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Objective: The role of angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) in the pandemic context of coronavirus disease 2019 (COVID-19) continues to be debated. Patients with hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease, or chronic obstructive pulmonary disease (COPD), who often use ACEi/ARB, may affect risk of severe COVID-19. However, there are no data available on the association of ACEi/ARB use with COVID-19 severity in this population. Design and method: This study is an observational study of patients with a positive SARS-CoV-2 test and inpatient treatment at a healthcare facility, using the registry information of COVIREGI-JP. Our primary outcomes were consisting of in-hospital death, ventilator support, extracorporeal membrane oxygenation support, and ICU admission. Out of the 6,055 patients, 1,921 patients with preexisting hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease, or COPD were enrolled. We also evaluated 1,097 patients with hypertension. Results: Factors associated with an increased risk of the primary outcomes were aging, male sex, COPD, severe renal impairment, and diabetes mellitus. No correlations were observed with ACEi/ARB, cerebro-cardiovascular diseases, or hypertension. Associated factors in male patients were aging, renal impairment, hypertension, and diabetes. In female patients, factors associated with an increased risk were aging, ACEi/ARB, renal impairment, and diabetes, whereas hypertension was associated with a lower risk of the primary outcomes. In patients with hypertension, factors associated with an increased risk of the primary outcomes were aging, male sex, severe renal impairment, and diabetes mellitus, but not ACEi/ ARB, cerebro-cardiovascular diseases, or COPD. Conclusions: Independent factors for the primary outcomes were aging, male sex, COPD, severe renal impairment, and diabetes, but not ACEi/ARB, in the COVID-19 patients with preexisting hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease or COPD. Based on this registry data analysis, more detailed data collection and analysis is needed with the cooperation of multiple healthcare facilities.
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Objective: To share the implementing experience of the May Measure (MMM) campaign in Nepal. Design and Methods: Nepal has been a part of the MMM initiative since its inception. NeDS Nepal, a not-fort profit NGO was responsible for the overall coordination of the campaign. We trained and mobilized community health workers and health science students as volunteers. Although MMM was not executed globally due to the COVID-19 pandemic in 2020, it was conducted in Nepal by following safety measures. Results: The volunteers set up screening sites in supermarkets, temples, colleges, grocery stores, primary health care clinics, banks, government offices, and meeting halls. Some of the volunteers also did house-to-house visits. Between 2017-2021, we screened over 130,000 participants. We identified > 30,000 high blood pressure participants, provided lifestyle counseling, and referred them to the health facility for further diagnosis and treatment. Out of them, ∼18000 were newly identified hypertension. Conclusions: Opportunistic screening like MMM is feasible and needed in the context of Nepal. This could potentially be embedded in the national screening program. It is also important to have a strategy for linking the patients with the health system for further diagnosis and treatment.
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Background: Both cancer and COVID-19 have been reported to be associated with an increased risk of VTE. Severe disease needing hospitalization is also associated with an increased risk of VTE. There is a paucity of data evaluating the effects of race on this risk, with the limited available data suggesting that such a correlation exists. Given the increased prevalence of comorbidities and risk factors for VTE in African Americans (AA), we sought to evaluate if there are racial disparities in the incidence of VTE in the hospitalized subset of COVID-19 patients with cancer. Method(s): This was a retrospective chart review of unvaccinated cancer patients hospitalized with COVID-19 at a major tertiary health facility. Only cancer patients who were on active systemic chemotherapy were included. The primary study outcomes were development of DVT or PE (VTE) within 30 days of COVID-19 diagnosis. Secondary outcomes included mortality, hospital length of stay, mechanical ventilation, ICU admission, and need for vasopressors. Mean and standard deviation were reported for continuous variables;proportions were reported for categorical variables. To compare between races, the Chi-square test was used for categorical variables and the t-test was used for continuous variables. Multivariable logistic regression was then conducted to assess the relationship between race and selected factors. All statistical tests were 2-sided with an alpha (significance) level of 0.05. Result(s): A total of 73 patients were included in our analysis. The median age of the cohort was 70 years (interquartile range [IQR] 64-79). Gender breakdown: 58.9% males, 41.1 females. 31.5% were Caucasian, 64.4% African American, 1.4% Hispanic, and 2.7% other races/ethnicities. There were 8 DVT/PE patients in the cohort. Of 23 Caucasians in our cohort, 3 (13.0%) had VTE. Of 47 African Americans, 5 (10.6%) had DVT/PE. There was no significant difference between the incidence of VTE and race (p > 0.05). Multivariable logistic regression did not show a significant relationship between race and VTE, controlling for age, ICU stay, intubation, vasopressor use, serum ferritin and serum IL-6 levels. Notably, all patients included in this study were on enoxaparin prophylaxis for VTE. The only variable associated with DVT/PE was age and the presence of hemoglobinopathy. Incidence of VTE was significantly associated with increasing age (p < 0.03) and the presence of hemoglobinopathy (p < 0.01). Hemoglobinopathy was only seen in AA cancer patients with VTE (n = 4), and none in Caucasian patients. Conclusion(s): Contrary to what has been reported in the literature, we did not detect racial disparity in the incidence of VTE in hospitalized cancer patients with COVID 19. Prophylactic anticoagulation likely had a protective effect. However, racial disparity was observed in AA cancer patients with hemoglobinopathy with increased VTE risk despite prophylactic anticoagulation. This warrants further evaluation in future studies.
