Emergence of BA.4/BA.5 Omicron Sub-lineages and Increased SARS-CoV-2 Incidence in Senegal

Background: The Omicron variant B.1.1.529 has led to a new dynamic in the COVID-19 pan-demic, with an increase in cases worldwide. Its rapid propagation favors the emergence of novel sub-lineages, including BA.4 and BA.5. The latter has shown increased transmissibility compared to other Omicron sub-lineages. In Senegal, the emergence of the Omicron variant in December 2021 characterized the triggering of a short and dense epidemiological wave that peaked at the end of February. This wave was followed by a period with a significant drop in the number of COVID-19 cases, but an upsurge in SARS-CoV-2 infection has been noted since mid-June. Objective(s): The purpose of this brief report is to give an update regarding the genomic situation of SARS-CoV-2 in Dakar during this phase of recrudescence of cases. Method(s): We performed amplicon-based SARS-CoV-2 sequencing on nasopharyngeal swab samples from declared COVID-19 patients and outbound travelers that tested positive. Result(s): Ongoing genomic surveillance activities showed that more than half of recent COVID-19 cases were due to the BA.4 and BA.5 sub-lineages that share two critical mutations associated with increased transmissibility and immune response escape. The circulation of recombinants between Omicron sub-lineages was also noted. Conclusion(s): Despite the lack of proven severity of BA.4 and BA.5 sub-lineages, their increased transmis-sibility causes a rapid spread of the virus, hence a surge in the number of cases. This rapid spread consti-tutes a greater risk of exposure for vulnerable patients. To tackle this issue, any increase in the number of cases must be monitored to support public health stakeholders. Therefore, genomic surveillance is an ever-essential element in managing this pandemic.Copyright © 2022 Bentham Science Publishers.

Whatsapp platform as a teledentistry tool in oral and maxillofacial pathologies in Senegal

Objective: To study the contribution of teledentistry, via the WhatsApp application of the "Dentists of Senegal", on the management of oral and maxillofacial pathology. Material(s) and Method(s): This was a descriptive cross-sectional study. The study took place over a period of 3 months, from 1 October to December 30, 2020. This study was conducted on the WhatsApp group platform of the Senegalese Dentists. A total of 150 communications were included. Result(s): Public sector dentists sent more communications, 88% of the communications. By specialty, general practitioners had sent more communications, 82.7% of communications. For the oral surgery receiver site, 71% of communications were received. 65% of referring dentists had given a diagnosis. Patients with tumours and cysts represented more than half of the sample (53.3%) followed by trauma patients (18.6%). The most common infections were cellulitis (46.66%) and osteitis (33.33%). Oral and maxillofacial surgeons managed 69.33% of the pathology. Conclusion(s): WhatsApp is a fundamental contribution to the remote diagnosis and management of oral and maxillofacial pathologies, especially during the current covid-19 pandemic.Copyright © 2021

Management of odontostomatological emergencies during the covid19 pandemic at the General Hospital Grand Yoff in Dakar

Objective: Describe the sociodemographic, clinical and therapeutic aspects of the patients received for an emergency, during this period of pandemic, in a service of reference the service of odontostomatology General Hospital Grand Yoff of Dakar. Patients and Methods: This was a descriptive cross-sectional study over a threemonth period from March 3 to June 3, 2020. Referred and non-referred patients received for odontostomatological emergencies were included in the study. The data collected were entered in Excel and analyzed using SPSS20.0 software with Chi2 tests performed between certain variables with a significance level set at 0.05. Result(s): Non-referred patients represented 64.9% (n = 131) of the study population and referred patients 35.1% (n = 71). Emergencies were infectious in 74.7% (n = 151) of cases and traumatic in 14.3% (n = 29). Acute apical periodontitis was encountered in 44.6% (n = 90), cellulitis in 16.4% (n = 33) and pulpitis in 9.4% (n = 19) of cases. Therapeutic attitudes were dominated by dental avulsion in 56.4% (n = 114) of cases, pulp sedation in 9.4% (n = 19) of cases and mono-maxillary restraint in 8.4% (n = 17) of cases. Conclusion(s): Despite the risk of contamination and possible dissemination of the covid19 virus, the continuity of oral care must be ensured because of the emergencies that can jeopardize the functional or even vital prognosis of patients. Certain recautions must therefore be taken at the level of the structures of care of these affections.Copyright © 2021

