Advantages of Total Bilirubin for Predicting Malignant Obstructive Jaundice, A Combination of the Pandemic Era and Limited Resources Settings

BACKGROUND: Hepatopancreatobiliary (HPB) cancer incidence and mortality are increasing worldwide. An initial diagnostic predictor is needed for recommending further diagnostic modalities, referral, and curative or palliative decisions. There were no studies conducted in area with limited accessibility setting of the COVID-19 pandemic, coupled with limited human resources and facilities. AIM: We aimed to investigate the advantages of total bilirubin for predicting malignant obstructive jaundice, a combination of the pandemic era and limited resources settings. METHOD(S): Data from all cholestasis jaundice patients at M. Djamil Hospital in Pandemic COVID-19 period from July 2020 to May 2022 were retrospectively collected. The data included demographics, bilirubin fraction results, and final diagnosis. Bivariate analysis for obtain demographic risk factor, and Receiver Operating Characteristics (ROC) analysis for getting bilirubin value. RESULT(S): Of a total 132 patients included, 35.6% were malignant obstructive jaundice, and Pancreatic adeno ca was the most malignant etiology (34.4%). Bivariate analysis showed a significant correlation between age and malignant etiology (p = 0,024). Direct and total Bilirubin reach the same level of Area Under Curve (AUC). Total bilirubin at the cutoff point level of 10.7 mg/dl had the most optimal results on all elements of ROC output, AUC 0.88, sensitivity 76.6%, specificity 90.1%, +LR 8.14, and-LR 0.26. CONCLUSION(S): The bilirubin fraction is a good initial indicator for differentiating benign and malignant etiology (AUC 0.8-0.9) in pandemic era and resource-limited areas to improve diagnostic effectiveness and reduce referral duration.Copyright © 2023 Avit Suchitra, M. Iqbal Rivai, Juni Mitra, Irwan Abdul Rachman, Rini Suswita, Rizqy Tansa.

The Impact of the Sars-Cov-2 Pandemic (COVID-19) on the Incidence of Newly Diagnosed Multiple Myeloma Patients Using a Federated Network of Real-World Evidence in US and Germany

Objectives: COVID-19 had an impact on health care, including diagnostics. Early diagnosis of MM is a critical factor for prognosis. We examined the impact of COVID-19 on incidence of NDMM patients and on characteristics in NDMM patients in US and in Germany. Method(s): 44,164 NDMM patients were identified in TriNetX federated network across 55 healthcare organizations in US between January 2018 and December 2021. A bivariate analysis examined changes in patient characteristics in two cohorts before (Cohort 1;n=25513) and after (Cohort 2;n=18.651) the start of the COVID-19 pandemic in March 2020. 4172 NDMM patients were identified in the German database in a sample of across >100 healthcare organizations in the same time period. Similarly, bivariate analysis examined changes in patient characteristics before (Cohort 1;n=2252) and after (Cohort 2;n=1920) the start of pandemic. Result(s): Analysis of US data showed a significant decrease in incidence of NDMM. Bivariate analysis revealed that NDMM patients in Cohort 2 have a significantly higher risk profile compared with patients in Cohort 1, higher incidence of renal failure (13.5% v. 15.43%), heart failure (10.3% v 11.26%), bone lesions (12.6% v. 13.05%) and anemia (26.8% v. 29.75%). The German data indicated an increased risk profile in Cohort 2, with higher reporting of renal impairment (12.3% v. 15.5%) and cardiac impairment (8.3% v. 10.9%). The higher risk profile was reflected in a significant increase of all SLiM-CRAB criteria, notably hypercalcemia (24.1 % v. 36.9%), bone marrow plasma cell infiltration (28.1% v. 36.8%) and free light chain involvement (27.3% v. 41.3%). Conclusion(s): The results provide real-world evidence of a change in risk profile for patients with NDMM during COVID-19. This higher risk profile is observed in both the US and Germany, and may negatively impact outcomes such as progression-free and five-year overall survival.Copyright © 2023

Participation in COVID-19 clinical trials, willingness to participate, and trust in sources of information among persons with and without cancer in Puerto Rico

