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Background: During the outbreak of the highly contagious Coronavirus disease 19 (COVID19), rapid and simple prognostic tools were needed to support clinical decisions and predict the need of invasive mechanical ventilation. the ROX index, and the lung ultrasound score (LUSS) were proposed to objectively predict patient prognosis in addition to the subjective clinical assessment Aim: This study aimed to compare lung ultrasound score with ROX index in predicting the need of invasive ventilation in COVID-19 patients requiring advanced oxygen therapy. Patients and Methods: We studied 50 patients with severe COVID-19 pneumonia in the intensive care unit in the isolated area at Kasr Al-Ainy hospital. Complete Medical history, physical examination and laboratory investigations were obtained on admission. All patients underwent bedside lung ultrasonography scan and LUSS was calculated at the 2nd and the 12th hours, also ROX index was calculated at the 2nd, 6th and 12th hours from initiating the advanced oxygen therapy. Result(s): From a total of fifty patients with COVID-19, 56.0% were males, with mean age of 65.98 + 11.68 years, and mortality rate was 68%. The optimal cut off value of the ROX index at (2, 6, 12 hour) is (2.495, 2.675, 3.06) respectively, (p <0.001) with sensitivity 90.9% and specificity 76.5% at the 12 hour. Also the optimal cut off point of LUSS is 25.50 (p <0.001) with sensitivity 93.9% and specificity 88.2% for prediction of the invasive mechanical ventilation. Conclusion and recommendations: The study concluded that LUSS is more sensitive in predicting the need of invasive mechanical ventilation than ROX index.Copyright © 2023, Codon Publications. All rights reserved.
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This paper develops and analyzes a SARS-CoV-2 dynamics model with logistic growth of healthy epithelial cells, CTL immune and humoral (antibody) immune responses. The model is incorporated with four mixed (distributed/discrete) time delays, delay in the formation of latent infected epithelial cells, delay in the formation of active infected epithelial cells, delay in the activation of latent infected epithelial cells, and maturation delay of new SARS-CoV-2 particles. We establish that the model's solutions are non-negative and ultimately bounded. We deduce that the model has five steady states and their existence and stability are perfectly determined by four threshold parameters. We study the global stability of the model's steady states using Lyapunov method. The analytical results are enhanced by numerical simulations. The impact of intracellular time delays on the dynamical behavior of the SARS-CoV-2 is addressed. We noted that increasing the time delay period can suppress the viral replication and control the infection. This could be helpful to create new drugs that extend the delay time period.
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This paper develops and analyzes a SARS-CoV-2 dynamics model with logistic growth of healthy epithelial cells, CTL immune and humoral (antibody) immune responses. The model is incorporated with four mixed (distributed/discrete) time delays, delay in the formation of latent infected epithelial cells, delay in the formation of active infected epithelial cells, delay in the activation of latent infected epithelial cells, and maturation delay of new SARS-CoV-2 particles. We establish that the model's solutions are non-negative and ultimately bounded. We deduce that the model has five steady states and their existence and stability are perfectly determined by four threshold parameters. We study the global stability of the model's steady states using Lyapunov method. The analytical results are enhanced by numerical simulations. The impact of intracellular time delays on the dynamical behavior of the SARS-CoV-2 is addressed. We noted that increasing the time delay period can suppress the viral replication and control the infection. This could be helpful to create new drugs that extend the delay time period.
