Evaluation of COVID-19 Vaccines in Primary Prevention Against Infections and Reduction in Severity of Illness Following the Outbreak of Sars-Cov-2 Omicron Variant in Shanghai

Objectives: To evaluate COVID-19 vaccines in primary prevention against infections and lessening the severity of illness following the most recent outbreak of the SARS-CoV-2 Omicron variant in Shanghai. Method(s): To investigate whether inactivated vaccines were effective in protecting against COVID-19 infections, we estimated the odds ratio (OR) of the vaccination in COVID-19 cases vs. matched community-based healthy controls. To evaluate the potential benefits of vaccination in lowering the risk of symptomatic infection (vs. asymptomatic), we estimated the relative risk (RR) of symptomatic infections among diagnosed patients. We also applied the multivariate stepwise Logistic regression analyses to measure the risk of disease severity (symptomatic vs. asymptomatic and moderate/severe vs. mild) in COVID-19 patient cohort with vaccination status as an independent variable while controlling for potential confounding factors. Result(s): Out of the 153,544 COVID-19 patients included in the analysis, 118,124 (76.9%) patients had been vaccinated and 143,225(93.3%) were asymptomatic patients. Of the 10,319 symptomatic patients, 10,031(97.2%), 281(2.7%) and 7(0.1%) experienced mild, moderate, and severe infections, respectively. There is no evidence that the vaccination helped protect from infections (OR=0.82, p=0.613). The vaccination, however, offered a small but significant protection against symptomatic infections (RR=0.92, p < 0.001) and halved the risk of moderate/severe infections (OR=0.48, 95% CI: 0.37 - 0.61). Older age (> 60 years) and malignant tumors were significantly associated with moderate/severe infections. Gender also appeared to be a risk factor for symptomatic infections, with females being associated with a lower risk for moderate/severe illness. Conclusion(s): Inactivated COVID-19 vaccines helped provide a small but significant protection against symptomatic infections and halved risk of moderate/severe illness among symptomatic patients. The vaccination was not effective in blocking COVID-19 Omicron variant community spread.Copyright © 2023

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.

Prevalence and related factors of depression, anxiety, and insomnia among medical staff during COVID-19 pandemic

[Background] The epidemic of coronavirus disease 2019 (COVID-19) seriously affects the psychological status of medical staff who directly face the risk of the disease. [Objective] This study investigates the prevalence and related factors of depression, anxiety, and insomnia among medical staff during the COVID-19 pandemic. [Methods] From February 13 to March 1, 2020, a network questionnaire survey was conducted among 482 medical staff selected by convenience sampling. A self-designed questionnaire was used to investigate the basic demographic information and COVID-19-related questions. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI) were used to estimate the prevalence of depression, anxiety, and insomnia among the medical staff. Stepwise multiple linear regression analysis was performed with PHQ-9 score, GAD-7 score, and ISI score as dependent variables. Multivariate logistic regression analysis (forward-conditional method) on depression, anxiety, and insomnia as dependent variables was performed with basic demographic information and COVID-19-related questions as independent variables. [Results] Among the surveyed medical staff, the prevalence rates of depression, anxiety, and insomnia were 14.3%, 11.2%, and 23.2%, respectively. There were no significant differences in the prevalence rates among different age, gender, local risk level, and occupation groups and those aiding Hubei Province or not. The medical staff who directly contacted fever or diagnosed patients had more serious depression (b=1.73, 95%CI: 0.79-2.66) and insomnia (b=2.43, 95%CI: 1.48-3.39) and a higher risk of insomnia (OR=1.89, 95%CI: 1.21-2.96). The medical staff whose current protective measures cannot prevent infection had more serious depression (b=1.72, 95% CI: 0.65-2.80), anxiety (b=1.75, 95% CI: 0.76-2.75), and insomnia (b=1.73, 95% CI: 0.63-2.82), and had a higher risk of depression (OR=1.97, 95% CI: 1.11-3.49), anxiety (OR=3.00, 95%CI: 1.64-5.46), and insomnia (OR=1.79, 95%CI: 1.08-2.96). [Conclusion] During the COVID-19 epidemic, the risks of depression, anxiety, and insomnia among selected medical staff are increased compared with the non-epidemic period. Occupational exposure to high-risk groups and protective measures would significantly affect mental health of medical staff.Copyright © 2021, Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.

