A new contextual and comprehensive application of the UTAUT2 model post‐COVID‐19 pandemic in higher education

This study examines tertiary students' behavioural intention to resume face‐to‐face mode of study, post‐COVID‐19. A modified UTAUT2 model of nine factors and a moderator is used to investigate the impact of these factors on developing country's tertiary students' behavioural intention. The influence of these students' behavioural intention on se behaviour is also examined. Using a quantitative research approach, data were gathered from 419 students at a regional university using convenience sampling technique. Data were analysed to test and validate the proposed model using covariance‐based structural equation modelling. The study's findings reveal significant positive relationships between social influence, hedonic motivation, facilitating conditions, commitment, behavioural intention and use behaviour. However, it did not find performance expectancy, effort expectancy, price value, trust and comfortability, reporting any significant positive influence on behavioural intentions. Additionally, the moderating analysis shows that COVID‐19 fear did not moderate or strengthen the association between behavioural intentions and use behaviour, given the insignificant interaction effect of COVID‐19 fear. This study provides novelty in the contextual application of the modified UTAUT2 model, post‐COVID‐19. The addition of three additional constructs (trust, commitment and comfortability) has further improved the predictive power of the model. Lastly, the new construct that emerged in recent literature, COVID‐19 fear, has been tested for the first time within the UTAUT2 model as a moderator between behavioural intentions and use behaviour. In terms of practical implications, this study first adds to the current literature on higher education, after the COVID‐19 situation, being useful to education scholars. Second, it also offers specific suggestions to educational institutions and policymakers who fund universities. Such suggestions include: involving students' families in orientation and open day events, featuring family and friend support in promotional activities, upgrading facilities, including more teaching and learning sessions with team‐based assessments, encouraging comfortable interactions and continuously practising COVID‐19 safety protocols. [ FROM AUTHOR] Copyright of Higher Education Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Arbovirus and its potential to lead the next global pandemic from sub-Saharan Africa: What lessons have we learned from COVID-19?

Risk and predisposing factors for viral zoonoses abound in the sub-Saharan Africa (SSA) region with significant public health implications. For several decades, there have been several reports on the emergence and re-emergence of arbovirus infections. The lifetime burden of arboviral diseases in developing countries is still poorly understood. Studies indicate significant healthcare disruptions and economic losses attributed to the viruses in resource-poor communities marked by impairment in the performance of daily activities. Arboviruses have reportedly evolved survival strategies to aid their proliferation in favorable niches, further magnifying their public health relevance. However, there is poor knowledge about the viruses in the region. Thus, this review presents a survey of zoonotic arboviruses in SSA, the burden associated with their diseases, management of diseases as well as their prevention and control, mobility and determinants of infections, their vectors, and co-infection with various microorganisms. Lessons learned from the ongoing coronavirus disease 2019 (COVID-19) pandemic coupled with routine surveillance of zoonotic hosts for these viruses will improve our understanding of their evolution, their potential to cause a pandemic, control and prevention measures, and vaccine development.Copyright © GERMS 2022.

Minimally Invasive Coronary Artery Revascularization During Current Pandemics, New Hope! - Our Experience in a Third World Country

Objective: Since the last decade, the notion of minimally invasive cardiac surgery (MICS) has gained worldwide rapid popularity. Bangladesh is not far from mastering this technique due to the increasing interest of both patients and surgeons. Meanwhile, during this COVID-19 era could it help patients, remains the main question. In this context, we have operated on a total of 523 patients from October 2020 to November 2021 including, 89 patients who were MICS and among them, 17 were coronary artery bypass grafting. Method(s): We have included all patients who underwent minimally invasive coronary artery surgery in our hospital from October 2020 to November 2021 irrespective of single (MIDCAB) / multi-vessel disease (MICAS) or combined valve replacement with coronary revascularization. Data were collected from the hospital database, telephone conversations, and direct clinic visits. All data were analyzed statistically and expressed in the form of tables. Result(s): In the last 14 months of pandemics we have operated on a total of 89 MICS patients, among them 10 were Minimally Invasive Direct Coronary Artery Bypass (MIDCAB), 6 were double or triple vessels coronary artery surgery (MICAS), 1 patient underwent upper-mini aortic valve replacement along with coronary revascularization. One of our patients needed re-exploration for chest wall bleeding on the same day. Mean ICU and hospital stay in our series were less than conventional revascularization. There was no in-hospital or 30 days' mortality in our series. Conclusion(s): Cardiac surgery these days is headed toward less invasive approaches with the aid of technology, advanced instruments, and pioneer's lead. But from our in-hospital results we conclude that by avoiding median sternotomy, these minimal invasive revascularization techniques can provide hope to the patients by alleviating symptoms with restored vascularity, reduced morbidity, preventing sudden cardiac death. Health costs reduction with shorter hospital and ICU stay are the added benefits.

