Post-Discharge Spirometry Evaluation in Patients Recovering from Moderate-to-Critical COVID-19: A Prospective Cohort Study (preprint)

To determine the prevalence and types of spirometry abnormalities among post-COVID-19 patients in Malaysia, with secondary objective focusing on associated factors. Conducted at the COVID-19 Research Clinic, Faculty of Medicine, University Technology MARA, from March 2021 to December 2022, this study included patients three months post-discharge from hospitals following moderate-to-critical COVID-19. Of 408 patients studied, abnormal spirometry was found in 46.8%, with 28.4% exhibiting a restrictive pattern, 17.4% showing preserved ratio impaired spirometry (PRISm), and 1.0% displaying an obstructive pattern. Factors independently associated with abnormal spirometry included older age (OR: 1.0, 95% CI: 1.01–1.04, p = 0.003), underlying cardiovascular disease (OR: 3.5, 95% CI: 1.19–10.47, p = 0.023), history of acute respiratory distress syndrome (p < 0.001), shorter discharge-to-follow-up interval (OR: 0.9, 95% CI: 1.00–1.02, p = 0.035), oxygen desaturation during 6-minute walk test (OR: 1.9, 95% CI: 1.20–3.06, p = 0.007), and presence of consolidation (OR: 8.1, 95% CI: 1.75–37.42, p = 0.008) or ground-glass opacity (OR: 2.6, 95% CI: 1.52–4.30, p < 0.001) on chest X-ray. This study highlights patients recovering from moderate-to-critical COVID-19 often exhibit abnormal spirometry, notably a restrictive pattern and PRISm. Routine spirometry screening for high-risk patients is recommended.

Regulation of virion production by the ORF8 signal peptide across SARS-CoV-2 variants (preprint)

The open reading frame 8 (ORF8), an accessory protein of SARS-CoV-2, is prone to deletions and mutations across different viral variants, which was first described in several Singapore variants. The reason why viral evolution favors loss or inactivation of ORF8 is not fully understood, although the effects of ORF8 on inflammation, immune evasion, and disease severity have been described. Here we show using clinical ORF8 deficient viral isolates, virus like particles (VLPs) and viral replicons that ORF8 expression dampens viral particle production. ORF8 physically interacts with the viral Spike protein and induces Golgi fragmentation, overall contributing to less virus particle production. Using systematic ORF8 deletions, we mapped the particle reducing function to its N terminal signal peptide. Interestingly, this part of ORF8 is severely truncated in the recent XBB.1.5 variant, and when restored, suppresses viral particle production in the context of the entire viral genome. Collectively, our data support the model that evolutionary pressure exists to delete ORF8 sequence and expression across SARS-CoV-2 variants to fully enable viral particle production.

An Exploratory Analysis of COVID Bot vs Human Disinformation Dissemination stemming from the Disinformation Dozen on Telegram (preprint)

The COVID-19 pandemic of 2021 led to a worldwide health crisis that was accompanied by an infodemic. A group of 12 social media personalities, dubbed the ``Disinformation Dozen", were identified as key in spreading disinformation regarding the COVID-19 virus, treatments, and vaccines. This study focuses on the spread of disinformation propagated by this group on Telegram, a mobile messaging and social media platform. After segregating users into three groups -- the Disinformation Dozen, bots, and humans --, we perform an investigation with a dataset of Telegram messages from January to June 2023, comparatively analyzing temporal, topical, and network features. We observe that the Disinformation Dozen are highly involved in the initial dissemination of disinformation but are not the main drivers of the propagation of disinformation. Bot users are extremely active in conversation threads, while human users are active propagators of information, disseminating posts between Telegram channels through the forwarding mechanism.

Cyborgs for strategic communication on social media (preprint)

Social media platforms are a key ground of information consumption and dissemination. Key figures like politicians, celebrities and activists have leveraged on its wide user base for strategic communication. Strategic communications, or StratCom, is the deliberate act of information creation and distribution. Its techniques are used by these key figures for establishing their brand and amplifying their messages. Automated scripts are used on top of personal touches to quickly and effectively perform these tasks. The combination of automation and manual online posting creates a Cyborg social media profile, which is a hybrid between bot and human. In this study, we establish a quantitative definition for a Cyborg account, which is an account that are detected as bots in one time window, and identified as humans in another. This definition makes use of frequent changes of bot classification labels and large differences in bot likelihood scores to identify Cyborgs. We perform a large-scale analysis across over 3.1 million users from Twitter collected from two key events, the 2020 Coronavirus pandemic and 2020 US Elections. We extract Cyborgs from two datasets and employ tools from network science, natural language processing and manual annotation to characterize Cyborg accounts. Our analyses identify Cyborg accounts are mostly constructed for strategic communication uses, have a strong duality in their bot/human classification and are tactically positioned in the social media network, aiding these accounts to promote their desired content. Cyborgs are also discovered to have long online lives, indicating their ability to evade bot detectors, or the graciousness of platforms to allow their operations.