Sars-CoV-2 in critical immunocompromised patients. Evolution and prognosis

Introduction: In this study, we share the results of immunosuppressed patients who suffered from acute respiratory distress syndrome (ARDS) secondary to COVID-19 pneumonia managed in our ICU. Method(s): We tracked all patients admitted to ICU of a Tertiary Hospital diagnosed with severe SARS-COV2 pneumonia from March 1, 2020 to January 31, 2022. The definition of Immunocompromised patient is based on history of transplantation, active neoplasia, autoimmune diseases or HIV. Collected data includes: sex, age, type of immunosuppression, vaccination, mechanical ventilation, ECMO VV, incidence of superinfections and mortality. Result(s): From a cohort of 425 patients, 55 met the inclusion criteria. 33% were women and 67% male. The average age was 58 years for women and 62 years for men. Out of these patients, 27% had solid organ transplants. 40% suffered from neoplasic disease. 27% had autoimmune diseases and were under treatment with immunosuppressants. 3 had HIV. Only the 29% had received at least 1 dose of COVID 19 vaccine. 80% required orotracheal intubation. 3.64% (2) required Veno-Venous ECMO. 61% presented bacterial superinfection, with the most frequent germs being Pseudomonas aeruginosa and Enterococcus. 36% had viral superinfection, being cytomegalovirus the most frequent one. 32% had fungal superinfection, mainly by Aspergillus fumigatus. 27% did not suffer any superinfection. 40% of the total sample died. After logistic regression, in our model (AUC 83,4% (Se 57.1%, Sp 87.9%), we identified need of intubation as independent variable of mortality (OR 27,06 IC95% 1.76-415.55, p = 0.018). Conclusion(s): Immunocompromised patients with ARDS secondary to COVID-19 pneumonia present high mortality, with statistically significant difference when mechanical ventilation is needed. The most frequently isolated germs causing superinfection in this group of patients are bacterias. We believe that this group of patients require special care in our ICU units and an in-depth analysis and study to optimize their prognosis.

SARS-CoV-2 VIRAL LOAD CHANGE IN A RANDOMIZED TRIAL ON THREE DIFFERENT EARLY THERAPIES

Background: SARS-CoV-2 Omicron sublineages exhibit evolving escape to in vitro neutralization by monoclonal antibodies (mAbs), with an unclear impact on in vivo treatment response. Our aim is to assess the impact of SARS-Cov-2 variants on the decline of viral load (VL) after treatment with 3 different drugs approved in EU for the early treatment of patients with mild-moderate COVID-19. Method(s): Post-hoc analysis from MONET (EudraCT: 2021-004188-28), phase 4 open-label RCT to assess efficacy of 500 mg intravenous sotrovimab (SOT), 600 mg intramuscular tixagevimab/cilgavimab (TIX/CIL) and oral 5-days course of NMV/r 300/100 mg BID, in non-hospitalized high-risk patients (pts) with early COVID-19. Pts' features were analyzed as binary variables by Chi-squared test. SARS-Cov-2 VL in nasopharyngeal swabs was carried out at randomization (1d) and at day 7 (7d) by cycle threshold value (Ct). Variant sequencing was performed at 1d. Ct variation was assessed by mixed effect log-linear model including random intercept at pts' level, log of Ct as independent variable, time, arm, viral variant as dependent variables, and interaction between time and arm. Multiple comparisons were adjusted by Bonferroni. Result(s): Among the 320 pts included between 4 Mar and 16 Nov, 2022, 108 (33.75%) received NMV/r, 103 (32.19%) TIX/CIL, and 109 (34.06%) SOT. Main characteristics were balanced across arms. Most of the pts were infected either with BA.2 (N=194;60.63%) or BA.4/BA.5 (N=100;31.25%) (Fig1A). VL at 1d was similar across the arms. In contrast, mean 7d VL was significantly lower in pts receiving NMV/r than in those receiving TIX/ CIL or SOT (P< 0.001) No significant VL variation was observed between the mAb arms (Fig1B). The analysis of the impact of viral variants suggests that while VL was significantly affected by variants (P=0.034), the superior effect of NMV/r over mAbs was homogeneous across all variant groups (P=0.290 for interaction) (Fig1C). Conclusion(s): Our study provides for the first time strong in vivo evidence that, when used against Omicron lineages, NMV/r exerts a stronger antiviral effect than mAbs. These results confirm previous in vitro evidence suggesting that mAbs may not retain neutralizing activity against all Omicron sublineages and provide preliminary information on how to use VL variation as a surrogate marker of efficacy. Further studies are needed to investigate whether the superior virologic activity of NMV/r over mAbs is confirmed for newly emerging variants, including BQ.1.1 or XBB.

