of the virus in the environment are both efficient approaches to control the disease's spread.
ABSTRACT
The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) causes Covid-19, an infectious illness. A methodology was created to track the vaccination history of people with the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that causes Covid-19, an infectious illness. The system operates on a Raspberry Pi processor that is designed to authenticate the vaccination records of individuals. The Vaccination Identification System consists of various components connected to the Raspberry Pi Zero 2W microprocessor, Pi camera, an LCD display, LED indicators, a buzzer, a DC servo motor, and a PCB converter. The proposed system grants access to vaccinated individuals and denies access to those who are not vaccinated.
ABSTRACT
In the new millennium, humanity has faced with a global challenge in the form of the novel coronavirus infection (COVID-19). In addition to systemic and respiratory symptoms, SARS-CoV-2 causes neurological disorders, as it is a neurotropic virus. Many scientists assume that SARS-CoV-2 can enter the nervous system through the functional receptor of angiotensin-converting enzyme 2, which is present in glial cells, neurons, skeletal muscles, and other organs. Neurological complications are manifested by damage to the central nervous system, peripheral nervous system, and cranial nerves, as well as by mental disorders. Mental illnesses develop due to neuroinflammation and neuronal death after brain infection with SARS-CoV-2. The article describes a clinical case of a 63-year-old man with the co-occurring novel coronavirus infection and obvious mental disorder who has never had any mental illnesses before. The given clinical example demonstrates the importance of studying the cause-and-effect relationship between COVID-19 and mental illness. In the medium- and long-term perspective, COVID-19 is expected to result in mental health disorders during COVID-19 recovery. Besides, an increase in the number of patients with mental disorders who were mentally healthy before COVID-19 infection is also expected.
ABSTRACT
As the current global pandemic of the novel coronavirus diseases 2019 (COVID-19) continues to rage, the scientific and medical worlds are working to establish an effective therapy against the illness. Recently questions regarding non-steroidal anti-inflammatory drugs (NSAIDs) as a potential therapeutic option for COVID-19 have surfaced. While some studies hint towards the possible benefit of NSAIDs against SARS-CoV-2 infection, the current body of evidence also sheds light on the potential risk of using NSAIDs in COVID-19 patients. Thus, the available literature does not provide conclusive evidence for or against the use of NSAIDs for treating COVID-19 patients. Given the limited data available, we suggest cautionary approaches for the public to avoid possible harm until further evidence emerges. NSAIDs should not be used as the first-line agents for COVID-19 unlessunder medical supervision. Moreover, patients with chronic inflammatory conditions should continue the NSAIDs as per their regular prescriptions.
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ObjectiveTo explore Young Persons (YP) and healthcare professionals (HCP) experiences of virtual consultations (VC) and establish whether developmentally appropriate healthcare can be delivered virtually.MethodYP and HCP questionnaire surveys were designed and piloted. Electronic questionnaire links were sent by post, email or text message January–April 2021 to YP aged 13–25 years old, with predefined chronic gastrointestinal conditions, attending a gastroenterology/hepatology VC. HCP undertaking VC were invited to complete staff questionnaire. Results were anonymous and collated using Excel version 2302.ResultsFive UK hospital trusts participated, with 35 HCP responses. Of the 100 YP completing the survey 66% were female and 34% male aged between 13 years and 25 years (median: 18 years). 13% were new appointments and 87% follow ups, 29% were by video, 69% by phone and 2% gave no response. 80% of HCP spoke to YP directly but not privately (69%). 87% of YP and 88% HCP found VC useful. 83% of YP want VC again, although 20% preferred face to face. 43% of HCP required improved phone/internet connection. 77% of YP required hospital appointments for tests following VC.ConclusionsOverall respondents were satisfied with VC, finding them useful, convenient and time saving. Successful VC rely on appropriate patient selection and availability of reliable technology. Patient preference is key which may alter with time.
