PPE effect on Hearing, Speech, Breathing and work performance in Health care workers

Using Personal protective equipment has become an integral part of work for all health care workers during the COVID19 pandemic however they do have an effect on their work performance. Aim(s):This study aimed to determine the effect of Personal Protective Equipment(PPE) on hearing, speech, and breathing on the work performance among the healthcare workers(HCWs) involved in treating COVID patients. Material(s) and Method(s): This is a descriptive cross-sectional survey conducted among the health care workers(HCWs) in a COVID designated hospital in Pondicherry, South India. A semi-structured questionnaire was constructed, and 384 eligible health care workers participated in the study. Their responses were collected in an excel sheet, and the data were analyzed. Result(s): Our survey showed that 79.7% of participants (n=306) had donned PPE for a total of 6 hours, and their work performance was significantly affected by the following factors, such as difficulty in hearing (p=0.053), difficulty in understanding speech (p=0.048), increased efforts in talking to patients and coworkers (p= 0.004) and increased measures of breathing(p=0.057). Conclusion(s): The use of personal protective equipment significantly impairs communication between coworkers and patients.PPE also increases the burden of breathing, and both these entities seem to influence the work performance of the HCWs. Hence we suggest that alternate communication strategies be taught and employed and formulate newer protocols with user-friendly PPEs to decrease the burden on breathing and for better communication for effective work performance. Copyright © 2022, Anka Publishers. All rights reserved.

Examining First Year Engineering Students' Perceptions Towards Online Speaking Assessment Amidst Covid-19 Pandemic

This study explores First Year Engineering students' perceptions towards online speaking assessment amidst COVID-19 pandemic. To ensure that the education process remained uninterrupted during the pandemic, schools and higher learning institutions were forced to shift to full time remote teaching and learning which has indirectly impacted assessment and evaluation of all courses. This study aims to examine first year engineering students' views on their experience having online speaking assessment amidst covid-19 pandemic. Investigating students' perceptions as the end user towards online assessment is highly crucial to determine the effectiveness of teaching and learning. A quantitative method of study was conducted with questionnaire derived from Technology Acceptance Model (TAM) was adopted to collect responses from 163 undergraduate Diploma engineering students doing their first semester in Universiti Teknikal Malaysia Melaka, Malaysia. The key findings indicated that the students were well receptive of online speaking assessment and were fully ready to have online speaking assessment in the future. The study also discovered that students' perceived self-efficacy towards online speaking assessment was low and there was significant difference in perceptions between students from rural and students from urban area on online speaking assessment. This study is important to higher learning institutions to serve as a guide in making planning related to implementation of online speaking assessment during the pandemic. This research is also significant for its contribution towards language teaching practices in higher learning institution and will be helpful for the educators to identify ways to enhance students' online assessment experience for an effective teaching and learning. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Gestational Age at Booking for Antenatal Care in a Tertiary Healthcare Facility: A Glance

Background: Perinatal care is important to improve the outcome of the pregnancy and reduce associated morbidity and/or mortality to the pregnant mother and the developing fetus. Ideally, preconception counseling and preparedness for conception are necessary for an optimal pregnancy outcome. But this is not practiced by everyone due to various reasons. In such a scenario, an early antenatal visit will provide an opportunity for early screening and prepare a plan of care that will result in a better outcome of the pregnancy. In many countries, pregnant women still start their first antenatal visit late. Hence this study aims to determine the mean gestational age at booking, the magnitude and the factors associated with late booking for antenatal care in a tertiary care referral hospital. Objective(s): (1) To assess the gestational age of booking for antenatal care in a tertiary referral healthcare facility. (2) To assess the prevalence of late booking and factors contributing to it. Material(s) and Method(s): This is a prospective study conducted on pregnant women visiting the outpatient Obstetrics and Gynaecology Department at Saveetha Medical College and Hospital from February 2020 to July 2020. A total of 203 pregnant mothers, who consented to the study, were interviewed at the antenatal clinic by using a structured questionnaire. The data was compiled and assessed using Microsoft Excel. The mean gestational age at booking and prevalence of late booking visit and their causes are assessed. Bivariate and multivariate data analysis was performed using Statistical Software for the Social Sciences (SPSS) for Windows version 16.0. Result(s): This study showed that 203 pregnant women who participated in the study were between 19 and 40 years of age. A total of 121 patients were nulliparous, and 82 were multiparous. The mean gestational age at booking was found to be approximately 11 weeks of gestation in the study group. Around 83 were late for their booking visit (40.89%). Lack of knowledge of early booking and its benefits was the most common cause of increased gestational age at the first antenatal visit (28.92%). The recent COVID-19 outbreak this year has caused a delay in the booking of 12 patients (14.46%). Copyright © The Author(s). 2022.