Reactivation of Surgical Campaigns after the Covid Pandemic: Surgeons in Action with Hernia International Foundations in 2022

Aim: The Cirujanos en Accion and Hernia International foundations carried out their own and collaborative surgical campaigns in developing countries. In 2020 and 2021 the programme had to be suspended due to Covid. In 2022 we restarted our actions, analysed the difficulties of reactivation and described the campaigns that had been carried out and those that had to be delayed. Material/ Methods: We describe the 9 campaigns of Surgeons in Action, our own and in collaboration with Hernia International and our own campaign to the region of Naborno Karabakh, planned for September and cancelled 24 hours before departure due to the resurgence of armed conflict. An analysis is made of volunteers, places, type (adults or children or mixed), collaborations with other foundations, patients operated and procedures done according to pathologies, integration with local staff with exchange of knowledge. Result(s): Made in 8 countries (Benin, Camerun, Gambia (2), Kenya, Liberia, Mozambique, Tanzania, Sierra Leone) and postponed in one country, the Naborno Karabakh region of Armenia. 85 volunteers (25 general and 10 paediatric surgeons, 19 anaesthetists, 3 intensivists, 23 nurses, 5 audiovisuals);local staff;1144 patients (473 children, 671 adults), 1325 procedures for various pathologies (hernias, goitres, hydroceles, undescendend testis, soft tissue tumours, etc.) Conclusion(s): 9 campaigns have been carried out successfully and new locations have been opened with a good projection for the coming years, and we have experienced difficulties with the cancellation of a mega-campaign in an area with geopolitical conflicts - to be taken into account in the future.

Covid 19 corruption in the public health sector - Emerging evidence from Bangladesh.

This paper explores the Covid-19-related corruption in Bangladesh. Specifically, we analyse the issue of Covid-19-related corruption in the health sector of Bangladesh. We also explore how denial strategies adapted by government officials have worsened the problem. Using Cohen's (2001) notion of denial strategies, we analyse media reports during the pandemic that highlighted Covid-19-related corruption occurring in the Bangladeshi health sector. Our analyses reveal that the Covid-19 pandemic has given rise to a new wave of corruption, particularly in the procurement of testing kits and personal protective equipment (PPE), as well as the issuance of false COVID-19 certificates. We call for an in-depth investigation of Covid-19-related corruption in Bangladesh and other developing countries that follows similar social, contextual and cultural values via interviews with policymakers and health professionals. Our paper extends the ongoing debate on Covid-19-related corruption and its impacts on the public health sectors.

COVID-19 and the Motorcycle Taxi Sector in Sub-Saharan African Cities: A Key Stakeholders' Perspective

This article assesses the impact of the COVID-19 outbreak on the urban motorcycle taxi (MCT) sector in Sub-Saharan Africa (SSA). MCToperators in SSA provide essential transport services and have shown ingenuity and an ability to adapt and innovate when responding to different challenges, including health challenges. However, policymakers and regulators often remain somewhat hostile toward the sector. The article discusses the measures and restrictions put in place to reduce the spread of COVID-19 and key stakeholders' perspectives on these and on the sector's level of compliance. Primary data were collected in six SSA countries during the last quarter of 2020. Between 10 and 15 qualitative interviews with key stakeholders relevant to the urban MCT sector were conducted in each country. These interviews were conducted with stakeholders based in the capital city and a secondary city, to ensure a geographically broader understanding of the measures, restrictions, and perspectives. The impact of COVID-19 measures on the MCT and motor-tricycle taxi sector was significant and overwhelmingly negative. Lockdowns, restrictions on the maximum number of passengers allowed to be carried at once, and more generally, a COVID-19-induced reduction in demand, resulted in a drop in income for operators, according to the key stakeholders. However, some key stakeholders indicated an increase in MCT activity and income because of the motorcycles' ability to bypass police and army controls. In most study countries measures were formulated in a non-consultative manner. This, we argue, is symptomatic of governments' unwillingness to seriously engage with the sector. © National Academy of Sciences: Transportation Research Board 2021.

