An Online Survey of the Perceptions of Clinical and Non-Clinical Professionals on Healthcare for Non-Communicable Diseases and COVID-19 Measures During the Pandemic in Malaysia.

Objectives: This study assesses the opinions of health professionals in Malaysia on the disruption of non-communicable disease (NCD) services during the COVID-19 pandemic from March 2020 to January 2022. Methods: We conducted a cross-sectional online survey with 191 non-clinical public health workers and clinical health service workers in Malaysia from November 2021 to January 2022. Participants were recruited by the Malaysian Ministry of Health using major networks including key experts and practitioners. Secondary respondents were subsequently enrolled through snowballing. Results: The most notable issues raised by the survey participants relate to NCD service disruption, the redirection of NCD care resources, and NCD care being overburdened post-pandemic. Respondents also reported accounts of resilience and prompt reaction from the healthcare system, as well as calls for innovation. Conclusion: Most respondents perceived that the challenges arising from COVID-19 were mostly managed well by the healthcare system, which was able to provide the necessary services to NCD patients during this health emergency. However, the study identifies gaps in the health system response and preparedness capacity, and highlights solutions for strengthening NCD services.

Exploring key-stakeholder perceptions on non-communicable disease care during the COVID-19 pandemic in Kenya.

Introduction: over one third of total Disability-Adjusted-Life-Years lost in Kenya are due to non-communicable diseases (NCD). In response, the Government declared significant commitment towards improving NCD care. The COVID-19 pandemic increased the burden on the already overstretched health systems in Kenya. The aims of this study are to assess whether health care providers perceived NCD care to be optimal during the pandemic and explore how to improve responses to future emergencies. Methods: this cross-sectional online survey included healthcare personnel with non-clinical roles (public health workers and policy-makers) and those delivering health care (doctors and nurses). Respondents were recruited between May and September 2021 by random sampling, completed by snowball sampling. Results: among 236 participants (42% in clinical, 58% in non-clinical roles) there was an overall consensus between respondents on NCD care being disrupted and compromised during the pandemic in Kenya. Detracted supplies, funding, and technical resources affected the continuity of NCDs' response, despite government efforts. Respondents agreed that the enhanced personnel capacity and competencies to manage COVID-19 patients were positive, but noted a lack of guidance for redirecting care for chronic diseases, and advocated for digital innovation as a solution. Conclusion: this paper explores the perceptions of key stakeholders involved in the management of NCDs in Kenya to improve planning for future emergency responses. Gaps were identified in health system response and preparedness capacity during the pandemic including the perceived need to strengthen NCD services, with solutions offered to guide resilience efforts to protect the health system from disruption.

Intubation strategy in COVID-19 era: An observational study.

Background and Aims: Aerosol protection equipment aim at protecting the anaesthesiologist, from aerosol-borne infections, namely, severe acute respiratory syndrome corona virus-2. Methods: We improvised the first-generation intubation box (IB) by increasing its dimensions, including heat and moisture exchanger with filter, suction catheter, and attaching arm sleeves to make a modified intubation box (MIB). The impact of IB, MIB and transparent sheets (TS) on the patient outcomes during airway management was evaluated. Results: A significant difference in median (interquartile range in minutes) was observed in time to intubate between IB (4 [4-5]); TS (0.5 [0.3-0.5]) and MIB (0.3 [0.3-1.5]): P = 0.004); and airway devices; McCoy (0.5 [0.3-2]), CMac (0.5 [0.3-1.5]): P = 0.004. First-pass success was 100% with the TS, whereas more than three attempts were required with IB 66.7% and 5.2% with MIB. Video laryngoscope was associated with less airway-related adverse events (ARAEs). The need for mask ventilation (and hence possible aerosolisation) was maximum with IB. All the ARAEs resolved uneventfully. No breach of personal protective equipment was observed; none of the health-care professionals involved in patient care developed any symptoms suggestive of COVID-19. Conclusion: Video laryngoscope is favourable for managing airway in COVID-19 times. In view of the ongoing pandemic and added protection that it offers, it is worthwhile to include the MIB in the armamentarium for managing the airway of patients with COVID-19.

