Effect Of Rosuvastatin In The Protection Against Azithromycin Induced Cardiotoxicity In Covid-19 Patients: A One-Year Prospective Study

Background Azithromycin is a widely used broad-spectrum antibiotic that was recently used in the treatment protocol of COVID-19 but its cardiac side effects became a more prominent concern. Rosuvastatin is a synthetic statin that showed anti-inflammatory, antioxidant and autonomic nervous system regulatory effects in addition, there is increasing evidence supporting that it could play a beneficial role in patients with COVID-19. Objective To evaluate the protective effect of Rousvastatin against Azithromycin-induced cardiotoxicity in Covid-19 patients. Patients and Methods This is a prospective study that was conducted on adult patients diagnosed with COVID-19 who were admitted to isolation centres in Minia Governorate, Egypt for the period of one year (June 2021 to May 2022). The study included a total of 80 COVID-19 patients who were divided into 2 groups (n=40 each), group (I) "Azithromycin group" that included patients received Azithromycin (500 mg/day for 5 days) orally and group (II) "Azithromycin + Rosuvastatin group" that included patients received Azithromycin by oral route as group (I) plus Rosuvastatin 20 mg/day orally. All included cases were subjected to full history taking, clinical examination and laboratory investigations and after treatment, the outcome measures were reported and compared. Results No significant differences were observed between groups regarding demographic and baseline characteristics. Also, the two groups were comparable with no significant differences in pulse rate, blood sugar, CBC, electrolyte elements, liver enzymes, and kidney function (a slight reduction was noticed in group II). While, Ferritin level was significantly lower in group (II) compared to group (I), (830 ± 72.5 vs. 865 ± 69.5, p=0.03). No significant differences were observed among groups as regards Troponin level (p=0.56) "Only one case was positive in group (I)". Both groups were almost comparable without significant differences in both stages of infection and mortality (p=0.38 and 1.0, respectively). Conclusion Rosuvastatin did not have a significant role in the protection of Azithromycin-induced cardiotoxicity, it slightly ameliorates the biochemical and stress markers alterations of Azithromycin. Further larger studies are warranted for investigating this issue. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A case of multisystem inflammatory syndrome in children (MIS-C)

Background/Purpose: MIS-C is uncommon and yet potentially life threatening disorder associated with COVID-19 infection. MIS-C Malaysia Study Group had reported 174 cases, mostly affecting children < 12 years old (93.7%). The fatality rate was 4%. Hereby, we report a case of MIS-C at our adult rheumatology centre. Method(s): Patient's admission note and electrical medical information were reviewed. Result(s): This is a 17 year-old adolescent with underlying obesity (BMI 42 kg/m2). He completed COVID-19 vaccination (Pfizer-BioNTech x 2 doses) in October 2021. In end-February 2022, he presented acutely with recurrent seizures associated with fever (40.3degreeC) and headache. The COVID-19 RTK antigen and PCR tests were positive, and COVID-19 IgM & IgG were negative. At emergency room, he developed haemodynamic instability, needing ventilatory support for respiratory failure and inotropic therapy on Day 1 of illness. The initial diagnosis was severe COVID-19 infection with encephalitis and secondary bacterial infection. Subsequent investigations showed evidence of systemic inflammation with organ dysfunction involving neurological (seizures, CNS vasculitis), cardiac (myocarditis), renal (acute kidney injury) and gastrointestinal (acute livery injury) systems. MIS-C was then diagnosed with early initiation of immunomodulatory treatment (IVIg 2 g/kg and IV methylprednisolone 1-2 mg/kg/day) according to ACR recommendation. Low dose aspirin and high intensity prophylactic SC enoxaparin were prescribed but were discontinued soon due to bleeding tendency. Antimicrobial therapy was continued until microbiological study was proven sterile. With the immunomodulatory treatment, he had rapid clinical and laboratory improvement within first week and was transferred out from ICU on Day 10 of illness. The organ dysfunction was mostly resolved with no sequelae except for high blood pressure requiring antihypertensive. Inflammatory markers were markedly reduced;Serum ferritin reduced from 22,339 to 565.8 mug/L, procalcitonin decreased from 26.7 ng/ml to 1.5 ng/ml and CRP normalised (<5 mg/L). Home discharge was made on Day 16 of illness with oral prednisolone 60 mg daily without antiplatelet. During clinic visit after D30 of illness, he remained asymptomatic with good effort tolerance and normal blood pressure readings. He subsequently completed the high school examination in April 2022 and even enrolled at college later. Oral prednisolone was eventually tapered off at 3rd month of illness with appointments for MRI cardiac and brain scheduled for further assessment. Conclusion(s): MIS-C is a hyperinflammatory syndrome which requires high clinical suspicion as many patients response well to early immunodulatory treatment without sequelae. Long term follow up maybe needed for those with cardiac involvement. (Table Presented).