The efficacy of hospital-based interventions in reducing length of stay for inpatients with diabetes

Background: People living with diabetes are at increased risk of being admitted to hospital and to stay in hospital longer. With a rising prevalence of diabetes globally and excessive expenditure on this condition, opportunities to reduce length of hospital stay must be prioritised. Aim: This review aims to explore the efficacy of hospital-based interventions (i.e., a clinical interaction in a hospital setting for health-related outcomes) in reducing length of hospital stay for the inpatient with diabetes and describing the findings based on a systematic review of relevant studies. Method: A systematic search of CINAHL, Medline Ovid, Web of Science and SCOPUS databases for research papers relating to adult inpatients with diabetes was conducted for the period 2010–2020. Methodological assessments were undertaken with a narrative synthesis to assess study quality and implement Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria with the population, intervention, comparison, outcome model utilised in the search strategy. Results: Seventeen intervention studies spanning a range of inpatient areas relevant to adults with diabetes examined clinical procedures and treatments (n=8), education of patients and junior doctors (n=2), multidisciplinary teams, diabetes inpatient specialist nurses (n=5) and the use of technology (n=2). The studies demonstrated significant improvements in clinical outcomes including reduction in length of hospital stay. Encouraging results were seen with the introduction of a podiatric foot coordinator position that showed the most significant reduction in length of hospital stay at 10.4 days, closely followed by a diabetic foot ulcer treatment programme that established a reduced length of hospital stay of 9.3 days and a nurse led insulin protocol showed reduced length of hospital stay by 4.1 days. These studies also demonstrated improved clinical outcomes across other parameters including estimated cost savings of £234K, lowered amputation rate, and decreased hypoglycaemia and hyperglycaemia. Similarly, remaining studies determined additional outcomes of increased time in target, high levels of patient satisfaction and postoperative complications significantly decreased. Discussion: This review demonstrates the potential for hospital-based interventions to impact positively on length of stay for adults with diabetes and demonstrates significantly reduced length of hospital stay following a podiatric high-risk foot coordinator position and diabetic foot ulcer treatment programme. Investment in and commissioning of programmes that show significant impact in reducing length of stay and hospital costs should be worthwhile. As the health service rebuilds and recovers from the devastation of COVID-19 the adaptability of the healthcare system is vital for future planning. As length of stay is a key performance indicator, made even more relevant during the pandemic, these results should be a catalyst for nurses and managers with cooperation from organisational management to facilitate translation of such evidence into practice.

'Bittersweet' and 'alienating': An extreme comparison of collaborative autoethnographic perspectives from higher education students, non- teaching staff and faculty during the pandemic in the UK and Singapore

This article, via collaborative autoethnographic reflections, provides an extreme comparison of intraperiod responses in two countries (the UK and Singapore) to the novel coronavirus (COVID-19) pandemic in higher education. Taking autoethnographic examples from these countries from three pairs of stakeholders of higher education (HE) - students, non-teaching academic staff, and lecturers - we discuss contrasting experiences in pursuit of answering the research question: What were our experiences working/studying in HE during the COVID-19 global pandemic? Despite the pronounced differences of the higher education landscapes in the UK and in Singapore and the heterogeneous experiences of them, five common themes emerged during an inductive analysis: impact on work, impact on learning, wellbeing, awareness and flexibility. There are significant opportunities to learn by examining the different experiences. We recommend overcoming the many separations between HE stakeholders and to engage all of them (students, lecturers (both adjuncts and full-time faculty), non-teaching staff) with the overall goal of improving the teaching and learning experiences. Technology should not be revered as a panacea and sound pedagogical practices are as important as ever.

