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BACKGROUND: Barotrauma is a lesion generated for changes in the pressure and/or volume within a specific anatomic way;pneumo-mediastinum and pneumothorax are clear samples of this effect, frequently related to infectious symptoms. CLINICAL CASES: Two clinical cases are presented, 34 and 44 years old, that had pneumonia due to COVID-19, with subsequent exacerbation of the symptoms caused by barotrauma. Patients were evaluated at emergency unit of the Hospital Angeles Pedregal, Mexico City;their clinical presentation was similar and was unleashed by repeated cough in the context of pneumonia due to SARS-CoV-2. CONCLUSION(S): Now there is more experience on the complications associated during COVID-19, although more cases must be study to know their prognostic meaning and, in case it becomes a progression marker of the illness, to establish specific measures and therapeutic recommendations. The presentation of pneumonia stands out despite the vaccination, having to get the general population make consciousness of continuing with measures of respiratory isolation.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
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Purpose: Disability in knee osteoarthritis (KOA) is known to be largely due to pain, the mechanism of which is complex and multidimensional with alterations in nociceptive processing in the peripheral and central nervous system (CNS) leading to persistent pain. Current clinical practice guidelines for KOA provide strong recommendations for education and exercise including land-based or mind-body approaches. However, individually these strategies are only moderately effective. One potential reason for this is a lack of understanding of their underlying mechanisms and how their combination might impact nervous system modulation. Neuromuscular exercise is known to improve lower extremity strength. Mind-body approaches as well as pain neuroscience education (PNE) are uniquely positioned to potentially reverse CNS adaptations by inducing positive neuroplastic changes and improving descending modulation of pain resulting in decreased pain. To our knowledge, neuromuscular exercise, mind-body techniques, and PNE have not been studied in combination. We therefore aimed to establish the feasibility of an intervention consisting of these three elements referred to as Pain Informed Movement (PIM). The results of this study will inform necessary modifications for a two-arm pilot randomized controlled trial (RCT). Method(s): This study was a single-arm feasibility trial with a nested qualitative component and the primary feasibility outcome of complete follow up. Inclusion criteria: age >= 40 years, KOA clinical diagnosis or people fulfilling the NICE diagnostic criteria, and average pain intensity >=3/10 on the numeric pain rating scale. PIM consisted of twice weekly in-person exercise sessions and a third home exercise session for 8 weeks. In addition, PNE, provided as online videos, covered the following topics: purpose of pain, neurophysiological changes associated with pain, movement guidelines when pain persists, mind-body techniques to impact neurophysiology and support moving with ease that included breath awareness and regulation, muscle tension regulation, awareness of pain related thoughts and emotions, and relaxation. The mind-body techniques and the PNE topics were implemented during the group exercise sessions that included evidence-based neuromuscular exercises aimed at improving sensorimotor control and functionality of the knee joint. Participants completed questionnaires and in-person assessments at baseline and at program completion. Assessments included weight and height, chair stands as a measure of functional leg strength, and conditioned pain modulation to assess efficiency of the descending modulatory pathways. Participants also had their blood drawn to monitor changes in brain derived neurotrophic factor (BDNF), a marker of neuroplasticity. Questionnaires included the Pain Catastrophizing Scale, Hospital Anxiety and Depression Scale, the Knee Injury and Osteoarthritis Outcome Score - function and pain subscales, Chronic Pain Self Efficacy scale, pain intensity rated in the past 24 hours, the past week, and worst pain in the past 24 hours. Secondary feasibility outcomes included acceptability of the intervention, burden of assessments, recruitment rate, compliance rate, adherence rate, and self-reported adverse events. Feasibility findings were evaluated against a-priori success criteria. In the qualitative component, participants were invited to an online focus group and were asked about their experience and perceptions of the program. Interview recordings were analyzed using thematic content analysis to identify suggestions for program modification. Result(s): In total, 19 participants (mean age 63.3 years (SD 10.5), 73% female) were enrolled, with a complete follow up rate of 74% (n=14) for our primary objective, indicating that modifications would be needed to proceed. Of the 5 dropouts, only one was study related. We will be adding additional inclusion criteria of: ability to get up and down from the floor independently, and no use of mobility aids. Adherence to in-person treatment sessions was 91%, hich indicates proceeding with the protocol for the next phase (i.e., pilot RCT). Some absences were due to unmodifiable factors (e.g., COVID-19). We will make protocol amendments for the purpose of improving the adherence rate to include 'no planned absences'. All other success criteria were met: recruitment rate, compliance to exercise sessions, program acceptability, duration, frequency, and delivery, likelihood of recommending the program to others and taking the program again, burden, and adverse events (Table 1). Analysis of the focus groups revealed that the video content pertaining to the mind-body techniques would benefit from on screen demonstrations by the instructor to assist with participants' execution of breath and muscle tension regulation. The majority of participants improved in most of the physical assessment outcomes and questionnaires (Table 2). Conclusion(s): The PIM program is feasible, acceptable, not burdensome, does not cause adverse events, and had an excellent compliance rate. Minor modifications are needed to optimize enrolment and adherence rates. Although improvements in pain, function, and psychological measures were observed, the feasibility nature of this study precludes any conclusions regarding efficacy. A pilot two-arm RCT will be conducted to establish the feasibility and explore potential effects of PIM when compared to conventional neuromuscular exercise and standard OA education. [Formula presented] [Formula presented]Copyright © 2023