3D-Printed Microfluidics Potential in Combating Future and Current Pandemics (COVID-19).

Coronavirus disease (COVID-19) emerged in China in December 2019. In March 2020, the WHO declared it a pandemic leading to worldwide lockdowns and travel restrictions. By May, it infected 4,789,205 and killed 318,789 people. This led to severe shortages in the medical sector besides devastating socio-economic effects. Many technologies such as artificial intelligence (AI), virtual reality (VR), microfluidics, 3D printing, and 3D scanning can step into contain the virus and hinder its extensive spread. This article aims to explore the potentials of 3D printing and microfluidic in accelerating the diagnosis and monitoring of the disease and fulfilling the shortages of personal protective equipment (PPE) and medical equipment. It highlights the main applications of 3D printers and microfluidics in providing PPE (masks, respirators, face shields, goggles, and isolation chambers/hoods), supportive care (respiratory equipment) and diagnostic supplies (sampling swabs & lab-on-chip) to ease the COVID-19 pressures. Also, the cost of such technology and regulation considerations are addressed. We conclude that 3D printing provided reusable and low-cost solutions to mitigate the shortages. However, safety, sterility, and compatibility with environmental protection standards need to be guaranteed through standardization and assessment by regulatory bodies. Finally, lessons learned from this pandemic can also help the world prepare for upcoming outbreaks.

Kidney Transplantation From Deceased Donors With Vaccine-induced Immune Thrombocytopenia and Thrombosis: An Updated Analysis of the UK Experience.

BACKGROUND: The emergence and attendant mortality of vaccine-induced immune thrombocytopenia and thrombosis (VITT) as a consequence of vaccination against severe acute respiratory syndrome coronavirus 2 have resulted in some patients with VITT being considered as deceased organ donors. Outcomes after kidney transplantation in this context are poorly described. Because the disease seems to be mediated by antiplatelet factor 4 antibodies, there is a theoretical risk of transmission via passenger leukocytes within the allograft. METHODS: We analyzed the experience of kidney transplantation from donors with VITT in the United Kingdom between January and June 2021. We followed-up all recipients of kidney-only transplants from donors with VITT to detect major postoperative complications or features of disease transmission and assess graft survival and function. RESULTS: There were 16 kidney donors and 30 single kidney transplant recipients in our study period. Of 11 preimplantation biopsies, 4 showed widespread glomerular microthrombi. After a median of 5 mo, patient and graft survival were 97% and 90%, respectively. The median 3-mo estimated glomerular filtration rate was 51 mL/min/1.73 m 2 . Two recipients had detectable antiplatelet factor 4 antibodies but no evidence of clinical disease after transplantation. Major hemorrhagic complications occurred in 3 recipients, all of whom had independent risk factors for bleeding, resulting in the loss of 2 grafts. The involvement of VITT could not be completely excluded in one of these cases. CONCLUSIONS: The UK experience to date shows that favorable outcomes are possible after kidney transplantation from donors with VITT but highlights the need for ongoing vigilance for donor-related complications in these patients.

