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Many measures have been imposed by governments around the world to limit the spread of COVID-19. Iraqi authorities adopted a continuous cycles of reinforcement and relaxation in the measures, thus travel behaviors are significantly affected as a result of these measures. This study focuses on the impact of the COVID-19 pandemic on travel pattern in Al-Qadisiyah governorate, Iraq, during three different phases, one phase before pandemic and two phases during the pandemic to study the impact of the variation in imposed measures. Data were collected through a qualitative interviews and online questionnaire surveys that included questions on primary purpose of trip, mode choice of transport, frequency of trips before and during pandemic (including two phases). Descriptive analysis and inferential statistical analysis (especially nonparametric tests) were conducted to analyze the collected data. Results show a significant shifting from work/studying trips to shopping and others trips purposes during the first phase, where distance education and teleworking were imposed. In the second phase, the recommendation for work and study from home were lifted thus the primary trips for work or study purposes have resumed somewhat like their previous pace but with less frequent than its usual in pre-pandemic. A significant reduction in public transport and car-sharing usage was observed during first phase-COVID-19 compared to pre-COVID-19 and second phase-COVID-19. People gave the pandemicrelated factors a higher priority than general factors when selecting a transport mode during the pandemic. However, they put less priority for such factors during second phase of COVID-19 as compared to first phase, due to relaxation in the imposed measures. Changes in travel behavior during a pandemic have an impact on travel demand and favorable transport modes, thus understanding this behavior can help in transportation planning, and decision-making. © 2023 WITPress. All rights reserved.
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Objectives: To evaluate the safety and immunogenicity of CoronaVac and ChAdOx1 vaccines against SARS-CoV-2 in patients with Rheumatoid Arthritis (RA). Method(s): These data are from the 'SAFER (Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases)' study, a Brazilian multicentric longitudinal phase IV study to evaluate COVID-19 vaccine in immunomediated rheumatic diseases (IMRDs). Adverse events (AEs) in patients with RA were assessed after two doses of ChAdOx1 or CoronaVac. Stratification of postvaccination AEs was performed using a diary, filled out daily. The titers of neutralizing antibodies against the receptor-biding domain of SARS-CoV-2 (anti-RBD) were measured by chemilumine scence test after each dose of immunizers. Proportions between groups were compared using the Chi-square and Fisher's exact tests for categorical variables. Clinical Disease Activity Index (CDAI) before and after vaccination was assessed using the McNemar test. Result(s): A total of 188 patients with RA were included in the study, most of them were female. CoronaVac was used in 109 patients and ChAdOx1 in 79. Only mild AEs were observed. The more common AEs after the first dose were pain at injection site (46,7%), headache (39,4%), arthralgia (39,4%) and myalgia (30,5%), and ChAdOx1 had a higher frequency of pain at the injection site (66% vs 32 %, p alpha 0.001) arthralgia (62% vs 22%, p alpha 0.001) and myalgia (45% vs 20%, p alpha 0.001) compared to CoronaVac. The more common AEs after the second dose were pain at the injection site (37%), arthralgia (31%), myalgia (23%) and headache (21%). Arthralgia (41,42 % vs 25 %, p = 0.02) and pain at injection site (51,43% vs 27%, p = 0.001) were more common with ChAdOx1. No patients had a flare after vaccination. The titers of anti-RBDafter two doses of ChAdOx1 were higher compared to two doses of CoronaVac (6,03 BAU/mL vs 4,67 BAU/mL, p alpha 0,001). Conclusion(s): The frequency of local adverse effects, particularly pain at injection site, was high. AEs were more frequent with ChAdOx1, especially after the first dose. The use of the immunizers dis not change the degree of inflammatory activity of the disease. In patients with RA, ChAdOx1 was more immunogenic than CoronaVac. .