Written and spoken corpus of real and fake social media postings about COVID-19 (preprint)

This study investigates the linguistic traits of fake news and real news. There are two parts to this study: text data and speech data. The text data for this study consisted of 6420 COVID-19 related tweets re-filtered from Patwa et al. (2021). After cleaning, the dataset contained 3049 tweets, with 2161 labeled as 'real' and 888 as 'fake'. The speech data for this study was collected from TikTok, focusing on COVID-19 related videos. Research assistants fact-checked each video's content using credible sources and labeled them as 'Real', 'Fake', or 'Questionable', resulting in a dataset of 91 real entries and 109 fake entries from 200 TikTok videos with a total word count of 53,710 words. The data was analysed using the Linguistic Inquiry and Word Count (LIWC) software to detect patterns in linguistic data. The results indicate a set of linguistic features that distinguish fake news from real news in both written and speech data. This offers valuable insights into the role of language in shaping trust, social media interactions, and the propagation of fake news.

Drug Discovery in Low Data Regimes: Leveraging a Computational Pipeline for the Discovery of Novel SARS-CoV-2 Nsp14-MTase Inhibitors (preprint)

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to significant global morbidity and mortality. A crucial viral protein, the non-structural protein 14 (nsp14), catalyzes the methylation of viral RNA and plays a critical role in viral genome replication and transcription. Due to the low mutation rate in the nsp region among various SARS-CoV-2 variants, nsp14 has emerged as a promising therapeutic target. However, discovering potential inhibitors remains a challenge. In this work, we introduce a computational pipeline for the rapid and efficient identification of potential nsp14 inhibitors by leveraging virtual screening and the NCI open compound collection, which contains 250,000 freely available molecules for researchers worldwide. The introduced pipeline provides a cost-effective and efficient approach for early-stage drug discovery by allowing researchers to evaluate promising molecules without incurring synthesis expenses. Our pipeline successfully identified seven promising candidates after experimentally validating only 40 compounds. Notably, we discovered NSC620333, a compound that exhibits a strong binding affinity to nsp14 with a dissociation constant of 427 {+/-} 84 nM. In addition, we gained new insights into the structure and function of this protein through molecular dynamics simulations. We identified new conformational states of the protein and determined that residues Phe367, Tyr368, and Gln354 within the binding pocket serve as stabilizing residues for novel ligand interactions. We also found that metal coordination complexes are crucial for the overall function of the binding pocket. Lastly, we present the solved crystal structure of the nsp14-MTase complexed with SS148, a potent inhibitor of methyltransferase activity at the nanomolar level (IC50 value of 70 {+/-} 6 nM). Our computational pipeline accurately predicted the binding pose of SS148, demonstrating its effectiveness and potential in accelerating drug discovery efforts against SARS-CoV-2 and other emerging viruses.

IMPACT OF THE COVID-19 PANDEMIC ON ROUTINE HIV CARE AND ANTIRETROVIRAL TREATMENT OUTCOMES IN KENYA: A NATIONALLY REPRESENTATIVE ANALYSIS (preprint)

Background: The COVID-19 pandemic adversely disrupted global health service delivery. We aimed to assess impact of the pandemic on same-day HIV diagnosis/ART initiation, six-months non-retention and initial virologic non-suppression (VnS) among individuals starting antiretroviral therapy (ART) in Kenya. Methods: Individual-level longitudinal service delivery data were analysed. Random sampling of individuals aged >15 years starting ART between April 2018 - March 2021 was done. Date of ART initiation was stratified into pre-COVID-19 (April 2018 - March 2019 and April 2019 - March 2020) and COVID-19 (April 2020 - March 2021) periods. Mixed effects generalised linear, survival and logistic regression models were used to determine the effect of COVID-19 pandemic on same-day HIV diagnosis/ART initiation, six-months non-retention and VnS, respectively. Results: Of 7,046 individuals sampled, 35.5%, 36.0% and 28.4% started ART during April 2018 - March 2019, April 2019 - March 2020 and April 2020 - March 2021, respectively. Compared to the pre-COVID-19 period, the COVID-19 period had higher same-day HIV diagnosis/ART initiation (adjusted risk ratio [95% CI]: 1.09 [1.04-1.13], p<0.001) and lower six-months non-retention (adjusted hazard ratio [95% CI]: 0.66 [0.58-0.74], p<0.001). Of those sampled, 3,296 (46.8%) had a viral load test done at a median 6.2 (IQR, 5.3-7.3) months after ART initiation. Compared to the pre-COVID-19 period, there was no significant difference in VnS during the COVID-19 period (adjusted odds ratio [95% CI]: 0.79 [95% CI: 0.52-1.20], p=0.264). Conclusions: In the short term, the COVID-19 pandemic did not have an adverse impact on HIV care and treatment outcomes in Kenya. Timely, strategic and sustained COVID-19 response may have played a critical role in mitigating adverse effects of the pandemic and point towards maturity, versatility and resilience of the HIV program in Kenya. Continued monitoring to assess long-term impact of the COVID-19 pandemic on HIV care and treatment program in Kenya is warranted.

