Long-Term Hydroxychloroquine and Its Association with Covid-19 Infection, a Cohort Study from a South American Hospital

Objectives: We aimed at examining whether patients with rheumatological conditions receiving chronic hydroxychloroquine therapy are at a lower risk of developing SARS-CoV-2 infection than those not receiving hydroxychloroquine. Method(s): This historical cohort study included information of all patients aged 18 years or older with rheumatoid arthritis, systemic lupus erythematosus, or associated rheumatological conditions (based on International Classification of Diseases, 10th edition, diagnostic codes). A propensity score was calculated for each patient, and each patientwho was receiving hydroxychloroquine was matched to two patients who were not receiving hydroxychloroquine (controls). The primary endpoint was the proportion of patients with PCR-confirmed SARS-CoV-2 infection among those receiving chronic hydroxychloroquine versus the propensity-matched patients not receiving chronic hydroxychloroquine in 2021. Result(s): 322 patients receiving hydroxychloroquine and 645 patients not receiving hydroxychloroquine were included in the primary analysis. The incidence of active SARS-CoV-2 infections during the study period did not differ between patients receiving hydroxychloroquine and patients not receiving hydroxychloroquine ( [0 3%] vs 78 [0 4%] of 21406;odds ratio 0 79, 95% CI 0 52-1 20, p = 0 27). There were no significant differences in secondary outcomes between the two groups of patients who developed active SARS-CoV-2 infection. For all patients in the study, overall mortality was lower in the hydroxychloroquine group than in the group of patients who did not receive hydroxychloroquine (odds ratio hydroxychloroquine was not associated with the development of active SARS-CoV-2 infection (odds ratio 0 79, 95% CI 0 51-1 42) Conclusion(s): Hydroxychloroquine was not associated with a protective effect against SARS-CoV-2 infection in a large group of patients with rheumatological conditions.

Cool Your Jets Bro

History: Twenty-two year old male basic trainee was brought to the ED after collapsing during a routine ruck march. At mile 8/12, soldier was noted to develop an unsteady gate and had witnessed loss of consciousness. A rectal core temperature was obtained and noted to be >107degreeF. Cooling initiated with ice sheets and EMS was activated. On arrival to the ED, patient demonstrated confusion and persistently elevated core temperatures despite ice sheeting, chilled saline and cold water bladder lavage. Cooling measures were discontinued after patient achieved euthermia in the ED;however, his temperatures subsequently spiked>103degreeF. Given rebound hyperthermia, an endovascular cooling (EVC) device was placed in the right femoral vein and patient was transferred to the ICU. Multiple attempts to place EVC device on standby were unsuccessful with subsequent rebound hyperthermia. Prolonged cooling was required. Physical Exam: VS: HR 121, BP 85/68, RR 22 SpO2 100% RA, Temp 102.4degreeF Gen: young adult male, NAD, shivering, A&Ox2 (person and place only) HEENT: Scleral anicteric, conjunctiva non-injected, moist mucus membranes Neck: Supple, no LAD Chest: CTAB, no wheezes/rales/rhonchi CV: tachycardia, regular rhythm, normal S1, S2 without murmurs, rubs, gallops ABD: NABS, soft/non-distended, no guarding or rebound EXT: No LE edema, tenderness SKIN: blisters with broad erythematous bases on bilateral heels Neuro: CN II-XII grossly intact, 5/5 strength in all extremities. Differential Diagnosis: 216. Septic Shock 217. Hypothalamic Stroke 218. Exertional Heat Stroke (EHS) 219. Neuroleptic Malignant Syndrome 220. Thyroid Storm Test Results: CBC: 18.2>14.5/40.6<167 CMP: 128/3.5 88/1831/2.7<104, AST 264, ALT 80, Ca 8.8 Lactate: 7.1 CK: 11 460 Myoglobin: 18 017 TSH: 3.16 CXR: No acute cardiopulmonary process Blood Cx: negative x2 CSF Cx: Negative COVID/Influenza/EBV: Negative Brain MRI: wnl. Final Diagnosis: Exertional Heat Stroke. Discussion(s): No EVC protocols exist for the management of EHS or rebound/refractory hyperthermia. As a result, the protocol used for this patient was adapted from post-cardiac arrest cooling protocols. It is unclear if this adapted protocol contributed to his delayed cooling and rebound hyperthermia as it was not intended for this patient demographic/ pathophysiology. Furthermore, despite initiating empiric antibiotics upon admission, delayed recognition and tailored therapy for his bilateral ankle cellulitis may have contributed to the difficulty in achieving euthermia. In summary, more research needs to be done to evaluate and develop an EVC protocol for EHS. Outcome(s): Euthermia was achieved and maintained after 36 hours of continuous EVC, at which point it was discontinued. His CK, AST/ALT, creatinine and sodium down-trended after discontinuation of EVC. Patient's antibiotics were transitioned to an oral formulation for treatment of ankle cellulitis and he was prepared for discharge. He was discharged with regular follow-up with the Fort Benning Heat Clinic. Follow-Up: After discharge, patient had regularly scheduled visits with the Fort Benning Heat Clinic. His typical lab markers for exertional heat stroke were regularly monitored. He had continued resolution of his Rhabdomyolysis, acute kidney injury and hyponatremia with typical treatment. Soldier returned to duty after 10 weeks of close monitoring and rehabilitation.