The Effect of the Covid-19 Pandemic on Education Costs in Vocational Nutrition Polytechnic

Vocational education plays a strategic role in the creation of a skilled workforce who is ready to enter the world of work. In order to achieve the standard competency level, the proportion of practice is required to be 60% and large financing is required. During the Covid-19 pandemic there were many changes in the world of education, PBM had to be done online or online, children's education costs were not fulfilled due to layoffs, the economy slumped and had an impact on entrepreneurship and the influence of student personal costs. The cost of education has changed a lot. A study of changes in financing is needed for planning learning in covid conditions and demands for changes in learning patterns in the 4.0 era. The design used in this research is an explanatory mixed method research, quantitative data is taken together with qualitative data collection. The independent variable is the influence of the pandemic, the dependent variable is the cost of education (education budget and student personal costs). Online survey using googleform. The sample of level II and III students who have been exposed to face-to-face and online learning is 143 students. The education budget & costs are presented with the percentage of reduction and increase. Individual operational costs before and during the pandemic were used the Mann Whitney test at 95% confidence level. The recurrent cost budget that is used to finance the operational activities of PBM for D3 Nutrition Study Program for one budget year, with the predicate BLU should have financial management flexibility, so that student advice to provide tuition fee relief, complete facilities (campus wifi, practical equipment, air conditioning class), providing adequate quotas and spending for practical purposes as well as sufficient costs for student activities can be facilitated. All budget items decreased during the epidemic, except for the cost of providing goods and services for competency and IT compliance. The results of the survey on individual personal costs showed that the significance of all items in question, parents' income, living costs and transport costs decreased before and during the pandemic, while Quota and refreshing costs / personal needs increased on average. A deeper study is needed on the education budget and changes in individual operational costs during the Covid-19 pandemic and facing the challenges ahead in the 4.0 era.Copyright © 2020 Ubiquity Press. All rights reserved.

Post-COVID-19 cardiovascular complications and their association with clinical characteristics, symptoms and comorbidities - the LATE-COVID study

Background: Among many complications of coronavirus disease 2019 (COVID-19) there is a wide range of cardiovascular (CV) problems ranging from mild to severe ones. Even asymptomatic patients and those with mild course of COVID-19 may develop severe CV complications. Factors leading to such state have not been extensively studied so far. Purpose(s): We aimed to assess which factors were linked to the severe complications of COVID-19. Method(s): We included 200 consecutive patients admitted to the Department of Cardiology and Adult Congenital Heart Diseases of the Polish Mother's Memorial Research Institute (PMMHRI) due to post-Covid cardiovascular complications. SARS-CoV2 infection was confirmed with real-life PCR testing. Laboratory tests, 24-hour ECG monitoring and echocardiography were performed in all patients from the investigated group. For the purposes of our study severe complications were defined as: Myocarditis, a decrease of ejection fraction >10% from the pre-disease value, thromboembolic complications, angina pectoris requiring myocardial revascularization and the new onset of atrial fibrillation of supraventricular tachycardia. Some patients presented more than one of the above. Statistical analysis was performed using the software Statistica v.13 (TIBCO Software Inc., Palo Alto, CA, USA). Data were presented as mean +/-SD or median (25th- 75th percentile) for continuous variables and as proportions for categorical variables. Comparisons between groups were performed using Student's t-test for independent variables and the Mann-Whitney U test or chi2 test with Yates's correction, as appropriate. For all calculations p-values <0.05 were considered statistically significant. Result(s): Finally, we included 200 consecutive patients (aged 54+/-16 years, 76 males - 38%), hospitalized for COVID-19 complications after a median 3 (2-6) months following the acute phase of infection. On admission patients presented with dyspnea (23%), impairment of exercise tolerance (47%), chest pain (32%), increase in blood pressure (29%), palpitations (25%), weight loss (13%), brain fog (6%), general malaise (11%), headache (5%), limb pain (13%), swelling (14%). Severe complications of COVID-19 were diagnosed in 31 patients (16%).Taking into consideration symptoms, the presence of severe COVID-19 complications was significantly associated with dyspnoea and deterioration of exercise tolerance. In comparison to patients with mild complications, severe ones were linked to age (the older patients, the higher risk), previous history of heart failure and diabetes mellitus. We did not observe statistically significant differences in severity of complications depending on smoking status (Tables 1 and 2). Conclusion(s): Previous history of heart failure and diabetes mellitus as well as symptoms (dyspnoea and deterioration of exercise tolerance) along with older age are related to more severe complications following COVID- 19.

Correlates of excessive internet use in a representative sample of the czech adult population.