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Objective. To analyse, through the experience of the women interviewed, the impact that the migratory experience has had on them in the context of pregnancy and childbirth, and the quality of the obstetric care received during labor and childbirth. Materials and Methods. For this study, a qualitative methodology was adopted known as Cohen's phenomenology. The study was conducted in the period between January 2022 - March 2022 recruiting a sample of 11 immigrant women at the Policlinico of Bari and the Societa Cooperativa Sociale OASI 2 San Francesco Onlus. Results. From the analysis of the interviews, five main themes emerged: Migration, Memory, Assistance to immigrant women, The language barrier, Loneliness. The stories uncovered the basic needs that bring every woman together during pregnancy and childbirth and the cultural aspects, bringing out the impact of migratory trauma. The women reported that they had received good obstetric care, defining the image of a midwife as the one who stands beside. However, several difficulties emerged, from the language barrier to loneliness, burdened by the restrictions imposed by the COVID-19 pandemic. Conclusions. It emerged from the interviews that the preparation of the midwife in the transcultural field is essential in order to be able to provide appropriate and personalized assistance. The goal of health workers is to create a mental attitude of openness towards confrontation and knowledge, and suspension from judgment. It is important to approach the life of immigrant women and tear down barriers, embracing the possibility of other narratives of body, health and disease.
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Background: In this paper, an attempt has been made to estimate the Case Fatality Ratio (CFR) for coronavirus disease of India and a few selected countries. And also, it highlighted the pros and cons of obtaining crude and adjusted CFR of COVID-19 pandemic. Material(s) and Method(s): Data extracted from the WHO situation report and the University of Oxford website have been used for this analysis. The CFR and its 95% confidence interval were computed, trend and bar plot was used for graphical representation. Result(s): The worldwide crude CFR stands 6.73% (95% CI 6.69 to 6.76) based on 21, 83, 877 confirmed and 1,46,872 death cases(as on 17th April, 2020). Belgium was the highest CFR at 13.95% as compared to others. However, India's CFR was found to be around 3.26% (as on 17th April, 2020). Conclusion(s): In conclusion, the estimation and interpretation of CFR are critical in response to ongoing COVID-19. The initial CFR estimates are subject to change, still, it is useful for healthcare planning over the coming months. Moreover, the precise and robust estimates of CFR will be available only at the end of the epidemic.Copyright © 2021 Bentham Science Publishers.
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Background: Vaccinations are of paramount importance in eradicating various diseases. Currently, there have been numerous reports on the development of new-onset autoimmune phenomena and disease flares following COVID-19 vaccination. The etiology and vaccine trigger mechanism of autoimmune disease still remains unclear. Molecular mimicry, by-stander activation and role of vaccine adjuvants are the main pathogenic mechanisms linked to an autoimmune phenomenon. However, vaccines as inducers of an autoimmunity is still an arguable subject. Case: We report a case series of six patients who developed new onset autoimmune reaction and disease flares following SARS-COV 2 vaccine. The patients received viral vector vaccine, inactivated vaccine and mRNA vaccine who developed symptoms in an average of 7-28 days following inoculation. A 27 year old male, previously healthy developed new onset of clinical amyopathic dermatomyositis after a week of 1st and 2nd dose of a viral vector vaccine. Two patients with systemic lupus erythematous developed severe cutaneous, hematologic and renal flare 14 and 28 days following vaccination. Two rheumatoid arthritis patients in long remission, developed atypical arthritis and disease flares after 10 and 14 days of inactivated and mRNA vaccine inoculation. One patient with spondylarthritis in remission experienced disease flare 7 days following inactivated SARS-COV- 2 vaccination. The patient age ranges from 19-72 years old of whom two are males and four are females. The management was individualized which includes oral corticosteroid and disease modifying anti-rheumatic drugs which showed improvement of symptoms. Conclusion: Development of an autoimmune reaction following SARS-COV 2 vaccination is of scientific and public importance. Vaccination might potentially trigger an autoimmune disease, however further investigations need to be established. The causative link between vaccination and autoimmunity needs to be studied. Susceptibility to a vaccine-induced autoimmunity might be triggered by the individual's genetic predisposition and several pathomechanisms.