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"5 However, more recent findings, such as the presentation of joint swelling without EM in Black children, are the result of research efforts to identify differences among racial and ethnic groups in presentations of disease symptoms, with the aim of greater diagnostic accuracy and reduced health care disparities.4 Treatment of Lyme disease Although most resources, such as the CDC's website,1 published articles and sites,2,3 and the Red Book,5 recommend that pediatric, adolescent, and young adult patients with Lyme disease receive an antibiotic, such as doxycycline, amoxicillin, or cefuroxime (for penicillin-allergic patients), these publications differ in recommended dosage and duration of treatment. [...]PHCPs who are unfamiliar with antibiotic treatments for Lyme disease should consult with infectious disease specialists. Children who have evidence of Lyme carditis, Lyme arthritis, cranial neuritis, Lyme meningitis, or radiculoneuritis should immediately be referred to infectious disease and the appropriate pediatric specialists.2 Respiratory infections and health care inequities Although researchers have reported studies on racial and ethnic inequities among children related to respiratory diseases over the last 20 years, few randomized controlled trials have scientifically investigated the problem or have identified and rigorously investigated evidencebased interventions. The COVID-19 pandemic brought a new focus in pediatric health care on the inequities experienced by Black, Hispanic, American Indian or Alaska Native, and Pacific Islander children living in poverty, who regularly experience a disproportionate number of respirator y illnesses and infections.6 Several studies have shown increased hospitalization rates for Blac k and H ispan ic children who contracted COVID-19.6 One team of researchers studying children from birth to 4 years old reported a hospitalization rate of 55% for Black and Hispanic children.7 For years, PHCPs have observed and treated children for asthma in all health care settings. Bhavnani et al reported that Black children had a 7-fold higher rate of emergency department visits compared with White children in 2019, 1 year before the pandemic began.8 However, the difference decreased to a 2-fold increase for Black children compared with White children in 2020, when COVID-19 measures such as masking, social distancing, and school closures were in place.8 Researchers are continuing to investigate why Black and Hispanic children are more vulnerable to upper respiratory infections with viruses such as influenza, rhinovirus, and adenovirus.8 Summertime prevention of respiratory infections Talking about prevention strategies with families is the first step toward reducing asthma episodes and exacerbations.
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BackgroundRestrictions on outdoor movements due to the coronavirus disease (COVID-19) pandemic have led to a decreased physical activity;this can lead to sarcopenia and frailty in older adults. Our recent study has demonstrated a significant decrease in the trunk muscle mass immediately after the pandemic's first wave (April–May 2020) among Japanese community-dwelling older women. In the present study, we further examined whether muscle mass recovery or deterioration occurs after 1 year of the pandemic's first wave by comparing physical measurements among the following assessment periods: before the first wave, immediately after the first wave, and at 1-year follow-up thereafter.MethodsThis study included 77 women (78.0 ± 5.7 years) who underwent physical measurements for muscle mass, grip strength, one-leg stand-up ability (3 s), and oral motor skills and answered questionnaires on sociality (social network, participation, and support) in the three assessment periods.ResultsThe frequency of going out and the subjective vitality were significantly decreased immediately after the first wave;these recovered at the 1-year follow-up (P < 0.001). When comparing muscular measures, the trunk muscle mass index preferentially decreased immediately after the first wave but recovered significantly at the 1-year follow-up (P < 0.001). Conversely, the appendicular skeletal muscle mass index (ASMI) and grip strength continued to decrease until the 1-year follow-up (P < 0.001 and P = 0.03, respectively). The ability to perform a one-leg stand-up for 3 s and the oral motor skills did not change significantly across the assessment periods. The prevalence of pre-sarcopenia and sarcopenia tended to increase during these periods (P = 0.068). The reduction and subsequent recovery patterns for sociality were similar to those observed for the trunk muscle mass.ConclusionsOur findings demonstrated differences in the reversibility of skeletal muscle mass and strength at 1 year after the first wave of the COVID-19 pandemic: the trunk muscle mass declined acutely and recovered rapidly, whereas the ASMI and grip strength declined continuously. These differences in the skeletal muscle recovery and deterioration might help formulate short-term or long-term strategies for COVID-19-related sarcopenia prevention in community-dwelling older adults.