Objectives: the aim of the study was description of the association between the number of hours spent on the internet and symptomatology of Internet addiction, corrected by sociodemographic data, mental instability, alcohol and cannabis use, gambling, and subjective estimation of physical and mental health using responses from a representative sample of Czech respondents during COVID-19 pandemic. Sample and setting: The group consisted of 2 602 people (1 206 men, 1 396 women), average age 44,61 years, SD = 15,8223, range 15-85 years randomly selected by quota selection based on age, gender, education and region. Data were processed by hierarchical multivariate linear regression analysis (OLS). The dependent variable was data from the Excessive Internet Use test. Independent variables were age, gender, net income, marital status, education, subjective estimation of mental and physical health, data from MHI-5, CAGE, cast and PGsi tools. Result(s): the results are in line with previous research, which indicates that the development of internet addiction is mainly due to time spent on the Internet, the risk is inversely related to age and slightly higher in men. The influence of other variables measuring substance use, gambling and mental health supports hypotheses about common etiology of various types of addiction and their association with mental health. Study limitation: the study is based on self-referential data, has a heuristic, empirical character and does not rely on a pre-formulated theory.Copyright © 2022 TIGIS Spol. s.r.o.. All rights reserved.

New Onset Renal Replacement Therapy Is a Predictor of Covid-19 Adverse Outcome in Patients with Advanced Chronic Kidney Disease Due to Type 2 Diabetes Mellitus

Introduction: The patients with diabetic kidney disease (DKD) due to type 2 diabetes mellitus (T2DM) are at a high risk of adverse outcomes of COVID-19. In some cases, rapidly progressive kidney injury requires urgent initiation of renal replacement therapy (RRT) - hemodialysis de novo (HD de novo). The objective of this study is to identify risks factors of adverse outcomes and predictive value of HD de novo in patients with DKD due to T2DM and COVID-19. Method(s): The patients with chronic kidney disease 4-5 stages (CKD 4-5) with laboratory-confirmed COVID-19 were included in the retrospective observational study. The observation period 04.01-10.30.2020. Data were collected from electronic medical database. The following independent variables were analyzed at hospital admission: age, gender, body mass index (BMI), general comorbidity (Charlson Index, CCI), the insulin demand (InsD), fasting blood glucose (FBG), glomerular filtration rate (GFR), Plasma creatinine (Pcr), serum albumin (SA), proteinuria, time from onset to admission, NEWS2-scale points, pulmonary involvement (Chest CT), Hb, WBC, lymphocytes, platelet count, LDH, CPR, ferritin, D-dimer, procalcitonin, Interleukin-6. The observation group was divided into subgroups: 1 - HD not required (HD n/r), 2 - HD de novo. Result(s): A total of 55 patients were included. Mediana age was 69 y (IQR 64;80), fe-males 59%. The overall mortality - 38.2%. In 18 patients (32.7%) HD de novo was initiated due to rapidly progressive renal failure. The results of comparative analyses of demographic, initial clinical and laboratory data are presented in Tables (*Mann-Whitney U-test;IQR, interquartile range;Me, mediana). [Formula presented] [Formula presented] The mortality in both subgroups was 21.6 % vs 72.2 % respectively (p <0,001). HD de novo was determined as an independent predictor of adverse outcome (OR 9.42;95% CI, 2.58-34.4, p = 0.001). The analysis showed that FBG >= 10 mmol/L at admission (OR, 3.38;95% CI, 1.04-10.98, p = 0.050), SA at admission <= 35 g/L (OR 3.41;95% CI, 1.00-11.55, p = 0.050), News2 >4 points (OR 5.60;95% CI, 1.67-19.47, p = 0.006), GFR <= 20 ml/min/1,73m2 at admission (OR 4.24;95%;CI 1.29-13.99, p = 0.020) were independent predictors of HD de novo. Cumulative survival in subgroup HD de novo was 10% (significantly less, than in patients HD n/r) (Fig.). [Formula presented] Conclusion(s): Approximately every third patient with advanced nondialysis DKD required new onset RRT.New onset RRT is an independent predictor of lethal outcome of COVID-19. High FBG, low SA, low GFR and high NEWS2 score at admission are the risk factors of HD initiation during hospitalization. No conflict of interestCopyright © 2023

CO-RADS, COVID-PCR and prognosis relationship in patients followed in intensive care unit with the diagnosis of COVID-19

Introduction: The gold standard method in the diagnosis of COVID-19 is real-time reverse transcriptase-polymerase chain reaction (RT-PCR) however, its sensitivity is reported to be between 42-83% in different studies. Aims and objectives: In this study, we aimed to examine the relationship between CO-RADS levels and prognosis in patients followed in the intensive care unit with the diagnosis of COVID-19. Method(s): All consecutive adult patients with clinically, radiologically, and/or laboratory positive COVID-19 admitted to the Intensive Care Unit between January 2020 and October 2021 were evaluated. Clinical and laboratory data of the patients include characteristics, comorbidities, treatment protocol, respiratory support, hospital stay, RT-PCR status, laboratory test, CO-RADS scores, complications, and prognosis collected from the electronic hospital record system. Result(s): 375 patients were included in the study. In univariate analysis, age, intubation status, serum albumin, CRP, D-dimer, and CO-RADS score were found to be effective variables on mortality. In multivariate analysis, CO-RADS score, and serum albumin levels were found as independent variables affecting mortality (Figure 1). Conclusion(s): This study presents the prognostic value of the CO-RADS classification in patients with COVID-19.