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BACKGROUND: Health information technology (HIT) is being increasingly necessary to manage the ever-increasing amount of data generate by the health system in general, including primary health care (PHC). AIM: This study aimed to provide an overview of HIT being currently use in the health systems and PHC as well as to highlight the advantages and disadvantages of HIT options. METHOD(S): This is a narrative literature review of papers, documents, and websites that address and discuss HIT for the health systems. The analysis of the retrieved materials provided an overview of the importance of HIT for the health system, the various options of health technology currently available, as well as the future trends. Strengths and weaknesses have been highlighted as well. RESULT(S): HIT is being increasingly used in the health sector, as an indispensable tool to handle the extraordinary amount of data being generated by the health system but also as an instrument to improve the quality of health care through the reduction of medical errors and health care-associated costs, improvement of patient follow-up and monitoring, and also as a tool that informs and guides clinical decision-making. A large variety of HIT options is available, including telehealth, telemedicine, mobile health, electronic medical records, electronic health records, personal health records, electronic prescriptions (e-prescriptions), wearables, metadata, and even artificial intelligence. Each HIT option has its own advantages and disadvantages. PHC could benefit from the implementation of various HIT options. CONCLUSION(S): The decision which HIT option(s) to employ will depend on many factors, but the process needs to employ small steps, strong political will, cooperation, and coordination between all stakeholders. Copyright © 2022 Erion Dasho, Loreta Kuneshka, Ervin Toci.
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COVID-19 first time appeared in December 2019 in Wuhan, China. The number of cases increased rapidly in china and outside and the World Health Organization declared a pandemic on 11th March 2020. The pregnant and postpartum women, child, and neonatal populations are vulnerable to this disease due to immunological and physiological changes. This paper analyzed the published evidence for assessing the effect of COVID-19 on neonatal health and health care. Online published literature was searched from PubMed, Google Scholar, and other official webpages using keywords: "coronavirus/COVID-19/new coronavirus 2019"/SARS-CoV-2 and neonatal health/care/outcomes" and reviewed to prepare this article. COVID-19 is the potential to transmit either mother to fetus or mother/caregiver to neonates. However, neonates born from infected mothers did not show significant clinical features. Pharyngeal-swab, amniotic-fluid, cord-blood, and breast-milk test results were not found positive. Health facility-based vaginal/caesarian delivery was considered a low risk of transmission. However, recommended to separate neonates with infected mothers/caregivers and test immediately after birth to avoid the possible transmission. Mothers/caregivers should take routine preventive measures such as washing hands frequently and avoiding contact with infected people. If neonates suffered from the server acute respiratory distress requires intensive care urgently. Despite the possibility of the intrauterine transmission of COVID-19 direct evidence is still lacking so it needs more studies for further confirmation. The International Pediatric Association suggested preventive programs, curative care, vaccination, and telemedicine care as the minimum services and called on its members to address these cares during the pandemic. Copyright © 2020, Kathmandu University. All rights reserved.