Developing a COVID-19 Yeast Oral Vaccine for Low Income Countries

The novel COVID-19 vaccines have been instrumental at transforming the pandemic into an endemic disease. However, many contemporary vaccines, especially the landmark mRNA vaccines, require cold storage that makes them difficult for low income and developing countries to keep and distribute, and no shelf stable, low-cost alternative currently exists. In response to this need, we are developing a novel COVID-19 vaccine delivery system using the probiotic yeast Saccharomyces boulardii. We engineered an integrating construct to express the receptor binding domain (RBD) of the SARS-CoV-2 spike protein tagged with the yeast pheromone secretion signal and with the Claudin-4 targeting sequence of the Clostridium perfringens enterotoxin. Preliminary data from two animal trials suggest that our candidate yeast oral COVID-19 vaccine can trigger a robust humoral immune response in mice. Experiments are underway to assess its effect on the murine T-cell response. Our laboratory is supported in part by a research grant from the PCHRD-DOST of the Republic of the Philippines.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Total quality management in Peruvian goods companies during the COVID-19 pandemic

PurposeThe aim of this research is to empirically assess the nine dimensions of the Total Quality Management (TQM) model, which have been categorized into four blocks: the top management block, the supplier block, the process management block and the customer block. The nine dimensions represent key strategic activities of company performance. A comparative analysis of companies with ISO 9001 certification and those without certification in a developing country during the COVID-19 pandemic is carried out.Design/methodology/approachA survey was administered to the management of 259 Peruvian goods companies (in the mining, repair and manufacturing sectors) during the COVID-19 pandemic. The survey consisted of 35 Likert-scale items, which were grouped into the following nine TQM dimensions: Top management (leadership), quality planning, quality audit and assessment, product design, suppliers' quality management, process control and improvement, education and training, quality circles and focus on customer satisfaction. Then, Cronbach's alpha, the Kolmogorov–Smirnov test, the Mann–Whitney U test and means were computed for each of the dimensions. This analysis made it possible to estimate significant differences between ISO 9001 certified and non-certified goods companies in terms of the dimensions.FindingsThe results showed that, for ISO 9001 certified companies, the averages for all of the dimensions were significantly different from those of non-certified companies, except for the education and training dimension. ISO 9001 certified companies scored higher than non-certified companies in the TQM dimensions. For both certified and non-certified companies, the leadership dimension had the highest average and the quality circles dimension had the lowest average.Originality/valueThis study addresses two main gaps highlighted in the research on quality management: the application of Quality Management Systems (QMS) in developing countries like Peru, and the impact of ISO 9001 on the performance of goods companies during the COVID-19 pandemic.

Influence of digital divide in the entrepreneurial motor of a digital economy: a system dynamics approach

The creation of digital ventures in developing countries is an alternative to the generation of jobs in the ICT sector, but the lack of qualified individuals in ICT-related skills inhibits the growth of new companies, a gap that is analyzed with the digital divide theory. This research aims to understand the dynamics using a simulation model that combines aspects of the adoption of ICTS, internet availability, skills, with the entrepreneurial motor of innovation systems. The methodology is developed with data from a national ICT survey and organizations in Colombia. Different scenarios are analyzed regarding ICT education and inclusive policies. Results show that Covid-19 pandemic consequences could have a negative effect during five years and that under a scenario of accelerated growth of ICT, the sector could demand up to 400.000 ICT- related jobs by 2035. The main contribution of this research is the understanding of the ICT systems from an inclusive perspective, identifying the key variables that determine the growth of ventures and the development of digital skills among individuals. © 2023

Negative Emotions, Triggers, and Coping Strategies Among Postpartum Indian Women During Second Wave of COVID-19 Pandemic: Lessons for the Subsequent Waves and Beyond.

Introduction: The study aimed to evaluate COVID-19 associated psychological distress among pregnant and postpartum women during the second wave of COVID-19 in India. Methods: A cross-sectional survey was done using a pre-validated tool involving 491 participants attending a tertiary-care hospital during the second wave of COVID-19 in India. Results: Three-fourths of participants experienced negative emotions such as fear and various features of depression. Participants (75%) reported COVID-related news on TV/Radio/Newspapers including social media as the major trigger for these negative emotions. Loss of social support mainly affected postpartum women (p < 0.001) and working women (p < 0.001). Inability to access healthcare services had negative associations with age (p < 0.001), education (p < 0.001), and socioeconomic class (p < 0.001). Various coping strategies being followed by participants included watching TV/Videos or reading books (93%), resorting to social media (77%), spending more time praying and meditating (86%), and engaging in hobbies (56%). Conclusion: During the second wave, the COVID-19 pandemic had a significantly high negative impact on the psychological and social well-being of pregnant and postpartum women. Hence, it is important to initiate appropriate preventive and corrective steps by the policymakers for any future waves of the pandemic.