Management of Acquired von Willebrand Syndrome During Prolonged VV-ECMO

Acquired von Willebrand syndrome (AVWS) contributes to bleeding during extracorporeal membrane oxygenation (ECMO) support. Although it is recognized that AVWS rapidly resolves after ECMO decannulation, this approach may often be clinically unsuitable. In such cases, optimal AVWS management during ECMO support is not well established. We report our approach to managing AVWS in a patient on veno-venous (VV) ECMO for 59 days. A 19-year-old male developed hypoxemic respiratory failure from SARS-CoV-2 pneumonia. Following intubation, he progressed to VV-ECMO support for refractory hypoxemia and was started on bivalirudin for systemic anticoagulation. Two days later, he developed refractory gastrointestinal and oro-nasopharyngeal bleeding despite blood product transfusions and discontinuing bivalirudin. He was started on pantoprazole along with infusions of octreotide and aminocaproic acid. Upper endoscopy on ECMO day 5 revealed an ulcerative bleeding vessel in the duodenum that was clipped. Recurrent mucosal bleeding precluded resumption of systemic anticoagulation. On ECMO day 23, AVWS was diagnosed based on elevated von Willebrand factor (VWF) activity (207%, normal 55-189%) and antigen (234%, normal 50-210%) levels with abnormally low VWF high-molecular-weight multimers. Factor VIII complex was administered twice over the following week. Between doses, the ECMO circuit was exchanged to empirically mitigate suspected shear-related VWF consumption from the fibrin burden, and a repeat endoscopy controlled additional intestinal bleeding with local hemostatic agents. He received 36 units of red blood cells, 2 units of platelets, 2 units of plasma, and 7 pooled units of cryoprecipitate over 31 days leading into these combined interventions. In the 28 days afterwards, he received 3 units of red blood cells, 3.5 pooled units of cryoprecipitate, and no additional platelets or plasma. Our patient was maintained off systemic anticoagulation for 54 of 59 days of VV-ECMO support without any thrombotic complications occurring. With no subsequent clinical evidence of bleeding, repeat VWF testing was done two months post-decannulation and showed near-normal VWF activity (54%) and normal multimer distribution. Our patient rehabilitated well without any neurologic deficits and on discharge was requiring supplemental oxygen with sleep and strenuous activity. Avoiding systemic anticoagulation, repleting VWF, maintaining circuit integrity, and providing local hemostasis, when possible, may be a safe and effective management strategy of AVWS on ECMO support when decannulation is not a viable option.

Clinical Features, Laboratory Findings Outcomes in Multisystem Inflammatory Syndrome (Mis-C) Following Covid-19 Infection - a Multicenter, Observational, Ambidirectional Cohort Study in Rio De Janeiro State, Brazil