Anticoagulants in COVID-19:Is there a role for a D-dimerdriven dosing ?

Introduction: The optimal anticoagulant treatment regimen in hospitalized COVID-19 patients is debated amid studies investigating the effectiveness of different dosing strategies. Aims and Objectives: The aim of this study was to compare the rates of disease progression and mortality in patients treated with LMWH according to a protocol based on baseline D-dimer levels (prophylactic dose when level is below 1000 ng/mL, intermediate dose between 1000 and 3000 ng/mL, therapeutic dose when levels exceed 3000 ng/mL)(on-protocol) and those treated with a fixed-dose regimen (off-protocol). Method(s): This was a retrospective analysis of all patients admitted to a university hospital for COVID-19 pneumonia during a one-year period. Out of a total of 384 patients (mean age 61.5+/-15.9y, 216 male), 294 patients with complete data composed the study group. Result(s): 174 patients were treated on-protocol and 120 patients were off-protocol. The on-protocol group had higher CRP, ferritin, LDH and D-dimer levels and lower SpO2/FiO2 levels at admission. Disease progression developed in 44 out of 174 on-protocol patients (25.3%) vs 53 of 120 off-protocol patients (44.2%) during the follow-up (p=0.001) and 29 (16.7%) vs 32 (26.7%), respectively, died in hospital (p=0.041). Logistic regression analysis was performed and included age, presence of comorbidities, LMWH regimen, baseline SpO2/FiO2, CRP and LDH levels as independent variables. The presence of cardiac comorbidity, age and LDH levels, but not LMWH treatment regimen, were associated with both disease progression and mortality. Conclusion(s): A d-dimer-driven LMWH treatment protocol is not associated with better clinical outcomes in hospitalized COVID-19 patients.

Remdesivir Associated Bradycardia and Outcomes in Covid-19 Patients: A Multicenter Retrospective Study

Background Antiviral agents, such as remdesivir, have shown promising results in helping reduce the morbidity and healthcare burden of COVID-19 in hospitalized patients. However, an increasing number of studies have reported a relationship between Remdesivir and bradycardia. Therefore, this study aims to analyze the relationship between bradycardia and outcomes in patients on remdesivir. Methods We conducted a retrospective study of 2,935 consecutive COVID-19 patients admitted to seven hospitals in Southern California in the United States between January 2020 and August 2021. First, we did a backward logistic regression to analyze the relationship between remdesivir use and other independent variables. Finally, we did a backward selection Cox multivariate regression analysis on the sub-group of patients who received remdesivir to evaluate the mortality risk in bradycardic patients on remdesivir. Results The mean age of the study population was 63 years;56% were males, 44% received remdesivir, and 52% developed bradycardia. Our analysis showed that remdesivir was associated with increased odds of bradycardia (OR 1.9, p<0.001). Patients that were on remdesivir in our study were sicker patients with increased odds of having elevated CRP (OR 1.03, p<0.001), elevated WBC on admission (OR 1.06, p<0.001), and increased length of hospital stay (OR 1.02, p=0.002). However, remdesivir was associated with a decreased odds of mechanical ventilation (OR 0.53, p<0.001). In the sub-group analysis comparing bradycardia and non-bradycardia patients that received remdesivir, bradycardia was associated with decreased mortality risk (HR 0.69, p=0.002). Conclusion Our study showed that remdesivir was associated with bradycardia in COVID-19 patients. However, it decreased the odds of being on a ventilator, even in patients with increased inflammatory markers on admission. Furthermore, patients on remdesivir that developed bradycardia did not have any increased risk of death. Therefore, clinicians should not withhold remdesivir from patients at risk of developing bradycardia because bradycardia in such patients was not found to worsen the clinical outcome.Copyright © 2023 American College of Cardiology Foundation

COVID-19 Vaccine Literacy and Vaccine Hesitancy Level Among Healthcare Professionals in Turkiye, Their Relationship and Influencing Factors: A Cross-Sectional Study