The Promise of Teleconsultation in the Era of Pandemic: A Case from Bangladesh.

Background: In 2016, the Government of Bangladesh (GoB) established a teleconsultation service called Shastho Batayon to increase access to physicians. During COVID-19 pandemic, health care access became limited due to movement restrictions. In response, GoB made Shastho Batayon toll free, publicized the number through media, increased the number of call center doctors, introduced automated messages on COVID-19 preventive measures, and developed a scoring system to classify risk groups for COVID-19. Objectives and Methods: In this case report, we describe how an existing national teleconsultation service can be utilized in a low- and middle-income country to address primary health care needs during a public health emergency. We conducted secondary analysis of Shastho Batayon service data from January to April 2020. Results: The total calls for doctor's consultation increased during the pandemic. Prepandemic, Shastho Batayon received less than 20,000 calls per month. In March 2020, when the first cases of COVID-19 were confirmed, Shastho Batayon services received 60,811 calls for doctor's consultation, which increased to 125,660 calls in April, 2020. The doctor's consultation for primary care has increased for all conditions. Shastho Batayon services screened 28,944 patients with the influenza-like illness or COVID-19-like symptoms in March and April, 2020, provided preventive measures, advice, and referral to designated hospitals based on a national guideline. Conclusions: In public health emergencies such as COVID-19 pandemic, teleconsultation services can help provide prevention guidelines, debunk misinformation, identify risk categories, and refer people to appropriate service and facilities in a timely manner.

Changing Trends of Pregnancy Related Acute Kidney Injury - a Single Centre Prospective Observational Study from Southern India

Introduction: Pregnancy-related acute kidney injury (PR-AKI) in India is largely showing a declining trend due to improved and accessible obstetric care. Nevertheless, PR-AKI continues to cause significant maternal and fetal morbidity and mortality. This study was taken up with the intention to study the incidence and clinical spectrum of AKI in pregnancy in recent times and assess maternal and neonatal outcomes Methods: All pregnant women admitted in the Department of Obstetrics and Gynecology at St John's Medical College Hospital, Bengaluru between January 2018 to June 2020 were screened for AKI with the following criteria 1. Increase in serum creatinine to >0.8mg/dL and/or a sudden increase in serum creatinine by more than 50% when prior renal function was normal. 2. Oligo-anuria 3. Need for renal replacement therapy Women with preexisting CKD were excluded. Patient's clinical and laboratory details recorded. Dialysis support was provided if indicated. The clinical profile and renal outcome of the mother and fetal outcome was assessed at the time of discharge. Mothers' were also followed up at the end of 3 months of postpartum period. Recovery was categorized as Complete recovery- normal serum creatinine (<0.8 mg/dL) or a previously known baseline and no proteinuria /hypertension at the end of 3 months Partial recovery- renal function improved but serum creatinine did not return to normal range and patient was dialysis independent. No recovery- patient continued to require dialysis at the end of 3months. Result(s): Of the 2650 deliveries in the study period 42 women (Mean age 26.9 +/-3.6 years) were diagnosed AKI during pregnancy (1.58%). Baseline characteristics and outcomes are depicted in table 1. Majority of women (n=37) were referred from peripheral hospitals. Hypertension and decreased fetal movements were the common reasons for referral. Third trimester was the most common time of presentation (76.1%). Severe Preeclampsia and HELLP syndrome was the leading cause of AKI (59.5%).ATN secondary to obstetric complications, sepsis and hemolytic uremic syndrome were the other causes. One case each of cortical necrosis, acute fatty liver of pregnancy and COVID 19 associated AKI was seen. Mean duration of hospital stay was 12.1+/-6.9 days. More than one third patients' required ICU stay (35.7%).12 patients (28.5%) required renal replacement therapy. Of them, 3 were dialysis dependent at the end of 3 months and 4 had partial renal recovery. 3 patients expired during hospital stay. Fetal survival was 69.04%.13 babies' required NICU care (44.8%). Neonatal outcomes are summarized in table 2. Close to one third of the pregnancies with AKI were associated with intrauterine fetal demise (28.5%). Low birth weight and prematurity were the common reasons for NICU admission with mean NICU stay of 8.2 +/-2.3 days [Formula presented] [Formula presented] Conclusion(s): Severe preeclampsia was the most common cause of AKI in our study. PR-AKI continues to be a significant problem in the peripheries of developing countries where availability of health care facilities is meager, with late referral to tertiary care centers. One third of the patients required ICU stay & dialytic support. Women who required dialysis had poorer renal prognosis. There was 30% fetal loss seen in PR-AKI and also a higher incidence of low birth weight and prematurity. No conflict of interestCopyright © 2023

