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Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a significant health and financial issue in the current century. Despite significant attempts to manage the illness, the transmission routes of the virus and its widespread genomic mutations have led to an increasing number of new infections and mortality rates. In the absence of specific treatment for this new virus, identifying and managing factors affecting the prognosis of the disease is one of the critical strategies to reduce disease mortality. Patients with iron deficiency anemia (IDA), who account for an estimated half a billion people globally, are more prone to infections due to immune system disorders. Since they visit hospitals more frequently for follow-up care and diagnosis, they are more susceptible to becoming infected with SARS-CoV-2. Once infected with SARS-CoV-2, low hemoglobin (Hb) levels and compromised immune systems disrupt the restriction of infection in these individuals, ultimately leading to severe complications of COVID-19.
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Objective: Coronaviruses are a large family of viruses that cause different types of diseases. This study aims to evaluate the risk factors for mortality based on comorbidity and sociodemographic characteristics among COVID-19 patients. Methods: This cross-sectional study conducted in Herat, Afghanistan, from February 24 to July 5, 2020, used data provided by the public health department, including sociodemographics, symptoms, comorbidities, hospitalization, contact history, and COVID-19 test type. The Chi-square test was used to observe differences between categorical variables. In bivariate analysis, all independent variables with a significant p-value were put into the model. Odds ratios and 95% confidence intervals were calculated, and a p-value less than 0.05 was considered statistically significant. Results: The study analyzed 11,183 COVID-19 cases, with a 53.5% positivity rate. Recovery rates in the city and Herat province districts were 96.2% and 94.7%, respectively. Case-fatality rates varied with age, with 0.4% for those aged 1-29 and 33% for those aged 80-105. Mortality rates were highest for those with COPD and cancer, at 12.5% and 18.2%, respectively. In the logistic regression results, age, gender, and COPD were significant variables for COVID-19 mortality. Conclusion: By providing more health service facilities to people in risk groups, especially in rural areas, the mortality rate of COVID-19 and other diseases can be decreased.
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Background: Students worldwide belong to a vulnerable group with an above-average tendency towards depressive disorders. Empirical studies also show that depressive moods among students have increased significantly during the coronavirus disease 2019 (COVID-19) pandemic. Objectives: The aim of the article is to examine whether the stress experiences caused by the pandemic are related to the depressed mood of the students. In addition, it is analyzed whether resilience, coping and social support as resources are associated with the depressive moods of students. The aim is to clarify which resources can explain the connection between the stress experiences caused by the pandemic and the depressive mood of students as mediators. Methods: The study is based on an online survey of students at Magdeburg-Stendal University of Applied Sciences for the 2020/21 winter semester. The data of 621 students were evaluated. A mediation analysis was carried out. Results: Pandemic-related stress experiences are significantly related to the depressive moods of students. Resilience is also a significant factor influencing depressive moods and partially mediates the influence of pandemic-related stressful experiences on the depressed mood of the students. Coping and social support show no significant association with the depressed mood of the students. Conclusion: Starting points for reducing the depressive mood lie in reducing the stress caused by the pandemic and in strengthening the resilience of the students.
