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Introduction: Surgical treatment of rectal cancer depends on clinical stage, size and location of primary tumor. A sphincter preserving technique such as low anterior resection (LAR) is the preferred method if negative distal margin can be achieved. If an adequate distal margin cannot be obtained, an abdominoperineal resection (APR) is required. A proctosigmoidectomy (Hartmann's procedure) is performed in patients with potentially curable obstructing rectal cancer after neoadjuvant chemoradiotherapy, or as a palliative treatment for locally advanced rectal cancer. Aim(s): The aim of this retrospective study was to investigate the impact of COVID 19 pandemic on the number and type of surgeries performed for the treatment of rectal cancer in UHC Zagreb, Department of Surgery. Material(s) and Method(s): Collected data were extracted from medical records of the patients who underwent surgery at the Department of Surgery from 1st of January 2016 to 31st of December 2022 with prior Ethics Committee approval. Total of 688 patients were included. Retrospective analysis of number and type of surgery was done consecutively by years for the period of interest. Result(s): In 2016 total of 75 patients underwent elective surgery for rectal cancer. LAR was performed in 64% (N=48) of patients, Hartmann's procedure in 20% (N=15), and APR in 16% (N=12). In 2017, 94 surgeries were performed. LAR accounted for 64% (N=60), Hartmann's procedure 17% (N=16), and APR 19% (N=18). In 2018, 115 surgeries were performed. LAR accounted for 69% (N=79), Hartmann's procedure 10% (N=12), and APR 21% (N=24). In 2019, 80 surgeries were performed. LAR accounted for 67% (N=54), Hartmann's procedure 9% (N=80), and APR 24%. In 2020, 78 surgeries were performed. LAR accounted for 59% (N=46), Hartmann's procedure 14% (N=11), and APR 27% (N=21). In 2021, 124 surgeries were performed. LAR accounted for 66% (N=82), Hartmann's procedure 14% (N=17), and APR 20% (N=25). In 2022, 122 surgeries were performed. LAR accounted for 64% (N=78), Hartmann's procedure 15% (N=18), and APR 21% (N=26). Conclusion(s): Our results show steady growth in numbers of performed surgeries in the years prior to the pandemic, with exception of the year 2019 when our department underwent organizational changes. In 2020, significant decrease in number of surgeries was observed as a result of restrictive epidemiological measures established to reduce the spread of COVID 19 infection. COVID 19 pandemic measures also resulted in delayed diagnosis and treatment of rectal cancer which is indirectly shown through the increasing share of Hartmann's procedure. In the years following the relaxation of measures, significant increase in number of performed surgeries that exceeded all the pre-pandemic years was recorded. Constant elevated share of Hartmann's procedure was noted as possible consequence of post COVID delay in diagnosis and confirmation of rectal cancer in more advanced stages of disease.
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Introduction: Effective spinal anaesthesia for caesarean delivery (CD) is assumed to cause bilateral sympathetic blockade with increased feet skin temperature due to vasodilatation [1]. There has been no published study of peripheral skin temperature measurements during spinal anaesthesia for CD. Our study investigated foot skin temperature changes as spinal anaesthesia was established. Method(s): A single centre, prospective observational study with ethics committee approval (IRAS No. 263967). With informed consent, 60 healthy parturients, 37-42 weeks' gestation with singleton pregnancy scheduled for category 4 CD with spinal anaesthesia were recruited. Standard spinal anaesthesia used 0.5% hyperbaric bupivacaine and diamorphine with IV Phenylephrine and fluids. Skin temperature was measured on the dorsum of both feet with Covidien Mon-a-Therm© skin thermistor sensors prior to intrathecal injection and every minute after until completion of surgery. Theatre room temperature and ambient temperature under surgical drapes were recorded. Two controls were recruited. Result(s): All participants had successful spinal anaesthesia. The Figure shows mean (95% CI) skin temperature changes of both feet of participants during spinal anaesthesia and for controls. The maximum rate of skin temperature increase occurred 5-12 minutes after spinal injection with temperature change plateauing after 30 mins. The mean temperature range was 5.54degreeC (min = 29.7degreeC;max = 35.2degreeC). Discussion(s): This study characterises for the first time the peripheral temperature changes in the feet that occur with sympathetic block after spinal anaesthesia in parturients. Increased bilateral foot skin temperatures occur within 10 minutes of spinal injection. This may be useful for determining successful spinal anaesthesia for CD in addition to other assessments [2]. The insights may be useful for assessing epidural analgesia. The study was supported by an OAA research grant. Data collected by ROAR group.Copyright © 2023 Elsevier Ltd