Objective: Healthcare professionals (HP) play a role in vaccine acceptance as they influence people's decisions by sharing their personal experiences. The study was aimed to determine the coronavirus disease-2019 (COVID-19) vaccine literacy (VL) and vaccine hesitancy (VH) level among HP in Turkiye, their relationship and influencing factors. Material(s) and Method(s): This cross-sectional online study was applied to 1,111 HP between 15.02.2022-15.03.2022. The sociodemographic data form, COVID-19 Vaccine Literacy Scale (CVLS), and Vaccine Hesitancy Scale-long form (VHS) were used. Sociodemographic characteristics, questions about COVID-19 and COVID-19 vaccines were considered as independent variables, while VL and VH were considered as dependent variables. Result(s): Of the participants, 33.8% (n=376) were physicians, 25.2% (n=280) were nurses/midwives and 41.0% (n=455) were other HP. The CVLS functional mean score of HP was 2.6+/-0.7 and the interactivecritical mean score was 3.0+/-0.6. The VHS mean score was 44.6+/-16.3. Being a physician (p<0.001 for functional, p=0.002 for interactive-critical) and thinking that the origin of the coronavirus is a natural source from animals (p=0.029 for functional, p<0.001 for interactive-critical) were the factors that increased VL. Being a physician (p<0.001) and having high CVLS mean scores (p<0.001 for functional and interactive-critical) were the factors that decreased the VH. There was a weak negative correlation between VL and VH levels (r=-0.223 for functional, r=-0.323 for interactive-critical) (p<0.001). Conclusion(s): Considering that high VL level decreased VH level, it is obvious that the knowledge level of HP about COVID-19 vaccines should be increased.Copyright © 2023 by Turkiye Klinikleri.

Outcome of Covid 19 Patients Requiring Hemodialysis

Introduction: The aim of the study is to determine the patient's outcome and mortality rate of COVID-19 patients requiring hemodialysis in Anwar Khan Modern Medical College & Hospital. Method(s): Retrospective cohort study of medical record of patients with COVID-19 hospitalized at Anwar Khan Modern Medical College & Hospital during the months of September 2020 to January 2021. The dependent variable was in patient's outcome and mortality rate and independent variables included clinical conditions, physical examination results, oxygen requirements, diagnosis, clinical features, and complications. Result(s): Total 98 patients were included. Among them 97 patients were treated with hemodialysis and 1 was pre-dialysis patient. Median age was 59 years and 52 (53.06%) were male and 46 (46.94%) were female. The most frequent comorbidities were chronic kidney disease (CKD), hypertension (HTN), and diabetes mellitus (DM). Patients were diagnosed with different clinical manifestation when they arrived at hospital. Major manifestations were cough, breathlessness, fatigue, fever and body ache. The patients showed some other complications including fluctuated blood pressure (50.1%), vomiting (19.38%), shivering (37.76%), chest pain (16.33%).Treatment was given according to WHO and Bangladesh Government Covid-19 treatment guideline. We observed lower mortality rate. 11 (11.23%) patients died during this observation period. Mortality rate of male patients were 7(7.14%) and female patient were 4(4.08%). Another 87(88.79%) patients were alive according to the observations. Conclusion(s): We found low mortality rate in our cohort study. Dead patients had severe clinical manifestations and complications i.e. DM, HTN, CKD with cough, breathlessness and fatigue. Close monitoring, guideline medication and patient care reduces mortality. No conflict of interestCopyright © 2023

COVID-19 MORTALITY CORRELATES WITH CHRONIC DISEASE BURDEN AMONG COUNTRIES' ONGOING SOCIAL DEVELOPMENT

Background: The COVID-19 death rate has varied by country. Although studies have suggested some biomedical risk factors including hypertension, social factors may not yet be explored enough to prepare for the next pandemic, which might include health policies such as the role of achievement of universal health coverage (UHC). In this study, global data were probed from an ecological perspective. Methods: COVID-19 pandemic-relevant data were obtained from websites provided by WHO, UN, and academic society. The outcome variable was defined as annual COVID-19 deaths per 100,000 population in 2020 and 2021. The chronic disease mortality defined by addition of mortalities from cardiovascular diseases and neoplasms in 2019 in the same unit as the outcome variable, and Socio-Demographic Index (SDI), a new metric for social development created by Global Burden of Disease Study were used for main variables. Also, non-communicable disease risk factors and social factors including the UHC service coverage index were for independent variables. Countries which had elderly population (age > = 65 y.o.) over seven per cent and between middle and high SDI quintiles (divisions by SDI) were included for analyses. Results: The COVID-19 mortality was significantly higher in 2021 than in 2020, particularly in high-middle SDI quintile countries. A multiple regression model suggested that the preceding chronic disease mortality positively correlated to the COVID-19 mortality, in contrast to a negative correlation of SDI (Table 1). By multiple logistic regression models using dummy variables for the three-quantile groups of the SDI-to-mortality negative slope coefficient levels as an indicator of social disparity, i.e., Mild Medium and Steep, respectively, aging (elderlies' proportion), raised blood pressure prevalence (SBP > = 140 and/or DBP > = 90 mmHg), obesity prevalence (BMI > = 30 kg/m2), current tobacco use, and alcohol consumption per capita had a positive correlation as a way of slope gradient order. On the other hand, among risk factors, diabetes prevalence had a negative correlation to Steep. With data from a systematic review, angiotensin converting enzyme 1 homozygote insertion (II) polymorphism prevalence was correlated with Mild. The UHC service coverage index had a significant protective correlation. Conclusion: Taken together, the disparity in the chronic disease burden was a culprit for the impact of the pandemic, especially among countries in the middle of transition to advanced society, represented by middle and high-middle SDI. Therefore, accelerating primary care system under UHC should offer the key to the alleviated chronic disease burden and the next pandemic preparedness.