Objectives: As of March 5th, 2022, around 1.585 cases of MIS-C and 98 deaths (6,4%) were reported in Brazil. The state of Rio de Janeiro State (RJ) having 94 cases (5,9%) and 4 deaths (4,2%)1.Our aim was to evaluate clinical and laboratory features, and management of MIS-C in seven pediatric hospitals in RJ, Brazil. Method(s): Multicenter, observational, ambidirectional cohort study in seven tertiary hospitals in RJ(Brazil), assessing medical charts of pediatric inpatients (0-18 years) diagnosed with MIS-C according to WHO/CDC criteria, from August, 2020 to February, 2022. Descriptive statistics were used to analyze distributions of continuous variables, frequencies, and proportions. Result(s): A total of 112 cases of MIS-C were enrolled. The mean age was 4.2 years and thre was male predominance (59,8%). All cases had a SARS-CoV-2 contact (29.5% close contact;31.3%:positive PCR;serology:43.8%).Only 12.5% had comorbidities. Length of stay (LOS) was 7 days.Median duration of fever was 8 days. Most common symptoms were: rash(67%);gastrointestinal (67%);conjunctivitis (42%);neurological(39.6%);cardiovascular(37.5%);cervical lymphadenopathy (36.6%), and shock/hypotension(28.6%).Co-infection occurred in 3 patients. Forty-four patients fulfilled criteria for Kawasaki disease. Most patients were admitted to PICU(12;62,5%) for amedian of 2 days. Respiratory distress was seen in 18,7%;hypotension:28,6%, and shock in 23,2%. Main laboratory findings were: high C-reactive protein in 95%;D-dimer:77%, anemia:77%, thrombocytosis:63%;transaminitis:43.8%, lymphopenia:38%;hypoalbuminemia:34%;thrombocytopenia: 29%;hypertriglyceridemia:28%, and high pro-BNP in 27%. Echocardiogram was performed in 91/112 patients;abnormal in 70,3%;exhibiting myocardial dysfunction( 25%);pericardial effusion(21%);coronary dilation/aneurysms(11%) and, valvulitis (14.5%). IVIG+corticosteroids (CTC) were administered in 59.8%(67/ 112);18.6%(18/112) IVIG only;10.7%(12/112) CTC only;3.4%(4/112)biologics, and 15(13.3%) received no treatment. ASA low dose in 77.7% (87/112) and moderate/high dose in 34.8%. Oxygen support was needed in 27,7%;vasoactive amines:18,7%;dialysis:5,3%, and transfusion:18,7%.One patient died from a cytokine storm syndrome. Conclusion(s): Our study reports a higher number of MIS-C cases in RJ than the number reported to Brazilian authorities, highlighting underreporting. Our patients were younger, had fewer comorbidities, cardiovascular/gastrointestinal/renal involvement, shortest LOS in ICU, and a higher frequency of myopericarditis.

[Epidemiological characterization of COVID-2019 in Mexican pregnant women: a cohort study]

Background: COVID-19 in pregnancy can increase the risk of complications due to the cardiorespiratory and immunological changes typical of pregnancy. Objective: To report the epidemiological characterization of COVID-19 in Mexican pregnant women. Material and methods: Cohort study on pregnant women with a positive COVID-19 test, which were followed until delivery and one month later. Results: 758 pregnant women were included in the analysis. Mothers' mean age was 28.8 +/- 6.1 years;the majority were workers 497 (65.6%) and with an urban origin (482, 63.6%);the most common blood group was O with 458 (63.0%);478 (63.0%) were nulliparous women and more than 25% had some comorbidities;the average gestation weeks at infection were 34.4 +/- 5.1 weeks;only 170 pregnant women (22.4%) received vaccination;the most frequent vaccine was BioNTech Pfizer (96, 60%);there were no serious adverse events attributed to vaccination. The mean gestational age at delivery was 35.4 +/- 5.2 weeks;85% of pregnancies were cesarean section;the most frequent complication was prematurity (406, 53.5%), followed by preeclampsia (199, 26.2%);there were 5 cases of maternal death and 39 cases of perinatal death. Conclusions: COVID-19 in pregnancy increases the risk of preterm birth, preeclampsia, and maternal death. Vaccination against COVID-19 in this series showed no risk for pregnant women and their newborns. Copyright © 2023 Revista Medica del Instituto Mexicano del Seguro Social.

Multisystem inflammatory syndrome associated with COVID-19 in adult: the case report

The multisystem inflammatory syndrome associated with COVID-19 coronavirus infection was first described in April-May 2020, mainly among children who had an acute infectious disease. Soon there were reports of the development of MIS in adults (MIS-A). More than 200 cases of MVS in adults have been described and systematized in the world, while in Russia there is no separate registration of MVS, a single description of MVS is given in the literature. Material and methods. We presented Case report of MIS-A in a 21-year-old woman, accompanied by persistent fever, multiple organ failure syndrome, is presented. The stages of diagnosis and treatment of MIS-A. Result and discussion. A positive effect was achieved during therapy with corticosteroids and intravenous immunoglobulin. MIS-A is a rare life-threatening complication of a COVID-19 that requires emergency therapy with the inclusion of corticosteroids and intravenous immunoglobulin in an adequate dose. The given example will be interesting for general practitioners, infectious disease specialists and therapists.Copyright © 2023 The authors.