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Objectives: Patients with Systemic Lupus Erythematosus (SLE) are predisposed to serious infections due to immunocompromise, comorbidities, immunomodulatory and/or immunosuppressive therapy, as well as the lack of these medications faced by patients dependent on the Sistema Unico de Saude (SUS) during the COVID-19 pandemic. Studies revealed a low risk of worsening disease activity after vaccination against SARS-CoV-2 and safety in the continuity of immunomodulatory therapy during the vaccination stages. Thus, immunization against COVID-19 is an important pillar in reducingmorbidity and mortality related to infectious conditions and SLE. This study had the objective to understand the disease activity in SLE patients after vaccination against COVID-19. Method(s): This is an observational, longitudinal, ambidirectional study with follow-up of subgroups of patients with immune-mediated rheumatic diseases immunized with vaccines made available by the Programa Nacional de Imunizacao (Butantan Institute, Pfizer/BioNTech, BioManguinhos/Fiocruz and Janssen). Data from the SLE disease activity index 2000 (SLEDAI-2 K) and sociodemographic data were collected and stored via an online platform, with a comparison of the index before and after each dose. This study was approved by the local Research Ethics Committee, and it is associated to the SAFER Project from Brazilian Society of Rheumatology. Result(s): A total of 223 patients were included, of which 83% were female and 39% had SLE, 36.7 +/- 11.76 years old. Regarding the disease activity, at inclusion the mean PGA score(SD) was 2,61 +/- 2,77. After the 1st dose it was 1.38 +/- 2.17, after the 2nd dose it was 2,35 +/- 2,99, after the 3rd dose it was 2,19 +/- 2,58 and after the 4th dose 1.18 +/- 1.88. The mean SLEDAI-2 K score at inclusion was 7,27 +/- 9,70, after the 1st dose it was 2,75 +/- 5,29, after the 2nd dose it was 4,73 +/- 6,40, after the 3rd dose 3,33 +/- 5,51 and after the 4th dose 2.12 +/- 4.27. 6% of the patients referred worsening disease activity after the 1st dose, 14,3%after the 2nd dose, and no patient reportedworsening of disease activity after the 3rd and 4th doses. Conclusion(s): Vaccination did not contribute toworsening disease activity of the SLE patientss studied, according to the indices used to assess disease activity.
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Objectives: Immunization against SARS-CoV-2 is an effective strategy to reduce morbidity and mortality in the face of the COVID-19 pandemic. People with Immune-mediated Rheumatic Diseases (IMRD) also benefited from this campaign. However, there is a limited amount of data on the outcome of vaccination in these patients, in terms of those who were infected by the virus. This study had the objective to evaluate the rate of COVID-19 cases in patients with IMRD after vaccination against SARS-CoV-2. Method(s): Observational, longitudinal and ambidirectional study with follow-up of subgroups of patients with IMRD immunized with vaccines made available by the National Immunization Plan (inactivated adsorbed vaccine registered by the Instituto Butantan (IB), recombinant vaccines registered by Bio Manguinhos/ Fiocruz and by Janssen, and Pfizer/BioNTech). Sociodemographic data and questionnaires on flu syndrome, laboratory confirmation of infection and need for hospitalization and outcomes were collected and stored via an online platform. This study is associated to the SAFER Project from the Brazilian Society of Rheumatology and it was approved by the local Research Ethics Committee. Result(s): A total of 223 patients aged over 18 years, mean age 42.79 +/- 15.18 years, were included. All were within the inclusion/exclusion criteria, with 83% being female. The main IMRD included were systemic lupus erythematosus (39%) and rheumatoid arthritis (33.6%). After the 1st dose, 1.45% of patients had COVID-19, 50% sought health services (emergency care), without the need for hospitalization and after the 2nd dose, 1.5% had the disease, of which none sought health services, required hospitalization or had a negative outcome. After the 3rd dose,: 2.9%were infected with SARS-CoV-2 one month later, 15.6% two to three months later and 5.5% four to six months later, all with laboratory confirmation;only 4% presenting any serious complication;there were no deaths. After the 4th dose, 9.1%of patients had COVID-19, of which 40%were hospitalized, without the need for assisted ventilation;half of these patients had a serious complication, but there no deaths. Conclusion(s): In this study, we observed the effectiveness of the vaccine in preventing severe cases of COVID-19 and complications of SARS-CoV-2 infection.
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Objectives: Chronic Inflammatory Immune-mediated Diseases (CIMD) can cause pain and severe discomfort to the patient, leading to significant reductions in his/her quality of life. Vaccination against COVID-19 has proven to be an efficient method in preventing cases and serious repercussions. However, there is insufficient evidence on the safety of these vaccines in the CIMD population. Objective(s): To assess disease activity in adolescent patients with CIMD after vaccination against SARS-CoV-2. Method(s): Observational, longitudinal, ambidirectional study with follow-up of groups of adolescent patients with CIMDwho received the vaccine provided by the National Immunization Program -Pfizer/BioNTech. Sociodemographic and clinical disease activity data were collected before and after each vaccine dose. Data were stored through an online platform (REDCap). This study is associated to the SAFER Project from the Brazilian Society of Rheumatology and was approved by the local Research Ethics Committee. Result(s): Nineteen adolescents aged between 12 and 17 years were included, all of whom met the inclusion/exclusion criteria. Of the total, 31.6% have Juvenile Idiopathic Arthritis (JIA)-14.33 +/- 2.25 years of age, whose subtypes included persistent oligoarticular JIA (16.7%), Polyarticular Rheumatoid Factor (RF) negative (33.3%), Polyarticular RF positive (16.7%) and Systemic (33.3%);68.4% have Systemic Lupus Erythematosus (SLE) -14.77 +/- 1.96 years of age. Regarding JIA patients, at inclusion, the mean disease activity assessed by the physician was 3 +/- 3.83 and 3.25 +/- 3.77 as assessed by the patient. After the 1st dose, the mean activity assessed by the physician was 2.8 +/- 3.9 and after the 2nd dose it was 3 +/- 4.24. Themean activity after the first dose as assessed by the patient was 3.2 +/- 3.96, and after the 2nd dose it was 2.8 +/- 3.11. In the SLE patients, at inclusion, the mean degree of disease activity was 1.92 +/- 1.83 and of the SLEDAI-2 K was 4.67 +/- 5.14. After the 1st dose, the mean disease activity was 1.11 +/- 1.96, and after the 2nd dose, it was 2.25 +/- 2.76. After the 1st dose, the SLEDAI-2 K was 1.11 +/- 1.76, and after the 2nd dose it was 4.25 +/- 5.28. No reports of worsening of disease activity after the vaccine were found. Conclusion(s): The vaccination proved not to contribute to worsening of clinical activity of rheumatic diseases in adolescents, without significant changes in SLE assessment indices and in the personal and medical assessment of JIA patients.
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Objectives: In the Chronic Inflammatory Immune-mediated Diseases (CIMD), infections mainly occur in the respiratory tract and their occurrence is related to drug-induced immunosuppression, underlying diseases and comorbidities. To reduce this morbidity and mortality, vaccination is an effective means of prevention. However, the available studies on SARS-CoV-2 vaccines have not addressed this group of patients with CIMD, and there are still many doubts regarding the indications, adverse effects, safety and efficacy of these vaccines. Objective(s): to evaluate the adverse effects of vaccines against SARS-CoV-2 in adolescent patients with CIMD. Method(s): Research associated to the SAFER Project from Brazilian Society of Rheumatology. It is an observational, longitudinal, ambidirectional study, with follow-up of groups of vaccinated adolescent patients with CIMD, vaccine by Pfizer/BioNTech. Sociodemographic data were collected, stored on an online platform, and adverse events were presented by filling in diaries issued for each patient. This study was approved by the local Research Ethics Committee. Result(s): We included 19 adolescents, aged between 12 to 17 years, who met the inclusion and exclusion criteria. The mean age was 14.63 +/- 2.01 years. Of these, 68.4% were female. In relation to CIMD, 31.6% have Juvenile Idiopathic Arthritis and 68.4% have Systemic Lupus Erythematosus. All were vaccinated with the Pfizer vaccine. In the 1st dose, the main adverse effects presented were Pain at the injection site (85.7%), Headache (42.9%), Tiredness (33.3%) and Edema and skin induration at the injection site (26, 7%). After the 2nd dose, the only adverse effect reported was Pain at the injection site (57.1%), with no other complaints. Conclusion(s): The adverse effects reported are of mild tomoderate reactogenicity;no serious adverse events were reported.
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Intro: The spike protein of the SARS-CoV-2 virus targets the human cell receptor of angiotensin-converting enzyme (ACE2), including the myocardium and heart's conduction system. Patients diagnosed with COVID-19 have also been found to exhibit cardiac arrhythmia. Here, a whole-genome sequencing analysis using long-read sequencing was proposed to evaluate the virus genome in a patient who presented with AVNRT as a main presentation of COVID-19. Method(s): The sample was recovered from nasopharyngeal and oropharyngeal swab specimens of a 46-year-old female with no comorbidities who presented with palpitation, and ECG showed typical AVNRT features. The RT-qPCR of SARS- CoV-2 was confirmed positive with a CT-value of 15.82. The total RNAs were extracted and proceeded for RT-qPCR and proceeded with Oxford Nanopore Flongle sequencing. The genomics data of the virus was deposited in GISAID (EPI_ISL_3241561) and further analysed using online bioinformatics tools such as Nextclade CLI 2.3.0. Ethical approval (IREC 2021-080) for the study was obtained from IIUM Research Ethics Committee. Finding(s): Here, we reported a total of 29,775 bp near-complete whole-genome belonging to clade 21J (Delta) of AY.79 lineage (also known as B.1.617.2.79), which formed a dominant variant in Malaysia during the time of sampling. Discussion(s): While a previous study showed an association between Delta variant infection with fulminant myocarditis, the present study reported the benign AVNRT as the main presentation of SARS-CoV-2 infection. Furthermore, we observed the presence of the C3037T mutation previously described in the endomyocardial biopsy of a patient with persistent arrhythmia. Conclusion(s): Even though SARS-CoV-2 targets the respiratory tract, the present study supports the evidence that the ACE2 receptors are present in the heart. In addition, COVID19 is causing more and more damage to heart tissue, and viral transcription has been confirmed on cardiomyocytes. Further functional studies are needed to explore the associated mutations and their relation to cardiac manifestation.Copyright © 2023
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Background/Aims Up to one-third of people with rheumatological conditions were required to 'shield' from COVID-19. This co-produced, qualitative research aimed to understand experiences of the shielding process and the impact of shielding upon people's lives. Methods Adults who shielded due to rheumatological disease participated in audio-recorded interviews and focus groups (FGs). Framework analysis combined inductive and deductive approaches. Creative materials were collected. Two patient contributors proposed the study, are co-investigators, and conducted the research alongside a clinical academic and four-member patient advisory group. COREQ and GRIPP2 guidelines were followed. Full ethical approval was granted by the University of Manchester Research Ethics Committee (2021- 11544-20348). Results Data were generated from 28 interview and 12 FG participants between October 2021-January 2022. 15 people contributed creative materials. Characteristics included 44/48 (85%) female, ages 18-75 years, non-white 10/48 (21%), all UK regions (Table 1). Corbin & Strauss's theory, 'Three lines of work: Managing chronic illness', frames the findings. Shielding increased and shifted the burden of 'illness work' onto patients, e.g., in gaining access to vaccines and navigating risks and uncertainties due to COVID-19. 'Life work' was increased as participants struggled to access food and medicines. Participants' self-identity was re-appraised in the context of their illness. Many feared for their lives because of their diagnosis for the first time, increasing 'biographical work'. Participants' perceived value to society changed over time: feeling equal to the general population at the first UK national lockdown;abandoned by society due to 'freedom day' and formal shielding's end. 'Emotional work' was added to 'Three lines of work'. Shielding notification induced fear, stress, devastation, shock and disbelief, balanced by a feeling of being protected. Emotions experienced include anxiety, guilt, anger and frustration. Mental health problems were experienced, often for the first time. Many continued to shield beyond formal shielding's end. Conclusion This co-produced, qualitative research highlights experiences and impact of shielding including increased illness, life, biographical and emotional work. Clearer, personalised information would help shielders to understand their risk and vaccine response, informing re-integration into society.
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INTRODUCTION AND OBJECTIVE: Randomised comparative outcomes are unavailable for focal therapy in localised prostate cancer. IP4 CHRONOS is an RCT aimed to optimise recruitment of patients dependent upon clinician and patient equipoise. METHOD(S): Patients with clinically significant localised prostate cancer could opt for IP4-CHRONOS-A or IP4-CHRONOS-B. IP4- CHRONOS-A randomised patients 1:1 between focal therapy(HIFU or cryotherapy) versus radical therapy(radiation or prostatectomy). Using a multi-arm-multistage(MAMS)design, IP4-CHRONOS-B randomised between focal alone(FTA) and focal combined with neoadjuvant medication (12 weeks of finasteride [FTF] or bicalutamide [FTB]). We report the pilot phase outcomes on feasibility of randomisation, early safety outcomes relative to treatment and genito-urinary functional outcomes following over 12 months treatment in IP4-CHRONOS-B. IP4-CHRONOS had ethics committee approval and was registered(ISRCTN17796995). RESULT(S): Following COVID-19 adjustments, IP4-CHRONOSA did not meet its feasibility target. Having randomised 36 patients via10 sites with a recruitment rate (95% CI) of 18% (13-23) & randomisation rate of 97%(86-100). IP4-CHRONOS-B did meet its target, randomising 64 patients across 7 sites with a recruitment rate of 43% (35-52) &randomisation rate of 100%(94-100). The only patients to withdraw were randomised to the radical arm of IP4-CHRONOS-A(4 [22%]) All patients in IP4-CHRONOS-B were compliant with neoadjuvant treatment.Only 1 patient reported CTCAE V4.0 grade>=3 adverse event(AE) in IP4-CHRONOS-A following radical treatment, another patient in each arm reported a serious adverse event(SAE) following treatment. 1 &3 patients reported an AE &SAE following FTB. 2 and 3 patients reported an AE &SAE following FTA. No patients reported any AE or SAE event following FTF. Figure 1 demonstrates generally well preserved genito-urinary function following focal treatment+/-neoadjuvant treatment. CONCLUSION(S): IP4-CHRONOS evaluated patient and physician equipoise regarding focal therapy. Traditional randomisation was not feasible due to strong patient preferences, while a MAMS RCT investigating the role of neoadjuvant agents combined with focal therapy was.
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Background. The COVID-19 pandemic has become a substantial global health crisis, unparalleled in world history. Infection dynamics can have specific characteristics in different countries due to social, economic, climatic, or geographic factors. Aim(s): to study features of SARS-CoV-2 collective immunity among the Armenian population. Materials and methods. A cross-sectional, randomized study of collective immunity was carried out according to a program developed by Rospotrebnadzor and the St. Petersburg Pasteur Institute, taking into account WHO recommendations. The study was approved by the ethics committees of the National Center for Infectious Diseases (Armenia) and the St. Petersburg Pasteur Institute (Russia). A volunteer cohort was formed (N = 6057), randomized by age and region. The study's analysis included: shares and distributions of antibodies (Abs) to nucleocapsid (Nc) antigen (Ag) and receptor binding domain (RBD) S-1 Ag in the cohort;and quantitative determination of these Abs by ELISA. During the survey, a history of vaccination was indicated by 4395 people. Results. Overall seropositivity formed in the whole cohort (by April 14, 2022) was 98.6% (95% CI: 98.1-98.7). It did not depend on age, place of residence, or occupation. When quantifying Nc and RBD Abs, the proportions of volunteers with Nc Ab levels of 1-17 BAU/ml and RBD Ab levels of 22.6-220 BAU/ml were the smallest, amounting to 6.9% (95% CI: 6.2-7.5) and 20.4% (95% CI: 19.4-21.4), respectively. With increasing serum concentrations (Nc > 667 BAU/ml, RBD > 450 BAU/ml), the proportions of individuals with the corresponding levels were 20.2% for Nc (95% CI: 19.2-21.3) and 54.2% for RBD (95% CI: 52.9-55.5). Vaccination coverage was 72.6% (95% CI: 71.5-73.7). The most frequently used were Sinopharm/BIBP (32.4%), AZD1222 (22.3%), and Gam-COVID-Vac (21%). The remaining vaccines (CoronaVac, mRNA-1273, BNT162b2, CoviVac) were used by 24.3% of vaccinated individuals. When summing vaccines by platform, it was found that: vector vaccines were used in 40.34% (95% CI: 33.57-42.39) of cases;whole-virion vaccines were used in 26.83% (95% CI: 24.76-32.20);and mRNA vaccines were used in 6.33% (95% CI: 4.84-8.91). Conclusion. The epidemic situation in Armenia by April 2022 was characterized by a high level of collective immunity, independent of age or regional factors. Vector and whole-virion vaccines have been used most widely.Copyright © Popova A.Yu. et al., 2023.
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Background and Aims: The covid-19 pandemic has reversed years of progress in the fight to end tuberculosis. So, the discovery of new drugs as antituberculosis is very much needed. Our previous studies have shown that the extract of Centella asiatica is able to inhibit the growth of Mycobacterium tuberculosis in vitro and requires further research. The aims of this study is to prove the effect of Centella asiatica inhibit Mycobacterium tuberculosis in rat model tuberculosis. Method(s): The protocol in this study was approved by the veterinary ethics committee of Airlangga University. The rat tuberculosis model was induced by intrathecal injection of a suspension of Mycobacterium tuberculosis strain H37 Rv. Twenty-eight tuberculosis rat were randomly divided into four groups. Groups 1,2, and 3 were treated with ethanol extract of Centella asiatica at 375 mg/kgBW, 750 mg/kgBW and 1500 mg/kgBW, and the fourth group was the control group. Centella asiatica extract is administered orally via an intragastric feeding tube for two weeks, once daily At the end of the experimental period, rats were sacrificed by cervical decapitation. The left lung tissue was taken aseptically and cultured on Middlebrook 7H10. Result(s): The results showed that there was no bacterial growth on the culture media in the group that received Centella asiatica extract at a dose of 750 and 1500 mg/kg BW. Conclusion(s): The conclusion in this study, that Centella asiatica extract inhibit the growth of Mycobacterium tuberculosis at doses of 750 and 1500 mg/kg BW. We thank the Directorate of Research and Community Services, the Directorate General of Higher Education, and Ministry of Education and Culture in Indonesia for the financial supportCopyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.
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Background: Long term evolution of Multisystem Inflammatory Syndrome in children (MIS-C) is poorly understood. In this report, we described the frequency of persistent symptoms and sequels after one-year monitoring in a cohort of MIS-C patients. Method(s): This is a prospective observational study in under-18-aged patients diagnosed with MIS-C between October 2020 and April 2021 in a tertiary hospital. Data from initial episode was obtained from the Spanish national database and the medical history. A standardized phone questionnaire was done one year after the acute episode. As patients pared by age and sex were included with i) history of acute COVID-19, from the same national database, and ii) with peritonitis diagnosis in the electronic medical record. Data was collected using REDCap and analysed with R. Ethics committee approval was obtained. Result(s): A total of 48 patients were included in the study, 16 in each group. Average age at hospitalization was 11,2 years old [IQR: 6,6-14,4] and 52% (23/48) were male. MIS-C patients presented high frequently 94% (15/16) cardiological complications during hospitalization, in contrast with 19% (3/16) of acute COVID-19 patients and 25% (4/16) of peritonitis group (p< 0.01). All of them resolved after a year except the ones associated to hypoxic ischemic encephalopathy in a patient with MIS-C that need ECMO assistance. Summary characteristics during acute episode are shown in Table 1. After one-year follow-up, 88% MIS-C patients suffered one or more symptoms, more frequently: headache (44%), fatigue (38%), insomnia (38%) and concentration problems (38%). A total of 56% of COVID-19 patients presented persisted symptoms, mainly fatigue and concentration problems (19%), and 31% in peritonitis group (19% loss of appetite and abdominal pain), (p< 0.001). MIS-C patients visited more frequently the medical professionals due to emotional change, behaviour or interpersonal relationships after the disease [4/16 (25%) in MIS-C vs. 0/16 (0%) in both control groups, p= 0.028]. Conclusion(s): Majority of MIS-C patients have persistent symptoms one year after acute episode, even with the resolution of cardiological complications. Frequency of long term symptoms in MIS-C patients is significantly higher than in COVID-19 hospitalized and than in a control group of surgical peritonitis patients. Summary characteristics during acute episode.
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Background Targeted screening for Gestational Diabetes Mellitus (GDM) occurs routinely at 24-28 weeks gestation using the oral glucose tolerance test (OGTT). During the COVID-19 pandemic, the Health Service Executive (HSE) and the Royal College of Obstetricians and Gynaecologists recommended discontinuing the OGTT to minimise hospital visits. Fasting plasma glucose (FPG), random plasma glucose (RPG), and glycated haemoglobin (HbA1c) were instead proposed for diagnosing GDM. This study retrospectively compared testing patterns and putative diagnostic rates for GDM in pregnancies using the HSE guidelines pre- and post-pandemic. Methods Pregnancies with complete gestation in the 18 months before (Group1) or 18 months after (Group2) adoption of revised HSE guidance at CUMH (01/05/2020) were included. Women with pre-existing diabetes mellitus were excluded. Results were extracted from databases at the Departments of Clinical Biochemistry and Haematology at CUH. Diagnostic cut-offs for GDM were: OGTT (FPG >=5.1 mmol/L or 2-h plasma glucose >=8.5 mmol/L), FPG (>=5.1 mmol/L), RPG (>=9 mmol/L), and HbA1c (>=39 mmol/mol). Diagnostic rates were compared using Chi-square analysis. The study was approved by the Cork Teaching Hospitals Clinical Research Ethics Committee. Results In Group1, 43.8% of 6,737 pregnancies had an OGTT, compared with 20.5% of 6,743 pregnancies in Group2. After implementing the revised guidelines, OGTT requests were 34.5% and 79.7% lower for primary and secondary care, respectively. Comparing Group1 with Group2, FPG was measured in 46.9 vs 49.8%, RPG in 13.3 vs 11.8%, and HbA1c in 23.7 vs 51.9%. The positive rate for GDM testing was 15.9% in Group1 and 22.0% in Group2 (p<0.00001). Conclusions OGTT use fell significantly with revised HSE guidelines, although only a modest reduction was observed in primary care. HbA1c use in pregnancy doubled during the pandemic. The proportion of pregnancies with biomarkers positive for GDM showed a small but significant increase upon adopting the new diagnostic guidelines.
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Introduction: The purpose of this study was to evaluate the functional status and ongoing respiratory symptoms of patients who have been discharged home, who were admitted to the intensive care unit (ICU) with severe COVID-19 disease. Long term complications post critical illness, such as post intensive care syndrome (PICS), are well-recognised [1], however, little data exists specific to COVID-19 ICU survivors. Method(s): Local ethics committee approval was secured. Participants were recruited using the electronic intensive care chart database. All patients, from March 2020 to November 2021, who survived Covid-19 were included. Researchers conducted phone interviews with participants and completed three questionnaires;Katz Index of Independent Living Questionnaire, Karnofsky Performance Status Scale and the American Thoracic Society (ATS) Respiratory Disease Questionnaire. Data was input and analysed using excel and stored on a password encrypted computer. Result(s): Database search revealed 61 patients available, 33 of 61 patients were included. 20 (61%) were male, 13 (39%) were female. Mean age was 58, with a range of 25-81. Mean length of ICU stay was 15 days, with a range of 1-74 days. 15 (45%) patients were intubated. Most common Katz score (range 1-6) was the highest score of 6 in 23 (70%) patients. Most common Karnofsky score (range 10-100) was 60 in 11 (33%) patients, with 31 (94%) scoring < 100. The most frequent ATS shortness of breath (SOB) grade (range 0-4) was 3 in 10 (9%) patients, with 23 (70%) patients scoring > 0. 14 (42%) patients had an ongoing cough, 11 (33%) patients had a wheeze and 0 (0%) patients were on home oxygen therapy. Conclusion(s): This study highlights in the majority of patients who survived severe Covid-19 disease to discharge home, there were serious ongoing limitations to their functional status and exercise tolerance, however, they remained independent of basic activities of daily living.
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Objective: Studies have shown that individuals with disabilities participate in routine immunization programs less than individuals without any disabilities. This study was carried out to explore the attitudes of parents of children and adolescents aged 0-18 years with an intellectual disability towards vaccination before the COVID-19 pandemic. Material(s) and Method(s): This descriptive study was conducted with the parents of 94 children and adolescents aged 0-18 years who were educated in a special training center in Izmir. Socio-demographic Questionnaire and Attitudes towards Vaccination Scale were used as data collection tools for the study. Attitudes towards Vaccine Scale has been developed by Cvjetkovic et al. Ethics approval was obtained from the Izmir Katip Celebi University Non-Invasive Clinical Research Ethics Committee, and institutional approval was obtained from the institution administration. Result(s): The rate of parents who stated that they believed that vaccines had serious side effects was 73.4%. The rate of families who had never been vaccinated and thought that the vaccines were ineffective was 14.9%. The parents' total ATVS median score was 43 and they displayed a moderately positive attitude. Those who believed that "vaccines have serious side effects" had the lowest median ATVS score (p< 0.005). Median ATVS scores of fully vaccinated parents were higher than those of the parents who did not have any vaccinations and who had incomplete vaccination, and they displayed a more positive attitude (p< 0.005). According to the parents' sources of information, ATVS scores were compared (p< 0.005), and the median ATVS scores of those who received information from healthcare personnel were higher than those of the parents who received information from other sources (p< 0.005). Conclusion(s): In this study, while 14.9% of the parents of children and adolescents with intellectual disabilities reported that they did not get their children vaccinated, 85.1% got their children vaccinated. Children and adolescents with intellectual disabilities have higher health risks due to various reasons such as the inadequacy of health protection and improvement programs, and therefore, they should be among the priority groups in immunization.Copyright © 2023 by Pediatric Infectious Diseases and Immunization Society.
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Despite all efforts of the world community, the COVID-19 pandemic remains one of the main epidemiological challenges of our time. Even with its widespread distribution, the infection may have certain local features due to social, geographic, and climatic factors. Objective(s): to study collective immunity to SARS-CoV-2 in the population of the Republic of Tajikistan. A cross-sectional, randomized study of herd immunity was carried out according to a program developed by Rospotrebnadzor and the St. Petersburg Pasteur Institute, taking into account WHO recommendations. The ethics committees of the corresponding entities approved the study: Tajik Ministry of Health and Social Protection;and the St. Petersburg Pasteur Institute (Russia). Based on questionnaire results, 4,022 people were selected, representing 0.15% (95% CI: 0.14-0.15) of the total population randomized by age and region. In subsequent laboratory analysis, 3682 people took part. The distribution and quantitative content of antibodies (Abs) to viral nucleocapsid (N Ag) and receptor binding domain (RBD Ag) were determined by ELISA. When questioned, a history of SARS-CoV-2 vaccination was indicated by 69.7% (95% CI: 68.2-71.2) of the volunteer cohort. Vector vaccines were most frequently used (50.6%;95% CI: 48.7-52.5), with whole-virion inactivated preparations in second place (23.0%: 95% CI: 21.4-26.6) and mRNA vaccines in third place (21.0%;95% CI:19.4-22.6). The cohort (n = 3682) featured 27.5% men and 72.5% women. The overall seroprevalence was 98.5% (95% CI: 97.7-99.2) in men and 99.4% (95% CI: 99.0-99.6) in women (differences statistically insignificant). Overall seroprevalence in the cohort was 99.2% (95% CI: 98.8-99.4) and ranged from 97.2 to 100% in certain subgroups. Asymptomatic seropositivity in the whole cohort was 98.4% (95% CI: 97.6-99.1). As a result of a mandatory vaccination program introduced in Tajikistan under a COVID-19 Emergency Project, the level of herd immunity among vaccinated individuals reached 99.5% (95% CI: 99.1-99.7), which is similar to the level reached in the cohort as a whole. The epidemic situation that developed in Tajikistan by mid-March 2022 was characterized by an almost absolute level of herd immunity, as evidenced by an absence of detected overt COVID-19 cases since the end of February (2022).Copyright © Popova A.Yu. et al., 2023 The article can be used under the Creative Commons Attribution 4.0 License.
ABSTRACT
Introduction: Anxiety in patients undergoing Magnetic resonance imaging (MRI) examinations has been well documented along with causes and strategies to support patent through this. During the Covid-19 pandemic, mask wearing in clinical settings became compulsory for both staff and patients. Whilst staff may be more familiar with wearing personal protective equipment it is unknown how this could affect patient experiences. We know that patients can get claustrophobic in MR scans which affects their wellbeing, scan attendance and even scan quality. This study aims to understand if wearing a mask had any effect of their willingness to comply with the scan, and if they were adequately prepared, and how it affects their feelings about attending for future scan appointments. Method(s): A purposive sampling technique was chosen with participants being invited nationally across the UK. Inclusion criteria required that participants be aged 18 years or older, their scan had taken place in a UK organisation either NHS or private between March 2020 and December 2021 and that they had worn a face mask during their scan. Ethical approval was gained from University of Derby Research and Ethics Committee. Informed consent and participation information sheets were completed. No identifying data was collected and therefore responses were anonymous. A mixed methods online survey design was utilised, and this was shared on social media using professional accounts and charities. Result(s): Inductive thematic analysis was used with both researchers independently blind coded the qualitative data. The main themes emerged which were anxiety and discomfort, information and preparation and positivity around the experience. The quantitative data analysis in on-going and will be presented in the final presentation. Conclusion(s): We should review patient experiences taking a holistic approach to the entire examination including preparatory material as well as activity in the waiting area and scan room. We need to consider the impact of mask wearing on anxiety and discomfort and revisit what patient preparation looks like to ensure patients have a better experience. This needs to take place in the education of student radiographers as well as qualified professionals in clinical departments. People want to feel prepared and be treated as individuals. We must embrace the principles of person-centred care at every level of what we do.Copyright © 2022