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Background: Hemodialysis (HD) patients are at higher risk for SARS-CoV-2 infection and its severe complications compared to the general population. Several studies examined the effectiveness of COVID-19 vaccines in this highly vulnerable population but showed mixed results. The aim of this study was to determine the effectiveness of mRNA vaccines against confirmed SARS-CoV-2 infection in HD patients in the State of Qatar. Method(s): We used a test-negative case-control design to determine the effectiveness of vaccination in HD patients > 14 days after the second dose. Ninetyfive patients had positive SARS-CoV-2 PCR (cases), while 884 patients had negative PCR (controls). Vaccine effectiveness was determined using the following formula [Vaccine effectiveness = 1 - Odds (T+ vaccinated) /Odds (T+ non-vaccinated)]. Result(s): Thirty out of 691 vaccinated HD patients had positive SARS-CoV-2 PCR versus 65 out of 288 non-vaccinated patients (4% vs. 23%, P<0.0001). Patients were more likely to have positive PCR if they were females (P<0.0001), elderly (P=0.02), or Asians (P=0.03). The overall effectiveness of mRNA COVID-19 vaccines against confirmed SARS-CoV-2 infection was 84.5% (95% CI: 76.5-89.8;Table 1) Conclusion(s): Our data support the importance of using the mRNA COVID-19 vaccine in HD patients to prevent SARS-CoV-2 infection in such a high-risk population.
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Background: Hamad general Hospital is the main provider of (HD) in Qatar with 932 patients. We established a team from dialysis nurses under direct nephrologist supervision for management of (MBD). We introduced Etelcalcetide in Qatar in May 2021 for HD patients unable to tolerate oral cinacalcet (GIT symptoms) especially during the COVID-19 pandemic where patients had difficulties dispensing medicine and have proper follow up Methods: Our study followed patients from May 2021 till March 2022. We included HD for >6 months patients with (HPT) despite being on cinacalcet therapy. Patients recruited from all HD centers (4) in Qatar. Data collected through electronic medical records. Result(s): 50 patients fulfilled inclusion criteria and were included in study period. Median (PTH) on cinacalcet was 946 pg./ml (Mean 1123pg/ml). After conversion to Etelcalcetide, PTH median level had significant improvement to 623 pg./ml (mean 749 pg./ ml). Average improvement in PTH level was 46% (36% of patients with 50% improvement and 48% of patients with >50% improvement). The Median dose for Etelcalcetide was 21.5mg /week. (Patients with within our PTH target range (150-500pg/ml) improved from 8% in May 2021 (on cinacalcet) to 38% in March 2022 (on Etelcalcetide) p=0.0003) while patients with PTH above 800 decreased from 50% to 20% for the same period (p=0.001). Reasons for conversion from Cinacalcet to Etelcalcetide were noncompliance due to GIT side effects (with resistant elevation of PTH despite optimal dose (90% of patients) also due to the COVID-19 pandemic and its effect in following medication in the face of shortage of our nurses and physician. Conclusion(s): Our project to optimize MBD management in HD patients with uncontrolled HPT not tolerating Cinacalcet by utilizing Etelcalcetide showed significant improvement in PTH outcomes. It was well tolerated with no reported significant side effects. Utilizing MBD team proven to be a wise decision during the peak of the COVID-19 pandemic with physician shortage and service disturbances. (Figure Presented).
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Technological advancements have enabled remote exams as a viable alternative to in-person proctoring. In light of the COVID-19 pandemic, educational institutions relied heavily on remote operation. The sudden shift exposed the weaknesses in available proctoring solutions, as pertains to fairness, economic viability, data privacy, network issues and usability. Moreover, whether they are equal in function to physical proctoring is questionable. Based on extensive research, we establish the system requirements and design for Dr. Proctor, a non-commercial solution that addresses many of the exposed concerns about remote proctoring.
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Background: Coronavirus illness (COVID-19) reached the level of a significant public health emergency in 2019, with an estimated worldwide death toll of more than 1,00,000 people 2019. Coronavirus illness (COVID-19). This survey was conducted to identify the factors influencing COVID-19 practice among undergraduate nursing students at the University of Nizwa, Sultanate of Oman. Methods: A quantitative cross-sectional online survey of sixty-four undergraduate nursing students chosen from the school of Nursing at the University of Nizwa in Sultanate of Oman took part from July 30 to August 5, 2021. Results: Participants' average age was 22.27 +/- 1.04, and the male-to-female ratio was 31.8% (n=64). Nursing students had adequate knowledge (13.67 +/- 3.46), a positive attitude (48.14 +/- 12.29), and good practices (32.6 +/- 6.12), according to the results of a survey. Female students, compared to males (0.006, p<0.05), were more likely to follow better practices. Significant positive associations were found between age (0.025, p<0.05), gender (0.006, P<0.05), living areas (0.031, p<0.05), grade (0.000, p<0.05), Clinical practice experienced (0.016, p<0.05) and practice on COVID -19. Conclusions: The study findings exhibited the essential elements that affected COVID-19 precautionary practices, knowledge, and a positive attitude, which were the most critical variables to consider. Male students and students who reside in rural regions should be targeted for further health education, and efforts should be made to ensure these groups have access to reliable and effective online tools to assist them.