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BackgroundGCA is a critically ischemic large vessel vasculitis, varying in extent, severity and outcomes, hence requires disease stratification using clinical, laboratory and imaging parameters, for targeted management. Although DMARDs are used, the effectiveness in real life, such adjuvants remain un-elucidated. We performed a prospective, multi centre cohort study of new GCA stratified into remitting, relapsing, refractory, ischemic disease.ObjectivesWe assessed prognostic factors and compared critical outcomes such as remission with glucocorticoid (GC) monotherapy versus GC plus DMARDs in the first 12 months.MethodsHAS GCA study (1) recruited consecutive patients with new onset GCA from 7 centres (UK, Italy, Spain, Netherlands). diagnosis was confirmed used a modified GiACTA criteria at 6 months follow up. All underwent ultrasound (bilateral common, parietal, frontal temporal arteries, and axillary arteries) using accepted standard cut-off values [2]. GCA patients had US at baseline,1,3,6,12 months and halo count (HC) and Halo score (Temporal TAHS, axillary AAHS, total THS) assessed [3]. The primary outcome- remission at 12 months (absence of signs/symptoms, CRP<5 mg/dl, prednisolone < 5 mg daily). Results are reported as descriptive statistics.Results229 participants included in the study (GCA- 84 (36.68 %) (Figure 1). Study recruited during Covid pandemic,73 completed,11 lost to follow-up (died -7, withdrawn-4). The deceased/withdrawn patients (compared to completers) were older (80 v74 yrs, p=0.018), preponderantly male (73% v 36%, p=0.043) with visual symptoms (91% v 49%, p=0.010) partial/total sight loss (55% v 21%, p=0.024), lower CRP (21 v 68, p=0.061) and ESR (42 v 62, p= 0.317).Of 73 completers 36 required early DMARDs (<12 weeks) for refractory/relapsing/ischemic/GC related AEs. This group had more LV involvement (50% v 11%, p=0.0003), Remission attained at 12 months 32/36 (89%) in DMARD group was comparable to the remitting GC monotherapy group 33/37 (89%) with comparable cumulative GC doses (Figure 1, Table 1).At 12-months follow up, median TAHS, AAHS and THS reduced from 13 to 3, 12 to 9 and 21.5 to 12, respectively.ConclusionOur study suggests, elderly males with visual symptoms, sight loss, lower CRP are a high-risk group with increased mortality within GCA. Difficult to treat disease is seen in half of all patients especially with LV involvement. This group responds well to early DMARD use achieving remission comparable to the remitting group at 12 months. Current therapies fail to achieve remission in 9.5 % of cases. HS and HC show significant improvement mirroring clinical outcomes during first 12 months of therapy.References[1]Sebastian A et al. BMC Rheum. 2020[2]Schafer VS et al. Rheumatology 2017[3]van der Geest KSM et al. ARD 2020Table 1.comparison between the DMARD-used group and only GC group in all the GCA completed the 12 months follow upPatients' characteristicsGCA with completed follow-up (n=73)GCA treated with DMARD=36GCA not treated with DMARD=37Age, median (range) years73.5 (60-89)76 (60-89)Sex, Females, n (%)23 (64)24 (65)US halo score (HS)/IMT median (range)Temporal artery HS11 (0-23)13 (1-22)Axillary artery HS12 (0-21)12 (0-18)Axillary artery IMT (mm)0.77 (0.33-2.6)0.82 (0.39-1.21)Total HS22.5 (2-41)21 (5-40)Clinical features, n (%)Temporal headache25(69)30 (81)Scalp tenderness17 (47)19 (51)Jaw & Tongue claudication22 (61)24 (65)Polymyalgic symptoms21 (58)13 (35)Constitutional symptoms21 (58)18 (49)Any visual disturbance15 (42)21 (57)Partial or complete vision loss8 (22)7 (19)History of PMR6 (17)3 (8)Exam findings, n (%)Temporal artery abnormality24 (67)30 (81)AION/ CRAO8 (22)6 (16)Ocular nerve palsy1 (3)3 (8)Lab markers at baseline, median (range)CRP mg/dL,72.2 (6.4-292)59 (6-206)ESR mm/hr67 (9-130)57 (2-120)GC treatment, median (range)GC starting dose, (baseline)45 (0-60)50 (0-60)GC dose at 12m,5 (0-25)2.5 (0-10)Cumulative GC dose at 12m4627.5 (2600-10260.5)4622.5 (944-10737.5)Remission with prednisolone dose ≤5 mg at 12m, n (%)32 (89)33 (89)Acknowledgements:NIL.Disclosure of InterestsBhaskar Dasgupta Consultant of: Roche, Chugai, Sanofi, Grant/research support from: Roche, Sanofi, AbbVie, and GlaxoSmithKline, Kornelis van der Geest Speakers bureau: Roche, Grant/research support from: AbbVie, Alessandro Tomelleri: None declared, Pierluigi Macchioni: None declared, Giulia Klinowski: None declared, Carlo Salvarani: None declared, Abdul Kayani: None declared, Mohammad Tariq: None declared, Diana Prieto-Peña: None declared, Edoardo Conticini: None declared, Muhammad Khurshid: None declared, Sue Inness: None declared, Jo Jackson: None declared, Alwin Sebastian: None declared.