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Intro: The unavailability of specific treatment for COVID-19 prompted the empirical use of remdesivir, a viral RNA polymerase inhibitor. Since evidences present conflicting results, this study aims to determine the clinical effectiveness and adverse events of adjunctive remdesivir administration vs standard of care (non-remdesivir) in COVID-19 adult patients in a tertiary hospital in Baguio City, Philippines. Method(s): We performed a single-center, retrospective study of severe to critical COVID-19 patients admitted from September 2020 to September 2021. Stratified random sampling was employed and data collection was through chart review. Analysis was done with R Statistical Software version 4, utilizing paired T-test and McNemar test, with p-value of <0.05 considered as significant. Finding(s): A total of 318 patients were reviewed and classified into the remdesivir (n=159) and standard of care (non-remdesivir) (n=159) groups. Baseline characteristics were comparable except for co-morbidities (p<0.05). There were no noted significant differences between both groups in terms of morality (p=0.885) and reduction in chest radiograph infiltrates (p=0.182). However, the average number of days to clinical improvement (7 days vs 12 days) and recovery (16 days vs 21 days) were statistically lesser in the remdesivir group (p=0.00). Also, those who experienced diarrhea (p=0.33) and transaminitis (p=0.003) were significantly higher in those given remdesivir. Conclusion(s): There was no significant difference in terms of mortality in those given remdesivir vs standard of care alone. Nevertheless, remdesivir administration is associated with significantly faster time to clinical improvement and recovery. The drug is thought to facilitate faster lung viral load clearance and improved pulmonary function through inhibition of RNA polymerase. Though not potentially life-threatening, the drug may cause diarrhea and elevation in transaminases.Copyright © 2023
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INTRODUCTION AND OBJECTIVE: Some reports have indicated that the COVID vaccine could affect parameters used for some cancer screenings. The effect of COVID vaccination on breast cancer screening mammograms has been hotly debated and anecdotal reports of a rise in prostate-specific antigen (PSA) after COVID vaccination have appeared in the media. We explored the relationship between PSA levels and COVID vaccination. METHOD(S): With IRB approval, we queried the electronic medical record for men who received at least two mRNA COVID vaccine injections (Pfizer or Moderna), at least one PSA test within two years prior to the first vaccine injection and at least one PSA within one year of their second injection and before any third injection. PSA results were grouped according to the timing of the post vaccination PSA. The pre-vaccine PSA closest to the first injection was used. Both within and between subject analyses were conducted. Wilcoxon signed rank tests were performed to compare PSAs pre- and post- vaccine for each time defined group. McNemar tests were used to assess the percentage of patients crossing a 4.0 ng/dl threshold when compared with their prevaccine PSA. Difference in relative PSA change across the groups was compared using a Kruskal Wallis test. RESULT(S): 5713 men met inclusion criteria. Median prevaccine PSA was 1.2 ng/dl (IQR 0.6-2.7 ng/dl). The median time difference between vaccine injection 1 and 2 was 22 days (IQR 21- 28 days). Within each time group, a significant increase in PSA was observed pre to post and a higher proportion of men went above 4.0 relative to those going below. However, no significant differences were observed across groups (Table 1). CONCLUSION(S): Due to the lack of intergroup differences, PSA increases most likely reflect natural progression rather than any temporal effect of vaccination.
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Background: School-based sleep education programmes can promote the importance of sleep health and may improve adolescent sleep. To date, only limited research has examined the feasibility of integrating sleep programmes into the school curriculum. Objectives: This study evaluated the feasibility, acceptability and preliminary efficacy of the Strathclyde intervention to encourage good sleep health in teenagers (SIESTA). Methods: A total 171 students (12–15 years, 53% women) from secondary schools in Scotland participated in the study. Recruitment and retention, data collection and design procedures were assessed to establish feasibility. Qualitative feedback on acceptability was collected via focus group discussions. Outcome measures assessing insomnia symptoms, sleep hygiene, depression, anxiety and stress were completed at baseline and post-intervention to explore the preliminary effects of SIESTA. Results: All schools that were approached consented to participate, and most students completed assessments at both time points (171) with a dropout rate of 5%. Assessment measures provided sufficient data to compare baseline and post-intervention values. Training and delivery manuals ensured successful delivery of the programme. Qualitative feedback indicated SIESTA was acceptable, and students spoke favourably about the content, delivery and techniques. Students reported that SIESTA was age-appropriate, relevant and the techniques were beneficial. There were significant improvements in insomnia and stress, but no improvements were noted for sleep hygiene, depression or anxiety. Conclusion: The findings suggest that SIESTA is feasible and acceptable for delivery via the school curriculum. The results indicate that a controlled trial is required to further investigate the efficacy of SIESTA implemented in an educational context.