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BACKGROUND AND AIMS: Patient-centred care is a concept focussing on meeting the specific health needs of patients as expressed by them. There is increasing evidence to show that patient centred care can help to achieve higher rates of patient satisfaction, clinical outcomes and overall better experience, particularly for patients with chronic disease. Patients Reported Experience Measures (PREM) is another concept associated with patient-cantered care. PREM surveys capture information about the healthcare experience as perceived by patients. Its importance lies in the incorporation of patient feedback into the clinical decisions and service evolution. Dialysis patients play an important role in their treatment and their voice matters to provide proper care. PREM was first conducted in 2019 in our dialysis unit including 200 patients. In 2020, COVID-19 impacted the dialysis services and resulted in many challenges including staff shortage and deployment. METHOD: We used a validated questionnaire from the National Health Service in United Kingedm. It consisted of 7 questions covering demographics, dialysis options, patient portal, patient's relationship with the staff, teamwork and travelling abroad. The survey involved 317 randomly selected patients who have been at least 1 year on dialysis. We performed a comparison of the 2019 and 2020 results using Chi-squared test. RESULTS: 257 patients on hemodialysis and 60 on peritoneal dialysis participated in the survey. Majority of the surveyed patients (65%) were on dialysis from 1-5 years and 32% with more than 5 years' survival on dialysis. Sixty five % of patients responded that they were on follow up in nephrology or low clearance clinic before starting dialysis. Access to dialysis team, nurses and doctors from home declined in 2020 due to the shortage of staff in the dialysis services and deployment of many staff to COVID-19 facilities, 62% of surveyed patients were able to contact their care givers from home compared with 87% in 2019 (P < 0.0001). Regarding education, 78% of the patients responded that they received education before starting dialysis and it was in an understandable manner while patients' response to the same question was 85% in 2019 (P = 0.047). 44% received education on side effects, which is remarkably less compared with 74% in 2019 (P = 0.0001). CONCLUSION: Patient reported experience helps in the evaluation of health services. Exploring patient experience in dialysis patients in Qatar, we found negative impact of COVID-19 from patients' perspectives. Our PREM survey showed significant decline in many parameters likely attributed to COVID-19 consequences including the shortage of staff.
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BACKGROUND AND AIMS: Management of end-stage renal disease (ESRD) on dialysis has been challenging during the COVID19 epidemic. Staff illness led to a shortage of manpower that affected patient care. We established a specialty nursing management for mineral and bone disease (MBD) in the ambulatory dialysis service in Qatar in 2016. We are presenting a retrospective study about the effects of the COVID-19 epidemic on MBD outcomes in ambulatory dialysis patients in the State of Qatar. METHOD: A retrospective cohort study in all adult patients with ESRD on chronic hemodialysis therapy (>1 month) in ambulatory dialysis clinics in the State of Qatar. Data collected were patient's characteristics, laboratory and diagnostic investigations for each patient through our electronic data system (nationwide). We focused on parathyroid hormone (PTH), calcium and phosphorus levels done routinely on monthly basis. The study duration was 31 months (January 2019-September 2021). RESULTS: We included 623 patients. Age was 56 ± 11 years old and 61% were male. The main comorbidities were diabetes mellitus (63%), hypertension (92%) and cardiovascular disease (22%). The percentage of patients with PTH levels within targets ranged from 63 to 74%. It was stable before and during the first wave of COVID-19 in Qatar (March-June 2020) then dropped afterward briefly for 3 months (October-December 2020) (74% versus 63% respectively P = 0.0003). PTH level in target improved afterward and also during the second wave of COVID-19 (February- May 2021) but then dropped again for 3 months (July-September 2021) [72% versus 66% respectively P = 0.02 (graph below with details)]. Patients with phosphorus and calcium in the target were mostly stable [79% (77-83%) and 76% (74-79%), respectively]. CONCLUSION: Our retrospective study regarding the effect of the COVID-19 epidemic on MBD outcomes in hemodialysis (HD) showed a temporary drop in PTH level in the target without affecting calcium and phosphorus targets. The delayed drop after COVID-19 waves in PTH in target could be related to the routine quarterly measurement of PTH. We think that establishing a solid management system for MBD led to reasonably stable outcomes despite all challenges during the COVID-19 epidemic. (Figure Presented).