Acupuncture for Management of Endodontic Emergencies: a Review.

Root canal treatment (RCT) employed for painful endodontic conditions like apical periodontitis and irreversible pulpitis is associated with a high incidence of postoperative pain. Pharmacological management for this purpose is effective, but not entirely free from side effects and in some cases may fail to provide adequate relief. Furthermore, concerns have been raised regarding the transmission of coronavirus disease-2019 (COVID-19) as a result of the aerosols generated and prolonged chair side time required for RCT. Acupuncture is a traditional Chinese therapy commonly employed as an alternative for the treatment of pain. And what's more, the use of acupuncture has been recently reported as treatment for the management of endodontic pain as well as on the anesthetic success in patients with irreversible pulpitis. This review aims to evaluate the current evidence for acupuncture in endodontics and its potential role in emergency pain relief and management for patients. To combat this, a thorough search for literature within the field was performed in five electronic databases. Retrieved studies were screened according to the pre-defined eligibility criteria. After both an electronic and manual search, five studies were selected for review. These studies reported the beneficial effects of acupuncture in reducing the failure of nerve block in patients with irreversible pulpitis and in controlling both intraoperative and postoperative pain following RCT. In addition, it was also reported to reduce anxiety surrounding the dental procedure and minimized the intake of analgesics after the endodontic procedure, which can result in some unwanted side effects. However, more in depth clinical research is required before any recommendation regarding the application of acupuncture in endodontic patients can be made.

Salivary biomarkers in COVID-19 patients.

The use of salivary biomarkers in diagnosis, treatment, and overall prognosis of coronavirus disease 2019 (COVID-19) has been developed recently. Salivary biomarkers are extremely promising as they are fast to obtain and involve noninvasive collection of specimens. Monitoring patients in real time is necessary in this pandemic. Saliva is another biofluid with major advantages at the molecular level. Methods that detect viral presence in the host secretions measure the current infection by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), whereas the detection of human antibodies against SARS-CoV-2 evaluates the past exposure to the virus. There is an urgent need to increase the active research for the detection of SARS-CoV-2 in saliva because diagnostics may provide a reliable and cost-effective method and is suitable for the fast and early detection of COVID-19 infection. Salivary biomarkers have a potential to be a vital guide in determining coronavirus disease. Many people still do not get results of COVID-19 tests due to imbalance between supply and demand at large testing centers. The use of saliva has various advantages compared to collection of nasopharyngeal swabs. New techniques should be developed for detecting salivary biomarkers that help in diagnosis of COVID-19.

Optimal Covid-19 vaccine stations location and allocation strategies

Purpose This study proposes strategies for vaccine center allocation for coronavirus disease (COVID) vaccine by determining the number of vaccination stations required for the vaccination drive, location of vaccination station, assignment of demand group to vaccination station, allocation of the scarce medical professional teams to station and number of optimal days a vaccination station to be functional in a week. Design/methodology/approach The authors propose a mixed-integer nonlinear programming model. However, to handle nonlinearity, the authors devise a heuristic and then propose a two-stage mixed-integer linear programming (MILP) formulation to optimize the allocation of vaccination centers or stations to demand groups in the first stage and the allocation of vaccination centers to cold storage links in the second stage. The first stage optimizes the cost and average distance traveled by people to reach the vaccination center, whereas the second stage optimizes the vaccine's holding and storage and transportation cost by efficiently allocating cold storage links to the centers. Findings The model is studied for the real-world case of Chandigarh, India. The results obtained validate that the proposed approach can immensely help government agencies and policymaking body for a successful vaccination drive. The model tries to find a tradeoff between loss due to underutilized medical teams and the distance traveled by a demand group to get the vaccination. Originality/value To the best of our knowledge, there are hardly any studies on a vaccination program at such a scale due to sudden outbreaks such as Covid-19.

The impact of the COVID-19 pandemic on the career choice of medicine: A cross-sectional study amongst pre-medical students in Pakistan.