Changing consumption behaviour towards immune-boosting food amidst COVID-19 outbreak: tracing the future trajectory

Businesses throughout the world have been affected by the coronavirus outbreak. Across countries and industries, small firms have suffered, and India is no different. While many enterprises were destroyed by the COVID-19 scenario, hundreds of others were able to cope. People are getting increasingly concerned about their physical and emotional health as the coronavirus pandemic spreads around the world. People's perspectives on life and what they value have altered. Consumers have been compelled to alter their routines as a result of the outbreak. People throughout the world are attempting to adapt to a new normal. Immune-Boosting foods have become the talk of the town amidst the pandemic. With this backdrop, the present study aimed to understand the demand for ImmuneBoosting foods and the factors that have contributed to the market for immune-boosting foods. The sample data for this study was collected using the purposive sampling technique. Statistical interventions using multiple linear regression and correlation were conducted to understand the relationship between various factors related to immuneboosting foods. The study revealed that the pandemic had increased the respondents' inclination to purchase Immune-Boosting foods. Further, the inclination towards consumption of immune-boosting foods was influenced by independent variables like familiarity with immune-boosting foods, health consciousness, fear of contracting the disease, family testing COVID-19 positive, immune-boosting foods as a trending topic, Influence of social media, Frequent advertisements and offers, testimonials of others regarding Immune-Boosting foods. From the study, it can be inferred that the COVID-19 pandemic has laid a strong foundation for the future of immune-boosting foods. Copyright © 2022 The Authors. Published by Rynnye Lyan Resources.

Evaluation of Burnout Syndrome in Paediatric Intensive Care Unit during Covid-19 Pandemic

BACKGROUND AND AIM: Burnout Syndrome (BS) is an illness that became more noticeable due to Coronavirus Disease 2019 (COVID-19) pandemic in result of the increased demand of healthcare systems. The objective of this study is to investigate BS in the participating Pediatric Intensive Care Units (PICU). METHOD(S): This is a cross-sectional observational study, in which the same survey was sent in 2020 and 2021 to the same population. It included questions about demographic data and the Maslach Burnout Inventory - Human Services Survey, that comprises three sub scales: Depersonalizaition (DP), Emotional Exhaustion (EE) and Personal Accomplishment (PA). The questionnaire was electronically sent to the healthcare workers caring for children in the PICU of participating hospitals. The units had both patients with COVID-19 and other illnesses. There was an overall response rate of 28% in both years analyzed. The answers were analyzed by interpreting the answers to the MBI-HSS and possible relations to dependent and independent variables. Also, simple and multiple linear regression models were assembled to compare the mean scores between the categories of the independent variables of interest. RESULT(S): In the year 2020 there was a majority of participants with low DP, moderate PA and low EE. In the following year, there was an increase in PA levels, which were now mainly high, and both of the other two sub scales remained the same. CONCLUSION(S): Although the second wave of COVID presented historically, with a higher number of cases in general, the healthcare workers showed some overall improvement regarding their burnout syndrome levels.

Hydroxychloroquine Fails Hospitalized Adults with Covid-19: A Smart Analysis of the Orchid Trial