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201 Table 1Demographics of cohortVariableCategory/SummaryNegativePositiveOverallORP-value95%CI low95%CI high3043(79.7%)777(20.3%)3820AgeMean/SD21.19/6.7920.93/6.0721.12/6.640.9800.2580.9451.015Median (Q1-Q3)18(15, 27)19(16, 25)18(15, 27)Min-Max14-3614-3614-36BMIMean/SD23.34/4.8924.12/4.9023.48/4.831.068<.0011.0351.103Median (Q1-Q3)22.44(19.9, 25.9)23.39(20.5, 26.8)22.60(20.06, 26.03)Min-Max13.36-55.2514.40-45.9013.36-55.25SexWomen1107(36.3%)250(32.4%)1357 (35.5%)1Men1935 (63.5%)521(67.6%)2456 (64.3%)1.2020.0321.0161.421EthnicityWhite2789(91.65%)707(90.99%)3496(91.5%)Asian89(2.92%)23(2.96%)112 (2.93%)Black53(1.74%)11(1.42%)64 (1.68%)Other112(3.68%)36(4.63%)148 (3.87%)BAME vs. White1.0870.5550.8241.434Group Sedentary495(16.24%)112(14.53%)607 (15.89%)1typeRecreational1331(43.67%)302(39.17%)1633 (42.76%)0.7720.0030.6500.916Elite1222(40.09%)357(46.30%)1579 (41.35%)0.7620.0240.6020.965MET A (0 METs)440 (14.44%)105(13.62%)545(14.27%)1CategoryB (<500 MET-min/week)91(2.99%)12(1.56%)103 (2.70%)0.5540.0700.2921 049C (500-999 MET-min/week)128(4.20%)25(3.24%)153 (4.01%)0.8200.4170.5081.324D (1000-1499 MET-min/week)149(4.89%)37(4.80%)186 (4.87%)1.0780.7220.7121.633E (>1500MET-min/week)2240(73.49%)592(76.78%)2832 (74.16%)1.1220.3300.8901.414 201 Table 2The effects of demographics, physical activity, and symptoms on disease durationORp-value95%CI low95%CI highMen vs. Women0.561<0.0010.4180.753MET categoriesCATEGORY B vs. A1.4360.5490.4414.679CATEGORY C vs. A0.8650.7430.3642.056CATEGORY D vs. A0.5440.0890.2691.098CATEGORY E vs. A0.5320.0020.3560.795Recreational vs. Elite athlete1.698<0.0011.2602.288Sedentary vs. Elite athlete2.255<0.0011.4913.411Sedentary vs. recreational1.3280.185.8732.019Shortness of breath (YES vs. NO)3.558<0.0012.6144.842Chest pain (YES vs. NO)2.341<0.0011.5093.630Chest tightness (YES vs. NO)2.733<0.0011.9143.902Palpitations (YES vs. NO)3.1370.0011.5616.305 201 Figure 1The effect of the available variables on the duration of the disease in COVID-19 positive participants[Figure omitted. See PDF]Conflict of InterestNone
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None is inconsequential: advancing digital technology, globalization of clinical trials, changes in clinical trial design, the inflow of private equity dollars, fewer sponsors lost to mergers and acquisitions, more CROs, the costs of clinical trials, precision medicine, lack of available talent, and-an under the radar trend-the continuing challenges of chronic disease. A 2020 report called them a "primary factor" in the growth of global CRO services market.2 Casey McTigue, an executive director at SRS Acquiom, an M&A services firm, put it this way: "We have seen record setting volumes for M&A." Market attention In 2019, the life sciences recruiter Pr°Clinical considered the following CROs worthy of close attention from investors and pharma alike: PPD, Medpace, PRA Health Sciences, KCR, ICON, IQVIA, PSI, Parexel.3 Of the eight, three still stand alone;the rest have merged or been acquired. Combined, their network covers 2,800 hospitals, clinics and long-term care facilities, and 200 research and pharmaceutical companies, a press release says. Since the combined R&D outlay of the top pharma houses now hovers at the $100 billion-and that majority of trials have CRO involvement-even the math challenged can appreciate the CRO industry's losses, or gains, depending on the road chosen.6 But the CRO industry has already proved its resiliency. Despite changes in market conditions between 2008 and 2019, SRS Acquiom found that of the 227 private life sciences deals in which it was the shareholder representative, 163 had earnouts, the potential dollar figure more than $37 billion.
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The gastrointestinal system, also referred to as the gut, is a universe that colonizes trillions of microbes. In addition to its digestive functions, the gut represents a biosystem that determines all the health vectors. It is now recognized as one of the body's defense systems, and good gut health regulates the body's immune responses. Disturbance of this barrier can trigger many diseases, including respiratory tract infections, as there is a close correlation between the gut microbiome and the chances of triggering illness. This review investigates the various factors affecting the gut microbiome, the diseases that can result from the dysregulation of the same, and their molecular mechanisms. The most basic solution to tackle this problem is to maintain the gut microbiome at the desired level. Timely diagnosis and interventions are needed for the proper management of the ensuing conditions. It is important to address the effects of factors on the gut microbiome and thereby regulate this level. The study also found that dysregulation in the system can lead to various diseases such as asthma, COPD, lung cancer following their respective pathways. In short, this paper reinforces the importance of the gut microbiome, the need to maintain its average level, and the need for proper interventions to treat the consequences. The manuscript posit that medications, diet as well and good physiological conditions of the human body can alter the microbiome and can ward off respiratory infections.