Introduction: Cancer patients have a high risk of severe COVID-19 and complications from it. Although the COVID-19 pandemic has led to an increase in the conduction of clinical trials (CTs), there is a scarcity of data on CT participation among cancer patients. We aimed to describe the level of participation in a COVID-19 CT, willingness to participate, as well as trust in sources of information for CTs among persons with and without a previous cancer diagnosis in Puerto Rico. Method(s): Data collected from November 2021 to March 2022 from two cross-sectional studies were merged and used for analysis. Informed consent, telephone, face-to-face, and online interviews were conducted among participants >=18 years old living in Puerto Rico (n=987). Descriptive statistics and bivariate analysis (Fisher's exact text and chi-squared test) was done to describe the outcomes of interest, overall and by cancer status. Result(s): Mean age of participants was 41+/-15.5 years. Most participants were women (71.3%), with an educational level greater than high school (89.5%) and with an annual family income below $20,000 (75.1%). Overall, 4.4% of participants (n=43) reported history of cancer diagnosis. Only 1.8% of the population reported to have participated in a COVID-19 CT to receive either a treatment or vaccine;stratifying by cancer, none of the cancer patients had participated in a COVID-19 CT, and only 1.9% of non-cancer patients participated. While 37.0% of the participants indicated being very willing to sign up for a CT assessing COVID-19 treatment, willingness was higher in cancer patients (55.8%) than among participants without cancer (36.1%). Regarding trust in sources of information for CTs, the level of trust ("a great deal/a fair amount") was higher for their physicians (87.6%), researchers (87.0%), the National Institute of Health (86.7%), their local clinics (82.9%), and a university hospital (82.7%), while it was lower for a pharmaceutical company (64.0%), and for friend, relative, or community leader (37.6%);no differences were observed by cancer status. Conclusion(s): While participation in COVID-19 CTs was extremely low in the study population, the willingness to participate was higher among cancer patients. Education on CTs and their availability are necessary to increase participation in this understudied group. Such efforts will enhance the representation of Hispanic and vulnerable populations, such as cancer patients, on COVID-19 CTs, and thus proper generalizability of study findings in the future.

Multivariate Conway-Maxwell-Poisson Distribution: Sarmanov Method and Doubly Intractable Bayesian Inference

In this article, a multivariate count distribution with Conway-Maxwell (COM)-Poisson marginals is proposed. To do this, we develop a modification of the Sarmanov method for constructing multivariate distributions. Our multivariate COM-Poisson (MultCOMP) model has desirable features such as (i) it admits a flexible covariance matrix allowing for both negative and positive nondiagonal entries;(ii) it overcomes the limitation of the existing bivariate COM-Poisson distributions in the literature that do not have COM-Poisson marginals;(iii) it allows for the analysis of multivariate counts and is not just limited to bivariate counts. Inferential challenges are presented by the likelihood specification as it depends on a number of intractable normalizing constants involving the model parameters. These obstacles motivate us to propose Bayesian inferential approaches where the resulting doubly intractable posterior is handled with via the noisy exchange algorithm or the Grouped Independence Metropolis–Hastings algorithm. Numerical experiments based on simulations are presented to illustrate the proposed Bayesian approach. We demonstrate the potential of the MultCOMP model through a real data application on the numbers of goals scored by the home and away teams in the English Premier League from 2018 to 2021. Here, our interest is to assess the effect of a lack of crowds during the COVID-19 pandemic on the well-known home team advantage. A MultCOMP model fit shows that there is evidence of a decreased number of goals scored by the home team, not accompanied by a reduced score from the opponent. Hence, our analysis suggests a smaller home team advantage in the absence of crowds, which agrees with the opinion of several football experts. Supplementary materials for this article are available online.

Frequency of antibiotic prescribing in adults hospitalized for SARS-CoV-2 in a high complexity institution in Santiago de Cali, Colombia.

Objective: To determine the frequency of antibiotic use and to know which clinical and socio-demographic variables were related to the probability of suffering infections associated with COVID-19. Method(s): Adults hospitalized for COVID-19 who received one or more antibiotics during hospitalization were evaluated. We performed a descriptive analysis of variables in the general population' bivariate analysis in two groups (documented vs. suspected infection) and multivariate logistic regression of factors associated with mortality. Result(s): It was determined that 60.4% of adults hospitalized for COVID-19 received antibiotics. Coinfection was documented in 6.2% and superinfection in 23.3%. Gram-negative germs were reported in 75.8% of cultures, fungi in 17.8% and gram-positive in 14.2%. Variables such as age, comorbidities, ICU, anemia, steroids, mechanical ventilation, hemofiltration were statistically significantly related to documented infection. High-flow cannula was associated as a protective factor. Overall mortality was 43.9%, 57.8% in the first group and 38.1% in the second (p=0.002). Conclusion(s): There is a considerable frequency of antibiotic use in subjects hospitalized for COVID-19, particularly related to relevant findings of bacterial superinfection, in those with comorbidities, such as diabetes mellitus, immunosuppression, anemia and fragility, in whom the behavior of the disease is more severe and lethal.Copyright © 2023 Asociacion Colombiana de Infectologia. All rights reserved.