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BackgroundIn 2018 NICE and NHS England approved one year of weekly subcutaneous tocilizumab for use in relapsing or refractory GCA [1, 2]. During the COVID pandemic NHS England allowed extended use of tocilizumab in selected high risk patients [3]. This extension ended in March 2022. This has created a cohort of patients who are now no longer treated with tocilizumab and may be at risk of GCA flare. Currently, NHS England does not allow retreatment with tocilizumab.ObjectivesThis service evaluation used an intention-to-treat approach to retrospectively evaluate patients, who were ratified to receive tocilizumab for GCA according to the NICE guidance. We aimed to describe this cohort of patients for whom the use of tocilizumab had been approved, and their outcomes in terms of complications and disease control.Methods49 patients were ratified to receive tocilizumab between May 2019 and April 2022 by a specialist multidisciplinary team at a single tertiary rheumatology center. Their response was assessed in terms of relapse rates, steroid usage and complications as described below.Results80% of the 49 cohort of patients consisted of females (Table 1). 55% of patients were diagnosed with GCA on combination of clinical history, laboratory and temporal artery duplex findings. 94% (46/49) had at least a week's course of tocilizumab. Around half (51%) had relapsing disease. 6% had first dose as intravenous due to critical ischaemia. 27% (13/49) of patients developed complications whilst on treatment. Six developed cytopenia, 3 acquired infections and 4 stopped due to other reasons. As per guidelines, tocilizumab was stopped after 12 months in 25 patients (51%). 16% stopped treatment early due to complications. 18% had incomplete information. 10% had ongoing treatment. One patient died several months after finishing tocilizumab. 47% had methotrexate as DMARD therapy added prior to tocilizumab commencement (Figure 1). Out of 25 patients who completeted treatment, 24% (6/25) relapsed. 83% of these relapses were diagnosed on recurrence of symptoms and high inflammatory markers. In addition, 3 patients, who had tocilizumab suspended relapsed. 2/3 of these patients had treatment suspended due to infection. 5/9 relapse patients did not have preceding DMARD therapy. 22% (2/9) of relapse patients had PET-CT due to involvement of extra-cranial disease. 56% (5/9) relapsed following a median follow-up of 11 months. Of relapsed patients, seven were treated with increased dose of prednisolone and two patients received 6 months extension of tocilizumab with adequate tolerance and efficacy.ConclusionOur data shows good tolerability of tocilizumab and a 24% flare rate amongst patients who completed treatment. This is less than the 50% rate seen in GiACTA and other cohorts, where the majority of which occurred within 6 months of stopping treatment [4]. DMARD treatment may reduce relapse rate, but this will require further study. The data describing the efficacy of treatment beyond one year is limited [3]. However, with no established guidance for treating patients following tocilizumab, extension of treatment is a plausible option.References[1]Tocilizumab for treating giant cell arteritis, NICE Technology Appraisal Guidance, 18 April 2018. https://www.nice.org.uk/guidance/ta518/resources/tocilizumab-for-treating-giant-cell-arteritis-pdf-82606786726597[2]Stone J, Tuckwell K, Dimonaco S et al.Trial of Tocilizumab in Giant-Cell Arteritis. N Engl J Med 2017;377:317-328.[3]Regola F, Cerudelli E,Bosio G. Long-term treatment with tocilizumab in giant cell arteritis: efficacy and safety in a monocentric cohort of patients Rheumatology Adv Pract 2020;0:1–9.[4]Conway R, Putman MS, Mackie SL. Benchmarking tocilizumab use for giant cell arteritis. Rheumatol Adv Pract. 2022;6(2):rkac037.Figure 1.Table 1.GenderAge at time of diagnosisIndication for stopping treatmentMaleFemale50-5960-6970-7980-89Completed treatmentComplicationsOngoing treatmentIncomplete information18313162010251058Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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The article is devoted to the global problems of modern medicine - HIV infection and the COVID-19 pandemic. The review of the literature highlights current ideas about the pathogenesis and course of COVID-19 in patients with HIV infection, and also touches upon the problems of concomitant pathology and mental health of patients with HIV in the setting of the COVID-19 pandemic. It has been shown that HIV-positive patients are a risk group for the severe course of COVID-19, in particular, individuals with severe immunodeficiency (CD4+ T lymphocytes 200 cells/l) due to the development of synergetic lung damage by SARS-CoV-2 and secondary infectious agents such as cytomegalovirus and Pneumocystis carinii. It has been proven that one of the targets of the SARS-CoV-2 virus is CD4+ T cells, which in COVID-19 leads to a more rapid progression of immunodeficiency in patients with HIV infection and, thus, significantly increases the risk of secondary diseases and death. Particular attention should be paid to middle-aged and elderly people living with HIV, who, compared with HIV-negative patients, are more likely to have concomitant pathology - arterial hypertension, cardiomyopathy and diabetes mellitus, which are the risk factors for severe COVID-19. The results of studies on the effect of antiretroviral drugs on the course of COVID-19 showed that HIV-infected patients receiving tenofovir + emtricitabine have a lower risk of severe COVID-19 and associated hospitalization than patients receiving other HIV treatment regimens. Clinical and preclinical data support the potential use of tenofovir in the treatment of novel coronavirus infection.
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Cardiovascular risk and diseases among patients recovered from COVID-19 is a recent field of study in the world medical literature and is also of vital importance because a large number of patients develop complications once the acute phase of the disease is over. The broad spectrum of myocardial injury in cardiovascular diseases can range from the asymptomatic elevation of cardiac troponin levels to the development of fulminant myocarditis and/or circulatory shock, which can leave significant sequelae. Despite the fact that there is no clear strategy to treat cardiac events that occur during COVID-19 infection and taking into account that treatment is mainly aimed at relieving patients' symptoms as they arise, the objective of this work was to find out and collect current evidence on this subject, so that readers can be offered a reference guide in Spanish that contributes to the development of their health profession. The methodology used was a literature search in databases including Medline, Scopus and ScienceDirect within a time window between 2019 and 2022. The main results revealed that the molecular and pathophysiological mechanisms involved in post-COVID-19 syndrome include the renin-angiotensin-aldosterone system since SARS-CoV-2 tropism is linked to angiotensin-converting enzyme 2. This causes an alteration of the neurohumoral response of the cardiovascular, renal and digestive systems, generating deficits in the signaling pathways and causing direct damage to the heart, lungs and other organs. Post-COVID-19 syndrome, in general, is defined as the occurrence or persistence of symptoms three or four weeks after the acute phase of the disease. This could then be considered as a time window of risk and strict follow-up to assess in a personalized way the risk among the different groups of patients, especially those with a past history of cardiovascular disease. The main results revealed disorders such as heart failure, arrhythmias, pericarditis and myocarditis, which require early detection and occur days or even weeks after the acute phase of COVID-19.Copyright © La revista. Publicado por la Universidad de San Martin de Porres, Peru.
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Introduction: the study of the characteristics of patients with COVID-19 makes it possible to determine risk groups in specific populations and to outline strategies by the institutions to improve the quality of care for these patients. Background: to characterize patients with COVID-19 in Pinar del Rio between March 2020 and March 2021. Methods: an observational, descriptive and cross-sectional study was carried out in patients diagnosed with COVID-19 in the province of Pinar del Rio between March 2020 and March 2021. The sample consisted of 450 patients who met the inclusion and exclusion criteria. Descriptive statistics were used for data analysis. Results: female patients predominated (56%), with a history of arterial hypertension (24,6%). A high incidence of COVID was found in individuals with between two and five chronic non-communicable diseases (40,2%). Of all patients diagnosed with COVID-19, 49% were passive smokers. Conclusions: COVID-19 occurred mainly in patients with several chronic diseases, as well as in those exposed.
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Introduction: COVID-19 caused healthcare professional workers have faced the pandemic on the frontline at the risk of being infected with the virus. Despite the low mortality rate at present and the low presence of patients with COVID-19 in health care centers, the application of a fourth booster dose has generated different positions among several countries. Background: to determine whether personnel considered being at high risk of vulnerability in the city of Santo Domingo de los Colorados, Ecuador, have favorable intentions for receiving the fourth booster dose of the COVID-19 vaccine. Method: a quantitative study of correlational scope and cross-sectional design was developed. A questionnaire consisting of 16 questions measured the following variables: risk of infection, perceived knowledge of the vaccine, confidence in the vaccine and intention to be vaccinated;this questionnaire was applied to 375 participants. Statistical analyses were developed using the microsoft Excel spreadsheed and Statistical Packagefor Social Sciences 21 (SPSS 21). Results: statistical analyses showed that the risk of infection (beta = 0.178**), perceived knowledge about the vaccine (beta = 0.218**) and confidence about the vaccine (beta = 0.192**) are significantly correlated with the intention to be fully vaccinated, thus showing the need for a fourth booster dose by vulnerable sectors. Conclusion: this is the first research that presents results regarding the intention to vaccinate vulnerable people and highlights the intention to access a fourth booster dose.
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The COVID 19 pandemic has disproportionately hit some vulnerable population groups. Those living in deprived areas, migrant population, and ethnic minorities are at higher risk of catching and dying from the virus than other groups, and they also face significant indirect health impacts of the COVID-19 pandemic - both mental health impacts and disruption of routine care. The working paper gathers evidence on the direct and indirect health impacts of the COVID-19 on the poor population and the ethnic minorities. It reviews factors underlying these inequalities, and maps policy interventions adopted by OECD countries to help address the disproportionate impacts of the COVID-19 pandemic on vulnerable population groups.
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We developed a pandemic telephone outreach protocol to identify risk for social isolation, health destabilization, medication issues, inadequate services and supports, and caregiver stress among older adults at high risk of destabilization. Screening, conducted between April 1, 2020, and May 8, 2020, was targeted to those who had previously been screened as frail or who were identified as vulnerable by their family physician. This study describes the implementation and results of this risk screening protocol and describes patient, caregiver, and health professional perceptions of this outreach initiative. Mixed methods included satisfaction surveys and interviews completed by patients/caregivers (N = 300 and N = 26, respectively) and health professionals (N = 18 and N = 9, respectively). A medical record audit collected information on patient characteristics and screening outcomes. A total of 335 patients were screened in the early weeks of the pandemic, of whom 23% were identified with at least one risk factor, most commonly related to the potential for health destabilization and medication risk. Follow-up referrals were made most frequently to physicians, a pharmacist, and a social worker. The outreach calls were very well received by patients and caregivers who described feeling cared for and valued at a time when they were socially isolated and lonely. The outreach calls provided access to trusted COVID-19 information and reassurance that health care was still available. The majority of health professionals (>86%) were "very" or "extremely" satisfied with the ease of completing the screening via telephone and value for time spent;for 79% the protocol was "very" or "extremely" feasible to implement. Health professional interviews revealed that patients were unaware they could access care during the pandemic lockdown but were reassured that care was available, potential crises were averted, and they supported future implementation. Risk screening provides a significant opportunity to provide information, support, and mitigate potential risks and is an important and feasible component of pandemic planning in primary care.