Students' attitudes on the use of Zoom in higher educational institutes of Sri Lanka

Purpose>There is a significant decrease in students' attendance in Zoom classes compared to traditional classes. This paper investigates the factors that affect students' attitudes, behavioral intentions and actual use of Zoom for online classes at higher educational institutions (HEIs) in Sri Lanka.Design/methodology/approach>This research uses the technology acceptance model (TAM) as a theoretical model. The data are collected from HEI students via an online survey form. The hypotheses between constructs in the model are tested using partial least squared–structural equation model.Findings>The analysis shows that computer self-efficacy (CSE) affects perceived usefulness (PU) and perceived ease of use (PEU), which affects attitude (ATT) and behavioral intention (BI) and actual use (AU) of Zoom in a chain reaction. Further, PEU affects PU, which, in turn, affects BI. Furthermore, the effect size of PU to BI is larger than ATT to BI.Practical implications>Students' attendance for Zoom classes mainly depends on CSE, PU and PEU. Therefore, HEIs should promote Zoom with interactive training before teaching online. Further, officials should revise the curriculum in schools to upsurge the CSE of students.Originality/value>During coronavirus-19, no research was published on students' use of Zoom for online classes in the Sri Lankan context. Moreover, the TAM model has been modified by including CSE as an external variable.

SPECTRa: An Online Tool for Simulating Prehospital Patient Care.

OBJECTIVES: To (1) develop a simulation software environment to conduct prehospital research during the COVID-19 pandemic on paramedics' teamwork and use of mobile computing devices, and (2) establish its feasibility for use as a research and training tool. BACKGROUND: Simulation-based research and training for prehospital environments has typically used live simulation, with highly realistic equipment and technology-enhanced manikins. However, such simulations are expensive, difficult to replicate, and require facilitators and participants to be at the same location. Although virtual simulation tools exist for prehospital care, it is unclear how best to use them for research and training. METHODS: We present SPECTRa-Simulated Prehospital Emergency Care for Team Research-an online simulated prehospital environment that lets participants care concurrently for single or multiple patients remotely. Patient scenarios are designed using Laerdal's SimDesigner. SPECTRa records data about scenario states and participants' virtual interaction with the simulated patients. SPECTRa's supporting environment records participants' verbal communication and their visual and physical interactions with their interface and devices using Zoom conferencing and audiovisual recording. We discuss a pilot research implementation to assess SPECTRa's feasibility. RESULTS: SPECTRa allows researchers to systematically test small-team interaction in single- or multipatient care scenarios and assess the impact of mobile devices on participants' assessment and care of patients. SPECTRa also supports pedagogical features that could allow prehospital educators to provide individual trainees or teams with online simulation training and evaluation. CONCLUSIONS: SPECTRa, an online tool for simulating prehospital patient care, shows potential for remote healthcare research and training.

Bridging the supply chain resilience research and practice gaps: pre and post COVID-19 perspectives