The incidence of deep vein thrombosis following COVID-19 vaccination in an Australian population

Introduction: After the COVID-19 vaccination roll out in March 2021 patients began presenting to a Victorian Emergency Department with lower limb pain following their vaccination. As a result, requests for ultrasound examinations, to exclude post vaccination deep vein thrombosis (DVT) began appearing. Method(s): A retrospective study of ultrasound examinations and their result over a 1-year period was undertaken. Patients were identified who had a clinical indication of having been referred following COVID-19 vaccination. Bivariate analysis was conducted, using logistic regression, to determine the strength of association between independent variables. Result(s): The study found 1689 patients had a lower limb DVT ultrasound examination. Ultrasound was positive for DVT in 244/1689 patients (14.4%). 104/1689 (6.1%) patients presented for ultrasound following COVID-19 vaccination. Six of these were found to have DVT detected. The association between post vaccination and DVT was an odds ratio (OR) of 0.347 (95% CI 0.150 to 0.799, p = 0.013). All patients had recently received AstraZeneca (AZ) vaccine. Four patients were diagnosed with superficial vein thrombosis (SVT) post vaccination. Nineteen patients were identified as COVID-19 positive. Three of these had DVT detected. Conclusion(s): This study found 6 patients out of 1689 (0.35%) of lower limb ultrasound examinations over a one-year period, were positive for DVT after COVID-19 vaccination. Take home message: The results showed post vaccination patients were less likely to be diagnosed with a DVT than the population referred who had not had recent vaccination.

Lymphocyte Populations and Autoantibodies, in a Cohort of Patients with Rheumatoid Arthritis: A Long-Term Study of Covid-19 Cases and Non-Covid-19 Controls

Objectives: To assess the immunological [Lymphocyte populations (LP) and Autoantibodies (Ab)] and clinical profile of rheumatoid arthritis (RA) patients who suffered from COVID-19 compared with non-COVID-19 RA patients. Method(s): A nested case-control study of RA patients treated under a strict follow-up model. RA patients and confirmed COVID-19 infection (last 24 months) and RA patients without the infection were included. Subgroups of cases: Long COVID (LC): symptoms after infection for >=4 weeks;Post COVID syndrome (PCS): symptoms for >=12 weeks;and patients with symptoms alpha4 weeks. Sociodemographic, clinical, and paraclinical variables of RA and COVID-19 infection (in cases) were captured. Antinuclear antibodies (ANA), anticardiolipin antibodies, lymphocyte populations (BD FACSDuetTM-BDFACSLyricTMmultiparameter flow cytometry) T cells, B cells, and NK were evaluated. Univariate and bivariate analyzes (STATA 17) were done. Result(s): 300 patients were included (148 cases/152 controls;87.3% women). Median age 59 years (IQR 11). 71.86% were in low disease activity. There were no significant differences in sociodemographic and clinical characteristics between cases and controls. Cases had a time since infection of 18.5 months (IQR 7). Of the total cases, 69%presented LC and 63%PCS.No significant differences were found between cases and controls in the lymphocyte population nor in the antibodies evaluated. There were no differences in the immune profile when comparing patients with LC and PCS with those with symptoms alpha4 weeks after COVID-19 infection. Conclusion(s): No differences were found in the behavior of the immunological profile (independent of symptoms of LC and PCS) in RA patients under strict follow up, evaluated long-term after infection with those who did not have COVID-19. This suggest that patients returned to their baseline homeostatic state, something that has not yet been reported up to now. These results should be replicated in populations with different RA characteristics.