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Reports on antibody titers following CoronaVac administration are still scarce, particularly when it comes to the post-vaccination effectiveness of CoronaVac in the Indonesian population. The purpose of this study is to determine the efficacy of COVID-19 vaccination by comparing the IgG levels against the S1 subunit of SARS-CoV-2 RBD after the first and second vaccinations. The researchers collected venous blood samples from participants after they received the CoronaVac 600 SU/0.5 mL vaccine at two different intervals (14 days and 28 days). Blood was drawn twice (after the first and second vaccinations) and tested for antibodies (positive antibody detection value of 50 AU/mL). Paired data were analyzed by using either the Wilcoxon test (numerical) or the McNemar test (categorical). The median IgG1 levels in the 14-day interval between vaccine doses were 64.40 AU/mL and IgG2 levels were 886.10 AU/mL. Meanwhile, the median IgG1 level was 146.10, and IgG2 level was 688.00.AU/mL in the group with a 28-day interval between vaccine doses. After the first vaccination, 60.00 % of study subjects had positive IgG levels, which increased to 98.57% after the second vaccination. Following the full-dose vaccination, all participants had higher antibody levels, and considered significant. The effect was stronger in the group that received the vaccine at 14-day intervals. CoronaVac has also been shown to increase the prevalence of detectable antibody positivity in study participants.Copyright © 2023 Russian Association of Allergologists and Clinical Immunologists, St. Petersburg Regional Branch (SPb RAACI). All rights reserved.
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Background & Objective: The late-term neurological effects of COVID-19 are not fully understood yet. Herein, we aimed to determine if COVID-19-related acute and late-term neurological symptoms exist in the patient group that differs from the general population during the pandemic period. Methods: Two hundred fifty patients with a history of COVID-19, whose treatments were completed at least one month before enrollment, were examined together with a control group consisting of 150 individuals that lived in the same socio-cultural environment during the same period. A survey that included questions about possible neurological symptoms that might be related to the COVID-19 infection was completed in both groups. Results: The patient and control groups were mostly similar regarding the neurological symptoms in the pre-pandemic period. The control group did not report any new symptoms except ageusia during the pandemic period. Whereas a number of neurological symptoms such as headache, ageusia and anosmia, difficulty in thinking and planning, forgetfulness, clumsiness of one or both hands, dizziness, unsteadiness, numbness in both hands and feet, and neuropathic pain occurred during the infection. Neurological symptoms, except headache and unsteadiness, prolonged to the late-term with a decreased prevalence. Conclusion: The emergence of new neurological symptoms during the pandemic in those with COVID-19 disease, unlike the control group, suggested that these symptoms are related to the infection itself. © 2023, ASEAN Neurological Association. All rights reserved.
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Background: The coronavirus disease 2019 (COVID-19) has been sabotaging the world over the last two years and vaccine is one of the key solutions. However, the concerns over its side effects can cause vaccine refusal, subsequently affecting many countries' education system recovery plans. Objective(s): To actively evaluate adverse effects and their severity following COVID-19 immunization among schoolchildren aged 12 to 17 years, to support parents' decision-making. Material(s) and Method(s): The present study was an observational study whereby a Google-form survey on Pfizer COVID-19 vaccine adverse effects (CVAE) was responded between January and April 2022 by 537 participants. Descriptive statistics were used to analyze basic characteristics. Chi-square tests were performed for comparative analyses between junior (aged 12 to 15 years) versus senior (aged 16 to 17 years) high school students, and McNemar's test for the first dose versus second dose groups analysis with a significance level set at p-value less than 0.05. Result(s): At least one CVAE was reported in 93.85% of the included participants, albeit mostly mild. The most common symptom as a local event was tenderness at the puncture site (82.50%), whereas systemic events were predominated by myalgia (74.67%). The second dose was associated with increased frequency and severity of adverse effects compared to the first dose (p<0.001). The older age group had significantly more side effects compared to the younger group (p<0.05). Conclusion(s): The high incidence of CVAEs in schoolchildren was predominated by mild symptoms, with the second dose and older group associated with increased frequency of symptoms. The predominance of mild symptoms found in the present study may help reduce the concerns of parents over CVAEs, ultimately accelerating vaccine coverage in the children group, which is still a gap in vaccine administration.Copyright © 2023 JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND.