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Background and AimFor most of the 83 years since acknowledging cystic fibrosis (CF) as a separate disease entity, treatment has primarily focused on symptomatic relief.1 Following the discovery of the CFTR gene, efforts have been made to produce therapies to target the underlying dysfunctions caused by CFTR mutations.2 Moderate transaminase elevations are commonly observed in CF patients. Severe transaminase elevations have been observed in patients taking CFTR modulators in clinical trials with the initial STRIVE trial revealing that treatment discontinuation was commonly due to an increase in hepatic enzymes.3 Consequently, liver function test (LFTs) monitoring is recommended for all patients before commencing therapy, every three months for the first year and annually thereafter. This audit aims to assess the compliance of LFT monitoring in clinical practice for paediatric patients initiated on CFTR modulators, evaluate the incidence of liver-related adverse effects, and examine trends between the CFTR modulator used and the clinical significance of LFT derangements, and determine if there are any sex-related correlations.MethodsPatient data, including date and age on treatment initiation, gender, LFT results at baseline (AST, ALT, ALP, GGT and total bilirubin), first derangement since initiation and monitoring frequency were extracted from the clinical system Meditech®, pseudonymised and analysed. There were 91 records of patients being treated with a CFTR modulator. Some patients were on more than one CFTR modulator as treatment can be switched if eligible. For the purpose of the audit after consultation with the local CF clinical team, a two-month deviation outside of the recommended monitoring frequency was considered non-compliant. LFT derangements were classified as clinically significant if the result was higher than 3 times the upper limit of normal (ULN).ResultsOur study found that most patients (50/91 – 54.9%) on CFTR modulators in the tertiary centre did not have their LFTs monitored following the recommended guidelines. A statistically significant increase in LFT abnormalities from pre- to post- intervention with a CFTR modulator was observed (p=0.015). Kaftrio®/Kalydeco® (3/20 – 15%) and Orkambi® (1/29 – 3.4%) were the only CFTR modulators that led to patients developing clinically significant derangements (>3x ULN). Additionally, a greater proportion of females (24/51 – 47.1%) than males (15/40 – 37.5%) had abnormal LFTs within the tertiary centre contrary to previous epidemiological studies where males have been documented to have a greater risk of abnormal LFTs. However, the strength of this association was negligible (φ =0.096, p=0.360).ConclusionIn conclusion, the tertiary centre's compliance with LFT monitoring guidelines for patients initiated on CFTR modulators was substandard. Most records of treatment initiation occurred during COVID-19, which impacted monitoring as many hospitals suspended routine clinical work to limit the spread of the infection in high-risk groups. Time constraints limited the audit during the data extraction period;therefore, results should be interpreted cautiously. In the absence of the COVID-19 pandemic a re-audit process should include patient lifestyle data and consider other medication regimens that could potentially alter LFTs. Introducing a blood clerk would enable the CF unit to monitor LFT changes more efficiently.ReferencesGuimbellot J, Taylor-Cousar JL. Combination CFTR modulator therapy in children and adults with cystic fibrosis. The Lancet Respiratory Medicine 2021;9:677–679.Lopes-Pacheco M. CFTR Modulators: The Changing Face of Cystic Fibrosis in the Era of Precision Medicine. Frontiers of Pharmacology 2020;10:1662.Gavioli EM, Guardado N, Haniff F, et al. A current review of the safety of cystic fibrosis transmembrane conductance regulator modulators. Journal of Clinical Pharmacy and Therapeutics 2021;46:286–294.
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Background: Monitoring differences in COVID-19 vaccination uptake in different groups is crucial to help inform the policy response to the pandemic. A key data gap is the absence of data on uptake by occupation. This study investigates differences in vaccination rates by occupation in England, using nationwide population-level data. Methods: We calculated the proportion of people who had received three COVID-19 vaccinations (assessed on 28 February 2022) by detailed occupational categories in adults aged 18-64 and estimated adjusted ORs to examine whether these differences were driven by occupation or other factors, such as education. We also examined whether vaccination rates differed by ability to work from home. Results: Our study population included 15 456 651 adults aged 18-64 years. Vaccination rates differed markedly by occupation, being higher in health professionals (84.7%) and teaching and other educational professionals (83.6%) and lowest in people working in elementary trades and related occupations (57.6%). We found substantial differences in vaccination rates looking at finer occupational groups. Adjusting for other factors likely to be linked to occupation and vaccination, such as education, did not substantially alter the results. Vaccination rates were associated with ability to work from home, the rate being higher in occupations which can be done from home. Many occupations with low vaccination rates also involved contact with the public or with vulnerable people Conclusions: Increasing vaccination coverage in occupations with low vaccination rates is crucial to help protecting the public and control infection. Efforts should be made to increase vaccination rates in occupations that cannot be done from home and involve contact with the public.