Functional outcome in patients with ischemic stroke and COVID-19 in Lima, Peru

Introduction: COVID-19 seems to induce ischemic stroke by several potential mechanisms including promoting hypercoagulability, and worse functional outcomes have been reported in patients with stroke and the infection with SARS-CoV-2. Objective(s): Determine the association between functional outcome and COVID-19 in patients with stroke. Patients and Methods: We performed a case control study comparing patients admitted to a neurological reference center in Peru with a diagnosis of stroke before (controls) and after (cases) the onset of the COVID-19 pandemic. There were 31 cases diagnosed with COVID-19 and 62 controls without COVID-19. Bivariate analysis and conditional fixed-effects Poisson regression analysis were used to evaluate the association between the functional outcome of the stroke and COVID-19. Result(s): Cases had higher baseline serum glucose (133.5, IQR: 117.5-174 versus 117, IQR: 101-130, p = 0.033) than controls, higher neutrophil counts (7.91, IQR: 5.93-9.57 versus 5.96, IQR: 4.41-7.79, p = 0.008), lower lymphocyte counts (1.48, IQR: 1.04-1.8 versus 1.83, IQR: 1.26-2.32, p = 0.025), higher neutrophil/lymphocyte ratios (5.44, IQR: 4.0-8.1 versus 3.29, IQR: 2.25-6.02, p = 0.011), higher NIH stroke scale/score (NIHSS) (14, IQR: 9-18 versus 7 IQR: 5-11, p = 0.000), and higher modified Rankin scores at discharge (4, IQR: 4-5 versus 2, IQR: 1-4), p = 0.001). Seven (21.88%) participants died in the group of cases versus 1 (1.56%) in the controls (p = 0.014). The odds ratio of having a bad functional outcome at discharge was 1.344 (CI: 1.079-4.039;p = 0.029), adjusted by NIHSS at admission. Conclusion(s): Our findings suggest that ischemic strokes associated with COVID-19 are more severe, have worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.Copyright © 2023 Sociedad Neurologica Argentina

RETENTION IN CARE AMONG PERUVIAN MSM AND TGW IN A REAL-WORLD HIV PrEP PROGRAM

Background: Tenofovir-based daily oral HIV pre-exposure prophylaxis (HIV PrEP) is a highly efficacious HIV prevention modality, but sustained use over time is needed for continued protection among individuals at high risk for HIV exposure. Suboptimal adherence and retention in care threaten to diminish the impact of HIV PrEP on reducing HIV burden. PrEP PERU is an ongoing, multi-site, prospective cohort study evaluating HIV PrEP implementation among adult men who have sex with men (MSM) and transgender women (TGW) accessing care at non-government health centers in Peru. We sought to evaluate HIV PrEP adherence and retention in care among PrEP PERU participants prior to the onset of COVID-19 service disruptions. Method(s): We analyzed baseline and follow-up data from the PrEP PERU study through 3/15/2020, the first day of Peru's COVID-19 lockdown. MSM and TGW >=18 years of age with at least one HIV risk factor were eligible for enrollment. After the first follow-up visit at 4 weeks, TDF/FTC refills and clinic visits occur quarterly, at the discretion of the prescribing clinician. The medication is provided free of charge, but participants pay for laboratory testing plus a small service fee for clinic visits. Data is collected at baseline and quarterly follow-up visits on sexual risk behaviors and HIV PrEP use. We used bivariate analysis to evaluate the association between baseline factors and 6-month HIV PrEP retention in care. As a proxy for adherence, pharmacy dispensation records were used to calculate the proportion of days covered (PDC) by TDF/FTC. Result(s): Overall, 351 participants started TDF/FTC at four study sites in Lima from 1/23/2017 to 3/15/2020. Of this analysis population, 94% were cisgender men, 10% identified as bisexual, and median age was 31 (interquartile range [IQR], 27 - 38). Among those with at least 6 months of observation time (n=302), 91% attended >=1 follow-up visit and 77% attended >=2 follow-up visits during the 6 months after enrollment. The proportion with favorable adherence (PDC >=0.8) was 85%. There were 6 confirmed HIV seroconversions in the analysis period (1.2 per 100 person-years). Conclusion(s): In this analysis of HIV PrEP outcomes among MSM and TGW prior to COVID-19 pandemic disruptions in Peru, over 3/4 of the population remained in care and had favorable measures of adherence during the first 6 months after.

Rise in Out-of-Hospital Cardiac Arrest Cases in Chicago in 2020

Background: Italy, France and New York City have reported an increase in out-of-hospital cardiac arrest (OHCA) incidence during the COVID-19 pandemic. The purpose of our study was to assess the effect of COVID-19 on OHCA cases in Chicago. Method(s): Cardiac Arrest Registry to Enhance Survival (CARES) database was used. Bivariate analysis was conducted to assess changes in demographic and other characteristics. We excluded the cases that occurred in a healthcare facility or a nursing home. We compared the cases reported in 2020 to 2019 (and prior years). ArcGIS was used to geocode incident addresses and to show the temporal distribution by community areas. Bivariate analysis was done using chi-square tests. Result(s): A total of 3221 OHCA cases were reported in Chicago in 2020, which is 31.5% higher than those reported in 2019 (n=2450 cases). This increase was higher than what has been noticed historically (for instance, the increase from 2018 to 2019 was only 17%). There was an increase in Hispanic OHCA cases (17.3% in 2020 vs. 13.5% in 2019, p<0.01) but a decrease in White cases (20.5% vs. 23.1%). The cases in 2020 were less likely to be reported at public location (22% vs. 26%, p<0.001) or have shockable rhythm (10% vs. 13%, p=0.0002). There was a marked increase in those that were declared dead in the field in 2020 (37% vs. 27%, p<0.001). However, there were no statistically significant differences in age distribution, gender, witnessed arrest (49% vs. 51%, p=0.07) or bystander cardiopulmonary resuscitation (BCPR) (23% vs. 22%, p=0.3). Conclusion(s): A better understanding of the causes of the excess cardiac arrest numbers will be important to help plan and better prepare for future public health interventions. The effect of COVID19 on OHCA survival needs to be examined further in future studies.