Purpose: In light of the COVID-19 pandemic, all business sectors have critical needs. They face multiple challenges to restructuring their operations to build a resilient, cost-effective and sustainable supply chain. Therefore, this paper aims to investigate the practice and the research gaps related to supply chains. Design/methodology/approach: This research paper is influenced by a literature review of the past decade. This review paper incorporates industry challenges of the COVID-19 pandemic, including future steps toward developing resilient supply chains in the new normal economy. The research provides a detailed framework for designing cost-effective survivable supply chains that withstand disruptions for the long term. Findings: The proposed research focuses on the effects of the COVID-19 pandemic on supply chains and attempts to bridge pre and post COVID-19 research and practice gaps. Post-COVID-19 resilient supply chains need to be transformed into survivable supply chains. The survivability of the supply chain can be achieved by combining both supply chain resilience and supply chain viability measures. To the best of the authors’ belief, this is the first study that grounds a theory to provide interconnection of five critical supply chain concepts to manage supply chain risk. This study is uniquely positioned to develop a theoretical framework to design a cost-effective, resilient and sustainable supply chain by establishing the interconnection among these concepts in supply chains. This framework helps practitioners to implement the key strategies at the operational, tactical and strategic levels that enhance maturity in supply chains. Research limitations/implications: The research findings are based on secondary reports such as industry reports, cases, research papers and expert opinions. The authors tried to consult with many companies. However, they were reluctant to share the recovery plan information from COVID. Also, as COVID still exists in many places in Canada, the authors could not gather every intended information from the companies. However, the authors have successfully shared the outcomes of this research with a reputed retail company in Canada. They recognized the importance of survivability in supply chains. Going forward, business organizations need to design cost-effective, sustainable and survivable supply chains. Originality/value: The study attempts to unify current research dealing with supply chain resilience. The study concludes with the limitations of the current research. It highlights the prospects of future research and bridges the supply chain practice gaps from the challenges faced by industries due to COVID-19. The study contributes to the literature by identifying gaps to bridge the supply chain practice and reiterating new research directions to develop a cost-effective, survivable and sustainable supply chain. © 2022, Emerald Publishing Limited.

Psychological Distress and COVID-19 Related Anxiety among Malaysian Women during the COVID-19 Pandemic.

The combination of COVID-19 outbreaks and nationwide lockdown led to an increased prevalence of psychological distress among the population, especially women, as they have to cope with greater family and work demands. We aimed to identify the factors contributing to psychological distress among Malaysian women during the COVID-19 pandemic. A cross-sectional study was conducted between October 2020 and April 2021, in a teaching hospital in Kuala Lumpur, Malaysia. A self-administered questionnaire was distributed among women, which consisted of (1) Participant's demographics, (2) COVID-19 knowledge and awareness, (3) Depression, Anxiety, Stress Scale-21 (DASS-21), and (4) COVID-19-related anxiety. Chi-square test and univariate analysis were performed to determine the significant factors associated with psychological distress. The mean scores for knowledge, COVID-19 anxiety, and DASS-21 subcomponents were compared using the Mann-Whitney U test. A total of three hundred and thirty-eight women completed the survey. The majority of respondents demonstrated adequate knowledge (95.6%) on COVID-19. The proportion of our women who reported symptoms of depression, anxiety, and stress were 17.2%, 25.1%, and 0.9%, respectively, resulting in a prevalence of psychological distress of 27.8%. Low education level (p = 0.017), unemployment (p = 0.028), loss of income (p = 0.033), and hospital admission for surgical procedures (p = 0.021) were significantly associated with a higher psychological burden. A greater level of COVID-19 anxiety was found among Malays (p = 0.027), pregnant women (p = 0.013), and those who suffered a loss of income (p = 0.038) during this pandemic. The COVID-19 pandemic had a negative effect on women's psychological wellbeing, especially those from the lower socio-economic background. Therefore, adequate information, as well as support, must be provided to the vulnerable groups during the ongoing pandemic, to lessen their psychological burden.

Microneedle-Based Vaccine Delivery: Review of an Emerging Technology.

Vaccination has produced a great improvement to the global health by decreasing/eradicating many infectious diseases responsible for significant morbidity and mortality. Thanks to vaccines, many infections affecting childhood have been greatly decreased or even eradicated (smallpox, measles, and polio). That is why great efforts are made to achieve mass vaccination against COVID-19. However, developed vaccines face many challenges with regard to their safety and stability. Moreover, needle phobia could prevent a significant proportion of the population from receiving vaccines. In this context, microneedles (MNs) could potentially present a solution to address these challenges. MNs represent single dose administration systems that do not need reconstitution or cold-chain storage. Being self-administered, pain-free, and capable of producing superior immunogenicity makes them a more attractive alternative. This review explores microneedles' types, safety, and efficacy in vaccine delivery. Preclinical and clinical studies for microneedle-based vaccines are discussed and patent examples are included.