Second wave of COVID-19 - Not a matter of great concern for pediatric hematologist/oncologist

Coronavirus disease-19 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic and is giving rise to a serious health threat globally. SARS-CoV-2 infection ranges from asymptomatic carrier state to severe illness requiring intensive care unit (ICU) management. It is postulated that with COVID-19 infection, children are less prone to develop severe symptoms as compared with adults. The data on immunocompromised children affected with COVID-19 infection is limited and not many publications are there on the effects of 2nd wave of COVID-19 infection in pediatric hematology/oncology patients till date. In our experience during second wave, 17 patients were found to be positive for SARS-CoV-2 with a male: female ratio of 2.4: 1 and median age of 8 years (range 1-18 years). Out of these 17 patients, 10 (58.8%) patients required hospital admission whereas the remaining were managed at home. Only 1 patient required ventilatory support and there was no mortality. Though the number of pediatric patients with COVID-19 infection were more during the second wave but majority had mild to moderate symptoms and were easily managed.Copyright © 2022 Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics

Validity of the 2-Minute-Step Test Administered Virtually

PURPOSE/HYPOTHESIS: The 2-minute-step test (2MST) is a face-to-face (F2F) measure used to clinically evaluate aerobic capacity in adults. With the onset of the COVID-19 pandemic, the need to assess cardiovascular health in a virtual environment became evident. The 2MST is amenable to being performed in a virtual environment due to low space requirements, simple instructions, and the ability to visually count step performance through a remote visual setup. The purpose of this study is to determine if there is a difference in performance on the 2MST when administered virtually compared with F2F. NUMBER OF SUBJECTS: 28 healthy adults aged 18-35 were recruited. Subjects were screened to determine eligibility and scheduled for a practice session in both test environments. Exclusion criterion included balance impairments, cardiopulmonary conditions, and pain/recent surgeries that would adversely impact stepping performance. MATERIALS AND METHODS: Subjects performed the 2MST virtually via Zoom platform and F2F on two separate days within 1 week of each other in a counterbalanced order. The primary outcome measure was total number of steps with the right leg to the marked height in both testing sessions. Heart rate was measured prior to performance and immediately upon test completion on both days. Group differences were analyzed using twotailed paired t-tests. RESULT(S): 25 adults (mean age = 24.0 years, 9males, 16 females) completed both sessions. Three subjects were not able to complete both tests and were excluded from analysis. There is no significant difference in mean number of steps performed F2F (M=108.6, SD=11.5) and virtual (M=109.2, SD=15.1);t(24)= .359, p = .7227. The average of the difference in steps between F2F and the virtual environment was <1 step (0.6). Change in heart rate (bpm) was not significantly different in the second test (M=50.4, SD=24.8) compared with the first test (M=46.7, SD=23.6) suggesting similar exertion in both test environments;t(23)=1.0288, p= .3143. CONCLUSION(S): Our findings indicate 2MST performance in healthy adults aged 18-35 is not significantly different when administered via Zoom compared with F2F. This suggests the 2MST may be an effective tool, if a visual virtual option such as Zoom or Facetime, is available when assessing aerobic capacity remotely. Limitations of the study include generalizability to other age groups is currently unknown and the ability of subjects to independently set up the test remotely was not assessed. As in all virtual assessments, clinical reasoning guides which patients are appropriate to perform outcome measures safely, if skilled assistance in not available. CLINICAL RELEVANCE: A valid tool to assess aerobic capacity in a virtual environment can improve patient care, improve access to physical activity interventions and improve health outcomes. Vulnerable populations, such as cancer survivors, who need virtual options for ongoing care will benefit from assessment tools that are adaptable and valid in virtual settings.

Outcome of Haploidentical Hematopoietic Stem Cell Transplantation with a Donor and Recipient Infected with SARS-CoV-2 Infection

The current coronavirus disease 2019 (COVID 19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV 2), has impacted many facets of hematopoietic cell transplantation (HCT) in both developed and developing countries. The full impact of the COVID 19 pandemic, caused by the SARS CoV 2, on the field of hematopoietic cell transplantation (HCT) is unknown. Here, we report a rare case of a 21-year-old male patient known to have chronic myeloid leukemia (CML) with progression to T-cell lymphoblastic lymphoma as extramedullary blast crisis of CML. The patient was treated by pediatric chemotherapy regimen then. He underwent haploidentical stem cell transplantation. Posttransplantation, on day +7, he developed SARS-CoV-2 after receiving stem cell graft from a donor who was diagnosed with SARS-CoV-2 on the day of stem cells harvesting. The case elaborates complications and outcome of a patient receiving stem cell transplant from a donor with SARS-CoV-2 infection.Copyright © 2023 Journal of Applied Hematology Published by Wolters Kluwer - Medknow.