Transgender Women Baseline Profile in Transcitar: Transspecific Cohort in Argentina

Background: Transgender women (TGW) are among the population most affected by the HIV epidemic in Argentina, despite a progressive legal framework. TransCITAR is a trans-specific cohort in Argentina that aims to assess physical and mental health among transgender and non-binary people (TGNBP). We present baseline characteristics of TGW. Method(s): TGW attending a trans-friendly clinic to receive HIV/STIs prevention/ treatment, mental health care and/or gender-affirming hormone therapy (GHT) were invited to participate. Semiannual visits including clinical assessments, laboratory tests, and psychosocial interviews were performed. Oral PrEP was offered as part of a combined prevention strategy since September 2021. Result(s): Between September/2019 and August/2022, 500 TGNBP were enrolled, 416 were TGW (median age: 30 years, IQR 25-37). High social vulnerability was observed (Table 1). Regarding trans-specific characteristics, 49.8% reported industrial silicone injections and 36.8% were receiving GHT. 76.9% were sex workers. Baseline STIs prevalence were: HIV 42.3% (10.2% diagnosed at enrolment), syphilis 40% (defined as positive nontreponemal test VDRL with titers of at least 1/8), past HBV 18.5%, chronic HBV 3.8%, HCV antibody positive 2.6%. Only 57% presented HBV protective antibodies titers (HBVsAb>=10UI/ml), 8 TGW were on PreP. For those with HIV, median CD4+ cell count was 602 cells/mm3 (IQR 378-933), 66.5% were on ART at enrolment (53.6% were virally suppressed) and 14.8% initiated at baseline. During 36 months of follow up, 4 TGW died (one AIDS-related and one COVID-19-related). Bivariate analyses showed that a positive HIV diagnosis was independently associated with migration, low level of education, unstable housing, silicone injecion and sex work, while was negatively associated with being on GHT. In multivariable logistic regression, only sociodemographic variables remain associated: migrant (aOR=.487, 95% CI=.304-.768);incomplete high school (aOR=.463, 95% CI=.300=.714);unstable housing (aOR=.614, 95% CI=.401- .940);and sex work (aOR=.324, 95% CI=.177-.593). Conclusion(s): TGW from TransCITAR presented poor health outcomes: high prevalence of HIV/syphilis, high proportion with incomplete/no HBV vaccine and high levels of depression and violence. A comprehensive approach to care and addressing social determinants of health is pivotal to reduce HIV burden in this population.

Playing and Affective and Behavioral Symptoms in Children and Adolescents [Playing and Mental Health]

Introduction: Pediatric mental problems have been increasing, especially after COVID-19, which led to reduced active play. In childhood and adolescence, active play has been recognized as a protective factor against psychopathology. Objective(s): To determine the association between gambling and internalizing or externalizing symptoms in children and adolescents. Material(s) and Method(s): Cross-sectional analytical observational study, with a sample of 1533 children and adolescents, between six and 18 years of age in the city of Manizales, during the second semester of 2021. The Child Behavior Checklist 6-18 (CBCL/6-18) and inquired about hobbies and active play, where bivariate analyzes were performed. Result(s): 69.4% of those surveyed are fond of art and 12.0% of sports. 46.37% presented significant symptoms in the CBCL. Statistically significant negative correlations were found between active gaming and the presence of symptoms in all CBCL domains, as well as a positive correlation between alterations in mental health and the use of video games. Conclusion(s): Active play is a behavior related to child and adolescent mental health, which is why it should be investigated and promoted from the first levels of health care.Copyright © 2023 Asociacion Colombiana de Psiquiatria

Groundwater Contamination Monitoring for Pollution Measurement and Transmission Applying WQI Approaches from a Region of the Erode District, Tamilnadu, India