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Introduction: The WHO SAGE Vaccine Hesitancy Matrix provides vaccine hesitancy solutions based on contextual influences, individual and group influences, and vaccine/vaccination-specific issues. There are limited studies about the impact of using this matrix on high school students to improve their COVID-19 vaccine hesitancy rates. Research Question or Hypothesis: Can an interprofessional, interactive vaccine hesitancy program change high school student's knowledge of and attitudes for the COVID-19 vaccine? Study Design: Pre-post interventional study. Method(s): An panel of healthcare providers, public health workers, teachers, and religious leaders implemented an interactive curriculum about scientific findings on COVID-19 vaccines, recognizing misinformation, and overcoming COVID-19 vaccine hesitancy for underrepresented high school students using matrix principles. Afterwards, participants designed two videos featuring different topics to improve vaccine confidence. Students also applied the principles learned at a COVID-19 pharmacy vaccination clinic event to address vaccinerelated misconceptions in the community. Entry and exit surveys for the participants were collected on a 5-point Likert scale. The McNemar test was used to evaluate changes from non-preferred to preferred responses with an alpha of 0.05. Result(s): Forty-five students (38% 10th grade, 40% 11th grade, 48% Caucasian, 33% African-American) participated in the 4-month program. Significantly more students agreed in post-tests, chi2(1, N = 31) = 4.167, p = 0.0412, that: "I have adequate knowledge about SARSCoV- 2 disease." More students agreed in post-tests, chi2(1, N = 31) = 6.750, p = 0.0094, that: "I have adequate knowledge about the SARS-CoV-2 vaccine." Overall, 25 students (64%) agreed that "I have talked to my peers about information I learned during the program". Finally, 20 students (51%) agreed that "I am comfortable serving as a SARS-CoV-2 vaccine ambassador where I can promote the SARSCoV- 2 vaccine to my community." Conclusion(s): This program increased the knowledge and attitudes of underserved students in vaccine hesitancy while being actively engaged in the SARS-CoV-2 pandemic that was disproportionately affecting their community.
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Background: Whether vaccines play a role triggering or reactivating inflammation in Multiple Sclerosis (MS) has been long debated. There are few reports suggesting that Sars-Cov2 vaccines, as well as COVID-19 infection, may exacerbate relapses in MS. Studies on large cohorts are needed to establish the safety of Sars-Cov2 vaccines in the MS population. Aim(s): To assess the risk of clinical and radiological reactivation following Sars-Cov2 vaccines in patients with MS. Method(s): Patients with MS with known date of SarsCov2 vaccination were identified among those followed up at the Multiple Sclerosis Center of the Tor Vergata University Hospital. Data on clinical relapses and radiological activity (Gadolinium enhancing and new T2 lesions) in the 12 months before and after vaccination were extracted from clinical charts. Result(s): We enrolled 751 patients (64,7% female, mean age 45.9 +/- 11.63 years, 89.9% relapsing-remitting, 5.5% secondary progressive and 4.7% primary progressive, disease duration 11.2 +/- 8.11 years, median EDSS 2.0 [1.0 - 4.0], 12.1% untreated, 41.1% treated with first line immunomodulators and 46.7% with second line high efficacy treatments). Among them, 96.7% received mRNABNT162b2 (Pfizer), 2% mRNA-1273 (Moderna) and 1.3% other COVID-19 vaccines. In the whole cohort we did not find a significant increase of the rate of patients with relapse in the 12 months after vaccines (2.3%) compared to the 12 months before (2,9%, McNemar test, p=0.5), as well as of the rate of patients with radiological activity (both 11.5%, McNemar test, p=0.13). Similar findings were obtained separately analysing untreated patients, patients treated with first line and treated with second line drugs at the time of vaccination. Conclusion(s): Our preliminary results in a large monocentric cohort of MS patients suggest that vaccination with Sars-Cov2 vaccines does not induce disease reactivation. Further analyses are needed to confirm these findings.