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In addition to being one of the most widespread and lethal diseases in the world, skin cancer is also one of the most common types of cancer. However, due to its complexity and fuzzy nature, the clinical diagnosis process of any disease, including skin cancer, prostate cancer, coronary artery disorders, diabetes, and COVID-19, is frequently accompanied by doubt. In order to address the uncertainty and ambiguity surrounding the diagnosis of skin cancer as well as the heavier burden on the overlay of the network nodes of the fuzzy neural network system that frequently occurs due to insignificant features that are used to predict or diagnose the disease, a fuzzy neural network expert system with an improved Gini index random forest-based feature importance measure algorithm was proposed in this work. A Greater Gini Index Out of the 30 features in the dataset, the five most fitting features of the diagnostic Wisconsin breast cancer database were chosen using a random forest-based feature importance measure algorithm. Two sets of classification models were created using the logistic regression, support vector machine, k-nearest neighbour, random forest, and Gaussian naive Bayes learning algorithms. As a result, models for classification that included all features (30) and models that only used the top five features were used. The efficacy of the two sets of categorization models was assessed, and the results of the assessment were compared. The comparison's results show that the models with the fittest features outperformed those with the most complete features in terms of accuracy, sensitivity, and sensitivity. A fuzzy neural network-based expert system was therefore developed, utilising the five best features, and it achieved 99.83 percent accuracy, 99.86 percent sensitivity, and 99.64 percent specificity. The system built in this study also stands to be the best in terms of accuracy, sensitivity, and specificity when compared to prior research that used fuzzy neural networks or other applicable artificial intelligence techniques on the same dataset for the diagnosis of skin cancer. The z-test was also performed, and the test result demonstrates that the system has significantly improved accuracy for early skin cancer diagnosis. Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
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Introduction: After more than 50 years of research we are yet to develop an effective treatment for the Acute Respiratory Distress Syndrome (ARDS). This stands in contrast to the advances made in supportive care, a prime example of which is the maturation of Extracorporeal Membrane Oxygenation (ECMO). While technologies such as ECMO 'buy time' for recovery, the identification of a therapy remains crucial to improving outcomes. Recently, mesenchymal stem cells (MSCs) have shown promise as a novel treatment.1 Importantly, cell therapy may represent a means to overcome the hurdles associated with successful pharmacological intervention in ARDS. Little is known about the interaction between cell therapy and ECMO. This is a deficiency, given that those receiving ECMO for ARDS are among the most severely ill and therefore most likely to benefit. This programme of work was designed to close that gap. Objectives: Using a translational pipeline, our objective was to assess the safety and efficacy of MSCs during ECMO for ARDS. Methods: We employed several diverse methods to address our objectives, including an ex-vivo ECMO simulation, complex sheep models of ARDS and ARDS and venovenous ECMO, systematic review methodology, and unsupervised machine learning techniques. Results: In our ex-vivo model, we were the first to demonstrate potential harms associated with MSC therapy during ECMO.2 When 40 × 10∧6 clinical-grade human MSCs (Cynata Therapeutics Ltd., Australia) were added to fresh whole human blood and subjected to extracorporeal circulation using commercial components, oxygenator and pump performance was severely impaired within 4 hours. These experiments also demonstrated benefits associated with MSCs, including trends toward lower inflammatory cytokine concentrations and less neutrophil activation.3 To validate our findings, we sought to test hMSCs in a clinicallyrelevant sheep model. At the outset we undertook a systematic review of existing pre-clinical models of ARDS and ECMO.4 This has since produced an international collaborative effort to characterise pre-clinical models of ECMO across a range of indications. We subsequently described a 'double-hit' model of ARDS which combines oleic acid and intra-tracheal E. coli lipopolysaccharide. Using cluster analysis, we showed that this model shares qualitative similarities with the 'hypo-inflammatory' phenotype identified in clinical cohorts [Millar JE et al. Physiological Reports 2021. In Press]. Finally, in a 24-hour model, combining our novel injury method, VV-ECMO, and best practice ventilatory and supportive care, we performed a controlled trial of intra-tracheal hMSC therapy5 [Editorial: Del Sorbo L, Fan E. AJRCCM 2020]. This study showed that hMSCs reduce histological evidence of lung injury and ameliorate shock. However, hMSC-mediated impairment of oxygenator function was evident again. Conclusion: This work addresses a gap in our understanding of cell therapy in critical illness. The findings are of direct clinical relevance, highlighting the potential harms of cell therapy during extracorporeal circulation. With a recent explosion in the number of registered clinical trials of MSCs for severe COVID-19 in mind, the use of MSCs during ECMO cannot be recommended.