Numerical Study of the Transmission of Exhaled Droplets between the Instructor and Students in a Typical Classroom

Conducting physical attendance exams during pandemics is a challenge facing many educational institutes and universities. Our study’s main objective is to numerically simulate the expected transmission of the harmful exhaled droplets of aerosols from an infected instructor to students in an exam room ventilated by a number of spiral diffusers. Several critical parameters, including the droplet size, the ventilation rate, and status of the entrance door were considered in the analysis. Two dimensionless indices, i.e., the specific normalized average concentration (SNAC) and the exceedance in exposure ratio (EER), were introduced to examine the effect of the said parameters on student exposure to the harmful droplets. The study revealed that the 5 μm droplets were less hazardous as they resulted in an 87% reduction in exposure when compared with the small 1 μm size droplets. We also found that when the ventilation rate ratio (VRR) increased above unity, an upward entrainment process, due to the swirl diffuser, of the aerosol droplets took place, and consequently the risk of student exposure was reduced. The results also demonstrated that increasing VRR from zero to 1 and then to 2 decreased the exceedance in the student exposure from 3.5 to 2.15 and then to less than zero, respectively. The study also showed that keeping the lecture room’s main door open is recommended as this reduced the risk of exposure by 26% in the case of a VRR equal to 2.

The management of dialysis access thrombosis during the COVID-19 pandemic.

BACKGROUND: Maintaining patent access is essential for haemodialysis dependent end stage renal failure patients. The COVID-19 pandemic has significantly affected surgical and interventional radiology services worldwide. We aimed to review the impact COVID-19 has caused to the management of acute dialysis access thrombosis. METHODS: We conducted a single centre retrospective review of outcomes of patients with arteriovenous fistula and arteriovenous graft thrombosis between March and May 2020, which coincided with the first peak of the COVID-19 pandemic in London, and a similar period in the previous year, March-May 2019. Outcomes in both cohorts of patients were compared, including attempts at salvage, salvage success, 1-month patency rates after salvage and subsequent surgery on the same access. We also analysed the use of tunnelled haemodialysis lines (THL), either due to failed salvage attempts or when salvage was not attempted. RESULTS: There was a similar incidence of access thrombosis in both periods (26 cases in 2019, 38 in 2020). There were 601 patients dialysing via an arteriovenous fistula or graft in 2019, and 568 patients in 2020. Access salvage, when attempted, had similar success rates and 1-month patency (salvage success 74% vs 80%, p = 0.39; 1-month patency 55% vs 62%, p = 0.69). The proportion of patients where access salvage was not attempted and a THL inserted was significantly higher in 2020 compared to 2019 (32% vs 4%, p = 0.007). There were more patients who subsequently had surgery to salvage or revise the same access in 2019 compared to 2020 (62% vs 13%, p < 0.001). CONCLUSIONS: During the peak of the COVID-19 pandemic, there were fewer attempts at access salvage. This was a conscious decision due to increased pressure on the healthcare system, access to emergency interventional radiology or operative theatres and the perceived risk/benefit ratio of access salvage. The long-term effects of this change in practice remain unknown.

Outcomes of Renal Transplant Recipients With SARS-CoV-2 Infection in the Eye of the Storm: A Comparative Study With Waitlisted Patients.