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Introduction: While there is anecdotal evidence that a SARSCoV- 2 (COVID-19) reverse transcription polymerase chain reaction screening nasopharyngeal swab confers an elevated risk of epistaxis, no studies substantiate this. We aim to assess the association between epistaxis and exposure to a provideradministered COVID-19 swab. Method(s): A paired-exposure crossover cohort design was used among all patients who received a single COVID-19 swab between April 2020 and March 2021. Occurrence of epistaxis was compared during the hazard period, the 7 days following the index COVID-19 swab, to the control period, the 7 days preceding the index COVID-19 swab. McNemar test was used to compare rates of control- and hazard-period epistaxis. Conditional logistic regression was used to evaluate sociodemographic and clinical risk factors for epistaxis. Result(s): A total of 827,987 participants were included, with 1047 epistaxis encounters. The prevalence of epistaxis during the hazard and control periods were 0.08% and 0.04%, respectively. Swab exposure was associated with 1.92-fold odds of epistaxis in the hazard period (95% CI, 1.73, 2.12];P<.01). Older age (odds ratio [OR] 1.07;95% CI, 1.02, 1.75), Asian ancestry (OR 1.68;95% CI, 1.40, 2.02), men (OR 1.33;95% CI, 1.16, 1.54), anticoagulation/antiplatelet use (OR 2.88;95% CI, 2.11, 3.92), hypertension (OR 2.31;95% CI, 1.92, 2.78), and prior facial trauma (OR 1.63;95% CI, 1.21, 2.19) were associated with significantly increased odds of epistaxis during the hazard period (P<.01). Conclusion(s): COVID-19 nasal swabs are associated with increased risk of epistaxis. Physicians should provide additional counseling to patients, particularly those at highest risk, including those on anticoagulants/antiplatelets or with hypertension, prior to undergoing a COVID-19 nasal swab.
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Background: Infections are a known trigger for Rheumatoid Arthritis (RA) fares.1 It is still unclear whether SARS-Cov-2 infection affects RA disease activity and the clinical response to biological disease-modifying antirheumatic drugs (bDMARDs). Objectives: To evaluate the effect of SARS-Cov-2 infection on disease activity and bDMARD responses in patients with RA. Methods: A retrospective study was carried out in a cohort of RA patients treated with bDMARDs from a tertiary hospital centre. Demographic and clinical data, including occurrence of SARS-Cov-2 infection, were obtained through medical records. Disease activity (DAS28, DAS28-CRP, CDAI and SDAI) and ACR and EULAR bDMARD responses were evaluated at four time points: baseline (t1-last evaluation before Covid-19 pandemic), before (t2) and after (t3) SARS-Cov-2 infection and at the end of follow-up (t4-last appointment of 2021). In patients with no record of SARS-Cov-2 infection the middle evaluations were obtained from two random consecutive appointments during Covid-19 pandemic. Statistical analysis (signifcance at p<0.05) was performed using paired t-test, Wilcoxon and McNemar tests for paired samples and unpaired t-test, Mann-Whitney, Fisher and χ2 tests for independent samples according to the type of variable and the presence of normal distribution. Results: Of the 237 patients included, most of them was women [n = 195 (82.3%)], with a mean age of 59.6 ± 10.1 years old and a median [min, max] disease duration of 18 [2, 50] years. The majority presented rheumatoid factor (RF) and/or anti-citrullinated protein antibodies (ACPA) positivity [n = 204 (87.9%)] and radiographic erosions [n = 119 (72.6%)]. The prevalence of SARS-Cov-2 infection was 11.4% (n=27). Mean disease activity was lower after SARS-Cov-2 infection compared to the previous evaluation on all scores used;however, this difference was not statistically signifcant. Nevertheless, when compared to the mean disease activity at the end of follow-up, there were statistically signifcant differences in DAS28-CRP (t2 3.2±1.0 vs. t4 2.8±1.1, p=0.017) and CDAI (t2 11.1±8.1 vs. t4 8.7±6.2, p=0.05) scores. The relative number of patients with no ACR or EULAR bDMARD responses before SARS-Cov-2 infection wasn't different from post infection and at the end of follow-up. At baseline, the infected and uninfected groups were similar regarding gender, age, RF and/or ACPA positiv-ity, erosive disease, disease and biologic treatment durations, baseline disease activity and ACR and EULAR response. The variation in disease activity and the relative number of patients with worsening or improving EULAR and ACR bDMARD responses between t2 and t3 were not signifcantly different in the two groups, as well as between t2 and t4. The prevalence of patients who switched to another bDMARD was signifcantly higher in the group of patients who had Covid-19 [n=4 (14.8%) vs. 9 (4.3%), p=0.047]. The main reason for switching was the ineffectiveness of the therapy (n=11). Conclusion: No worsening of disease activity or ACR and EULAR bDMARD responses was found after SARS-Cov-2 infection in RA patients under bDMARD. However, the later can be explained by the small sample size. Indeed, these patients exhibited a higher rate of switch due to ineffectiveness of therapy, suggesting a negative impact of SARS-Cov2 infection on the disease course.