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[...]many elementary and secondary schools were closed in 2020;when they reopened in 2021, masks and social distancing were in place. [...]these factors may have significantly reduced children and unvaccinated families from contracting and spreading the measles virus. Pediatric tuberculosis A diagnosis of pediatric tuberculosis (TB), for either latent TB (referred to as tuberculosis infection [TBI]7) or TB disease (active TB), is made for patients aged less than 15 years who have either a positive tuberculin skin test or a positive interferongamma release assay.7,8 Both tests have a high positive predictive value when used for children who have had a direct contact exposure to an adult with TB disease.7 Infants and young children are at increased risk of developing life-threatening forms of the disease, including TB meningitis and disseminated TB, compared with older children and adults.8 The greatest numbers of TB cases occur in children under 5 years old, with 38% of pediatric cases occurring within this age range.7 In addition, in 2020, 28% of the 10- to 14-year-old population had a diagnosis of pediatric TB.8 Data from TB cases in children aged less than 18 years living in the United States from 2010 to 2017 revealed that 32% of children with TB disease were born in other countries.9 Adults who have the TB bacterium, Mycobacterium tuberculosis, spread the organism via airborne transmission by coughing, speaking, or singing. [...]children with pediatric TB do not spread the organism as readily as adults, because pediatric TB is less infectious than the adult form.8 Children may present with a cough, weakness, weight loss, fever, change in playtime behaviors, and/or night sweats.8 Children younger than 4 years are at the highest riskof progressing from TBI to TB disease, with data showing a risk of 40% to 50% for infants less than 1 year old and 25% for 1- to 2-year-olds.8 However, children with a diagnosis of TBI who receive drug therapy and whose parents adhere to the regimen have a 90% reduced risk of developing TB disease.8 Adolescents older than 12 years have a risk of progression to adult-type TB disease. Providers need to be aware that the Centers for Disease Control and Prevention does not recommend the 4-month rifapentine-moxifloxacin TB regimen for children younger than 12 years.8 Best practices for pediatric providers include consulting a TB expert prior to beginning the treatment course, based on the available data showing that young children have a high risk of developing life-threatening TB disease.8 Conclusions Pediatric health care providers are on the frontlines for identifying infectious diseases and, to prevent poor outcomes, must react quickly to diagnose and treat cases in children and adolescents.
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Treatment should be initiated early in the illness as the greatest effect on outcome is achieved if given within 48 hours of the onset of symptoms.1 In one randomized controlled trial, baloxavir marboxil had greater efficacy than oseltamivir in adolescents and adults with influenza B virus infection.3 (You can see the recommended list of antiviral medications for this season on the online Table at contemporarypediatrics.com/ influenza-and-RSV-during-COVID). Health care providers are already seeing a less severe influenza and RSV season due to the COVID-19 precautions, with individuals wearing masks and continued physical distancing. What HCPs can do in the meantime is test as many patients as they can to determine the infecting organism and the most appropriate treatment. Because HCPs know that the 2018-2019 influenza vaccine reducedpediatric influenza A-associ-ated hospitalizations and emergency department visits by 40% to 60%,5 this season's approach has been to immunize as many children with the influenza vaccine and test as many as possible for influenza and COVID-19. There are many single testing options available and a few multiplex assays using RT-PCR, mostly in hospital labs. But as the flu season marches on, I anticipate more assays to be available for use in the office as well. ¦ COMMENTS?
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The final act of Philip Roth's achingly poignant novel, Nemesis, based on the 1944 polio epidemic condenses the trajectories of each of the main protagonists' lives as a result of events that sultry summer, Bucky Cantor, swapping life stories with a former pupil at his school. [...]the implications for long term (psychological and physical) health are arguably worse: late presentation for other febrile illness (EDs have never been so empty—something is wrong);fear of infection by dint of ‘exposure' to a health facility;interruption of standard health surveillance particularly vaccination;mental health;child abuse as a result of prolonged internment and loss of, at least the social side of, education. The reasons for less aggressive disease are still not completely understood, though there are a number of candidate explanators: host-response factors;lower infective dose (as most often from an adult household member);age related ACE receptor differences and more recent exposure to antigenically similar coronaviruses conferring relative immunity.