BACKGROUND: Patients with chronic kidney disease stage 5 and those on immunosuppression are particularly vulnerable and are shielded as per public health strategy. We present our experience of coronavirus disease 2019 (COVID-19) transplant patients in one of the most affected parts of the UK with direct comparison to waitlisted patients. METHODS: A single-center prospective study of symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive waitlisted and transplant patients was undertaken to compare these groups and assess clinical outcomes. RESULTS: A total of 60 consecutive symptomatic SARS-CoV-2 positive patients were identified with 32 active waitlisted patients and 28 functioning renal transplants. Demographics were similar. The incidence of symptomatic COVID-19 in the waitlisted group was 9.9% compared to 1.9% in renal transplant patients (P < 0.001). Immunosuppression did not influence initial symptomology. Fifteen percent of patients in the waitlisted and 32% in the transplant groups died (P = 0.726). Mortality as proportion of total waitlisted (321 patients) and transplant population (1434 patients) of our centre was 1.5% and 0.6% (P < 0.001), respectively. C-reactive protein (CRP) at 48 h and peak CRP were associated with mortality in both groups while quick sequential organ failure assessment score at 48 h (P = 0.036) was associated with mortality for transplant patients. CONCLUSIONS: Incidence of COVID-19 is higher in the waitlisted population but transplant patients have more severe disease, reflected by higher mortality. CRP at 48 h can be used as a predictive tool. In the absence of effective treatments, the current strategy of shielding is arguably the most important factor in protecting patients while resuming transplantation.

Experience of SARS-CoV-2 infection in two kidney transplant recipients living with HIV-1 infection.

There is still no consensus on the optimal management of COVID-19 within the general population due to the emerging evidence base. High-risk groups, including kidney transplant recipients living with HIV present unique additional challenges. Here we discuss two kidney transplant recipients living with HIV with SARS-CoV-2 infection and their clinical course, and review the existing literature for this subset of challenging patients.

Plasma Levels of Phospholipids in Patients With COVID-19; A Promising Simple Biochemical Parameter to Evaluate the Disease Severity (preprint)

Background Cronavirus-19 (COVID-19) pandemic is a worldwide public health problem knowing in China recently from December 25, 2019. Phospholipids are structural components of mammalian cytoskeleton and cell membranes. Phospholipids is an anionic lipid found in mammalian membranes in low amounts (1–2%) of the total phospholipids. Also, it suppressed viral attachment to the plasma membrane and subsequent replication in lung cells.  Aim: The present study was carried out to explain the correlation between the plasma phospholipids as well as secretory phospholipase-A2α2 (sPLA2α2) and cytokine storm; tumor necrosis factor (TNF)-α, interleukin--1β (IL-1β), interleukin-6 (IL)-6 and interleukin-13 (IL-13_ levels of patients with COVID-19 to assess the infection severity. Methods: Serum samples from enrolled 34 patients with mild, moderate, and acute COVID-19 infection. Complete blood picture (CBC), plasma d-dimer, ferritin, C-reactive protein (CRP), lipid profile, phospholipids, sPLA2α2 and TNF-α, IL-1β, IL-6 and IL-13 as well as lung computed tomography (CT) imaging.Results: CBC showed that the presence of leukopenia, lymphopenia, eosinopenia in patient with mild, moderate, and acute COVID-19 infection. Also, significant increase in plasma d-dimer, CRP, ferritin, triacyclglycerols, TNF-α, IL-1β, IL-6 and IL-13 levels as well as sPLA2α2 activity when compared to normal persons. However, plasma levels of phospholipids, cholesterol, HDL-C and LDL-C were decreased significantly in patient with acute COVID-19 infection only, when compared to normal persons. In addition, lung computed tomography (CT) scan showed that the presence of ground glass opacity (GGO), bronchial wall thickening, crazy paving sign as well as right, left, upper and lower lung predominant in patient with mild, moderate and acute COVID-19 infection. The levels of blood leukopenia, lymphopenia and eosinopenia as well as plasma phospholipids d-dimer, CRP, ferritin, cytokine storm and sPLA2α2 were pronounced in group of patients with acute COVID-19 infection more the mild and moderate one.Conclusion: The present study was showed that there is a correlation between plasma phospholipids depletion as well as elevation sPLA2α2 and cytokines storm with the severity of COVID-19 infection. Also, the plasma phospholipids levels can used to estimate COVID-19 infection severity and help to identify patients into three classes: mild, moderate and severe one.