RHEUMATOID ARTHRITIS FLARE FOLLOWING COVID-19 VACCINATION IN MALAYSIAN POPULATION AND ITS ASSOCIATED RISK FACTORS

BackgroundFlare of Rheumatoid Arthritis (RA) following COVID-19 vaccination has been reported with a low occurrence observed in those patients with disease remission. However, no local data is available in our multi-ethnic Malaysian population.ObjectivesTo evaluate the prevalence of RA flare in Malaysian patients following COVID-19 vaccination and its associated risk factors.MethodsThis was a cross-sectional study assessing RA flare based on patient-reported disease flare through self-administered questionnaires and physician-reported flare. Patient self-reported disease flare was defined as ‘a sudden worsening of rheumatology condition or arthritis within 1 month post-vaccination' while physician-reported flare was defined as ‘an increment of disease activity score 28-joint documented within 3 months post-vaccination‘ from either a scheduled or unscheduled clinic visit. A total of 186 RA patients attended the rheumatology clinic in Hospital Putrajaya from May to July 2022 who completed the primary COVID-19 vaccination under the Malaysian National Vaccination Programme were recruited. Demographic data, disease parameters including serology for rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA), cessation of disease modifying anti-rheumatic drugs (DMARDs) around vaccination, type of vaccines and adverse events were examined using descriptive and univariate analyses.ResultsMajority (93%) of RA patients enrolled were female with a mean age of 58 years old (standard deviation, SD 12.2) and mean disease duration was 12 years (SD 7.7). More than half were seropositive (66% RF, 63% ACPA) with 47.4% had double seropositivity (RF and ACPA positive). All patients received DMARDs with the majority (71%) were on methotrexate (MTX), 21.5% were on leflunomide, 17.7% on other DMARDs, with a small proportion (14%) of patients were receiving prednisolone. Only 4.8% of patients were on biologics or targeted synthetic disease modifying anti-rheumatic drugs. Half of the patients were in remission prior to vaccination. 62% of patients received Pfizer-BioNTech vaccine as the primary vaccine, followed by Sinovac-CoronaVac (24.6%) and Oxford-AstraZeneca (13.4%) vaccines. A booster dose had been administered to 80% of patients, of which 88.7% was Pfizer-BioNTech vaccine. MTX therapy were discontinued in 39.4% of patients (n=52) post-vaccination for a week duration. The prevalence of RA flare was only 12.9% (n=24) in which 14 were self-reported and 10 were physician-reported flares (4 severe flare, 6 mild-moderate flare). Flare rates were higher during the first and second dose of vaccination with 29.2% respectively, and only 12.5% were reported after booster vaccination. Common vaccine adverse effects were fever (16.8%), myalgia (8.6%) and arthralgia (6.4%). There were no significant differences in the occurrence of flare post-vaccination between age, gender, disease activity prior to vaccination, types of vaccine, usage of MTX and prednisolone, and discontinuation of MTX post-vaccination. Although seropositivity did not exhibit statistically significant flare rate post vaccination, sub-analysis revealed four times higher rate of flare in those who has double positivity compared to seronegative RA patients (12% vs 4%).ConclusionPrevelance of RA flare post-COVID-19 vaccination in Malaysian RA population is low. No significant associated risk factors were identified although double seropositivity appeared to have higher number of flares.References[1]Bixio, R., Bertelle, D., Masia, M., Pistillo, F., Carletto, A. and Rossini, M. (2021), Incidence of Disease Flare After BNT162b2 Coronavirus Disease 2019 Vaccination in Patients With Rheumatoid Arthritis in Remission. ACR Open Rheumatology, 3: 832-833.[2]Li X, Tong X, Yeung WWY, Kuan P, Yum SHH, Chui CSL, Lai FTT, Wan EYF, Wong CKH, Chan EWY, Lau CS, Wong ICK. Two-dose COVID-19 vaccination and possible arthritis flare among patients with rheumatoid arthritis in Hong Kong. