Radiation Overuse in Intensive Care Units: A Cause for Concern (preprint)

Radiological imaging is essential for acute patient management in Intensive Care Units (ICUs); however, it introduces the risk of exposure to ionizing radiation. This review synthesizes research on radiation exposure in intensive care unit (ICU) settings, highlighting its rise during the COVID-19 pandemic and repetitive imaging. Our analysis extends to radiation safety thresholds, revealing that some ICU patients exceed annual occupational limits, emphasizing the need to balance diagnostic utility against potential long-term risks, such as cancer. Prospective studies have demonstrated an increase in the median Cumulative Effective Dose (CED) in patients with trauma over time, prompting calls for improved awareness and monitoring. Moreover, innovative dose-reduction strategies and optimized protocols, especially in neuro-ICU units, promise to mitigate these risks. This review highlights the essential but risky role of radiological imaging in critical care. It advocates rigorous radiation management protocols to safeguard patient health, while ensuring the continuity of high-quality medical care.

Predictors of COVID-19 Vaccine Acceptability Among Refugees and Other Migrant Populations: A Systematic Scoping Review (preprint)

ObjectiveThis study aimed to map the existing literature to identify predictors of COVID-19 vaccine acceptability among refugees, immigrants, and other migrant populations. MethodsA systematic search of Medline, Embase, APA PsycInfo and Cumulative Index of Nursing and Allied Health Literature (CINAHL) was conducted up to 31 January 2023 to identify the relevant English peer-reviewed observational studies. Two independent reviewers screened, selected studies, and extracted data. ResultsWe identified 34 cross-sectional studies, primarily conducted in high income countries (76%). Lower vaccine acceptance was associated with mistrust in the host countries government and healthcare system, concerns about the safety and effectiveness of COVID-19 vaccines, limited knowledge of COVID-19 infection and vaccines, lower COVID-19 risk perception, and lower integration level in the host country. Female gender, younger age, lower education level, and being single were associated with lower vaccine acceptance in most studies. Additionally, sources of information about COVID-19 and vaccines and previous history of COVID-19 infection, also influence vaccine acceptance. Vaccine acceptability towards COVID-19 booster doses and various vaccine brands were not adequately studied. ConclusionsVaccine hesitancy and lack of trust in COVID-19 vaccines became significant public health concerns within migrant populations. These findings may help in providing information for current and future vaccine outreach strategies among migrant populations.

An updated research focus on the employment of computer-aided drug discovery and repurposing techniques for the identification and evaluation of SARS-CoV-2 Main protease inhibitors: A protocol for a systematic review and meta-analysis (preprint)

With the onset of the COVID-19 pandemic caused by the novel coronavirus (SARS-CoV-2), there has been a surge in the pursuit of potential therapeutic interventions for this deadly disease. Given the urgency of the situation, computational drug repurposing methods have emerged as a promising strategy for identifying effective treatments from a pool of approved drugs. This systematic review and meta-analaysis will assess the existing research on the use of computational approaches for drug repurposing in the context of COVID-19. SARS-CoV-2 Main Protease is a critical enzyme that plays a vital role in the replication cycle of the SARS-CoV-2 virus, and its inhibition is a promising strategy for the development of antiviral therapies. Different databases (PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE via EBSCOhost, Google Scholar, and WILEY online Library) will be utilized to identify and incorporate primary research articles in English and French that employed computational methodologies for drug repurposing in the context of COVID-19 and SARS-CoV-2 Main protease inhibition published between March 2020 to May 2023. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR), we will undertake a comprehensive search of relevant studies. Authors will also search peer-reviewed articles, grey literature sources, and reference lists to identify eligible studies. Title screening will be followed by independent abstract and full-text screening by two reviewers. Any study that focuses on the inhibition of the Mpro using computer aided methods will be included. The analysis of data will be carried out by utilizing two software tools - Review Manager software (version 5.3.5) and R software (version 3.6.1). To determine statistical heterogeneity, a standard chi-square test will be applied with a significance level of P < 0.10. Potential biases related to study size (such as publication bias) will be examined through the application of several techniques, including funnel plots, Egger's test, Begg's test, as well as Trim and Fill analysis. This study will provide evidence-based information and conduct a comprehensive analysis of the computer-aided drug discovery and repurposing of the SARS-CoV-2 Main protease inhibitors, thereby producing a high-quality synthesis of information. The study will also explore potential innovative therapeutic applications for preventing or treating the novel viral infection by the inhibition of the Main Protease. In addition, the review will highlight research gaps in the treatment of COVID-19 and provide suggestions for future research. The outcomes of this review will be shared through a peer-reviewed publication and presented at relevant conferences while ensuring proper dissemination to reach a wide audience.