A Comprehensive Review of 275 Kidney Transplants Performed over 3 1/2 Years;a Single Center Experience

Introduction: Access to kidney transplantation has always been a problem in the African countries with many patients having to travel to other medically advanced countries in Asia, Europe and America. This involves unnecessary excessive expenditure and the travails of journey and stay in an unknown foreign land. To ease this situation and to provide affordable Renal transplant services in their home land, we have made an effort to start the transplant services at our medical facility and have successfully carried out about 275 transplants over a period starting from Nov 2018 till September 2022. Method(s): All the Kidney transplants done between the period Nov 2018- September 2022 (275 cases) were included in the analysis. All the transplants were performed at a single center and the data were collected progressively during their Pre transplant evaluation, perioperative course and post op follow up. All the laboratory and radiological tests were done locally at the center except the HLA cross matches and tissue typing, which were outsourced to Transplant immunology labs outside the country. All the patients with positive DSA titres [about 70%], underwent Plasmapheresis and received IVIg before the transplantation. immunological assessment was done by NGS high resolution, for A B C DP DQ DR loci and X match was done by SAB analysis for class 1 and Class II antigens. All the patients underwent laparoscopic donor nephrectomy. All Patients received vaccinations for Hepatitis B, Pneumonia, Infuenza & Covid. Result(s): A series of 275 kidney transplants were performed over a period of 42 months [ Nov 2018- September 2022] at a private hospital successfully. All the cases were live donor kidney transplants with majority of the donors being 1st or 2nd degree relatives or spousal donors. About 70% of the patients had some degree of sensitization in the form of weakly positive B cell X match, or positive for DSAs at CL I, CLII with MFIs > 1000. All high-risk patients received induction with rabbit Thymoglobulin, and IV methyl prednisolone. Around 50 patients received Basiliximab. Of all patients, 4were HBsAg positive, and 6 were HIV positive,& HCV 1 patient. 8 patients required pretransplant Parathyroidectomy for refractory hyperparathyroidism, 3 patients required simultaneous native kidney nephrectomy at the time of transplant. 25 patients had multiple renal vessels which were double barreled and anastamosed.4 patients had lower urinary tract abnormalities requiring simultaneous/subsequent repair. Overall, 4 patients underwent 2nd transplant. All the donors underwent laparoscopic nephrectomy. Most of the patients had good immediate graft function except in 40 patients, who had delayed graft function;most of them improving over 2 - 6 weeks. 6 Patients had hyperacute rejection and the graft was lost,.4patients had main renal artery thrombosis, Renal allograft biopsy was done in 20 patients. Overall, the Patient survival was 95 %.at 1 year and graft survival 90%. Conclusion(s): Our experience shows that kidney transplantation is a viable and practical option for End stage kidney disease and can be performed even in resource constrained centers in third world countries and the survival rates of patients and the grafts are comparable to other centers across the world. No conflict of interestCopyright © 2023