Health perceptions and utilization in neurogastroenterology clinics during the COVID pandemic

Background: While COVID has had a significant impact of access to health care for adults, the impact on children is not known. The goal of this study was to determine the impact of the COVID pandemic on access to care and reintegration to school for children in subspecialty clinics at high risk for COVID -related complications. The secondary goal was to determine if any commonly prescribed gastrointestinal medications were associated with a higher risk of symptom development during the pandemic. Methods: We conducted a prospective questionnaire study of patients presenting to the motility, abdominal pain and aerodigestive clinics for follow up between July 2020 and March 2021 during the COVID pandemic. These clinics were chosen because aerodigestive patients may be at high risk for COVID-related respiratory complications and abdominal pain and motility patients may be at high risk for post-infectious gastrointestinal complications. Patients/families were asked about symptoms, comorbidities, medication use, and COVID risk factors and exposure before and during the pandemic as well as health related anxiety before and during the pandemic. Means were compared using t tests and paired t tests. Proportions were compared using Chi Square analyses. Results: 202 patients (age 6.5 ± 6.5 years, range 0.1 - 24.6y) completed the study questionnaire. Patient characteristics shown in Table 1. 144 (71.3%) patients were seen for aerodigestive concerns, 37 (18.3%) for motility concerns, 21 (10.4%) for functional gastrointestinal disorders. Health related anxiety: There were no differences in health-related anxiety between these three patient groups before, during or approaching the end of the pandemic (p>0.23). When comparing individual pre- and during pandemic anxiety scores, all patient groups endorsed greater health-related anxiety during and toward the end of the pandemic compared to before the pandemic (p<0.0001). Health Care Utilization: Despite complexities of accessing care, gastroenterology patients continued to access healthcare with 80.3% of patients continuing to seek in-person specialty care. Proton Pump Inhibitors (PPI) and motility medications were the most commonly prescribed during the pandemic;11% of patients taking a PPI and 5% of patients taking a motility medication were newly prescribed these therapies during the pandemic. Rates of H2 antagonist prescribing remained low before and during the pandemic. COVID-19 testing and positivity: To determine if there was a relationship between medication usage and COVID risk, we determined if medication use was associated with (1) frequency of getting tested and (2) frequency of a positive COVID test. PPI use was associated with a higher rates of COVID testing (p<0.01). 9% of the tested patients taking PPIs tested positive for COVID compared to 0% of the non-PPI patients (p<0.01). 9% of patients taking inhaled steroids and tested were positive for COVID, compared to 3% of the non-inhaled steroid patients (p<0.01). Neither motility medication or H2 antagonist use were associated in higher chance of getting tested or a positive COVID test result (p>0.194). Conclusions: The COVID pandemic has had a significant effect on health-related anxiety during and toward the end of the pandemic as school reintegration approaches. Both PPI use and inhaled steroids are associated with an increased risk of getting COVID testing and a positive result.

R Medicine 2020: The Power of Going Virtual

The third annual R/Medicine conference was planned as a physical event to be held in Philadelphia at the end of August 2020. However, a nationwide lockdown induced by the COVID-19 pandemic required a swift transition to a virtual conference. This article describes the challenges and benefits we encountered with this transition and provides an overview of the conference content.

Hand self-shiatsu to promote sleep among Veterans and their family members: A non-randomized, multiple-methods study

Introduction: The determinants of Veterans’ and their family members’ health and well-being are compromised by sleep deficiency (SD). The use of long-term drug therapies for treatment is controversial, and the evidence to support positive outcomes is limited. Instead, guidelines recommend non-pharmacological sleep interventions for SD. Hand self-shiatsu (HSS) is a drug-free, pragmatic, easy-to-learn self-management technique that provides patients with an intervention they can actively control, thus contributing to feelings of self-efficacy. The objective of this work was to examine whether a prescribed HSS intervention would result in improved objectively and subjectively measured sleep. Methods: This was a non-randomized controlled study. Objective (actigraphy) measures and standardized self-report questionnaires were applied at baseline and at four and eight weeks post-intervention. Participants also completed a detailed sleep log. Results: No significant differences were found in the actigraphy sleep dimensions across the three measurement time points in either the intervention or the control group. With respect to the self-report measures, a significant change was detected for sleep disturbance (χ22 = 10 [n = 25], p = 0.007) for the intervention group, and 77% stated they would recommend HSS to others. A significant change in two self-report measures was noted in the control group, a potential artifact of the sub-optimal recruitment to this group imposed by the COVID-19 restrictions. Discussion: Although actigraphy data did not support the hypothesis, the self-report measures and qualitative information from participants’ end-of-study interviews indicated endorsement of HSS for the management of sleep difficulties and increased self-efficacy. © 2021 Izvestiya of Saratov University. New Series. Series: Mathematics. Mechanics. Informatics. All rights reserved.