Mental health status and related factors influencing healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis (preprint)

Background: The mental health of healthcare workers during the coronavirus-2019 pandemic was seriously affected, and the risk of mental health problems was high. The present study sought to systematically evaluate the mental health problems of healthcare workers worldwide during the pandemic and to determine the latest global frequency of COVID-19 associated mental health problems. Methods: Data in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Elsevier, MEDLINE, PubMed, PsycINFO and the Web of Science before November 11, 2022, were systematically searched. Cohort, case-control and cross-sectional studies were included. The meta-analysis used a random effects model to synthesize the comprehensive prevalence rate of mental health problems. Subgroup analyses were performed based on time of data collection; whether the country was or was not developed; continent; doctors and nurses; doctors/nurses vs. other healthcare workers; and psychological evaluation scale. Results: A total of 161 studies were included, including 341,014 healthcare workers worldwide, with women accounting for 82.8%. Occupationally, 16.2% of the healthcare workers were doctors, 63.6% were nurses and 13.3% were other medical staff. During the pandemic, 47% (95% confidence interval [CI], 35-60%) of healthcare workers reported job burnout, 38% (95% CI, 35-41%) experienced anxiety, 34% (95% CI 30-38%) reported depression, 30% (95% CI, 29-31%) had acute stress disorder, and 26% (95% CI, 21-31%) had post-traumatic stress disorder. Conclusions: The study found that there were common mental health problems among health care workers during the COVID-19 pandemic. The most common was job burnout, followed by anxiety, depression, acute stress and post-traumatic stress disorder. Although the global pandemic has been brought under control, its long-term impact on the mental health of healthcare workers cannot be ignored. Additional research is required to develop measures to prevent, monitor and treat psychological disorders among healthcare workers.

Community-based models of care for management of type 2 diabetes mellitus among non-pregnant adults in sub-Saharan Africa: a scoping review (preprint)

Introduction The prevalence of type 2 diabetes mellitus (T2DM) and associated morbidity and mortality are increasing in sub-Saharan Africa (SSA). To facilitate access to quality care and improve treatment outcomes, there is a need for innovative community care models and optimized use of non-physician healthcare workers bringing diagnosis and care closer to patients’ homes. Aim We aimed to describe with a scoping review different models of community-based care for non-pregnant adults with T2DM in SSA, and to synthesize the model outcomes in terms of engagement in care, blood sugar control, acceptability, and end-organ damage. We further aimed to critically appraise the different models of care and compare community-based to facility-based care if data were available. Methods We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus, supplemented with backward and forward citation searches. We included cohort studies, randomized trials and case-control studies that reported on non-pregnant individuals diagnosed with T2DM in SSA, who received a substantial part of care in the community. Only studies which reported at least one of our outcomes of interest were included. A narrative analysis was conducted, and comparisons made between community-based and facility-based models, where within-study comparison was reported. Results 5,335 unique studies were retrieved, four of which met our inclusion criteria. Most studies were excluded because interventions were facility-based; community care interventions described in the studies were add-on features of a primarily facility-based care; and studies did not report outcomes of interest. The included studies reported on a total of 383 individuals with T2DM. Three different community care models were identified. 1) A community-initiated model where diagnosis, treatment and monitoring occurred primarily in the community. This model reported a higher linkage and engagement in care at 9 months compared to the corresponding facility model, but only slight reductions of average blood glucose levels at six months compared to baseline. 2) A facility-originated community model where after treatment initiation, a substantial part of follow-up was offered at community level. Two studies reported such a model of care, both had as core component home-delivery of medication. Acceptability of this approach was high. But neither study found improved T2DM control when compared to facility care 3) An eHealth model with high acceptability scores for both patients and care providers, and an absolute 1.76% reduction in average HbA1c levels at two months compared to baseline. There were no reported outcomes on end-organ damage. All four studies were rated as being at high risk for bias. Conclusion Evidence on models of care for persons with T2DM in SSA where a substantial part of care is shifted to the community is scant. Whereas available literature indicates high acceptability of community-based care, we found no conclusive data on their effectiveness in controlling blood sugar and preventing complications. Evidence from larger scale studies, ideally randomized trials with clinically relevant endpoints is needed before roll-out of community-based T2DM care can be recommended in SSA.