Higher Incidence in Trauma Severity Due to Higher Alcohol Consumption during the Pandemic

INTRODUCTION: The COVID-19 mandated lockdown created unintended outcomes in traumatic injury patterns and psychosocial behaviors compared to previous years during the same timeframe. The aim of this research is to describe a population of trauma patients during the past five years to determine particular trends in ETOH levels. METHOD(S): A retrospective cohort study on prospectively collected trauma registry data of all adult (>=18 years) trauma patients admitted to this ACS verified Level I trauma center in South Carolina, inclusive years 2017 to 2021. The data was grouped based upon the COVID-19 lockdown period, which included a time between March 15 to May 22. The five groups were compared based upon ETOH levels, patient demographics, injury patterns, morbidity, mortality, and comorbidity. Continuous variables were compared using the Kruska-Wallis test, whereas categorical variables were compared using Pearson's chi-square test of proportions, as appropriate in R software. RESULT(S): A total of 3281 adult trauma patients were included in the analysis during the lockdown periodacross five years. The ETOH mg/dL trend was in decline with a mean 138 mg/dL in 2019;however, began to significantly climb during 2020 (Mean = 164 mg/dL) and 2021 (Mean = 169 mg/dL;p < 0.01). The trauma population during the 2020 group was likely full activations (p < 0.01) with penetrating injuries (p < 0.01) who received a massive transfusion (p < 0.01). The 2020 group typically had a longer ICU length of stay (Mean = 1.77 days;p < 0.01), and longer ventilation days (Mean 0.72;p = 0.02). CONCLUSION(S): Excess alcohol consumption particularly during a pandemic year and beyond may lead to a higher incidence in trauma severity, such as penetrating injuries needing massive transfusions. The psychosocial impacts of government-mandated lockdowns may lead to increased alcohol consumption leading to a higher degree of severity and morbidity markers in the trauma population in South Carolina.

The Use of Invasive Mechanical Ventilation in Hospitalized Covid-19 Patients

INTRODUCTION: Increased mortality due to COVID-19 in the intensive care unit (ICU) raised questions about the best way and time to use invasive mechanical ventilation (IMV). The purpose of this study is to analyze effectiveness of IMV in COVID-19 patients. METHOD(S): We performed a retrospective analysis of adult patients admitted to our hospital with COVID-19 infection from May 2020 to December 2021. We reviewed the need of IMV in patients admitted to the ICU with APACHE II scores higher than 12.5. Outcomes from the IMV-receiving patients were compared to outcomes from patients on non-invasive mechanical ventilation (NIMV). The second analysis of IMV aimed to determine the best initiation time for IMV. Patients were divided into Group1: early intubation (IMV within the first 24hrs of admission) and Group2: late intubation (IMV later than 24hrs after admission). Primary outcomes included mortality and length of stay (LOS) in the ICU. Descriptive statistics, Mann-Whitney-U and Chi-square methods were used. RESULT(S): For the first part of the analysis, 82 patients were included. They were divided into 2 groups (IMV and NIMV) of 41 patients each. Median age in IMV group was 67 [51.5- 75.5] vs 64 [47.5-73.5]. 21 (51.2%) patients died in the IMV group vs 22 (53.7%) X2(1, N=82)=0.049, p=0.5. Median LOS in the IMV group was 10 [6-16] days vs 11 [5-19.5] days U(NIMV group=41, NNIMV group=41)=819, z=-0.2, p=0.84. For the second analysis, 68 patients were included. They were divided into 2 groups (Group1 and 2) of 34 patients each. Median age in group1 was 53.5 [25-90] vs 53.5 [37.75-65.25]. 19 (55.9%) patients in group1 were male vs. 26 (76.5%). The median APACHE II, SOFA and ICHIKADO scores on admission in group1 were 8 [6-10.5], 1.5 [1-2], 120 [110-165] points respectively vs 9.5 [6-16.5], 2 [1-4], 150 [132.5-200] points. 3 (8.8%) patients died in group1 vs 11 (32.4%) X2(1, N=68)=5.76,p=0.033. Median LOS in group1 was 4.5 [3-8.5] days vs 6 [3.75-10.5] days U(NGroup1=34, NGroup2=34)=450, z=-1.59, p=0.113. CONCLUSION(S): In COVID-19 patients admitted to the ICU with APACHE II score higher than 12.5, mortality and LOS were not significantly different in patients that received IMV vs those that received NIMV. Early intubation correlated with improved mortality, but not with length of ICU stay.