ABSTRACT
Background: There is little information in the literature on primary immunodeficiency (PID) or innate immune error (IEI) as a risk factor for severe COVID-19 disease. Our aim is to detail the course of COVID-19, especially in patients with PID who predominantly have antibody deficiencies. Method(s): In this cross-sectional retrospective study, we included 18 cases (12 males, 6 females) of our 120-patient IEI group, aged between 30 months and 32 years, predominantly with antibody deficiencies. Their mean age was 12.2 (3-32) years. This study retrospectively evaluated IEI patients between February 2020 and February 2022 to determine the prevalence of COVID-19. Assays used: Polymerase chain reaction (PCR) tests from nasopharyngeal swab were positive for SARS-CoV- 2. This study was approved by the Turkish Ministry of Health. Written consent was obtained from all patients or their parents. Sakarya University Ethics Committee was also applied to. Result(s): All of our patients had a benign course, suggesting a possible protective factor related to young age despite IEI. In our patients, there was no other comorbidity other than bronchiectasis in 1 patient. A total of 18/120 (15%) PID patients aged 30 months to 32 years tested positive for SARS-CoV- 2. All patients were on routine monthly IVIG or SCIG replacement therapy at the time of virus detection. In addition, 9/18 patients received intermediate-dose IVIG treatment. Also, 2/18 patients were completely asymptomatic, but 16 out of 18 patients were symptomatic. As a result, none of the patients showed any serious illness, and none even required supplemental oxygen and/or intensive care unit admission. Except for the intermediate dose IVIG treatment, 1 patient was treated with hydroxychloroquine, 1 patient with favipiravir, and 4 patients with ceftriaxone antibiotic treatment. Conclusion(s): If we look at the clinical course and outcome of COVID 19 disease in our patients, all of our patients showed a benign course as well as better results.
ABSTRACT
Introduction: Tuberculosis (TB) is a significant public health problem in Papua New Guinea (PNG). Poor infection prevention and control (IPC) measures in healthcare settings may partly contribute to the high burden of TB in PNG. This study examines the implementation of the TB infection prevention and control (TBIPC) policy introduced by the national health department in 2011 in rural hospitals in the Highlands and Momase region of PNG. Method(s): A self-administered structured questionnaire adapted from the WHO TBIPC framework and site observations were undertaken to assess the TBIPC activities. Questionnaires and observation data were analysed using SPSS. Fishers' exact test was performed to determine the similarities and differences in TBIC practices between the health facilities. Significance was assessed at p<=.05. Ethics approval was given by Griffith University Human Research Ethics Committee (GU Ref No: 2021/921). Result(s): Ten of thirteen rural hospitals in the Highlands and Momase region (78%) were surveyed. The majority (N=8,80%) of rural hospitals have inadequate TBIPC programs. Two (20%) facilities have intermediate or advanced TBIPC programs. The facility with advanced TBIPC employed a doctor with public health training. COVID-19 pandemic has provided the impetus to strengthen IPC programs in rural health facilities. Significant differences in TBIPC practices were identified across the two regions (p=0.03). Conclusion(s): Overall, TBIPC guidelines were inadequate in rural hospitals in PNG. The significant differences in TBIPC practices in rural hospitals remain a severe challenge to the TB control efforts. Public health training for health workers could play an important role in IPC programs.Copyright © 2022
ABSTRACT
Introduction: The disruption brought about by the COVID-19 pandemic to higher education teaching and learning, as well as to the community engagement opportunities, has also brought about some new learning opportunities. The purpose of the research was to explore the views and to describe their thoughts of the School of Healthcare Sciences (SoHCS) and the Faculty of Engineering, Built Environment and Information Technology (EBIT) undergraduate students' on the use of robotics and technology in educating the communities about COVID-19. Method(s): Participatory Action Research (PAR) was used for this study since the students from SoHCS and EBIT were invited to be active participants as future professionals. A total of 27 students volunteered and participated in in-depth interviews. The responses were analysed using ATLAS.ti from nine data sets for qualitative content. Data reduction, coding, and decoding analytic processes were used to analyse and interpret each of these qualitative data forms. Ethical approval was obtained from the research ethics committees in the Faculty of Health Sciences as well as the Faculty of Engineering, Built Environment and Information Technology. Result(s): Five themes that emerged from this study are namely: COVID-19 and community challenges and behaviour;COVID-19 communication;COVID-19 knowledge and understanding;COVID-19 myths and COVID-19 robotics and technology education. Conclusion(s): COVID-19 has proven to be a driver of technology innovation and can create new high-touch and high-quality services. Using information technology and robotics in health sciences or in community engagement projects would minimizes the exposure of health care workers and members of the communities to possible infections. These findings also reflect on the importance of engaging the students when interventions are planned because they play an important role as members of the community within the university and outside the university.Copyright © 2022