COVID-19 and Youth Sports: What Are the Risks of Getting Back on the Field Too Quickly?

The widespread shutdown in response to the coronavirus disease 2019 (COVID-19) pandemic, although varied across state and county levels, has undoubtedly impacted everyone to some degree. Within the pediatric population, the closure of schools and organized youth athletic programs has resulted in a unique situation that has made athletes physically deconditioned and at risk for injury. As sports and competition gradually restart, there are considerable risks to the skeletally immature athlete. The anatomic and physiologic changes that occur to bone and cartilage during growth make the young athlete particularly susceptible to both acute and overuse injuries. In the context of the pandemic, deconditioning, obesity, lack of variety, and the resultant mental health burden pose unique challenges in ensuring that young athletes safely return to the field. This review aims to identify risk factors for sport-related injuries and to outline strategies for minimizing these injuries as pediatric patients return-to-play after COVID-19. [Pediatr Ann. 2021;50(11):e465-e469.].

A mathematical model for repetitive behaviors of Covid-19 (preprint)

Covid-19 pandemic waves have been hitting us again and again in the past couple years in many countries, while the reason why they come in such repetitive manners remains unexplained, which have brought us with lingering anxieties and economic stagnations. We proposed a mathematical model to describe the mechanism of the repetitive appearance of the number of new cases based upon the SIQR model in which Q (quarantined infectors) were distinguished from I (un-quarantined ones). The repetitive behavior of the pandemic was simulated by an activator-inhibitor system around a fixed point in a phase space as a kind of self-organized oscillations. Periods between each wave were confirmed to be approximately similar. Repetitive behaviors were also observed in actual Covid-19 data. Practical policies and actions were discussed on the ways to effectively control the repetition of pandemic, and proactive PCR test especially after the peak-out stage is highly recommended.

Determinants of Herding Behavior in The Time Of COVID-19: The Case of Egyptian Stock Market Sectors (preprint)

This paper attempts to research in two parts, the first part aims to study the Herding Behavior in the sectors of the Egyptian Stock Exchange, when the second part aims to study the factors that affect the Herding Behavior according to the identification of those factors. Factors based on the presentation of previous literature related to herd behavior, and these factors are represented in the exchange rate, Stock trading volumes as an indicator of Liquidity, stock market returns, and indicators of the spread of the Corona virus represented in the number of cumulative cases and deaths according to the population in Egypt. During the period from 1/3/2020 to 31/7/2020. Sectors are five sectors of 76 companies, that have dispersion decrease (CSSD), and the sectors are (Basic Resources, Banks, Travel & Leisure, Health Care & Pharmaceuticals, Food, Beverages and Tobacco). The results of the multiple regression models for the sectors in which herd behavior appeared were as follows: - Basic resources determination coefficient (R2) (52.24%), and the variables determining herd behavior in the sector are variables (Corona virus Cumulative Cases, Cumulative Corona virus deaths).- Banks determination coefficient (R2) (66.85%), and the variables determining herd behavior in the sector are variables (Stock Market Return, Sector Trading Volumes, Corona virus Cumulative Cases, Cumulative Corona virus deaths).- Travel & Leisure determination coefficient (R2) (49.04%), and the variables determining herd behavior in the sector are variables (Stock Market Return, Exchange Rate, Sector Trading Volumes, Corona virus Cumulative Cases, Cumulative Corona virus deaths).- Health & Care Pharmaceuticals determination coefficient (R2) (41.84%), and the variables determining herd behavior in the sector are variables (Exchange Rate, Corona virus Cumulative Cases, Cumulative Corona virus deaths).- Food, Beverages and Tobacco determination coefficient (R2) (58.87%), and the variables determining herd behavior in the sector are variables (Stock Market Return, Sector Trading Volumes, Corona virus Cumulative Cases, Cumulative Corona virus deaths).