The need to incorporate communities in compartmental models

Tian et al. provide a framework for assessing population-level interventions of disease outbreaks through the construction of counterfactuals in a large-scale, natural experiment assessing the efficacy of mild, but early interventions compared to delayed interventions. The technique is applied to the recent SARS-CoV-2 outbreak with the population of Shenzhen, China acting as the mild-but-early treatment group and a combination of several US counties resembling Shenzhen but enacting a delayed intervention acting as the control. To help further the development of this framework and identify an avenue for further enhancement, we focus on the use and potential limitations of compartmental models. In particular, compartmental models make assumptions about the communicability of a disease that may not perform well when they are used for large areas with multiple communities where movement is restricted. To illustrate this phenomena, we provide a simulation of a directed percolation (outbreak) process on a simple stochastic block model with two blocks. The simulations show that when transmissibility between two communities is severely restricted an outbreak in two communities resembles a primary and secondary outbreak potentially causing policy and decision makers to mistake effective intervention strategies with noncompliance or inefficacy of an intervention. AMS 2000 subject classifications: Primary 37M05;secondary 62P10. © 2021. All Rights Reserved.

The impact of the covid-19 lockdown on young people’s health and wellbeing: How are family relationships and emotional support being affected?

PURPOSE The aim of this study is to draw out the potential con-sequences of the COVID-19 lockdown restrictions for young people’s future health outcomes by exploring changes to the family-based emotional support systems of the young people who took part. DESIGN/METHODOLOGY/ APPROACH It is based on qualitative research designed to explore the impact of the lockdown restrictions on young people engaged with the Health Foundation’s Young People’s Future Health Inquiry. The analysis is based on 13 semi-structured video-interviews carried out in May and June 2020. FINDINGS Lockdown restrictions have generally had a negative impact on the emotional wellbeing of the participants in this study. The findings indicate that the lockdown restrictions have had mixed effects on the emotional support that young people are able to receive from, and give to, their families. The negative effects might have been exacerbated by the closure or reduction of key services, such as mental health services. While communications technology has helped some young people maintain contact with their families, it is no substitute for in-person contact. ORIGINALITY/VALUE Given the recency of COVID-19, evidence on the impact of lockdown restrictions on young people’s family relationships is still very limited, but this study highlights the importance of this area of work. The study identifies potential policy impli-cations and highlights the need for further research into the effects of emotional support on young people’s health and wellbeing. © 2020, RJ4All Publications. All rights reserved.

Acute respiratory infections in children: prospective study on 109 cases at the University Hospital of Dakar, Senegal

The main objective of this study was to focus on the microbiological aspects of acute respiratory infections (ARI) in children in Senegalese hospitals. The hospital frequency of acute respiratory infections in children was 3.7%. The average age was 23.7 months with extremes between 1 month and 144 months. Peaks of consultations were found in August, March and April with 22%, 15.6%, and 12.8% respectively. Fever, respiratory distress and pulmonary condensation syndrome were the main signs found on examination in our patients. Bacteriology was positive in 82.6% of the samples and the most frequently found bacteria were: Streptococcus pneumoniae in 38.5%, Haemophilus influenza b in 32.1% and Moraxella catarrhalis in 25.7%. Virological tests were positive in 80.7%. The viruses most frequently found in the samples were Rhinovirus in 33% of the samples, Human respiratory syncytial virus in 24.8% and coronavirus in 15.6%. On mycological examination, only 4 samples out of 109 were positive, i.e. 3.7%. The only fungi found was Pneumocystis with its two serotypes Pneumocystis jirovecii and Pneumocystis pneumonia in equal proportions. Among the diagnoses retained, pneumonia was predominant and found in 61 of the cases, with a prevalence of 59.9%, followed by acute bronchiolitis with a prevalence of 16.51%. The average length of hospitalization was 10 days. Lethality was 1.8% or 2 cases. Acute respiratory infections in children still remain a public health problem in developing countries, with children under 5 years of age being the most affected, hence the need to strengthen programs to combat ARI.