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Background: Exercise therapy is recommended as frst line treatment for knee osteoarthritis (OA), but it remains to be sub-optimally applied (1). Movement-evoked pain is a potential barrier to exercise adherence, but recent evidence suggests that such pain can be improved by training (2). Walking programs are low-cost, easily adopted and can be performed outdoors which can minimize the risk of SARS-CoV-2 transmission when in a group (3). Objectives: To explore the acute pain trajectories of individuals with knee OA during a 24-week outdoor walking intervention. In addition, to explore the effect of pain trajectories and/or baseline characteristics on retention and adherence. Methods: Individuals with clinical knee OA and bone marrow lesions (BMLs) on magnetic resonance imaging (MRI) were asked to follow a 24-week walking program. Every week consisted of two one hour supervised group sessions at various outdoor locations and one unsupervised session. At the start and end of every supervised group walk, knee pain was self-reported by participants to their trainer using a numerical rating scale (NRS) (0-10). The difference between the NRS pain values was considered as an acute pain change evoked by that walk. At baseline, the most affected knee of each participant was assessed using the Visual Analogue Scale (VAS) pain, the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) pain, stiffness and function, wellbeing (3 questionnaires) and the Osteoarthritis Research Society International (OARSI) recommended strength and performance measures. Results: In total, N = 24 participants started the program of whom N = 7 (29%) withdrew. Pain at the start of each walk decreased from NRS 2.5 (SD 1.6) at the frst walk (N = 24) to NRS 0.9 (SD 0.8) at the fnal walk (N = 17). This pain was estimated to decrease on NRS by-0.04 (95% CI-0.05 to-0.02) per supervised session, p < 0.001 during the frst 12 weeks and-0.01 (95% CI-0.02 to-0.004), p = 0.004 during the second twelve weeks of the program. The number (%) of participants who experienced an acute increase in pain decreased from 11 (45.8%) at the frst walk to 4 (23.5%) at the last walk. At baseline, non-adherent participants (<70% of group sessions) (N = 11) had lower physical performance scores, including the 30s Chair Stand Test (mean 10 (SD 1.7) stands versus mean 12.0 (SD 1.7) stands, p = 0.011), Fast Past Walk Test (1.23 (SD 0.14) meter per seconds (m/s) vs 1.50 (SD 0.20) m/s, p = 0.001), Six Minute Walk Test (418.8 (SD 75.9) m vs 529 (SD 72.6) m, p = 0.002), compared to adherent participants (N = 13). Non-adherent participants also had less severe self-reported symptoms including WOMAC stiffness (90.7 (SD 44.5) mm vs 121.5 (SD 17.0) mm, p = 0.031), compared to adherent participants. During the frst two weeks of walking, acute increases in pain on average (mean ≥0.5 NRS) were reported by a greater number of non-adherent (N = 5 (45.5%)) than adherent participants (n = 4 (30.8%)). Conclusion: This was an exploratory study and results need to be interpreted with caution due to the small sample size. The walking program resulted in clinically important improvements (MCIIs) (≥ 1 on NRS) (4) in start pain and acute pain changes. Improvements in start pain during the frst 12-weeks were comparable to improvements measured in the NEMEX program (2) and may suggest that 12 weeks of exercise is sufficient to achieve MCIIs in pain. Improvements in acute changes in pain were smaller, which may have been related to a foor effect (5). Lower physical performance scores at baseline and more acute increases in pain during the frst two weeks was associated with non-adherence. Participants with these characteristics may beneft from a lighter introduction to exercise.
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Background: Individuals with autoimmune infammatory rheumatic diseases (AIRDs) have an increased baseline risk of severe COVID-19 infection. Intersection of inequity factors may result in more severe adverse effects through influencing opportunities for health. We sought to examine the extent to which populations experiencing inequities were considered in studies of COVID-19 vaccination in individuals with AIRDs. Objectives: The objective of this study is to assess how health equity is considered in studies of COVID-19 vaccination studies in individuals with AIRDs. Methods: All studies (N=19) from an ongoing Cochrane living systematic review on the effects of COVID-19 vaccination in people with AIRDs were included. We identifed inequity factors using the PROGRESS-Plus framework which stands for Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital. Age, multimorbidity, and health literacy were also assessed as 'Plus' factors. We applied the framework to assess equity considerations in relation to differences in COVID-19 baseline risk, description of participant characteristics, controlling for confounding factors, subgroup analysis and applicability of study fndings. RESULTS: All nineteen studies are cohort studies that followed individuals with AIRDs after COVID-19 vaccination. Two articles (11%) described differences in baseline risk for COVID-19 across age. All nineteen studies described participant age and sex, with race/ethnicity and multimorbidity described in four (21%) and occupation in one (5%). Seven studies (37%) controlled for age and/or sex as confounding factors. Eleven studies (58%) conducted subgroup analysis across at least one PROGRESS-Plus factor, most commonly age. Eight studies (42%) discussed at least one PROGRESS-Plus factor in interpreting the applicability of results, most commonly age (32%), then race/ethnicity and multimorbidity (11%). Conclusion: It is unknown whether COVID-19 vaccine studies on individuals with AIRDs are applicable to populations experiencing inequities, as key inequity factors beyond age and sex have little to no reporting or analysis. Future COVID-19 vaccine studies should report social characteristics of participants consistently, facilitating informed decisions about the applicability of study results to the population of interest.
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Introduction: The active community search is widely used in field practice and allows to identify symptomatic people, criteria of risk of contagion, control of the virus, knowledge of the population at risk and, in addition, allows the analysis of the relationship of these factors with the increased risk of affecting health. However, it is difficult to find a consensus on this aspect. Objective: To identify active community search strategies that have an effect on the control of COVID-19. Methods: A systematic search was conducted in the PubMed, Science Direct and LILACS databases, also in Google Scholar, Open Grey and PROSPERO, from December 2019 to January 2021. The selection criteria were previously defined with respect to the intervention and the research topic of the articles consulted. The protocol was sent for registration in the International Prospective Register of Systematic Reviews (PROSPERO). Registration number: CRD42020160617. Conclusions: Of the two identified strategies, the home visit of the medical team made up by students, professors and other health professionals stands out. It is necessary to take this result with caution because they are studies from the same country, although the importance of community participation in public health surveillance is reiterated.
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Background: As cancer treatments improve, patients' quality of life becomes even more important. In parallel, supportive care delivery is increasingly challenging, also due to resource pressures and COVID19. The effectiveness of digital and remote patient support tools as a complementary approach to improve patients' quality of life is under evaluation. Fatigue is considered among the most prevalent and persistent side effects regardless of tumour type;also, despite ongoing research, there is no single approach established. We compare the effectiveness of different self-care interventions delivered by online platforms to cancer patients in several countries. Methods: Patients report side effects (including Fatigue) on the CareAcross online platforms and receive tailored support to help them improve their quality of life. The supportive material encompasses many topics, and patients may receive several combinations. For Fatigue, different topics (nutrition, hydration, rest etc) were analysed to evaluate effectiveness based on prospectively collected patient reported outcomes. Results: 1456 breast, lung, colorectal or prostate cancer patients from 8 countries (mainly UK, Germany, France, Spain, Italy) reported Fatigue at least once. This analysis focuses on persistent fatigue: 1215 patients reported Fatigue more than once, receiving up to 7 permutations of topics (F1-F7;F4-7 consist of F1-3 combinations). All permutations include the “Physical Activity” topic (see Table). Overall, the “Hydration” topic stands out as consistently linked with the most effective material (all except F3). Comparative analysis between similar combinations shows that those with “Anemia warnings” and “Rest” tend to be more effective (F7>F6). Ambiguously, the “Physical activity before & after treatment”, “Relaxation exercises” and “Fatigue diary” topics contribute to effectiveness (F5>F1), but do not counterbalance absence of the previous 3 (F1>F3). Food-related topics have unclear impact, too: “Food types” is absent from the top combination (F2) where “Food timing” is used;however, that topic is linked with a slightly inferior combination (F7>F5). Conclusions: Fatigue is a complex, multifactorial challenge;digitally delivered interventions can lower its incidence. Hydration appears effective, but the nature of these interventions complicates their thorough evaluation. Randomised studies may enhance these findings and enable additional personalisation towards further quality of life improvements. (Table Presented).
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Purpose of the study: Coronavirus disease 2019 (COVID-19) has caused severe morbidity and mortality around the world. As a consequence, emergency calls have increased worldwide. Emergency services in Italy are coordinated by 118 Operation Centres (118-OC). This study analizes newtendencies in emergency calls received by 118- OC in Foggia University Hospital, covering the whole Province of Foggia and beyond, about 650,000 inhabitants. Materials and methods:We analized all emergency calls received by our 118-OC during the second half of 2020, corresponding to the second wave of COVID-19, when emergency services and hospitals were better prepared than the first wave. A similar period was chosen before pandemic, from July to December 2019, as control. R statistical software was used for analysis and chi-squared tests were performed to compare frequencies. Results: The increase in emergency calls in 2020 immediately stands out (p-value < 0.00001). However, in 2020 there was a statistically significant increase in “non-emergencies” and a decrease in “emergencies” (p-value < 0.00001). The decrease in overall emergencies was not proportional to all types of emergencies. Evaluating cardiocirculatory emergencies compared to non-cardiovascular ones, the former decreased much more than the others (p-value < 0.00001). Ultimately, a traumatic event was more likely to activate “118” than a cardiovascular event compared to pre-COVID times. Nevertheless, this decrease in cardiocirculatory emergencies was not accompanied by a decrease in STEMI, which were more numerous than expected (pvalue < 0.0001). Conclusions: COVID pandemic caused a decrease in real emergency calls, probably due to the fear of activating “118” even on the part of those who needed it. The suspicion of many cardiovascular diagnoses that have not been observed is conceivable. Moreover, our results show that in 2020 there were more cardiocirculatory events with STEMI than expected. Perhaps we need to recognize a linkbetween SARS-CoV-2 and acute coronary syndrome, as literature is beginning to hypothesize
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The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has been devastating human lives since 2019.While each country carries out their vaccination program, many of them also continue to work on vaccine development. Determination of SARS-CoV-2 neutralizing antibodies offers important information for evaluating immune responses to the virus. Neutralization capacity can contribute to the understanding of subjects such as the immune status of individuals, the need for revaccination, relapse and recovery from the disease, as well as evaluation of vaccine efficacy. Neutralizing antibodies block the virus by preventing the interaction of the virus's S protein receptor binding domain (RBD) with human angiotensin converting enzyme-2(ACE-2). The most commonly used methods for the detection of neutralizing antibody titer are cell culture experiments with the virus such as the plaque neutralization assay. While these tests require biosafety level 3 conditions, ELISA tests can be performed in general laboratory without any sterile environment. Furthermore, while traditional methods take 2-3 days, ELISA stands out with its ease of application and can give results in just 90 minutes. In this study, we developed a prototype ELISA kit which is based on the principle of blocking the protein-protein interaction between RBD-HRP and ACE-2 with a possible neutralizing antibody in serum. For this purpose, the RBD protein was first labeled with horseradish peroxidase (HRP). Optimum use concentrations of RBD-HRP protein and human serum in the selected dilution buffer and the amount of ACE-2 protein to be coated on the ELISA plate were determined. As a result of repeated studies with a large scale of serum, the coefficients of variation(CV) for intra/inter-assay were calculated as 10% and 12%, respectively. Preliminary results of accelerated shelf-life studies showed that the ELISA kit maintained its shelf life up to 1 year at +4°C.