Impact of Social Restriction Imposed by 2019-ncov Pandemic on the Mobility of Older People: A Scope Review Protocol (preprint)

Background The 2019‑nCoV pandemic represents a high risk for older people that sustain higher mortality rates compared to young adults. Limited social contact and restriction of mobility in the community (stay-at-home precautions) are recognised as measures to prevent SARS-CoV-2 infection among older people. The impact of these measures on health, physical function and emotional wellbeing are numerous, and might result in long-term adverse outcomes such as disability, falls and limited mobility. Thus, the objective of this scope review is to map the estimated impact of measures of social restrictions on the mobility of older people living in the community and to systematize the existing recommendations, anticipating possible intervention strategies gaps.Methods The search will be carried out using a standardized protocol in Latin American and Caribbean Literature on Health Sciences (LILACS), consulted by the Virtual Health Library (VHL), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), via PubMed; Web of Science, via Main Collection (Thomson Reuters Scientific) and SCOPUS. Documents and reports with recommendations from governmental and nongovernmental organizations will be consulted. Complete studies available in the English, Spanish or Portuguese languages included in the different methodological approaches (original articles, literature reviews, editorials and guidelines) that necessarily address the recommendations of social restriction measures for preventing Covid-19 disease and their impacts on mobility of older people will be included. Two reviewers will select the studies based on their titles and abstracts. The manuscripts and documents selected for full reading will be analysed by reviewers concerning the eligibility criteria. When disagreements occurred in any phase of the selection process, a third reviewer will be included for a consensus analysis. Data will be extracted using a template form and the PRISMA-ScR checklist will be used to guarantee quality and transparency. Results will be presented as a narrative summary, including tables and figures.Discussion Globally, recommendations to stay-at-home and social distancing are substantially affecting health and wellbeing of older people. Preserving mobility is crucial to active and healthy ageing. The evidence summarized in the selected studies will be analysed in order to answer the research questions. The results of this review will help clinical practitioners, health care providers and policy makers to estimate the impact of measures to protect older people from 2019‑nCoV and to identify gaps and anticipate needs for targeted interventions to prevent mobility decline. Systematic review registrationsubmitted on 10-09-2020 in https://osf.io/registries 

Covid-19 and E- consultation in Orthopaedics: Experience on delineating the spectrum of Orthopaedic disorders amenable to treatment via Tele-consultation (preprint)

Context: Covid-19 pandemic and lockdown scenario has forced to shut down the Outpatient consultation in hospitals and clinics. It was challenging to help out the patient population who were routine health care seekers for maintenance and follow-up.Aims: To tackle the prevailing routine Orthopaedic health care issue due to  Covid-19 lockdown strategy through Tele-consultation and to delineate the spectrum of Orthopaedic disorders that were amenable to treatment by e-Consultation.Methods and Material: We executed two Tele consultation designs (Call based and App based) for our institution to reach out to the patients. The Orthopaedic patient characteristics and disease management was documented and analyzed.Results: A total of 468 consultations with diverse Orthopaedic disorders including Congenital lesions, Developmental and Metabolic disorders, Infective disorders, inflammatory disorders, Traumatic disorders, Tumours, Degenerative disorders and Repetitive Strain Injuries were addressed.Conclusions: Clinical decision making through Tele-consultation in Orthopaedics is demanding. However, majority of routine Orthopaedic disorders are amenable to management.