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BACKGROUND: Associations between vitamin D (VD) deficiency and the risk of SARS-CoV-2 infection have been documented in cross-sectional population studies. Intervention studies in patients with moderate to severe COVID-19 have failed to consistently document a beneficial effect. OBJECTIVE: To determine the efficacy and safety of VD-supplementation in the prevention of SARS-CoV-2 infection in highly exposed individuals. METHODS: A double-blind, parallel, randomized trial was conducted. Frontline healthcare workers from four hospitals in Mexico City, who tested negative for SARS-CoV-2 infection, were enrolled between July 15 and December 30, 2020. Participants were randomly assigned to receive 4,000 IU VD (VDG) or placebo (PG) daily for 30 d. RT-PCR tests were taken at baseline and repeated if COVID-19 manifestations appeared during follow-up. Serum 25-hydroxyvitamin D3 and antibody tests were measured at baseline and at day 45. Per-protocol and intention-to-treat analysis were conducted. RESULTS: Of 321 recruited subjects, 94 VDG and 98 PG completed follow-up. SARS-CoV-2 infection rate was lower in VDG than in PG (6.4 vs. 24.5%, p <0.001). The risk of acquiring SARS-CoV-2 infection was lower in the VDG than in the PG (RR: 0.23; 95% CI: 0.09-0.55) and was associated with an increment in serum levels of 25-hydroxyvitamin D3 (RR: 0.87; 95% CI: 0.82-0.93), independently of VD deficiency. No significant adverse events were identified. CONCLUSIONS: Our results suggest that VD-supplementation in highly exposed individuals prevents SARS-CoV-2 infection without serious AEs and regardless of VD status.
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COVID-19 , COVID-19/prevención & control , Calcifediol , Estudios Transversales , Suplementos Dietéticos , Personal de Salud , Humanos , SARS-CoV-2 , Resultado del Tratamiento , Vitamina DRESUMEN
Background: Hamad Medical Corporation (HMC) is providing dialysis treatment to approximately 1050 patients. COVID-19 started from China in December 20191,2, and the first case in Qatar was confirmed on 27th February 2020. There were challenges to provide dialysis treatment for COVID-19 positive and negative patients during the pandemic due to severe staff shortage3, staff fear and psychological distress, workload, lack of dialysis slots, prolonged working hours and staff fatigue. Some staff were even deployed to COVID-19 facilities (modular dialysis services, hotel and quarantine facilities) to provide treatment. Methods: 1) A COVID-19 management committee was established 2) An on-call team was assigned to manage new cases and review dialysis slots availability. 3) Staff performance and adherence to safety measures was monitored. 4) A hierarchy model was implemented for COVID-19. A) Elimination: - Confirmed COVID-19 patients were not to receive dialysis at Ambulatory Dialysis centres. - Unit meetings were only held online. B) Substitution: - Dialysis services were to be provided in HMC dialysis facilities, COVID-19 hospitals, and isolation/quarantine facilities (home/hotels). - Administrators with chronic disease worked from home. C) Engineering: - Reduce number of chairs in tearoom and waiting area - Rearrange offices, working spaces, and conference room to keep everyone 2 meters apart. D) Administrative: - Staff, patient and family education - Screening by using visual triaging scale - Deployment of staff - Managing staff mental health and psychosocial well-being Results: 76 dialysis patients and 30 dialysis staff were infected. 900 hemodialysis sessions were provided inside quarantine and isolation facilities (home, hotel, Bu-Sidra, and other locations) and HazmMebaireek General Hospital (HMGH) Modular Dialysis Unit from March to October 2020 (Figure 1). The number of COVID-19 positive patients reduced from 39 in May 2020 to 12 in July 2020 (p=0002) (Figure 2). Conclusion: Thanks to our approach, we were able to provide a high quality and safe dialysis service for in-centre dialysis and in COVID-19 facilities and quarantine centres (home/hotels).