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Background: SARS-Cov-2 infection had a major impact on patients with infam-matory rheumatic diseases. Spondyloarthritis (SpA) patients were one of the most affected groups of these patients. Objectives: To assess the impact of Covid19 in spondyloarthritis patients under biological disease modifying anti-rheumatic drugs (bDMARDs). Methods: A retrospective observational study was conducted using registry data of patients with SpA under bDMARD therapy, followed at a tertiary level hospital, that have been diagnosed with COVID19 from March 2019 to December 2021. At least one evaluation previous (t0) and two evaluations after SARS-CoV-2 infection (t1, t2) were included in our analysis. Sociodemographic, clinical, disease activity, therapeutic response, function and general health status data were collected. Statistical analysis (signifcance at p < 0.05) was performed using paired T-test, Wilcoxon test and McNemar tests for paired samples. Linear and logistic regression models were performed to assess direction and strength of association Results: Thirty-two patients with SpA under bDMARD had COVID19, mostly women (20, 62.5%), with a disease course time averaged 18.65 (± 9.69) years, mainly with axial involvement (19, 59.4%) and positive for HLA-B27 antigen (11, 64.7%). The majority were under TNF inhibitors (30, 93.75%), with golimumab being the most common (9, 28.1%), and with a median bDMARD persistence of 2.63 (5.09) years. Seven (21.9%) were under a cDMARD, 3 (9.4%) under NSAID and 18 (56.3%) under corticosteroids. Three (9.4%) were already vaccinated against SARS-CoV-2, 2 (66.6%) with the mRNA-1273 vaccine, presenting a medium time since inoculation of 240 (± 234.01) days. Arterial hypertension was the most common comorbidity (5, 15.6%) and one patient (3.1%) had a previous diagnosis of type 2 diabetes. Most were never-smokers (17, 53.1%) and never-drinkers (29, 90.6%). The average age at infection was 40.97 (± 6.15) years and the most common symptom was cough (22, 68.8%), followed by headache (20, 62.5%) and myalgia (19, 59.4%). Event tree analysis didn't show association with SpA subtype, education level, work status, tobacco or alcohol consumption. Only one patient needed hospital admission but without needing of oxygen, therapy, ventilator or ECMO. Only one patient had an overlaid bacterial infection and no thromboembolic complications were observed. Two patients needed specific SARS CoV-2 infection treatment, one with hydroxychloroquine and another with azithromycin. Twelve (37.5%) patients suspended bDMARD at the time of infection, with only 2 (6.3%) maintaining suspension at the time of the first post-infection visit. When comparing clinical variables, higher disease activity was seen at t1 only for BASDAI mean values, without statistical signifcance. Higher all domains VAS scores were also observed at t1, but not at t2, also without statistical signifcance;moreover, physical function didn't change signifcantly. No differences were observed according to gender or SpA subtype, nor with the use of cDMARDs, NSAIDs or corticosteroids. The only statistically signifcant difference concerned MASES score between t0 and t1 (1 ± 4 vs. 2 ± 6, p=0.04), but not between t0 and t2. Higher baseline tender joint score (p < 0.01) and higher baseline LEI (p=0.03) negatively correlated with MASES score variation. Several baseline variables correlated positively with MASES at t1, including female gender (p < 0.01), corticosteroid use (p = 0.04), BASDAI (p < 0.01), ASDAS-ESR (p < 0.01), ASDAS-CRP (p < 0.01), DAS28 (p < 0.01), SPARCC (p = 0.04), physician VAS (p = 0.03) and total spine VAS (p = 0.01). Working status varied signifcantly after SARS-Cov-2 infection (at least part-time-29, 90.6% vs. 22, 68.8%, p= 0.016). Conclusion: SpA patients on bDMARD had a mild course of SARS-CoV-2 infection, with slight changes in enthesitis score in the short term, the latter particularly in those with higher disease activity in the pre-infection period. Long-term effects on work status could represent confounding factors related to the e onomic constraints of the pandemic.
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Introduction: In December 2019, there was a viral outbreak caused by coronaviruses (CoVs), which has led to numerous restrictive measures. Social distancing (SD) aims to reduce viral spread to the population, but affects sociodemographic aspects, sleep, eating habits and physical activity. Objective: Evaluate the changes caused by DS in aspects related to sleep, eating habits and physical activity in adult individuals. Methods: A study was carried out with 204 volunteers of both sexes. Questions related to sleep habits, eating habits and the practice of physical activity before and during the period of SD were assessed using an electronic questionnaire. The Wilcoxon test, McNemar test, and chisquare test (X2) were used to compare variables before and after SD. significance level of p<0.05 was adopted. Results: The sample consisted of 44 men and 160 women, with a mean age of 33.3±11.2 years and body mass index (BMI) 24.6±4.7 kg/m2. Regarding the TTS, there was an increase in sleep duration from 7.91±1.34hs to 8.43±1.23hs during DS (p<0.01). Sleep quality was considered “very good” or “good” in 73% of the sample in the period before DS. During social distancing, 55.4% reported that they started to sleep less at night and 35.3% reported sleep worsening during this period. Regarding the practice of exercise and physical activity, 73% of the participants practiced before SD, of which 65.1% interrupted the practice during the SD (p<0.01). Regarding eating habits, 32.4% noticed a worsening of eating habits during SD and 60.8% noticed changes in appetite, with increased appetite being the most perceived among participants (41.2%). Fastfood consumption was present at least once a week during SD in 48% of participants, consumption of frozen meals in 24.5% and consumption of sweets in 25%. Conclusion: It is concluded that the DS in adults contributed to increased sleep duration, worsening sleep quality, reduced exercising practices, and increased appetite and worsening eating habits.
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Introduction: The management of antihypertensive drugs and especially ACEI/ARA2 during the first wave of the SARS-CoV-2 pandemic was a matter of debate. The change in antihypertensive treatment during the pandemic and its repercussions have not been sufficiently studied. Methods: Observational and prospective study that analyzed consecutive patients admitted for respiratory infection and positive polymerase chain reaction (PCR) between March 1 and April 30, 2020. During the period analyzed, 921 patients were registered, of whom 673 patients were discharged;among them 359 were patients with a diagnosis of arterial hypertension and pharmacological treatment. These patients were followed up in days, from the time of discharge to data analysis, with a mean of 352±70.4 days. Results: The mean age was 74.4±12.9 years, and 50.7% were male. A total of 28.7% were diabetic patients, 49% were dyslipidemic, 17.8% were smokers, and 19.8% were obese. Of the patients analyzed, 13.4% had a previous diagnosis of ischemic heart disease, a similar percentage, 13.1% had heart failure, and 13.6% had atrial fibrillation. The antihypertensive drugs analyzed were ACE inhibitors (angiotensin-converting enzyme inhibitors), ARA-2 (angiotensin II receptor antagonists), calcium antagonists, thiazide diuretics, loop diuretics, aldosterone antagonists, beta-blockers and alpha-blockers. At discharge, 75.8% of the patients maintained their antihypertensive treatment, and the remaining 24.2% were modified. Prior to admission, 77.2% were taking ACE inhibitors or ARA-2;however, in 16.4% of the patients they were discontinued after admission. In contrast, treatment with calcium antagonists increased from 27.6% to 34.1% after hospitalization. In both cases there were statistically significant differences in the bivariate analysis in the McNemar test (p < 0.05 in both cases), with no differences in the other antihypertensive drugs analyzed. After follow-up, the combined event occurred in 28 patients, with the most frequent event being the development of HF;in contrast, only 0.8% presented ACS. Overall mortality was 8.9%. Picture 1 shows the events recorded according to the change in antihypertensive treatment and the maintenance or discontinuation of ACEI/ARA-2 in those patients who were already taking it on admission. Similarly, a survival analysis was performed in which no differences were observed in terms of all-cause mortality or major cardiovascular events between patients who maintained their antihypertensive treatment and those who modified it. Conclusions: In the population surviving SARS-CoV-2 respiratory infection, maintaining or discontinuing treatment with ACEI/ARA-2 did not influence mortality or the appearance of major cardiovascular events after the first year of follow-up. (Table Presented).