Background: The COVID-19 pandemic has significantly affected the lives of healthcare workers due to the frontline nature of their work. Their hard work and sacrifice have forged new perceptions of healthcare workers. These changes may potentially influence students' interest in medicine. This study explores how the COVID-19 pandemic has affected premedical students' decisions to pursue medicine as a career. Methods: A cross-sectional study using a self-designed online questionnaire was carried out amongst pre-medical students across Pakistan. Results: A total of 1695 students from 93 public and private schools filled in the survey. After the onset of the COVID-19 pandemic, significantly more pre-medical students want to pursue medicine (60.7%-62.9%) and less are unsure (20.2%-17%). Students are significantly more likely to be motivated to pursue medicine due to altruistic benefits to society (57% vs. 62.7%) and be deterred by the risk of contracting infections on duty (10%-14.6%). There is a minor but significant increase in the popularity of internal medicine (17.1%-18.9%), public health (4.1% vs. 5.7%), emergency medicine (3.8% vs. 5.7%), pediatrics (3.8% vs. 4.7%), and radiology (2.1% vs. 2.9%). Most pre-medical students felt that doctors routinely undergo physical and emotional turmoil (84%). Conclusions: Although awareness of hardships faced by medical professionals has increased, motivation to pursue medicine has grown. Through understanding trends in the motivations of students to pursue medicine, medical schools can accommodate the expectations of incoming students and reach out to potential applicants.

Impact of self-efficacy and sense of coherence on tobacco cessation motivation and readiness among slum dwellers in Ajmer city during COVID-19 health emergency.

Background: Tobacco cessation motivation majorly depends on self-efficacy and sense of coherence. Hence the aim and objective of the present study was to explore how self-efficacy (SE) in addition to sense of coherence (SOC) affected tobacco cessation motivation and readiness among slum dwellers during the COVID-19 health emergency. Materials and Methods: The ongoing research was a cross-sectional, descriptive questionnaire study. The research started in November and ended in December 2020. The research took place in primary health centres located in Ajmer's urban slums. In this analysis, east, west, north and south directions of Ajmer were chosen at random from each direction, and each slum had an associated primary health centre (PHC). From these 16 PHCs, people coming from slum areas were interviewed. The questionnaire consisted of demographic details, tobacco motivation and readiness, SOC and SE. Results: The majority of study participants (178, 56.7%) were not seriously considering reducing their tobacco intake. The majority of study subjects had poor sense of coherence {137 (43.6%)}, self-efficacy {141 (44.9%)} and tobacco cessation motivation and readiness {156 (49.7%)}. Using the logistic regression model, it was discovered that study participants with high SE and a high SOC had a substantial impact on successful tobacco cessation motivation and readiness (P = 0.01*), (P = 0.00*). Conclusion: It was concluded that the study participants with high self-efficacy and high sense of coherence had a significant impact on good tobacco cessation motivation and readiness.

Patients'/Caregivers' Perspectives on Telemedicine Service for Advanced Cancer Patients during the COVID-19 Pandemic: An Exploratory Survey.

INTRODUCTION: Novel coronavirus disease 2019 (COVID 19) has usurped human peace and mobility. The confinement of the population and the rising epidemic has disrupted the routine care for non-COVID-19 patients. Telehealth is a growing field, and its application in palliative care is seen as a solution to serve the population in this difficult crisis. METHODOLOGY: A exploratory survey was designed to assess the changes in the hospital-based practice of palliative care in the COVID-19 pandemic and patient/caregiver's perception about the provision of telehealth services to palliative care patients of a tertiary care cancer hospital of eastern India. RESULTS: There was a dramatic reduction in the outpatient clinic footfalls by 51% with teleconsultation. Although there was no change in the number of emergency visits, the inpatient admissions reduced by 44%. Nearly 82% of patient/caregivers gave a positive feedback about telemedicine care provided by the department and mentioned that the service provided them with support and connectedness. Almost 64% of the patients and caregivers reported that the service helped allay the fear and reassured them that there was a someone to support them. As high as 76% of the participants felt that they would prefer teleconsultation in future and were ready to pay for teleconsultations if charges were to be applied in the future. CONCLUSION: Telemedicine is an important tool and an essential service to care for palliative care patients in the community especially when the patient and health-care professionals are separated by a pandemic or natural disaster.