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BACKGROUND AND AIMS: Patients on maintenance dialysis are more susceptible to COVID-19 and its severe complications. We studied outcomes of COVID-19 infection in dialysis patients in the state of Qatar. Our primary outcome was to determine the mortality rate of dialysis patients with COVID-19 infection and associated risk factors. Our secondary outcomes were to assess the severity of COVID-19 in dialysis patients and its related complications such as the incidence of hypoxia, critical care unit admission, need for mechanical ventilation or inotropes, incidence of acute respiratory distress syndrome (ARDS), and length of hospital stay. METHOD: This was an observational, analytical, retrospective, nationwide study. We included all adult patients on dialysis who tested positive for COVID-19 (PCR assay of nasopharyngeal swab) during the period from February 1, 2020 to July 19, 2020. Patient demographics and clinical features were collected from a national electronic medical record. Laboratory tests were evaluated upon diagnosis and on day 7. RESULTS: There were 76 out of 1068 dialysis patients who were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). Eleven patients (15%) died during study period. Mortality due to COVID-19 among our dialysis cohort was 100 times higher than that in the general population for the same period (15% vs. 0.15%;OR 114.2 [95% CI: 1.53 to 2.44];p<0.001). Univariate analysis for risk factors associated with COVID-19-related death in dialysis patients showed minor but statistically significant increases in risks with age (OR 1.07), peak WBC peak level (OR 1.189), AST level at day 7 (OR 1.04), fibrinogen level at day 7 (OR 1.4), Ddimer level on day 7 (OR 1.94), and peak CRP level (OR 1.01). A major increase in the risk of death was noted with atrial fibrillation (OR, 8.7;p=0.008) and hypoxia (OR: 28;p=0.001). High severity of COVID-19 illness in dialysis manifested as 25% of patients required admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes for intractable hypotension or shock. The mean length of hospital stay was 19.2±10.4 days. Laboratory tests were remarkable for severely elevated ferritin, fibrinogen, CRP, and peak IL-6 levels and decreased albumin levels on day 7. CONCLUSION: This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high mortality rate of COVID-19 infection compared to the general population. Dialysis patients had severe COVID-19 course complicated by prolonged hospitalization and high need for critical care, mechanical ventilation and inotropes. Special care should be done to prevent COVID-19 in dialysis patients to avoid severe complications and mortality.
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Network infrastructures are being continuously challenged by virtue of increased demand, resource-hungry applications, and at times of crisis when people need to work from homes such as the current Covid-19 epidemic situation, where most of the countries applied partial or complete lockdown and most of the people worked from home. Opportunistic Mobile Social Networks (OMSN) prove to be a great candidate to support existing network infrastructures. However, OMSNs have copious challenges comprising frequent disconnections and long delays. In this research, we aim to enhance the performance of OMSNs including delivery ratio and delay. We build upon an interest-aware social forwarding algorithm, namely Interest Aware PeopleRank (IPeR) in two ways 1) By embracing directional forwarding (Directional-IPeR), and (2) By utilizing a combination of Directional forwarding and multi-hop forwarding (DMIPeR). Different interest distributions and users' densities are simulated using the Social-Aware Opportunistic Forwarding Simulator (SAROS). The results show that Directional-IPeR with a tolerance factor of 75% performed the best in terms of delay and delivery ratio compared to IPeR, and two other algorithms, namely MIPeR and DMIPeR. © 2020 by SCITEPRESS - Science and Technology Publications, Lda. All rights reserved