Investigating the moderating role of thwarted belongingness, perceived burdensomeness, and suicidal capability in suicidal behavior

Objective: Suicide is one of the leading causes of death in the world. The present research aimed to investigate the moderating role of thwarted belongingness, perceived burdensomeness, and suicidal capability in suicidal ideation, behavior, and attempts among the Iranian population. Method(s): The data were analyzed using cross-sectional regression models. The population of this study included 600 students of the University of Mohaghegh Ardabili. The tools used to collect the data in this study were the Patient Health Questionnaire-2, the Depressive Symptom Index-Suicidality Subscale (DSI-SS), the Suicide Attempt Questionnaire, the Interpersonal Needs Questionnaire (IPTS), the Suicide Capacity Scale-3, the Adverse Childhood Experiences, the Generalized Anxiety Disorder Questionnaire, and the Suicidal Behaviors Questionnaire-Revised. Result(s): The results of this study showed that there was an interaction between thwarted belongingness and perceived burdensomeness in suicidal behavior and DSI-SS. The results also showed that the acquired and practical capability subscales (suicidal capability) strengthen the relationship between suicidal behavior and the DSI-SS, on the one hand, and suicide attempt, on the other hand. Conclusion(s): The findings of the study showed that the interpersonal theory of suicide can pave the way to prevent suicidal ideation and behavior in Iranian society, and it is recommended that Iranian practitioners apply the theory in practice.Copyright © 2022 Yerkure Tanitim ve Yayincilik Hizmetleri A.S.. All rights reserved.

Current Prescribing Practices in Psoriatic Arthritis - Comparison between the Uk and Europe

Background/Aims Psoriatic arthritis (PsA) is a multi-system disease with a range of management options. Treatment may vary by geographic location. We compared disease characteristics and prescribing practices in the UK and Europe in the post-Covid era. Methods The ASSIST study was a cross-sectional observational study of PsA patients aged 18 years and older selected from 24 centres across 5 countries (UK, France, Germany, Italy and Spain) between July 2021 and March 2022 (IRAS: 287039). Patients attending a face-to-face appointment with a diagnosis of PsA made by a rheumatologist were selected by systematic sampling at each centre and treated in routine clinical practice. Patient and disease characteristics, current treatment and treatment decisions (medications unchanged, switched, added or reduced) were recorded. The analysis was descriptive, with no imputation of missing data. Results 503 patients were included, with arthritis subtype, patient age, disease activity and duration shown (Table 1). Physician- and patient-reported disease severity was highest in the UK, where median patient age was lowest. Conventional synthetic (cs) DMARDS constituted a higher percentage of current PsA treatment in UK than continental Europe (66.4% vs 44.9%), whereas biologic use was more frequent in Europe (68.1% vs 36.4%). Adalimumab was the most commonly used biologic in the UK and Spain. Adalimumab and secukinumab were equally used in Germany, and ixekizumab and adalimumab were joint-first in Italy. Implementing change to the current PsA treatment was most common in the UK, predominantly being a treatment increase. This may reflect the higher level of disease activity or younger patient age in the UK than other countries, as treatment escalation is more likely earlier in the disease course. In the UK, treatment escalation was more commonly achieved by medication addition (26.2%) than medication switch (14%) or dose increase (7.5%). In Europe, medication addition and switch were of more similar frequency (10.9% vs 9.85%). Conclusion Disease characteristics and treatment strategies varied between countries, but particularly between UK and the rest of Europe. In contrast to mainland Europe, csDMARDs predominated in the UK, perhaps reflecting current NICE guidelines. Treatment escalation was most common in the UK, in keeping with higher disease activity. (Table Presented).

Effect of Neurofeedback Training on male Swimmers' Stress Tolerance

This study aimed to analyze the effect of eight weeks of neurofeedback training to increase the stress tolerance level of swimmers the current researchers examined six all-India inter-university male swimmers. For the pre-test and post-test data on stress tolerance of swimmers, the current author used the computer-based, pre-designed "Determination Test" on the Schuhfried "Vienna Test System", and the alpha and beta training was provided by the pre-designed Med-Life biofeedback/neurofeedback system. Swimmers go-through under rigorous training cycle andat the time of the race, and to reduce that stress, the current author conducted this study on swimmers and found the difference in the mean of the pre-test, i.e., 27.67, while the post-test mean was 59.5;hence, the value of the t-statistic(5.338) is also significant to its corresponding p-value, i.e., 0.003, which is less than 0.05, which shows the significant difference between the pre-test and post-test, thus leading the current authors conclude that there was a significant improvement in the swimmers' perception of their stress tolerance level and, it shows that the 21 tutelage sessions were effective in increasing the swimmers' stress tolerance level, which can help the swimmers maintain an optimal state at the time of the race.Copyright © 2023, Anka Publishers. All rights reserved.