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INTRODUCTION: Healthcare workers experience a significant risk of exposure to and infection from SARS-CoV-2, COVID-19. Nonetheless, little research has focused on physicians' use of personal protective equipment (PPE), their concerns about becoming infected and their social distancing maneuvers. METHODS: All staff physicians at Advocate Lutheran General Hospital were invited to participate. Their COVID-19 IgG antibody level was measured and an online questionnaire was completed. The questionnaire assessed the risk of COVID-19 exposure, PPE usage, concern for contracting COVID-19, the performance of high-risk procedures, work in high-risk settings, and social distancing practices. Testing was performed in September (T0), and December 2020 (T1) at the height of the global pandemic. RESULTS: A total of 481 (26.7%) of 1800 AGLH physicians were enrolled at T0 and 458 (95% of the original group) at T1. A total of 21 (4.3%) and 39 (8.5%) participants had antibodies at T0 and T1. A total of 63 (13.8%) worked in high-risk settings and 111 (24.2%) performed high-risk procedures. Participants working in high-risk settings had increased exposure to COVID-19 infected patients (OR = 4.464 CI = 2.522-8.459, p < 0.001). Participants were highly adherent to the use of PPE and social distancing practices including mask-wearing in public (86%, 82.1%), avoiding crowds (85.1%, 85.6%), six feet distancing (83.8%, 83.4%), and avoiding public transportation (78%, 83.8%). A total of 251 (55.4%) participants expressed moderate to extreme concern about becoming infected with COVID-19. CONCLUSIONS AND RELEVANCE: Among a group of community physicians, consistent PPE use and social distancing practices were common. These practices were associated with a low level of initial acquisition of COVID-19 infections and a relatively low longitudinal risk of infection.
ABSTRACT
Introduction: It is common knowledge that mobility refers to a distinct vector for pathogens, but the importance of prevention and the infusion of public health practices within transportation systems is not manifest. Replication studies of this effect are important because transportation remains veiled in modern societies, since its demand is not direct, but derived. Methods: Variables mirroring transportation and logistics' systems intensity (trade data, the logistics performance index, and investment in transportation) are cross-tabulated with epidemiological data from the recent coronavirus pandemic. As the samples of the data pertain to a dependent commonality, the statistical hypothesis test applicable is McNemar's test. In addition, the statistical power of the test(s) is calculated as a marker of methodological validity and reliability. To further strengthen the analytical methodology, a plethora of descriptive statistics have been calculated and multiple correspondence analysis (MCA) has been conducted. Results: This work confirms that the domain of transportation bears a strong association with not only mortality of a disease, but its recovery rates as well. All crosstabs provide statistically significant results and the statistical power calculated is very high, signifying the appropriateness of the methodology and the very low probability of Type II error. The MCA results are significant, as well. Conclusions: The impact, or even the presence of transportation is veiled, as transportation comprises of derived demand dynamics. As such, its activities and even the prerequisites for its efficient operations many times go unnoticed. This work replicates a known effect, that mobility exacerbates the presence of a pathogen. The significance of this research lies on the fact that distinct indicators that reflect transportation and logistics are (though a robust calculatory methodology) statistically associated with epidemiological data.