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Awareness of COVID-19 infection, as a public crisis, makes an emergency condition for survivors. Regarding the importance of early rehabilitation, we should pay particular attention to the potential risk of real-life toxicants in COVID-19 survivors. The adverse effects underlying COVID-19 infection lead to persistent sequelae in survivors. In addition, complete rehabilitation is challenging in seriously-ill patients due to cytokine storm severity, inflammation, oxidative stress, and cell death contributing to multi-organ damage. Different foods, environmental/occupational pollutants, and unhealthy lifestyles are real-life examples of toxicants that can pose redox imbalance and oxidative damage to the biological system. The key concept is that survived patients with persistent tissue damage, low-grade inflammation, oxidative stress, and fibrosis are susceptible to real-life toxic stressors, which have the potential for oxidative stress. Moreover, fibrosis are susceptible to toxic stressors, which can induce harmful effects by promoting oxidative stress and pro-inflammatory components. This paper attempted to elucidate a vital toxicological concept in which the existing sequelae of COVID-19 survivors increase the potential risk of real-life toxicants and to propose a practical strategic approach to reduce toxicant exposure.
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IntroductionWork is a key determinant of COVID-19 outcomes, however occupational surveillance is a critical information gap in many countries, including Canada. Understanding the risk of SARS-CoV-2 by occupation can identify high risk groups that can be targeted for prevention strategies.Materials and MethodsThe cohort includes 1,205,847 former workers compensation (non-COVID-19) claimants (aged 15–65) linked to health databases in Ontario, Canada. Incident cases were defined as either having a confirmed positive polymerase chain reaction (PCR) test in the Ontario Laboratory Information System (OLIS), or an International Classification of Diseases (ICD-10-CA) diagnostic code of U07.1 in hospitalization or emergency department records (February 2020-December 2021). Workers were followed until diagnosis, death, emigration, age 65 or end of follow-up. Sex- and age-adjusted Cox proportional hazards models were used to estimate hazards ratios (HR) and 95% confidence intervals (CI) by occupation, compared to all other cohort members. Analyses were also conducted to examine occupational trends in testing and diagnosis during waves of infection.ResultsOverall, 80,740 COVID-19 cases were diagnosed among workers during follow-up, of those, 80% were diagnosed with a positive PCR test. Associations were identified between COVID-19 diagnosis and employment in nursing (HR=1.44, CI95%=1.40–1.49), air transport operating (HR=1.61, CI95%=1.47–1.77), textile/fur/leather products fabricating, assembling, and repairing (HR=1.38, CI95%=1.25–1.54), apparel and furnishing services (HR=1.38, CI95%=1.19–1.60), and janitor and cleaning services (HR=1.11, CI95%=1.06–1.16). Restricted analyses where health care workers were omitted from the comparison group strengthened some associations for other high-risk workers. Test positivity ranged between 4–16% across major occupation groups. Risks varied over time and with changes in protective measures in workplaces and in broader communities.ConclusionsElevated risk of SARS-CoV-2 infection in health care, manufacturing, transportation, and service workers were identified, underscoring the importance of including occupational data in COVID-19 surveillance. Occupational trends in severe outcomes and vaccination are also being explored.
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This report highlights the challenges faced by the global health community in managing cholera outbreaks during the ongoing COVID-19 pandemic and in areas with humanitarian crises and large population movements. In 2021, cholera outbreaks surged, particularly in West Africa, while preventive measures to control COVID-19, such as handwashing and social distancing, may have reduced cholera transmission. However, the pandemic's impact on healthcare access, laboratory capacity, and disease reporting systems, especially in crisis-affected regions, hindered cholera response capacity. Despite efforts to support vulnerable populations and reduce cholera transmission, climate events, and population displacement continued to expose susceptible communities. Globally, 90 countries reported data on cholera, with 35 countries reporting 223,370 cases and 4159 deaths, representing a 30% decrease in reported cases from 2020 but a significant increase in the number of deaths. Nigeria accounted for 50% of reported cases and had the highest number of deaths. Laboratory confirmation of suspected cholera cases remains a priority, and strategic, systematic testing by rapid diagnostic tests should be increased to meet the goals of the global roadmap to end cholera. The collection of demographic information, including age and gender, is also essential to target response measures accordingly.