Covid-19 Vaccine-Induced Myositis

Background/Aims Through the COVID pandemic there have emerged reports of autoimmunity or new rheumatic diseases presenting in patients after they had COVID-19. This is thought to be caused by cross-reactivity of the COVID-19 spike protein to human antigens. Given the use of mRNA COVID-19 vaccinations which express the spike protein we might expect to see presentation of new rheumatic diseases following their use. We discuss a case where this appears to have occurred. Methods Our patient is a 24-year-old male with mixed phenotype acute leukaemia who had been treated with allogenic stem cell transplant and was currently in remission. He presented with fevers, palpitations, myalgia and bilateral arm and leg swelling. Symptoms began the day after receiving the first dose of an mRNA COVID-19 vaccination (Pfizer/BioNTech.) There were no other symptoms or recent change in medications. Physical examination revealed tender oedema in his forearms, biceps and thighs bilaterally with sparring of the hands. He had reduced power with shoulder (MRC 3/5), elbow (4), wrist (4+) and hip (4) movements. Observations revealed tachycardia and fevers up to 40C. Results Laboratory studies showed markedly elevated C-reactive protein (202), creatinine kinase (6697) and troponin (593) whilst investigations for infection were negative. An autoimmune panel was positive for anti- PM-SCL-75-Ab. An electrocardiogram showed sinus tachycardia. Echocardiogram was normal. Bilateral upper limb dopplers revealed no deep vein thrombus. An MRI of his thighs showed diffuse symmetrical oedema within the muscles, in keeping with an inflammatory myositis. A quadricep muscle biopsy showed evidence of MHC class 1 up-regulation, suggesting an inflammatory process. In addition, there were numerous macrophages evident in the endomysium. While this can be seen in graft-versus-host disease (GVHD), they would usually be found in the perimysium. After discussion between haematology, rheumatology and neurology, this was felt to be a case of vaccine induced myositis and myocarditis. Autoimmune myositis was thought to be less likely due to the relative sparing of the hands and the absence of Raynaud's phenomenon. 1 gram of intravenous methylprednisolone was then given for 3 days. The patient had a marked response with defervescence, improving laboratory markers, improved myalgia and decreased limb swelling. The patient was stepped down to a reducing regime of prednisolone and discharged. Due to relapse whilst weaning he has started on mycophenalate mofetil and rituximab and now continues to improve. Conclusion There are case reports of myositis following COVID-19 vaccination but our patient's case is complicated by the differential diagnosis of GVHD and concurrent myocarditis. Ongoing work is needed to clarify the exact link between vaccination and the presentation of a new inflammatory myositis, but it is important to recognise and start treatment early in order to preserve muscle bulk and ensure recovery.

Covid Shielding Stories: Co-Produced Research to Understand the Voice of People Living with Arthritis and Auto-Immune Disease

Background/Aims Up to one-third of people with rheumatological conditions were required to 'shield' from COVID-19. This co-produced, qualitative research aimed to understand experiences of the shielding process and the impact of shielding upon people's lives. Methods Adults who shielded due to rheumatological disease participated in audio-recorded interviews and focus groups (FGs). Framework analysis combined inductive and deductive approaches. Creative materials were collected. Two patient contributors proposed the study, are co-investigators, and conducted the research alongside a clinical academic and four-member patient advisory group. COREQ and GRIPP2 guidelines were followed. Full ethical approval was granted by the University of Manchester Research Ethics Committee (2021- 11544-20348). Results Data were generated from 28 interview and 12 FG participants between October 2021-January 2022. 15 people contributed creative materials. Characteristics included 44/48 (85%) female, ages 18-75 years, non-white 10/48 (21%), all UK regions (Table 1). Corbin & Strauss's theory, 'Three lines of work: Managing chronic illness', frames the findings. Shielding increased and shifted the burden of 'illness work' onto patients, e.g., in gaining access to vaccines and navigating risks and uncertainties due to COVID-19. 'Life work' was increased as participants struggled to access food and medicines. Participants' self-identity was re-appraised in the context of their illness. Many feared for their lives because of their diagnosis for the first time, increasing 'biographical work'. Participants' perceived value to society changed over time: feeling equal to the general population at the first UK national lockdown;abandoned by society due to 'freedom day' and formal shielding's end. 'Emotional work' was added to 'Three lines of work'. Shielding notification induced fear, stress, devastation, shock and disbelief, balanced by a feeling of being protected. Emotions experienced include anxiety, guilt, anger and frustration. Mental health problems were experienced, often for the first time. Many continued to shield beyond formal shielding's end. Conclusion This co-produced, qualitative research highlights experiences and impact of shielding including increased illness, life, biographical and emotional work. Clearer, personalised information would help shielders to understand their risk and vaccine response, informing re-integration into society.