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Studies reporting the clinical presentations of COVID-19 in children in sub-Saharan Africa are few, especially from resource-constrained countries. This case series reports the demographic and clinical characteristics and laboratory findings of confirmed cases of COVID-19 in children seen at a district hospital in Sierra Leone. This is a report of nine COVID-19 paediatric cases managed at a secondary level hospital in Kambia District, Northern Sierra Leone. Each child was detected by contact tracing after an infected adult was identified by the COVID-19 response team. The clinical symptoms at presentation, clinical courses, and treatments instituted and patient outcomes are discussed in the context of the facilities available at a typical West African district hospital. Nine out of 30 individuals with confirmed COVID-19 infection who presented to the hospital from 24 April to 20 September 2020 and who were admitted to the isolation center of the hospital were in the paediatric age group. The mean age (SD) and median (IQR) of the children were 69.0 +/- 51.7months and 84.0 (10.5, 108.0) months, respectively;five (55.6%) were males. The children were asymptomatic or only had mild illnesses and none required intranasal oxygen or ventilatory support. In the five symptomatic children, the most common symptoms were fever (40%) and cough (40%). All children had normal haemoglobin, platelet and white blood cell (WBC) count. Four children had a positive malaria test and were treated with a complete course of anti-malaria medications. No child received steroid or had specific anti-COVID-19 treatment. All children stayed in the isolation center for 14 days and were re-tested for COVID-19 two weeks after initial diagnosis. No complications have been reported in any of them since discharge. The proportion of children among COVID-19 infected cases seen in a rural community in Sierra Leone was 30%. Fever was the most common symptom and malaria was confirmed in 40% of the infected children. This has significant implication on the diagnosis of COVID-19 in malaria-endemic settings and on how best to manage children who present with fever during the COVID-19 pandemic. Copyright © Hammed Hassan Adetola et al.
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Background: On March 2020, because of the COVID-19 pandemic, the Swiss Federal Council mobilised conscript formations of the Swiss Armed Forces. This was the largest military mobilisation since the Second World War. Purpose(s): To assess the roles of the militia pharmacy officers deployed throughout the country to assist the healthcare system. Method(s): All missions performed by militia pharmacy officers were systematically collected and evaluated. They were also compared to the official duties of pharmacists in the Swiss Armed Forces. Result(s): Ten pharmacy officers were enlisted in two out of four hospital battalions deployed, as well as in the medical logistic battalion and in the staff of the logistic brigade that embedded them. Their missions were mainly planning, conduct and control of medical logistics, as well as hygiene and drug manufacturing activities. In the hospital battalions, they especially managed: 1) supply of medical material dedicated to mission-related training, civilian health facilities assistance and medical transportation;2) establishment and application of hygiene procedures;3) provision of conscripts' own medication. In the medical logistic battalion, the support of both military and civilian pharmaceutical production facilities was the most important activity (e.g. disinfectants and anaesthetics manufacturing). Conclusion(s): Thanks to their civilian and military background, militia pharmacy officers have been quickly and effectively deployed throughout the country. The role of pharmacists within their respective battalions has emerged as especially crucial in the pandemic context and some of the performed missions were beyond their traditional duties. Their basic training has to be further developed accordingly.
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Purpose: To evaluate the SARS-CoV- 2 infection rate among vaccinated RMD patients in a tertiary hospital and its associations. Methodology: This cross-sectional study was performed among adult rheumatology patients who attended follow up at our centre from 1st April 2022 to 30th April 2022. Demographics and clinical data were compared between the vaccinated patients with SARS-CoV- 2 infection, Group 1 (G1) and without SARS-CoV- 2 infection, Group 2 (G2). Descriptive and inferential statistics were conducted using SPSS version 26. Result(s): We enrolled a total of 212 patients with underlying diagnosis of rheumatoid arthritis (94 patients, 44.3%), systemic lupus erythematosus (59 patients, 27.8%), spondyloarthropathies (30 patients, 14.2%) and others (29 patients, 13.7%). Of all these patients, 57 (26.9%) had SARS-CoV- 2 infection (G1) with mean (SD) age of 45.2 (+/-14.65) years compared to 53.4 (+/-15.22) years in G2 (P = 0.001). In G1, 50 (87.7%) were female, 32 (56.1%) were Malay and 26 (45.6%) with >= 1 comorbidity. Most patients in G1 received 3 doses of vaccine (n = 36, 63.2%) while 21 (36.8%) completed 2 doses of vaccine. Majority in G1 (n = 46, 80.7%) had clinical stage 2 SARS-CoV- 2 infection. Seven required admission to health care facilities with median stay of 6 +/- 2 days. Twenty-three patients (32.9%) in G1 received more than one immunosuppressive drug. Twenty-one out of 63 patients (33.3%) who had 2 doses of SARS-CoV- 2 vaccine had SARS-CoV- 2 infection compared to 36 out of 149 patients (24.2%) who received 3 doses of vaccine, albeit not significant. Conclusion(s): Despite a quarter of the cohort acquired SARS-CoV- 2 infection, the disease was notably less severe, attributed to younger age, less comorbidity and vaccine effectiveness. Type of immunosuppression and use of more than one immunosuppressive drugs were not associated with SARS-CoV- 2 infection.