COVID-19 cases and their outcome among patients with uncommon co-existing illnesses: A lesson from Northern India

Introduction Newer coexisting conditions should be identified in order to modify newer risk factors. Aim was to identify patients with non-classical or less common coexisting conditions in patients infected of COVID 19. Method Single centred study from June 2020 to May 2021 at a tertiary centre in North India. A preformed questionnaire was used to record clinical and laboratory parameters and to identify cases which are in addition to CDC list and Indian data. Results 0.67% (46) cases out of 6832 patients were identified to have non-classical coexisting illness. It was divided into 2 groups-infections A (60.1%) and non-infections B (39.9%). Group A included-tuberculosis- pulmonary (14.3%) & extra pulmonary (32.9%), bacterial (25.0%) viral infections [dengue, hepatitis B & C] (14.3%), HIV disease (10.7%) and malaria (3.6%). Group B included- organ transplant (27.8%), autoimmune [myasthenia gravis, polymyositis, psoriasis] (22.6%), haematologic [Haemophilia, ITP, Aplastic anaemia, APML, CML] (27.8%), uncommon malignancies [disseminated sacral chordoma and GTN] (11.1%) and snakebite (11.1%). Serum Procalcitonin was not helpful for diagnosis of bacterial infection in COVID-19 disease. Group A had significantly longer duration of illness, hepatitis and elevated CRP. The mortality in group A & B were 32.1% and 43.8% respectively. Death in non-severe COVID cases was in tetanus and snakebite. 30.7% death among tuberculosis patients. More than 70% of deaths were attributable to COVID 19 in both the groups. Conclusion In Indian settings, comorbidities like tuberculosis and bacterial infections can precipitate severe COVID 19 unlike other parts of the world where tuberculosis is relatively uncommon.

Nicotine dependence, perceived stress, and self-efficacy among primary health care professionals during the times of Covid-19 pandemic - A cross-sectional descriptive study.

BACKGROUND: Nicotine dependency would have increased during the times of COVID-19 among the primary health professionals, which would can be attributed to perceived stress and can also be influenced by self-efficacy; hence, the aim of the present study was to determine the relationship between nicotine dependence with perceived stress, self-efficacy among primary health care professionals during the times of covid-19 pandemic. MATERIALS AND METHODS: The present study was a cross-sectional descriptive questionnaire study. The study was conducted among primary health workers of Ajmer district; stratified random sampling technique was used to collect data. A questionnaire was prepared that consists of demographic details, questions on perceived stress, self-efficacy, and nicotine dependence. RESULTS: Perceived stress and nicotine dependence was high among study participants. Self-efficacy was low. There was significant (P ≤ 0.05) association between high nicotine dependence and high perceived stress. It was also reported that majority of study participants {58 (30.4%)} with high self-efficacy significantly (P ≤ 0.05) was associated with low nicotine dependence. CONCLUSION: High nicotine dependence was significantly associated with high perceived stress, while low nicotine dependence was significantly lower among primary health care workers' low perceived stress. Low nicotine dependence was significantly associated among study participants with high self-efficacy.

Emotional well-being of dentists and the effect of lockdown during the COVID-19 pandemic: A nationwide study.

BACKGROUND: Lockdown in India might have adverse effects on the emotional health of the dental professionals; hence, the aim of the present study was to determine the impact of various factors on emotional well-being of dental professionals due to the effect of lockdown during COVID-19. MATERIALS AND METHODS: It was a cross-sectional, descriptive, questionnaire study conducted on dentists in India during April 2020. Sampling technique was convenient sampling, and sampling frame was all the dental professionals in India. The questionnaire was prepared online using Google Forms, and the link was generated which was shared among as many dentists accessible as possible, with the help of message, mails, and WhatsApp. The questionnaire consists of questions on Demographic details, practice, and emotional well-being. A total of 1844 dental professionals in 14 states in India responded. The statistical analysis was done using SPSS version no. 20. IBM SPSS version 20.0 (IBM; Armonk, New York USA) Descriptive statistics and multinomial regression test was applied. RESULTS: Majority of study participants (1096 [59.4%]) belonged to age group of 26-35 years. Emotional well-being score of 1206 (65.4%) dental professionals in the times of COVID-19 outbreak was poor with score between 26 and 78. It was assessed that males have significantly (P = 0.00**) (P < 0.001**) (**highly significant) poorer emotional well-being 0.085 (0.829-1.429) compared to females. Married dental professionals - 0.023 (0.011-1.221) had significantly better (P = 0.05*) emotional well-being than others. CONCLUSION: Emotional well-being score of majority of dental professionals in the times of COVID-19 outbreak was poor. Gender, marital status, socioeconomic status, years of experience, practicing in clinic, and average number of patients seen per month before lockdown have significant impact on emotional wellbeing of dental professionals.

Remote triaging of urgent suspected head and neck cancer referrals: our experience during the first wave of the COVID-19 pandemic.

PURPOSE: In response to the coronavirus disease 2019 (COVID-19) pandemic, otolaryngology departments across the United Kingdom have adopted non-face-to-face clinics with consultations being carried out remotely, via telephone or video calls. By reducing footfall on hospital sites, the aim of this strategy was to limit direct contact and curb the spread of infection. This report outlines our experience of conducting a telephone triage clinic in the assessment of urgent suspected head and neck cancer referrals during the first wave of the COVID-19 pandemic. METHODS: New patients who were referred on the urgent suspected head and neck cancer pathway were prospectively identified between 1 May 2020 and 31 August 2020. Patients were triaged remotely using telephone consultations. Risk stratification was performed using the 'Head and Neck Cancer Risk Calculator' (HaNC-RC v.2). RESULTS: Four-hundred and twelve patients were triaged remotely during the 4-month study period. Of these, 248 patients were deemed 'low risk' (60.2%), 78 were classed as 'moderate risk' (18.9%) and 86 were considered 'high risk' (20.9%) according to the HaNC-RC v.2 risk score. Twenty-four patients who were assessed during the study period were diagnosed with head and neck cancer (5.82%). CONCLUSION: The use of teleconsultation, supported by a validated, symptom-based risk calculator, has the potential to provide a viable and effective adjunct in the assessment and management of new suspected head and neck cancer patients and should be considered as part of the inherent re-shaping of clinical service delivery following the ongoing pandemic.

COVID-19 infection with delayed presentation of infective endocarditis of the prosthetic pulmonary valve.

Pulmonary valve endocarditis after transcatheter pulmonary valve implantation has been an emerging concern due to the increasing prevalence of transcatheter placement of pulmonary valve in the treatment of residual right ventricular outflow tract stenosis or regurgitation. Pulmonary valve endocarditis is a dreadful complication of transcatheter pulmonary valve implantation that have been reported with Melody valve (Medtronic, Inc., Minneapolis, MN) and Edward Sapien valve (Edwards Life Sciences, Irvine, CA) till date. There are scanty available literatures for pulmonary valve endocarditis with Venus P valve (Venus Medtech, Hangzhou, China) implantation. Furthermore, cardiovascular comorbidity is common in COVID-19 infection with limited evidence of COVID-19 infection concomitant with infective endocarditis. This case happens to be the first reported case of infective endocarditis of pulmonary valve with concomitant COVID-19 infection and also delayed presentation of pulmonary valve endocarditis with Venus P valve implantation.