HIV Testing Rates in NC Emergency Departments Before and During Covid Mitigation

Background. During the early stages of the COVID-19 pandemic, non-emergent services were limited or suspended in multiple ways. Restrictions in primary care may have limited STI testing, such as HIV, where timely access to testing and care is critical to mitigation efforts. Conversely, Emergency Departments (ED) operated with fewer restrictions and more in-person options. Even though patient census numbers decreased in some areas from those seen pre-covid lockdown, EDs and hospitals often became overwhelmed with patients seeking care for both severe acute illness but just importantly services that might normally have been received in outpatient settings. Methods. Observational study of HIV screening year-over-year in four EDs that are part of a large healthcare system located in the Southeast. Screenings of individuals 18 and over seen in the EDs were normalized per 1000 patients. Rates were also compared to two primary care clinics, located in the same metropolitan area, serving mainly Medicaid and uninsured patients. Results. From March 2019 through February 2020 there were 33.47 tests per 1000 patients at two community clinics and 7.79 tests per 1000 patient at four EDs located in the same region during that span. From March 2020 to February 2021, screening numbers in the primary care clinics dropped to an average of 22.7/1000;however, screenings in the ED remained stable and slightly increased to 10.7/1000. From March 2021 to February 2022, screenings in the primary care clinics returned to an average 36.9/1000 with screenings in the ED still above pre-covid levels at 9.48/1000. These trends in the ED screening remained consistent across gender, race, and ethnicity. Patient census at four ED sites located in the southwestern region of North Carolina dropped significantly during the first year of physical distancing covid-19 mitigation measures when compared to the two years prior. These census numbers increased during the second year of covid-19 but failed to return to previous levels. During the first year of physical distancing covid-19 mitigation measures HIV testing rates in the emergency department remained constant, and even increased in more urban areas, despite the significant decrease in overall patient census. Conclusion. With the observation that HIV screening decreased in primary care settings during the beginning of the covid-19 pandemic, there exists the possibility that new HIV infections may yet remain undiagnosed. That HIV testing remained constant in the ED, however, reinforces the importance of having embedded procedures in place for screening and linking both newly positive and at-risk patients into care to help mitigate the HIV epidemic. (Figure Presented).

Expand accessibility of monoclonal antibody in COVID-19 among different ethnicities and races

Background. Anti-SARS-CoV-2 monoclonal antibodies are administered to patients with mild-moderate COVID-19 who are at high risk of progression to severe disease. It has been shown that in addition to medical comorbidities, race or ethnicity may also place patients at high risk for progression to severe COVID-19 infection due to social disparities including limited access to care. The purpose of this study is to increase the accessibility of monoclonal antibody infusion to patients at high risk for severe outcomes of COVID-19, irrespective of race and ethnicity, by expanding outreach resources when availability of oral antiviral therapies was limited. Methods. We performed a single-center retrospective analysis of patients with mild-moderate COVID-19 infection receiving sotrovimab, amonoclonal antibody, between December 2021 and January 2022. A total of 93 SARS-CoV-2-positive patients meeting EUA criteria for eligibility were infused with sotrovimab in different settings such as emergency department, outpatient setting including infusion clinics and cancer centers, home health as well as patients hospitalized due to reasons other than COVID-19 at RUSH medical center, Chicago. For context, during omicron surge, initially home health was set up followed by introduction to infusion clinics. Primary care provider could refer patients to the infusions clinics or home health. Results. Out of 93 patients, 8 patients received mAb infusion in emergency department, 25 patients each in cancer center and infusion clinic, 17 patients in home health setting and 18 patients who were hospitalized due to reasons other than COVID-19. The median age of participants was 57 years and 61.2% were females. Overall, Hispanic patients received mAb less often than did non-Hispanic patients (33% vs 62%). Black, Asian and other racial groups received mAb 18.2%, 3.23%, 3.23% less often, respectively, than did White patients. Interestingly, in home health setting, Hispanic patients received infusion more often than non-Hispanic patients (12.9% vs 5.3%). Conclusion. Implementation of programs centered around needs of community such as increase accessibility to COVID-19 medications through home health or infusion clinics may help mitigate the racial and ethnic disparities in COVID-19 and thus, promote health equity.

The MET Project: Distinguishing Multisystem Inflammatory Syndrome in Children from Typhus Using Artificial Intelligence

Background. Multisystem inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection shares features with other inflammatory states, notably Kawasaki Disease. The rickettsial infection murine typhus is also in the differential for MIS-C in endemic areas. As the therapeutic approaches differ, it is essential to distinguish these disorders soon after presentation, well before confirmatory serologic testing results. Our objective was to develop an algorithm to accurately predict MIS-C versus typhus. Methods. Retrospective review extracted demographic, clinical, and laboratory features available within 6 hours of presentation for 133 MIS-C and 87 typhus patients. 33 features were broken into 44 inputs and passed through an attention module to compute importance. Inputs were then entered into machine learning algorithms as MIS-C or typhus. Patients were divided into training and test cohorts respecting proportions in the dataset. An equation was built to calculate the 'MET' (MIS-C versus endemic typhus) score. Results. MIS-C patients were younger (8.4 v 11.2 years, p< 0.0001) and the majority (71%) presented on day 4-6 of fever;most typhus patients (84%) presented with >=6 days (mean 4.9 v 7.3 days, p< 0.0001). Typhus patients were more likely to have rash (86% v 51%, p< 0.0001) and MIS-C patients red eyes (71% v 36%, p< 0.0001), other features were similar. MIS-C patients had higher C-reactive protein levels (17.7 v 9.8 mg/dL), procalcitonin (14.0 v 0.48 ng/mL), fibrinogen (558 v 394 mg/ dL) and neutrophil-to-lymphocyte ratio (12 v 3.5), all p< 0.0001, other parameters were similar. MIS-C patients were also more likely to have elevated troponin (0.48 v 0.01 ng/mL, p< 0.0001) and require intensive care (66% v 6%, p< 0.0001). A long short term memory network outperformed 6 other models (99% accuracy using all 33 elements). The MET score predicted MIS-C versus typhus with 90% accuracy using only 10 features (sensitivity 90%, specificity 90%). Conclusion. The clinical and laboratory similarities between typhus and MIS-C present challenges, but they can be reliably distinguished using artificial intelligence with as little as 10 features. Our ongoing interprofessional collaboration aims to make the MET score readily available to clinicians for use in patient encounters.

SARS-CoV-2 specific T Cell: clinical validation of a rapid and easy to use method based on direct realtime PCR amplification

Introduction: SARS-CoV-2 immune-response is mediated by both humoral and cellular immunity. However, since Ab levels wane faster than SARS-CoV-2 specific T cells immunity, cellular immunity represents an important factor for COVID-19 immune defence. Determining immunoreactivity of SARS-CoV-2 specific T cells is of clinical relevance in transplant recipients or patients treated with immunomodulant therapy. SARS-CoV-2 specific T cells assays are currently based on ELISA, whilst rapid tests are pivotal for real-time patients' evaluation. In this study, a novel direct real-time PCR (dRT-PCR) targeting mRNA of CXCL10 for measuring SARS-CoV-2 specific T cells, was tested and evaluated. Method(s): A total of 104 healthcare workers, with two or three doses of homologous (Pfizer/BioNTech, n = 82) or heterologous (Pfizer/BioNTech and Vaxzevria or Moderna, n = 22) vaccinations were asked to collect a blood (Li-He) sample. Blood was stimulated overnight with SARS-CoV-2 spike peptides (S-peptide) or treated with non-stimulating substance. Stimulated/treated samples were diluted in Buffer A, mixed with dqTACT MS then loaded into the cartridge. The analysis was performed using SCV2 T Activation kit, bCube and bApp (Hyris srl, Lodi, Italy), equipped by an automatic result interpretation based on artificial intelligence. For a subgroup of 49 samples, IFN-y releases to SARS-CoV-2 spike peptides were tested by Quant-T-Cell SARS-CoV-2 and ELISA (Euroimmune, Lubeck, Germany). Result(s): Seventy-nine (75.9%) and 25 (24.1%) were females and males, respectively. Twenty-nine subjects were previously infected by SARS-CoV-2. Overall mean age (+/- SD) was 45.9+/-13.3 years. At qualitative analyses, 97 subjects (93.2%) resulted reactive to S-peptides, 3 (2.8%) were borderline and 4 were negative (3.8%). These negatives had their third vaccinal dose in December/November 2021. Previous infected individuals presented reactivity to S-peptides, with the exception of one subject with resulted reactive also in the untreated sample. Samples tested with both dRT-PCR and ELISA perfectly agreed (100%) with both methods. At quantitative analyses, between-assay correlation was 0.32 (p<0.001). Conclusion(s): Hyris dRT-PCR appeared accurate for determining presence or absence of immunoreactivity of SARS-CoV-2 specific T cell, especially when rapid analyses are required, such as for organ transplantation.

Estimation of immune response (IgG) to SARS-COV2 (COVID-19) after the third COVID-19 wave in Egypt, A cross-sectional Study

Since the start of the pandemic, the number of cases has been increased rapidly. Due to asymptomatic and mild cases and restricted testing in many geographic locations, the overall number of actual COVID-19 cases is likely significantly higher than the number of verified cases. Several COVID-19-related comorbid diseases impair immune system function, which has an impact on COVID-19 responsiveness. So, we evaluated the immune response to SARS-CoV-2 after the third wave of COVID-19 and assessed the effect of comorbid diseases on this immune response. The current cross-sectional study was conducted in August 2021 after the third wave of COVID-19. The study included 287 participants. All participants were asked about their epidemiological data, comorbid diseases, data suggesting COVID-19 infection, and precautions measures to minimize the exposure to the disease. Of the 278 participants, 50% had a positive IgG response to COVID-19. Regarding comorbid diseases, the IgG antibody titer was significantly lower in patients with chronic kidney diseases (CKD) on dialysis, ischemic heart disease, and chronic obstructive lung diseases than other participants (p= 0.01, p= 0.02, p= 0.005, respectively). Neither precaution measures nor comorbid diseases had a role in risk factors of COVID-19 infections in our participants. In conclusion, high seroprevalence (50%) of SARS-CoV-2 IgG antibody after the third wave of COVID-19 was observed in the current study. Comorbid conditions as hypertension, chronic cardiac diseases, chronic chest problems, and CKD on dialysis could decrease the immune response against COVID-19 infection. Copyright© by the Egyptian Association of Immunologists.

COVID-19 vaccine hesitancy among breast cancer patients in East Avenue Medical Center