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Background Frailty is defined as a clinical state of increased vulnerability to health and age associated stressors. The liver frailty index (LFI), composed of grip strength, chair stand and balance testing, is an accepted predictor of morbidity and mortality in cirrhosis. With the need for COVID-19 related social distancing, many appointments are being carried out virtually. The chair stand subcomponent of the LFI has the potential to be evaluated virtually, with a high reliability as compared to in-person testing noted in other disease populations. Objective To determine if the chair stand test is an independent predictor of morbidity and mortality in patients with cirrhosis. Methods 822 adult patients with cirrhosis were prospectively enrolled from five centers (3 in Canada, 1 in the United States, and 1 in India). Inclusion criteria included adult patients with cirrhosis. 787 of these patients completed a chair stand test at baseline, measured as the time (seconds) a patient takes to rise from sitting with their arms folded across their chest five times (measured in-person). The times were divided into 3 categories: >15 seconds, between 10 and 15 seconds, and <10 seconds. Patients who could not complete 5 chair stands were classified in the >15 seconds category. Primary outcome was all-cause mortality. Secondary outcome was unplanned all-cause hospital admission. Fine-Gray proportional hazard regression models were used to evaluate the association between the chair stand time and the outcomes. We adjusted for baseline age, sex, and MELD score and accounted for liver transplantation as a competing risk. Cumulative incidence functions were used to create a graphical representation of the survival analysis. Results Patients were divided into three groups: group 1, <10 seconds (n = 276);group 2, 10-15 seconds (n = 290);and group 3, >15 seconds (n = 221). Mortality was increased in group 3 in comparison to group 1 (HR 3.21, 95% CI: 2.16-4.78, p<0.001). Similarly, the hazard of non-elective hospitalizations was higher in group 3 in comparison to group 1 (HR 2.24, 95% CI: 1.73-2.91, p<0.001). Overall, patients with chair stand times greater than 15 seconds had increased all-cause mortality (HR 2.78, 95% CI 2.01-3.83, p<0.001) and non-elective hospitalizations (HR 1.84, 95% CI 1.48-2.29, p<0.001) when compared to patients with times less than 15 seconds. Conclusion A time to complete 5 chair stands of >15 seconds predicts morbidity and mortality in patients with cirrhosis. This test shows promise as a frailty measure that could be evaluated over a virtual platform. (Figure Presented)
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I am truly honored to be invited to present during the lecture named after Prof. Lazlo von Dobszay, who was a remarkable Hungarian PAG Pioneer. This lecture will highlight the HPV vaccination path, where it comes from (from Good), where it stands today (to Great) and what it can expect in the years to come (to Excellent) HPV is a virus we can all beat, if we want to and if we put in the necessary effort. Yes, we can, … but unfortunately on our way we have encountered a game changer: the COVID pandemic. As a result of this roadblock, there is a worldwide HPV Coverage Gap. This worldwide crisis will affect health care for many years. Now we have to be fast and effective to get the HPV coverage back on track. Only then can we achieve the goal to fully vaccinate 80% of the adolescents, in order to obtain a herd immunity. Infections with human papillomavirus (HPV) constitute an important source of morbidity and mortality worldwide in people of all ages and genders. The HPV induced cancers show a remarkable trend with e.g. a greater incidence of head and neck cancers as compared to cervical cancers Gender neutral protection against HPV-related diseases is our moral duty. The success of that protection heavily depends on the timing of vaccination, especially before and even after unplanned exposure. Child sexual abuse requires even faster HPV action, the sooner the better. Unfortunately, HPV vaccine supplies are currently insufficient to meet the demand and some countries have already postponed its administration. Running out of vaccines is a reality, increases in supplies are imperative Recent research focuses on the non-inferiority of one versus two doses of the vaccine. If one-dose HPV vaccination became viable, some of the significant barriers to scaling-up and sustaining Low Income Countries/Low- and Middle Income Countries may be overcome. The limitations of preventive vaccines justify continuous innovation and adaptation of vaccination strategies.