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Background: People who belong to the high-risk group are exposed to develop a more severe course of the coronavirus disease and have an increased risk of death if they are infected by COVID-19. To limit the spread of COVID-19 among the population, situationally appropriate regulations are enforced that change the way people live their daily lives. Background: How does the high-risk group deal with the impact of the coronavirus pandemic, the participatory research of their everyday organization, concerns and own health resources, are the focus of this study. Material and methods: The photovoice method was used in an online format to analyze the living environment of the high-risk group. In this context three online workshops were conducted. Seven high-risk patients affected by different chronic diseases describe with pictures and stories what COVID-19 means to them and what they are grateful for in this exceptional situation. The recruitment was done by personal contact of the research team with potential participants. Results: The co-researchers have formulated nine stories expressing their feelings of gratitude towards the healthcare system and their social environment. The question of a social stigmatization of persons with underlying diseases is critically reflected. The high-risk patients act in a health-competent way, consciously apply personal health resources, such as social contacts or health-promoting daily routines, to avoid negative consequences on their health and to increase their well-being. Discussion: The co-researchers show a health-competent lifestyle and are able to influence their well-being in a positive way;however, there are indications that the long-term approach to vulnerable communities needs to be discussed, especially concerning discrimination processes and a needs-based health care.
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Malaria is an endemic disease in a true sense. It is an acute febrile disease caused due to the parasite Plasmodium. However, unlike COVID-19, it failed to raise an international concern or gain the scientific limelight. Most of the 200 million globally affected by malaria, half of them are from Africa. Four of the nations, Nigeria (25%), the Democratic Republic of the Congo (11%), Mozambique (5%), and Uganda (4%), account for half of the world's malaria burden and is the leading cause of illness and death. In 2019, an estimated 5-6 million people died of malaria - most of them are young children in sub-Saharan Africa. Many of the countries affected by malaria have the lowest economic status. In the malaria-endemic region, the most vulnerable groups are young children and pregnant women. The costs of malaria are enormous to individuals, families, communities, societies, and nations. After a struggle for three decades, the much-awaited malaria vaccine, RTS, S (brand name Mosquirix), was finally launched;but it came with its controversies and allegations. This review explored the different angles of this disease, the vaccine development, and the emerging debates.
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BACKGROUND: COVID-19 vaccine uptake in Kenya is still low compared to other countries, especially in Europe and North America. In most parts of the country, a large percentage of the Kenyan population remains unvaccinated. As of October 2022, the Ministry of Health (Kenya) estimates that only 36.2% of the adult population had been fully vaccinated. METHODS: We conducted an experimental study in April 2022 targeting unvaccinated adults who had a history of hypertension and/or diabetes and those in the 60+ age group. We tested various messaging approaches using two different intervention channels. RESULTS: Although the overall rate of vaccinated individuals according to national records is low, responses from the study group collected through phone call conversations show that higher-risk adults such as those older than 60 or those with chronic illnesses have a remarkably high vaccination rate of 89%. After the study, four participants received a COVID-19 vaccine within 1 month of the intervention. These four participants all received a loss-messaging intervention approach during the study. CONCLUSION: This study supports a national approach to increasing COVID-19 vaccination rates using loss-messaging directed at unvaccinated, high-risk individuals.
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An association of periodontal disease with the severity of COVID 19 disease has been observed during COVID 19 pandemic. This article explores the various hypotheses that link the two conditions, to understand their interrelationship. Targeted research may help elucidate evidence for screening of high-risk groups and identification of therapeutic targets.