Introduction: Vaccine hesitancy has been an ongoing complex public issue in the Philippines posing threats to progress against preventable outbreaks and significant morbidity and mortality from COVID-19. Patients with cancer were not included in the initial vaccine trials against COVID-19 hence the plausible explanation behind vaccine hesitancy in this population. This study attempts to determine the factors affecting a patient diagnosed with breast cancer to receive COVID-19 vaccine based on constructs from the Health Beliefs Model (HBM). Objective(s): To determine the factors affecting a Filipino diagnosed with breast cancer to receive COVID-19 vaccine, namely;perceived susceptibility and severity to COVID-19 and perceived benefits and barriers to getting a vaccination against COVID-19. Method(s): A single- center, descriptive, cross-sectional study in patients diagnosed with breast cancer was conducted to assess COVID-19 vaccine hesitancy. Result(s): A total of 85 eligible breast cancer patients were included in the analyses. Age, socio-economic factors, and presence of co-morbidities and metastasis were not significantly associated with COVID-19 vaccine hesitancy. Concerns on efficacy, safety, faulty or fake vaccine, as well as if the vaccine was taken by many in the public were significantly associated with hesitancy (p <0.05) when taken as individual factors. The perception of COVID-19 vaccine safety under the perceived barriers construct was found to be the only significant factor to predict vaccine hesitancy (OR= 4.737, CI 1.75, 12.82). Conclusion(s): Interventions that focus on perceived barriers are most crucial in order to increase vaccination rate among breast cancer patients.

Intravitreal injections in the era of COVID-19-The Metro South Health Queensland experience

Background: Intravitreal anti-vascular endothelial growth factor therapy currently represents the treatment standard for vision-threatening macular conditions, while treatment delays cause precipitous vision loss. The COVID-19 pandemic prompted unprecedented delays for patients receiving intravitreal injections (IVI). We aim to provide real-world data on the effects of delayed IVI treatment due to COVID-19 at our center and its associated visual consequences. Method(s): In this retrospective cohort study based at a tertiary hospital in metropolitan Brisbane, medical records were reviewed for consecutive IVI patients within a 6-week interval between March-May 2020. Patients were divided into two groups based on whether they maintained or delayed their follow-up visit. Main outcome measures included best-corrected visual acuity (BCVA), central macular thickness as well as structural findings on OCT suggestive of disease activity. Result(s): A total of 682 patients were scheduled to receive IVI-based care, with treatment delay observed in 123 patients (18.5%) for an average period of 64 days. BCVA worsened in the delayed group by an average of 0.136 letters compared to 0.008 in the control group (p = 0.02), with the most significant change seen in neovascular age-related macular degeneration patients (p = 0.001). Patients on Aflibercept and Ranibizumab were more likely to maintain vision compared to those on Bevacizumab (p = 0.02 and p = 0.07). Retinal vein occlusion patients were most likely to suffer from longterm visual consequences from delayed follow-up. In multivariate linear regression model for risk factor analysis;BCVA, distance from hospital and patient age were all correlated with treatment delays. Conclusion(s): Patients who experienced treatment delays suffered short-term visual decline. However, visual losses were not sustained in majority of patients.

Measured subjective differences in intensity of clitoral and vaginally activated orgasm

Objectives: We aimed to investigate the difference in perceived intensity of orgasm among women experiencing clitoral or vaginally activated orgasm (VAO). Method(s): We reviewed data from the Sex@COVID online survey (Mollaioli et al, J Sex Med. 2021 Jan;18(1):35-49) to retrieve a sample of heterosexual Italian sexually active female subjects. Several validated questionnaires and inventories were used to investigate sexual and psychological health (GAD-7, Lowe et al, Med Care 2008;46:266-274;PHQ-9, Kroenke et al, J Gen Intern Med 2001;16:606-613;FSFI, Rosen et al, J Sex Marital Ther 2000;26:191-208). Result(s): 1207 women were included in analysis: 346 were in a non-cohabiting relationship (Group A, 28.7%), 581 were in a cohabiting relationship (Group B, 48.1%) and 280 were married (Group C, 23.2%). 40.9% of the study population reported being able to orgasm through both clitoral stimulation and vaginal penetration (n = 494), 35.4% through clitoral stimulation (n = 427) and 20.1% through vaginal stimulation (n = 243). Additionally, 3.6% (n = 43) reported being unable to reach orgasm at all. By analysis of variance, following adjustment for FSFI, PHQ-9, GAD-7 and age, women experiencing no orgasm had lower orgasmometer scores (beta = -0.75, p <0.001), and VAO were associated with higher orgasmic intensity compared to clitoral orgasms (beta = 0.10, p = 0.008). Experiencing both orgasms had no effect compared to VAO (beta = 0.03, p = 0.545). Women who preferred reaching orgasm through masturbation to partnered sexual activity had lower orgasmic intensity (beta = -0.28, p = 0.002). Groups B and C had better orgasmic intensity compared to group A (beta = 0.08, p = 0.009). Conclusion(s): Orgasmic intensity differs between VAO and clitoral orgasms, independently of other confounding factors. This finding provides additional insight on the role of the clitourethrovaginal complex in female sexual function. Conflicts of Interest: None of the authors report any competing interests for the present study. Copyright © 2022