The present research deals with the Risk assessment of groundwater quality. 79 groundwater samples were collected from domestic and agricultural usage open and bore wells during January 2021(COVID-19 Pandemic Period). Groundwater samples were tested to determine the physicochemical parameters using standard testing procedure for the preparation of spatial distribution maps of each parameter based on the World Health Organization (WHO) standard. Multivariate statistical analysis has shown the source of groundwater pollution from secondary leaching of chemical weathering of rocks. From the Water Quality Index and bivariate plot reveals that less than 20% of the area comes under high and very high-risk zone. The types of hardness diagram showed 32.91% of the samples fall in hard brackish water as illustrated by the Piper trilinear diagram. The research outcome result shows that the least percentage of industrials effluents due to the COVID-19 pandemic, not working for all industries during lock down period.

Analysis Factors that Affect Low Back Pain in Medical Students during the Study from Home

Low Back Pain (LBP) is a health problem that affects performance in working. Indonesia is a country affected by the COVID-19 pandemic, so a study from the home policy has been issued. This study aimed to determine the association between the factors that affect LBP in Medical Students at the Faculty of Medicine, University of Mataram during the study from home. This study is an observational analytic study design with the cross-sectional approach. The population of this study is Medical Students, Faculty of Medicine, University of Mataram with total sample of 185 people. Collecting data using questionnaires and analyzed using univariate, bivariate, and multivariate analysis. According to univariate analysis, amount of LBP complaints (53 people). Based on bivariate analysis, the p-value of gender factor (0.000);body mass index factor (0.840);social-economy status factor (0.499);sitting position factors (sitting position while studying factor (0.008), sitting location while studying factor (0.046), chair shape while studying factor (0.286), body position while studying factor (0.037), legs position while studying factor (0.339), back support use while studying factor (0.455), table use while studying factor (0.010), elbows position while studying factor (0.627), stretching between study time factor (0.372), duration in each stretch factor (0.389), time range between stretch factor (0.311)), and sitting duration factor (0.011). Based on multivariate analysis, the strength of the association (OR) to LBP are sitting position factor (sitting position while studying factor) (8.232), sitting duration factor (1.956), and gender factor (0.187). The dominant factors to LBP are gender factor, sitting position factor (sitting position while studying factor), and sitting duration factor. The factor that has the strongest association with LBP is sitting position factor (sitting position while studying factor).Copyright Published by Oriental Scientific Publishing Company © 2023.

Determinants of Stunting Children Under Five of Age During the COVID-19 in the Working Area of the Liwuto-Primary Public Health Center, Baubau City-Indonesia: A Community-Based Unmatched Case-Control Study

BACKGROUND: In Indonesia, the stunting prevalence has reached 24.4% in 2021. AIM: The study aims to examine the determinants of stunting among children under five of age during the COVID-19 pandemic in the working area of the Liwuto-Primary Public Health Center, Baubau city. METHOD(S): A community-based unmatched case-control study was conducted from January 10, to March 10, 2022, on a sample of 94, cases (n = 21), and controls (n = 73) of children aged 0-59 months with their respective mothers. Data were collected using a face-to-face interviewer-administered questionnaire and physical measurements standard. The data were analyzed using SPSS version 17. The variables were entered into the multivariable model using the backward stepwise regression approach. Multivariable logistic regression analysis was used to identify factors associated with stunting. Adjusted odds ratio (AOR) with a 95% confidence interval (95% CI) and p < 0.05 was used to declare the significance. RESULT(S): There are 22% of the stunting become in children under 5 years. Stunting children under 5 years was associated with maternal age (AOR = 5.71, 95%, CI: 1.91-17.03). While family income (AOR = 1.78, 95%, CI: 0.17-18.86), exclusive breastfeeding (AOR = 3.95, 95%, CI: 0.14-112.72), complementary feeding (AOR = 1.24, 95%, CI: 0.18-8.55), formal education (AOR = 0.74, 95%, CI: 0.36-1.53), and occupation (AOR = 2.98, 95%, CI: 0.24-36.55) were not associated with the stunting. CONCLUSION(S): Young mother under 30 years old was an important risk factor on the incidence of stunting in children under 5 years during the COVID-19 pandemic.Copyright © 2023 Jumadi Muhammadong, Ridwan Malimpo, Dahmar Karim, Yusman Muriman, Andi Tenri Mahmud.