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DDW 2022 Author Disclosures: Jukkaphop Chaikajornwat: NO financial relationship with a commercial interest ;Rapat Pittayanon: NO financial relationship with a commercial interest ;Prooksa Anancheunsook: NO financial relationship with a commercial interest ;Rungsun Rerknimitr: NO financial relationship with a commercial interest Introduction: Esophagogastroduodenoscopy (EGD) has been considered as an aerosol-generating procedures (AGP) with high risk of transmission of respiratory aerosols similar to an endotracheal intubation during COVID-19 pandemic. However, the risk of AGP at different distances to the patient’s mouth and the benefit of the protective measure such as the head box have never been fully studied. We performed a randomized control trial to evaluate the efficacy of acrylic head box for preventing the aerosol spreading to personnel standing at different distances to the patient’s mouth during EGD. Method: This trial is a randomized, open-label, single center, in adult patients scheduled for EGD between September and November 2021. Patients were randomly assigned with 1:1 allocation to either head box group or without head box group (control group). The 0.3- and 0.5-micron aerosol particles were measured with particle counters (PCE-PCO 1;PCE Deutschland GmbH, Meschede, Germany) at nurse anesthetist’s and endoscopist’s position for 2 minutes before EGD, and every 30 seconds automatically entire the procedure. The primary composite outcomes were the mean difference of aerosol particle level between during and before EGD at the nurse anesthetist’s face position (40 cm from the patient’s mouth) and at the endoscopist’s face position. (Figure) Result: The analysis included 50 patients undergoing EGD in each arm. The baseline characteristics were not difference between the 2 groups. The mean distance between the endoscopist’s face and the patient’s mouth was 66.1 ± 4.9 cm. (Figure) The mean differences of both 0.3- and 0.5-micron particle levels between during the procedure and baseline before the procedure measuring at the nurse anesthetist's position decreased in the head box group whereas those particle level increased in the control group (-491.9 versus 1095.8 particle/L (P=0.008) and -366.7 versus 249.8 particle/L (P=0.004), respectively). There was no significant difference of the mean differences of either 0.3- or 0.5-micron particle levels between during the procedure and baseline before the procedure measuring at the endoscopist’s position whether with or without headbox. (Table) Conclusion: EGD with the head box can reduce significant aerosolization to the endoscopy personnel including nurse anesthetist who standing near the patient’s mouth. However, those who stand further away such as the endoscopist who stands about 2 feet away from the patient’s mouth is already safe from aerosolization and does not get benefit from the head box because AGP from EGD affects only to the short-distant area. [Formula presented] [Formula presented]
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Background/Purpose: Previous research suggests that patients benefit from end-of-life (EoL) planning, including peace of mind that wishes will be followed, and less use of extreme treatments close to death. Unfortunately, EoL conversations often do not take place due to the patient's or physician's discomfort with the topic, or they focus primarily on medical decisions, and there has been limited qualitative research in this area. Thus, the present study examined qualitative outcomes from patients with advanced cancer who completed a 4-session weekly virtual psychotherapy group. Methods: The EoL group is based on The Last Chapter: Documenting your Pre- and Post-Death Decisions workbook and group therapy manual. The group consists of four weekly virtual sessions for patients to discuss and complete a comprehensive easily updated workbook to compile information, decisions, and documents about pre- and post-death decisions. Seven patients completed one-hour phone interviews 4-6 weeks after completion of the group. Interviews were audio-recoded and transcribed and included semistructured questions inquiring about thoughts, feelings, and impressions experienced during the group. An example question included: “Will you describe a particular moment or event that stands out for you?” Moustaka's (1994) qualitative data analysis was employed. Results: Five themes emerged including confronting mortality, finding freedom: motivated action on behalf of self and other, reclaiming self-identity, multigenerational influence: death in the past and future, enhanced medical care, and the COVID pandemic. One patient reported, “I found peace and satisfaction. Not only deciding what I want to do and what I want to happen, but how it will happen.” Conclusions and Implications: Overall, patients reported that the group and associated workbook enhanced their connections with others, helped them face their fears, and increased their sense of peace and fulfillment. Future studies should employ qualitative analysis to uncover themes and experiences not traditionally found in quantitative measures.