Advocacy and Adoption of Technology and Disparities in India

The number of people with diabetes globally, is rising at an alarming rate. South Asia is one of the hot spots of the diabetes epidemic. In India alone, there are over 74 million people with diabetes today. Unfortunately, 70% of the doctors in India practice in urban areas while 70% of India's population lives in rural areas. This mismatch between the availability of health care professionals and the rapid spread of diabetes in rural areas, provides an opportunity to use technology to deliver the diabetes care to remote rural areas. The first part of this presentation will talk about a model of successful delivery of diabetes health care in rural India. The Chunampet Rural Diabetes Program was carried out in a group of 42 villages in Kancheepuram District in Tamilnadu. Using a Mobile van, a population of 27,014 individuals (86.5% of the adult population) were screened for diabetes. All those detected with diabetes were offered a follow up care at a rural diabetes centre which was set up during the project. The results were very impressive and led to good improvement in A1c levels using low cost generic drugs. The second use of technology was during the COVID - 19 pandemic and the lock down which was enforced in India and many other countries. Thankfully, Telemedicine was also legalized in India at that time. Using technology, a system was created whereby the doctor and the patient stayed at home but blood tests were arranged at home for the patient.With the results, teleconsultation was done by doctors using the Electronic Medical Records which were made available on their mobile phones. Thus, despite the lockdown, patients managed to get their tests and diabetes consultations done remotely. The third use of technology is through our network of diabetes clinics across India. Even at centres where there was no ophthalmologist, retinal photographs were obtained using a lowcost retinal camera and were uploaded for centralized diabetic retinopathy grading unit where the images were read by trained retina specialists. The eye reports were sent back to the peripheral clinics in real time. Over one year period, 25,316 individuals with diabetes could have their eyes screened for diabetic retinopathy. Only 11.4 % needed referral to an ophthalmologist for further management. Finally, the use of mobile Apps has revolutionized diabetes treatment. Recently, we have developed three diabetes related tools. 'DIA' - an AI powered chatbot to assist people through automated digital conversations, 'DIALA' - a patientfriendly mobile app and 'DIANA' - a healthcare application for precision diabetes care. The details of these three tools are briefly described below : DIA : The Conversational AI Virtual Assistant 'DIA' can interact in English with its unique conversational AI technology and intuitive interface, it has proved to be a useful solution for patients, providing complex dialogues, with quick response time and offers comprehensive solutions for patients with diabetes. DIA's uses range from scheduling appointments and reminders for visits, lab tests and teleconsultation, to addressing enquiries on available medicines, treatments, and facilities.During an emergency, health crisis or in pandemic situations, it connects with caregivers and patients to take proper action as per the seriousness of their conditions. Further, it shares notifications, updates patient engagement and special offers. In addition to this, DIA can assist patients through reminders on their medicine refill via WhatsApp or SMS notifications and even facilitate purchase and tracking of medicine orders. DIALA : 'DIALA' is a DIAbetes Lifestyle Assistant Mobile Application. This app helps deliver superior and positive patient outcomes with weight tracking, step counts, diet plan adjustment, prescription refilling, availing reports of tests done, glucose monitoring data, scheduling appointments and sends reminders. It can help to monitor one's health and manage diabetes effectively. It is currently available in Android. DIANA : An advanced machine learning tool DIANA (DIAbetes Novel subgroup Assessment) is used to classify individuals with newly detected type 2 diabetes into specific subgroups such as insulin deficient or insulin resistance forms. This tool also gives the estimates of the risk for developing diabetes complications like eye or kidney disease. This machine learning approach has been developed based on published real world clinical data and will help the clinician offer individualized care for people with diabetes. In conclusion, judicious use of technology can help to bridge the socioeconomic and geographical challenges in delivering diabetes health care in developing countries.

Building a system dynamics model to analyze scenarios of COVID-19 policymaking in tourism-dependent developing countries: A case study of Cambodia

To control the COVID-19 pandemic, various policies have been implemented to restrict the mobility of people. Such policies, however, have resulted in huge damages to many economic sectors, especially the tourism sector and its auxiliary services. Focusing on Cambodia, this study presents a system dynamics (SD) model for assessing and selecting effective policy responses to contain the spread of COVID-19, while maintaining tourism development. Policies targeted in this study include international and domestic transportation bans, quarantine policy, tourist-centered protection measures, and enterprise-led protection measures. Two types of scenario analyses are conducted: one targets each policy separately and the other combines different policies. Among all scenarios, quarantine policy is evaluated to be the most effective policy as it balances the containment of the spread of COVID-19 and support for tourism development. This study provides a new way of guiding COVID-19 policymaking and exploring effective policies in the context of tourism.