A Dynamic Interaction Semiparametric Function-on-Scalar Model

Motivated by recent work studying massive functional data, such as the COVID-19 data, we propose a new dynamic interaction semiparametric function-on-scalar (DISeF) model. The proposed model is useful to explore the dynamic interaction among a set of covariates and their effects on the functional response. The proposed model includes many important models investigated recently as special cases. By tensor product B-spline approximating the unknown bivariate coefficient functions, a three-step efficient estimation procedure is developed to iteratively estimate bivariate varying-coefficient functions, the vector of index parameters, and the covariance functions of random effects. We also establish the asymptotic properties of the estimators including the convergence rate and their asymptotic distributions. In addition, we develop a test statistic to check whether the dynamic interaction varies with time/spatial locations, and we prove the asymptotic normality of the test statistic. The finite sample performance of our proposed method and of the test statistic are investigated with several simulation studies. Our proposed DISeF model is also used to analyze the COVID-19 data and the ADNI data. In both applications, hypothesis testing shows that the bivariate varying-coefficient functions significantly vary with the index and the time/spatial locations. For instance, we find that the interaction effect of the population aging and the socio-economic covariates, such as the number of hospital beds, physicians, nurses per 1000 people and GDP per capita, on the COVID-19 mortality rate varies in different periods of the COVID-19 pandemic. The healthcare infrastructure index related to the COVID-19 mortality rate is also obtained for 141 countries estimated based on the proposed DISeF model.

MORTALITY OF PATIENTS WITH CKD AND ITs RISK FACTORS ADMITTED TO HOSPITAL WITH COVID-19 IN ALMATY CITY KAZAKHSTAN BETWEEN 2020-2022

Introduction: The global prevalence of chronic kidney disease (CKD) is approximately between 9 and 12%. One of the main predictors of CKD is elderly age, and about 38% of patients are older than 65 years of age. People with CKD have impairment of the normal reaction of the innate and adaptive immune systems. Therefore, this cohort of patients is more predisposed to chronic comorbid conditions and viral infections. The COVID-19 pandemic shifted the morbidity and mortality of people with CKD. The research shows that patients with kidney disease were more likely to have worse outcomes from coronavirus infection compared to patients without CKD. The aim of this study is to investigate in-hospital mortality of CKD patients and its risk factors with coronavirus in Almaty, Kazakhstan. Method(s): The retrospective analysis includes patients, who had been admitted to a hospital with coronavirus infection, in the Almaty region of Kazakhstan, between June 2020 and June 2022. The database was extracted from the Unified National Electronic Healthcare System (UNEHS). Patients were included if they had been hospitalized with the main diagnosis of U07.1 (COVID-19, virus identified) and U07.2. (COVID-19, virus not identified). Patients' unique IDs were used to merge the database of CKD patients to define whether they had the disease or not. The statistical analysis was performed with STATA 16.0. Person's chi-square test was used for bivariate analysis, and Logistic regression was used for estimation of the relationship between in-hospital mortality and predictors. Result(s): The final cohort consisted of 58,970 patients, and 929 (2%) of them had CKD. The age of patients with kidney disease was statistically significantly higher than that of the comparison group (Table 1). As for the comorbid conditions, CKD patients had a higher ratio of acute myocardial infarction (AMI), diabetes, hypertension, congestive heart failure (CHF), and cerebrovascular disease (CVD) compared to the reference group. The mortality ratio was statistically significantly different in two groups. Table 1. Demographic characteristics and comorbidities of patients with and without CKD. [Formula presented] People of elderly age, male gender, having CKD, AMI, diabetes, hypertension, CHF, and CVD had higher odds of death according to unadjusted logistic regression (Table 2). After adjustment for the abovementioned predictors, age, male gender, CKD, diabetes, and CVD showed higher risks of mortality and remained statistically significant. Table 2. Association between socio-demographic and medical characteristics and in-hospital mortality of patients. [Formula presented] Conclusion(s): This research evaluated hospitalization outcomes of coronavirus patients with and without CKD in Almaty, Kazakhstan. The effect of socio-demographic factors and comorbidities on mortality was analyzed. Although CKD can be prevented and treated to a large extent, multimorbid conditions, especially viruses causing a pandemic, can alter the situation. Therefore, it is necessary to establish a comprehensive disease management strategy for unexpected infectious disease outbreaks. No conflict of interestCopyright © 2023