Psychological Impact of E-Learning among Students: A Survey

Aim: This study is conducted to know the psychological impact of e learning among the students. Background(s): From the time of very first beginning of civilization to modern days before corona pandemic situation, most of the students of India are very much used to with the offline mode of learning. But now the situation is changed totally. They are getting themselves adapted to the online mode of learning as per need of time. In this changed scenario they are totally disconnected from their usual life with frames schools teachers and society. This situation wreaks havoc to their psychology. Methodology: This study is conducted with primary data in form of online survey. It was conducted with a pre formed questionnaire. 428 responses were collected for the present study. With advanced Excel software statistical analysis done. Outcome(s): Results show that students have shown negative impression on online learning and still they are not ready totally psychologically. Still positive answers show neck to neck result, which signifies increasing interest towards e learning. More practices and awareness required before further implementation.Copyright © 2020 Ubiquity Press. All rights reserved.

Healthcare Seeking Behaviour of Hospitalised COVID-19 Patients During Second Wave in Tertiary Care Hospital of Northern India

Background: The Coronavirus Disease (COVID-19) pandemic continues its deadly reign all over the world. Devising effective strategies for detecting and controlling the infection has become ever more critical. Effective prevention and control of the pandemic is entirely dependent on human behavior in terms of practicing preventive and curative measures. During the second wave of COVID-19, people's perceptions of preventive and curative measures changed.Objective: To study healthcare-seeking behavior of hospitalized COVID-19 patients.Methods: Hospitalized patients due to COVID-19 in the month of March, April and May of 2021 were included in the study. Their attendants/close relatives were contacted telephonically to know about the admitted patients' healthcare-seeking behavior. Verbal consent was taken from attendants before the commencement of the interview, followed by informing them about the purpose of the interview.Results: Amongst the subjects, there were more males than females (67.5 vs 32.4%), age ranged between 18 to 88 with a mean value of 56.61 +/- 14.7 years. Self-medication was significantly associated with study subjects' mortality (p=0.03).Conclusion: Elderly people were having higher mortality rate than their younger counterparts. People were hesitant to visit primary care physicians after having symptoms of COVID-19.

Determinants of digital eye strain among university students in a district of India: a cross-sectional study

Aim: Digital device usage, especially during the pandemic, has catapulted into a new age problem, the computer vision syndrome. This study aimed to quantify the prevalence and determinants of digital eye strain (DES). Subject and Methods: A total of 345 university students in India were surveyed in June-July 2022, by a validated tool, the Computer Vision Syndrome Questionnaire (CVS-Q) © in this cross-sectional study. According to American Optometric Association, digital eye strain and computer vision syndrome are synonyms. Non-parametric tests of medians were used to compare the median DES scores, Chi square test to compare categorical variables, and binary logistic regression to find the determinants of DES. Result(s): The average age of the study participants was 21.0 +/- 2.2 years, ranging between 18-26 years with 52.8% females and 47.2% males. The prevalence of DES was 45.5% (CI 95% = 40.2%-50.8%). Any existing eye disease (p-value = 0.000, OR = 0.41, 95% CI = 0.26-0.65), average daily screen time (p-value = 0.001, OR = 1.61, 95% CI = 1.22-2.13) and using gadgets in the dark (p-value = 0.000, OR = 0.37, 95% CI = 0.23-0.61) were significant determinants of the same. Conclusion(s): Framing guidelines limiting the hours allotted for online classes for university students are imperative, with promotion of ergonomic practices for digital device usage such as blue light filters and night mode on devices.Copyright © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Monitoring the Covid-19 Immune Landscape in Japan