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Purpose: The COVID-19 pandemic has accelerated the adoption of digital health technologies for remote monitoring of participants in clinical trials, including measuring physical function. For trials in people with knee osteoarthritis (OA), standardized measures of function such as gait and chair stand are considered important outcomes. Wearable sensors have the potential to monitor these outcomes remotely. However, the reliability of wearable sensor metrics of gait and chair stand in participants’ homes and agreement between these metrics collected in laboratory and at-home have not been reported to date. Hence, our objective was to assess the reliability of wearable sensors for remote monitoring of gait and chair stand in people with knee OA. Methods: We used data from a substudy (n=20) embedded within an ongoing, single-arm clinical trial of an exercise intervention in people with knee OA (clinicaltrials.gov NCT04243096). Key inclusion criteria were age ≥ 50, BMI ≤ 40 kg/m2, physician diagnosed knee OA, score ≥ 3 on weight-bearing questions from the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain Subscale in the index knee, and ability to walk for 20 minutes without assistance. Key exclusion criteria included other major health conditions;prior, current, or planned major knee OA treatment;prior surgeries for knee OA;and contraindications to exercise. All assessments took place prior to initiation of the intervention. Participants completed two visits, an in-person lab visit and a remote at-home visit. The order of these visits was randomized across participants, with participants completing both visits between 1 and 20 days of each other. For the remote visit, participants were provided a wearable system consisting of three inertial sensors (Opal, APDM, Portland, OR, USA), two cones connected by a 7-meter rope, and an armless chair. Identical equipment was used during the in-person lab visit. During the remote visit, researchers guided the participants via video conference. Participants self-applied the sensors on each foot and on the lower back. They performed two trials each of a standardized gait task (self-selected walk for two laps of a 7-meter path defined by the cones and rope totaling 28 meters of walking) and chair stand task (five chair stands as quickly as possible with arms across the chest) in their home. Then, the participants removed the sensors, waited 15-minutes, re-applied the sensors, and performed two more trials of each task. At the end of the remote visit, participants completed a survey on their experience. During the in-person lab visit, participants performed two trials of the same tasks after a researcher placed the sensors on the participants. Spatiotemporal metrics of gait function and duration of chair stand were extracted from the sensor data using software (MoveoExplorer) provided by the sensor manufacturer. The mean of sensor metrics across each set of two trials were used in the analyses. We used Pearson’s correlation R2 and the intra-class correlation coefficients (ICC) to determine the correlation and the test-retest reliability of sensor metrics from the two repetitions of the tasks during the remote visit. We used ICCs and Bland-Altman plots and their 95% limits of agreement to examine agreement between sensor metrics from the remote (first two trials) and lab visits. Results: Participant characteristics are shown in Table 1. All ICCs were good to excellent (between 0.85 and 0.96) for the test-retest reliability during the remote visit and R2 ranged between 0.81 and 0.95 (Table 2, Figure 1). ICCs were moderate to excellent (between 0.63 and 0.91) for agreement between remote and lab visits (Table 2). Bland-Altman plots showed small bias in all metrics due to participants walking slightly faster during the lab visit compared to the remote visit (Figure 2). Participants were highly accepting of the remote visit (Table 3). Conclusions: In this cohort of people with knee OA who had moderate pain and disability, our method of estimating gait and chair stand fu ction remotely was found to be reliable, feasible, and acceptable. Wearable sensors could be used to remotely monitor gait and chair stand function in participant’s natural environments at a lower cost, reduced participant and researcher burden, and greater ecological validity overcoming many limitations of lab visits. Hence, our approach could be used in future clinical trials of people with knee OA. [Formula presented] [Formula presented] [Formula presented] [Formula presented] [Formula presented]
ABSTRACT
Background: Physical activity programmes have been shown to improve older adults' functional capacity, independence and quality of life. Research around structured exercise programmes has been completed in different groups of community-dwelling older people, however few studies have focused on the older population receiving formal home care. In a feasibility study, we embedded physical activity within older adults existing home care services through the 'Care to Move' (CTM) programme. The aim of this qualitative study is to explore older adults' experiences of the CTM programme. Methods: We conducted semi-structured telephone interviews with 13 older adults and one carer. Topics covered included participants overall experiences of the CTM programme, changes to their overall activity and participation, aspects of the programme that they liked or found valuable and issues that they found challenging. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery. Results: Four themes emerged: i) 'I'm feeling good about it', ii) 'safety and security is the name of the game', iii) 'we're a team as it stands', iv) 'it's [COVID] depressing for everybody at the moment'. Older adults identified benefits of CTM participation including improvements in physical and psychological wellbeing. However, frailty and multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of programme delivery and competing healthcare assistant (HCA) interests. The broader role of HCA's in supporting the CTM programme was highlighted as well as the emotional support that HCAs provided to older adults. HCA continuity was identified as a barrier to ongoing programme engagement. The impact of COVID on older adults physical and mental health negatively impacted programme delivery. Conclusion: Our findings suggest that embedding the CTM programme within home support services is feasible. Restructuring of services, addressing HCA continuity, and adopting individual approaches to programme delivery may enhance the implementation of services.