The Influence of Self Efficacy on Cognitive Load In Online Learning In The Pandemic Covid-19 On Nursing Students

online Learning is enacted as an effort to prevent the spread of covid-19. Various limitations and obstacles encountered during the process of online learning in the pandemic demanded adaptation better than educators and learners. Students need to do self-adjustment in learning and are expected to have the self efficacy to master and complete a task in online learning. Educators need to do the management of cognitive load in learning. The purpose of the study to determine the effect of self efficacy against the cognitive load in online learning in the pandemic covid-19. Quantitative research methods are correlational, involving 316 respondents. The process of data collection is done online. The results of the univariate analysis showed the majority of respondents have the level of self efficacy is high enough (27,2%), cognitive load category (73,1%). Most of the respondents have ICL the moderate category (66,8%), the ECL moderate category (71,8%) and all respondents have a GCL category (100%). Bivariate analysis using the correlation provided by kendall's tau-b shows there is significant influence the level of self efficacy of respondents to rate the cognitive load of the respondents where the value of Sig. (2-tailed) is 0.048% ownership of < 0.05, with the degree of influence of level of self efficacy of the respondents on the level of cognitive load that is very strong (of 0.96). Based on the results of the study, it is expected that lecturers can optimize the ability of students and develop values/character that support to increase self efficacy of students and make improvements learning strategies to reduce cognitive load of students.Copyright © 2020 Ubiquity Press. All rights reserved.

Contribution to the Study of Adverse Events Following Vaccination against Covid-19 in Chronic Hemodialysis Patients in Senegal: A Review of 367 Cases

Introduction: The aims of this study were to determine the prevalence and post-immunisation adverse events of COVID-19 vaccination in chronic hemodialysis patients in Senegal and to assess the factors associated with their occurrence. Method(s): This was a cross-sectional, multicenter, descriptive and analytical study from 1 April to 1 July 2021 including all chronic hemodialysis patients in the targeted centers who received at least one dose of COVID-19 vaccine and consented to participate in the study. Chronic hemodialysis patients unable to complete the questionnaire are not included. For each patient included, the following parameters were studied: socio-demographic data, history and comorbidities and COVID-19 vaccination (type of vaccine, existence of side effects and their type, and time of occurrence). Result(s): Of 535 chronic hemodialysis patients surveyed, 367 were included, representing a prevalence of 68.6% of COVID-19 vaccination. The median age was 51 years with extremes of 20 and 100 years and a sex ratio of 1.08. The most representative age group was over 60 years with 30.3%. The median duration of dialysis was 44.5 months with an interquartile range of [25;73] and extremes of 3 and 183 months. Patients with less than 30 months on dialysis (31.9%) were more represented. Hypertensive nephropathy was the most frequent cause of chronic kidney disease. It was observed in 128 patients (34.9%). The AstraZeneca vaccine was the most widely administered vaccine (98.4%). Post-immunisation adverse events were noted in 52.6% of patients. They were dominated by local side effects (65.6%) followed by influenza-like illness (60.8%). Other side effects were digestive (11,1%), neurological (9%), otorhinolaryngological (5,3%) and cardiovascular (4,8%). No deaths were recorded. One case of post-vaccination cellulitis was noted. Coagulation of the extracorporeal circuit during the 4 sessions of hemodialysis following the vaccination, despite the anticoagulation of the latter, was observed in one patient. Side effects occurred mainly on the day after vaccination in 56% of patients. Age < 50 years, diabetes and anticoagulation were associated with post-immunisation adverse events in the bivariate analysis. In the multivariate analysis, age < 50 years was a risk factor and anticoagulation had a protective effect. Conclusion(s): Vaccination against COVID-19 is well tolerated in chronic hemodialysis patients. No conflict of interestCopyright © 2023

Assessing Mental Health Status among COVID-19 Recovery Patients in Bangladesh- A Pilot Study

The impact of the COVID-19 pandemic has the potential to have long-lasting profound repercussions on the mental health of surviving patients from COVID-19. The main goal of this study is to assess the mental strength among post-COVID-19 recovery patients. A pilot survey study was conducted with 60 participants who willingly completed the questionnaire consisting of PCL-5, GAD-7, PHQ-9, and relevant questions. Univariate, bivariate analysis, and multivariate logistic regression were conducted to find the significant risk and protective factors associated with the mental health of recovery patients. The result found that 48.33% of the patients had PTSD symptoms, 30% identified to have severe anxiety, and 53.33% of them had gone through severe depression. The severity of illness, hospitalization, ignorance by family members, people staying away from them even after recovery were significant risk factors, and eating nutritious food, wearing masks were significant protective factors for PTSD, anxiety, and depression. This study's findings can guide policymakers as well as family members to take proper initiatives towards COVID-19 recovery patients, such as providing counseling, ensuring rehabilitation, reducing social stigma, which may bring consequential relief from psychological illness.