INTRODUCTION: Hydroxychloroquine (HCQ) was hoped to be repurposed for treating COVID-19, especially in regions where more expensive regimens were not available. Unfortunately, several randomized clinical trials (RCT) using HCQ to treat COVID-19, ranging from simple exposure to significant illness, have not improved outcomes. In five failed sepsis RCT's and one previous COVID-19 study the SMART statistical approach identified, from pre-randomization data, cohorts among whom study drugs reduced mortality significantly. Additionally, in one study the SMART statistical approach predicted futility. Whether such sub-groups exist in HCQ COVID-19 RCT's is unknown and is what this research aims to examine. OBJECTIVE(S): To determine from pre-randomization data if HCQ-responsive patients exist within the PETAL Clinical Trials Network ORCHID RCT in hospitalized COVID-19 patients. METHOD(S): With the approval of the BioLINCC data repository and the IRB of Inspira Health Network, HIPAAcompliant data on 452 ORCHID subjects (224 HCQ, 228 placebo) were analyzed. Pre-randomization stepwise logistic regression survival models were built separately for placebo and HCQ. Baseline data from all patients were then entered into both models. Interactions of placebo and HCQ survival models with 28-day mortality HCQ treatment effects determined optimum cutoffs, incrementally excluding from efficacy analysis patients predicted as HCQ non-responders. RESULT(S): Placebo model independent variables: age, VITHRH and potassium. HCQ model independent variables age, SOFA score SpO2, and D-BL-ICU. Overall, 28-day mortality was 10.71% placebo and 10.53% HCQ (p= 0.9483). Interactions of the mortality models with HCQ efficacy were optimized in a cohort of 49 patients (10.2% of total RCT), with placebo 28-day mortality 46% and HCQ mortality 24% (p=0.1085). In the non-SMART group (n=403, 89% of total), mortality was 6.5% placebo and 8.9% HCQ (p=0.3726) CONCLUSION(S): Even in a pre-randomization optimized SMART-identified cohort comprising only 10.2% of the ORCHID RCT, hydroxychloroquine did not reduce mortality significantly in hospitalized patients with COVID-19. These results predict futility for further RCTs of hydroxychloroquine in COVID-19. Hydroxychloroquine fails hospitalized COVID-19 patients.

Perceived Stress and Loneliness During the COVID-19 Pandemic in a Cognitive Aging Cohort

Background: The COVID-19 pandemic has had disproportionate effects on the health and well-being of older adults. Little is known about the effects of isolation and social distancing measures on the mental health of older adults with cognitive impairment. Method(s): 194 participants from the Wake Forest Alzheimer's Disease Research Center (ADRC) Clinical Core cohort adjudicated as cognitively normal (CN, n = 129), and mild cognitive impairment (MCI, n = 65) were given questionnaires cross-sectionally measuring loneliness, perceived stress, well-being, and coping style. We created multivariable regression models (adjusted for age, sex, race, and education) to assess relationships among dependent variables, loneliness and perceived stress, and independent variables of interest, well-being and coping style (Table 2). Result(s): Overall, the mean age was 72+/-8 years. Table 1 lists baseline demographic and study measures for CN and MCI groups. Table 2 shows associations between dependent variables (perceived stress, loneliness) and independent variables of interest. Participants with MCI had significantly higher levels of loneliness (B = 3.30;p = 0.03) than CN participants. Participants who reported lower eudaimonic and hedonic well-being had higher levels of perceived stress and loneliness (p < 0.01), and those who endorsed using self-blame and behavioral disengagement to cope with stress had higher perceived stress (B = 3.06, = < 0.01) and loneliness (B = 7.84, p < 0.01). There was no interaction by cognitive diagnosis. Conclusion(s): Participants with MCI had higher levels of loneliness, but not perceived stress, than those with normal cognition. We found that participants expressing high feelings of well-being had significantly lower, and participants reporting a coping style with self-blame and behavioral disengagement had significantly higher perceived stress and loneliness. Next steps involve exploring associations of neuroimaging and Alzheimer's disease biomarkers with perceived stress and loneliness and evaluating transcriptional measures of stress measured concurrently. Copyright © 2022 the Alzheimer's Association.

Fake News and social Cognition During The SARSCOV- 2 Pandemic: Initial Approach Towards understanding Belief In Misinformation

Introduction: Infodemic is a new term which refers to rapidly spreading information from both reliable and unreliable sources in the form of news and publications regarding the COVID-19 pandemic, which requires proper management strategies on its own to prevent the spread of fake news. This is especially relevant in a global state of alert where the fear of contagion is a common denominator and is reflected upon people's behaviors within a crisis context. Van Bavel et al (2020) affirm Emerging research is using social science to understand and counter the spread of fake news, and furtherly emphasize on the limitations of Fact Checking as the main approach to hinder such spread Objectives: Test the association between sociomoral cognition, religiousness and political identity, and belief in COVID-19 Fake News. Method(s): Online-based survey applied through opportunity sampling. Demographic variables political and religious orientation, RMET and B-IRI, and two dimensional utilitarian dilemmas were used and independent variables, and a selection of true and fake news in order to measure participants' belief in the latter as a dependent variable. Result(s): Morality (R2 = 0.08, p < 0.001), social cognition (R2 = 0.05, p < 0.05), and political and religious orientation (R2 = 0.1, p < 0.000001) predicted belief in COVID-19 fake news. On the other hand, no variables were found to predict belief in fake news unrelated to the pandemic. Conclusion(s): Higher impartial beneficence and more years of formal education point toward an evidence-based reasoning, while religiousness and affinity with right-wing ideals has been associated with intuition-based reasoning, thus affecting judgement accuracy.