Intro: COVID-19 vaccination in Japan started on February 17, 2021. Because the timing of vaccination and the risk of severe COVID-19 greatly varied with age, the present study aimed to monitor the age-specific fractions of the population who were immune to SARS-CoV-2 infection after vaccination. Method(s): Natural infection remained extremely rare, accounting for less than 5% of the population by the end of 2021;thus, we ignored natural infection- induced immunity and focused on vaccine-induced immunity. We estimated the fraction of the population immune to infection by age group using vaccination registry data from February 17, 2021, to October 17, 2021. We accounted for two important sources of delay: (i) reporting delay and (ii) time from vaccination until immune protection develops. Finding(s): At the end of the observation period, the proportion of individuals still susceptible to SARS-CoV-2 infection substantially varied by age and was estimated to be >=90% among people aged 0-14 years, in contrast to approximately 20% among the population aged >=65 years. We also estimated the effective reproduction number over time using a next-generation matrix while accounting for differences in the proportion immune to infection by age. Discussion(s): The COVID-19 immune landscape greatly varied by age, and a substantial proportion of young adults remained susceptible. Vaccination contributed to a marked decrease in the reproduction number. Conclusion(s): The present study offers a novel approach to monitoring the age- related immune landscape over time in Japan.Copyright © 2023

The Incidence of Large Vessel Vasculitis in Norfolk

Background/Aims There are no data on the collective incidence of the large vessel vasculitides. The incidence of GCA and Takayasu arteritis in the UK has been based on clinical coding in routine administrative datasets. There are no data on the incidence of these diseases based on clinically verfied diagnoses. We studied the incidence of the large vessel vasculitides in a stable population with a predominant Northern European ancestry. Methods Individuals attending a secondary care hospital with a clinically verified diagnosis of primary systemic vasculitis made between 2011-2020, who lived within the NR postcode districts of Norfolk county were included if they met classification criteria for GCA or Takayasu arteritis, or had definite tissue or imaging evidence of large vessel vasculitis. Population above the age of 18 as in the 2011 census, available from the office of national statistics, was accepted as the denominator. If classification criteria for both GCA and TAK were met, physician judgement was accepted as final diagnosis. Results 272 adults were diagnosed with large vessel vasculitis out of a population of 454,316. The annual incidence of large vessel vasculitis in Norfolk is 59.9/million in the adult population. The annual incidence of GCA is 9.9/100,000 over the age of 50 using the ACR 1990 criteria and 10.6/100,000 using the ACR/EULAR 2022 criteria. The rise in the incidence from 2017 onwards coincides with the establishment of a fast-track pathway (Table 1). The dip in the incidence in 2020 coincides with suspension of services during the SARS-CoV-2 pandemic. The annual incidence peaks at 168.5/100,000 in the 9th decade and is commoner in females (12.3/100,000 vs 7.3/100,000). The annual incidence of Takayasu arteritis is 3.3/million in the adult population using the ACR 1990 criteria and 1.1/million using the ACR/EULAR 2022 criteria. Conclusion This is the first study that reports the incidence of all objectively diagnosed large vessel vasculitis in a stable population in Norfolk county. The incidence of GCA rose with the establishment of a fasttrack pathway and its peak may have been affected by the SARS-CoV- 2 pandemic. GCA is commoner in females and peaks in the 8th and 9th decades. (Table Presented).

Limbic platform capitalism: understanding the contemporary marketing of health-demoting products on social media

The purposive design, production and marketing of legal but health-demoting products that stimulate habitual consumption and pleasure for maximum profit has been called 'limbic capitalism'. In this article, drawing on alcohol and tobacco as key examples, we extend this framework into the digital realm. We argue that 'limbic platform capitalism' is a serious threat to the health and wellbeing of individuals, communities and populations. Accessed routinely through everyday digital devices, social media platforms aggressively intensify limbic capitalism because they also work through embodied limbic processes. These platforms are designed to generate, analyse and apply vast amounts of personalised data in an effort to tune flows of online content to capture users' time and attention, and influence their affects, moods, emotions and desires in order to increase profits. Social media are central to young people's socialising, identities, leisure practices and engagement in civic life. Young people actively appropriate social media for their own ends but are simultaneously recruited as consumers who are specifically targeted by producers of limbic products and services. Social media platforms have seen large increases in users and traffic through the COVID-19 pandemic and limbic capitalism has worked to intensify marketing that is context, time and place specific, driving online purchases and deliveries of limbic products. This has public health implications that require immediate attention as existing regulatory frameworks are woefully inadequate in this era of data-driven, algorithmic marketing.