The impact of the COVID-19 pandemic on delay in diagnosis and management of lung cancer in developing countries

Introduction: The COVID-19 pandemic has caused an overload within health care structures in Tunisia, impacting negatively on the management of other pathologies. In this study, we estimated the impact of the COVID-19 pandemic on delay in diagnosis and management of lung cancer in a Department of Pulmonology in Tunisia. Method(s): A retrospective study including patients with lung cancer managed between January 2019 and December 2021 in the Pulmonology IV Department of Abderrahmane Mami Hospital. The patients were divided into two groups: Group 1(G1):(n= 59) included patients diagnosed before Covid-19 pandemic (January/December 2019). Group 2 (G2): (n =71) diagnosed during the Covid-19 pandemic (march 2020/December 2021). Result(s): One hundred and thirty male patients were included with an average age of 60.8 years. The mean delay between the onset of symptoms and the first consultation was 43.27 days in G1 versus 39.92 in G2 . The mean delay between first consultation and the histological diagnosis was significantly longer in G2 (34.3 days vs 31.85 days in G1;p = 0.037). The most common histological type in both groups was adenocarcinoma. Sixty point six percent of patients of G2 were diagnosed at metastatic stage (vs 47.5 % in G1 ). The mean delay between histological diagnosis and initiation of specific treatment was significantly longer in G2 (60.34 days vs 41.67 days in G1 ;p = 0.014). Conclusion(s): The study demonstrates the significant impact of COVID-19 on diagnostic and therapeutic delays for lung cancer patients in our department. A specific care pathway needs to be created in order to ensure treatment within the optimal deadlines.

Reasons for Delay in Indian Women Presenting with Primary Stage III or IV Breast Cancer: An Observational Study

Background: Developing countries like India share higher burden of deaths due to breast cancer, despite having lower incidence than the west. Greater proportion of patients presenting with advanced stages of cancer is one of the reasons for this disparity. Since the factors leading to such delay have not been well studied in Indian patients, we decided to perform this study. Methodology: This was an observational study conducted from Jan 2021 to July 2022. Purposive Non-Random sampling was used and patients who had stage 3 or 4 breast cancer and were between 18-80 years of age were recruited. Interview was done on a one-to-one basis in a secluded area. Descriptive statistics were used, and chi-square was used to study the association of socio-demographic and clinical variables with the delay status of the breast cancer. Result(s): A total of 75 participants were enrolled in the study with mean age of 52.5 years and SD of 12.5 years. Out of these, 74 had lump as their first symptom. Only 14 of these 74 presented early i.e., within 3 months of onset of symptoms. Rest 60 participants presented late (more than 3 months after onset of symptoms). Between these two groups, difference in incidences of pregnancy associated lumps (0% in < 3 months vs 13.1% in >= 3 months, p=0.002), patients being afraid of treatment related complications (0% in < 3months vs 6.6% in >= 3 months, p=0.039) and their inability to decide because of lack of knowledge (0% in < 3months vs 6.6% in >= 3 months, p=0.039) were statistically significant. To our surprise, the thought that the lump was harmless and painless, embarrassment, limited access to healthcare and distance from the nearest healthcare facility, financial limitations, educational status, socio-economic status, family history of breast cancer, fear of mutilating surgeries and use of traditional medicine or spiritual care didn't have significant effect on whether the patients presented within or after 3 months of onset of symptoms. On the question of COVID pandemic related delay, only 16% of all patients cited this as an additional reason for delay and this was again, not different between the patients who presented within or after 3 months of onset of symptoms. Conclusion(s): Health promotion in terms of proper evaluation of pregnancy related lumps and awareness about the management options of breast cancer may help patients to present earlier to healthcare facilities and may help in improving breast cancer related outcomes in developing countries like India.

Single Center Comparative Analysis of Abo Compatible Versus Abo Incompatible Kidney Transplant with Short Term 1 Year Follow Up