Projecting the Criticality of COVID-19 Transmission in India Using GIS and Machine Learning Methods

There is a new public health catastrophe forbidding the world. With the advent and spread of 2019 novel coronavirus (2019-nCoV). Learning from the experiences of various countries and the World Health Organization (WHO) guidelines, social distancing, use of sanitizers, thermal screening, quarantining, and provision of lockdown in the cities being the effective measure that can contain the spread of the pandemic. Though complete lockdown helps in containing the spread, it generates complexity by breaking the economic activity chain. Besides, laborers, farmers, and workers may lose their daily earnings. Owing to these detrimental effects, the government has to open the lockdown strategically. Prediction of the COVID-19 spread and analyzing when the cases would stop increasing helps in developing a strategy. An attempt is made in this paper to predict the time after which the number of new cases stops rising, considering the strong implementation of lockdown conditions using three different techniques such as Decision Tree, Support Vector Machine, and Gaussian Process Regression algorithm are used to project the number of cases. Thus, the projections are used in identifying inflection points, which would help in planning the easing of lockdown in a few of the areas strategically. The criticality in a region is evaluated using the criticality index (CI), which is proposed by authors in one of the past of research works. This research work is made available in a dashboard to enable the decision-makers to combat the pandemic.

A correlation study between meteorological parameters and COVID-19 pandemic in Mumbai, India.

BACKGROUND AND AIMS: Meteorological parameters play a major role in the transmission of infectious diseases such as COVID-19. In this study, we aim to analyze the correlation between meteorological parameters and COVID-19 pandemic in the financial capital of India, Mumbai. METHODS: In this research, we collected data from April 27 till July 25, 2020 (90 days). A Spearman rank correlation test along with two-tailed p test and an Artificial Neural Network (ANN) technique have been used to predict the associations of COVID-19 with meteorological parameters. RESULTS: A significant correlation of COVID-19 was found with temperature (Tmin), dew point (DPmax), relative humidity (RHmax, RHavg, RHmin) and surface pressure (Pmax, Pavg, Pmin). The parameters which showed significant correlation were then taken for the modeling and prediction of COVID-19 infections using Artificial Neural Network technique. CONCLUSIONS: It was found that the relative humidity and pressure parameters had the most influencing effect out of all other significant parameters (obtained from Spearman's method) on the active number of COVID-19 cases. The finding in this study might be useful for the public, local authorities, and the Ministry of Health, Govt. of India to combat COVID-19.

A systematic review of the role of hypovitaminosis D in coronavirus disease-19 (COVID-19) infection and mortality: Is there a role of recommending high dose Vitamin D supplementation?

There are several studies corelating Vitamin D deficiency and risk of poorer outcomes in coronavirus disease -19 (COVID-19) patients. Our aim was to perform systematic review of the existing literature on the role of vitamin D deficiency in COVID-19 infection and mortality and whether high dose vitamin D supplementation might be helpful in reducing risk and improving outcomes. A systematic search was conducted in PubMed, EMBASE and Cochrane Library up to 5th June 2020. The quality of included studies was evaluated using the Downs and Black risk of bias scale. The available literature was critically appraised. 61 reports were shortlisted. After removing duplicates and reassessing eligibility, three articles were included in final review. The three included studies in this review scored from 10 to 17 (out of 31) on the risk of bias assessment tool;all of them scored low on the power criterion based on the low number of subjects included in these studies. On reporting and selection of bias, all the studies scored an average or above average. All studies failed to reach an average score on confounding. Two studies which showed positive correlation between Vitamin D levels and COVID-19 infection rates scored low on risk of bias assessment. Study showing no impact of Vitamin D scored average.There is only circumstantial evidence that links outcomes of COVID-19 and vitamin D status. Role of high dose Vitamin D against COVID-19 needs to be thoroughly evaluated in observational studies or high-quality randomized controlled studies before recommending it.

Quarantine an effective mode for control of the spread of COVID19? A review.

The outbreak of COVID- 19 disease has taken the world by surprise. The disease mainly affects the respiratory system and is caused by a strain of coronavirus named SARS-CoV-2. Due to its high recombination rates the virus has an immense potential to spread rapidly. Within months of the first case being reported in Wuhan China, the disease has turned rapidly into a pandemic. The world health experts are already actively looking for a definite cure or vaccine for the disease, but till that many of the countries across the globe are looking up onto mass quarantine measures as a method to control its spread. This article is an attempt to review the effectiveness of these measures and the possible adverse effects of the same. Other possible modes of prevention and controlling the spread of the disease have also been reviewed in the article.