Second SARS-CoV-2 Booster Vaccination Significantly Reduces Haemodialysis Patients' Susceptibility to Infection With Omicron Variant

Background: Patients requiring haemodialysis (HD) have disproportionately poorer outcomes from SARS-CoV-2 infection and vaccines afford an opportunity to improve this. However, the efficacy of booster doses on infection with emerging variants remains unclear in this population. Method(s): We report the real-world impact of SARS-CoV-2 booster vaccinations in an ethnically diverse urban cohort of 1172 patients receiving in-centre HD who were routinely screened for SARS-CoV-2 infection by weekly nasopharyngeal PCR between 1st December 2021 and 31st March 2022, during dominant UK prevalence of B.1.1.529 variant ("Omicron"). Where possible, genomic sequencing was performed as standard of care. Result(s): At the start of the observation period, 896 (76.5%) had received 3 doses of SARS-CoV-2 vaccine and only 87 (7.4%) were unvaccinated. By end of study 664 (59.5%) had received 4 vaccine doses. 305 patients had PCR positive SARS-CoV-2 infection, with Omicron variant confirmed in all but one of samples successfully tested. Clinical course of infection was mild: around half of patients asymptomatic, only 1 in 20 hospitalised, case fatality 3%. Three or more vaccine doses significantly associated with reduced risk of SARS-CoV-2 PCR positivity compared to unvaccinated status, together with White ethnicity and lower deprivation index (Cox regression p<0.03). However, 2 booster doses further reduced the risk of infection by around a third compared to 1 boost, independent of age, gender and comorbidity. Conclusion(s): A second SARS-CoV-2 booster vaccine further reduces the risk of Omicron infection in haemodialysis patients. As such, a double-boost policy could significantly reduce the burden and associated spread of SARS-CoV-2 infection in this vulnerable population.

Role of Telemedicine in Otorhinolaryngology during COVID-19 Pandemic in a Tertiary Care Centre of Tamil Nadu: A Prospective Cohort Study

Introduction: Telemedicine is the practice of using telecommunication technology to provide healthcare services to patients in remote areas. Teleconsultation is used in various specialties of medicine, especially during the COVID-19 pandemic situation. But in developing countries like India, it is less practicable in surgical specialties like Otorhinolaryngology. Aim(s): To determine the eligibility and effectiveness of telemedicine practice in otorhinolaryngology during the COVID-19 pandemic in a tertiary care centre of Chengalpattu district, Tamil Nadu, India. Material(s) and Method(s): A prospective cohort study was conducted at Chettinad Hospital and Research Institute, Tamil Nadu, India from September 2021 to February 2022 which involved 90 patients who requested a consultation for various ear, nose, and throat complaints. Based on history, a provisional diagnosis was made and treated. Feedback forms contained 11 questions were sent during the revisit and analyses were made. Statistical analysis were done using mean, proportion and Chi-square test. Result(s): This study included 49 (54.4%) male and 41 (45.6%) female patients with a mean age of 40.68 years. Only 23 (25.6%) patients had no problem seeing the doctor clearly and 19 (21.1%) had no trouble hearing the doctor. Only 4 (4.4%) patients accepted teleconsultation and will use teleconsultation services again. Conclusion(s): This study concluded that teleconsultation practice was not satisfactory for the majority of patients in the field of otorhinolaryngology. The inability to arrive at the definitive diagnosis and subsequent therapeutic procedures by using telemedicine was the limitation. Copyright © 2022 Authors. All rights reserved.