Introduction: Kidney transplantation is the best treatment option for patients with end-stage kidney diseases. Quality and longevity of life are better with kidney transplant than chronic dialysis. Kidney paired donation and ABO incompatible kidney transplant (ABOiKT) are among the strategies to expand the living donor pool to overcome shortage of organs. Although first ABOiKT done in 1951 by Hume et al. was an unsuccessful attempt;Alexander et al. in 1987, proposed desensitization protocol with successful ABOiKT. Advancements in desensitization protocols have resulted in increasing success with ABOiKT. In developing countries like India, numbers of ABOiKT are steadily increasing. Aim of this study was to assess short term outcome of ABOiKT and their comparison with ABO compatible kidney transplant (ABOcKT). Method(s): This was a single center prospective observational study done over a period of 2 years. All the living donor kidney transplants including both ABOcKT and ABOiKT done between September 2020 to August 2021 at Jaslok Hospital and Research Center, Mumbai were included in this study. All ABOiKT recipients underwent pre-transplantation desensitization with injection rituximab and plasmapheresis. Pretransplant isoagglutinin titer of <= 1 : 8 was considered acceptable. Inj. Antithymocyte globulin (ATG) (1mg/kg), Inj. Anti-T lymphocyte globulin (ATLG) (3 to 5 mg/kg) or Inj. Basiliximab (20mg 2 doses 4 days apart) was used as induction agent. Triple immunosuppression regimen of prednisolone, tacrolimus and mycofenolate mofetil was started 7 days prior to transplant in ABOiKT and 2 days prior to transplant in ABOcKT and continued in post-transplant period. Valganciclovir was given to all patients for Cytomegalovirus (CMV) infection prophylaxis for 6 months. All the transplant recipients were followed up at 0, 3, 6, 9 and 12 months after transplant and in between when clinically indicated. Data collected was analyzed at the end of 1 year for outcomes of rejection episodes, graft dysfunction, graft loss, infections and death. Result(s): Total 95 patients were included in study, 29 (30.5%) out of them were ABOiKT recipients. Mean (SD) age of study population was 37.8 (+/- 10.5) years. Blood group B to B was the most common ABOcKT and B to O was the most common ABOiKT. Highest baseline isoagglutinin titer was 1:1024.There was no significant difference for rejection episodes, graft dysfunction, graft loss and death in ABOiKT and ABOcKT groups. Urinary tract infection was the most common infection in post-transplant period. COVID-19 was most common viral infection followed by CMV infection. Bacterial infections and overall infections were significantly higher in ABOiKT recipients (p value 0.001 and 0.006 respectively) but severe infections requiring hospitalizations and ICU care were not significantly higher. Two deaths occurred during our study, one in each group. One death was related to COVID-19 infection and second was because of pulmonary mucormycosis. Conclusion(s): Contrary to belief, ABOiKT has non inferior short term outcomes when compared with ABOcKT. Though in our study, bacterial infections were significantly higher in ABOiKT recipients, severe infections requiring hospitalization and ICU care were not increased. ABO incompatible kidney transplantation is an effective modality to increase donor pool and can be applied more widely. No conflict of interestCopyright © 2023

Clinical Characteristics of Hemodialysis Patients Hospitalized with Covid-19: A Case Series of 70 Cases from Dominican Republic

Introduction: The Coronavirus disease (COVID-19) is more severe in patients with pre-existing comorbidities;therefore, dialysis patients fall into this category. Not to mention the risk among patients receiving in-center dialysis, since they are known to be at higher risk of contracting this disease. Information about the clinical characteristics among hemodialysis patients with COVID-19 in Latin America and low-and middle-income countries are limited. Considering the importance of this topic, the aim of this study was to describe the clinical characteristics along with the outcome of 70 hemodialysis patients hospitalized for COVID-19. Method(s): This is a retrospective study in chronic hemodialysis patients hospitalized with COVID-19. All patients diagnosed with COVID-19 from March 2020 to January 2022 are included. Result(s): The mean age of the patients was 58 (range 19-87), where 65.7% were male. The most prevalent comorbidities were hypertension (98.6%) and type 2 diabetes (54.3%). The most common presenting symptoms were dyspnea (71.4%), fever (68.6%) and cough (58.6%). In addition of abnormal pulmonary auscultation in most patients (78.6%). Lymphocytopenia and elevated inflammatory markers as procalcitonin, erythrocyte sedimentation rate (ESR), D-dimer and C-reactive protein (CRP) were the main prevalent lab findings. At admission 90.1% had ground- glass abnormalities in the CT findings, being CO-RADS 3 the most frequent category between these patients. The average hospital stay was 8.51+/- 6.39 days;35.7% of these patients were admitted to the ICU and only 4 (5.7%) required mechanical ventilation. Therapeutic management included statins and antithrombotic therapy for all the patients at prophylactic doses. Treatment options were remdesivir, corticosteroids, hydroxychloroquine, antibiotics, and other immunosuppressant drugs. A total of 8 (11.4%) patients died during hospitalization and 62 (88.6%) were discharged. Conclusion(s): Even though dialysis patients are at higher risk of death, especially in developing countries, our findings suggest that the mortality rate were lower in comparison with other studies in Latin America and similar to some developed countries. The use of statins and antithrombotic prophylaxis in all hospitalized patients seems to be associated with a lower risk of death in conjunction with other therapeutic regimens according to the guidelines. No significant adverse effects were observed with remdesivir in these patients, so we believe that its use is beneficial in conjunction with the use of statins and antithrombotic prophylaxis, based on the patient's requirements. No conflict of interestCopyright © 2023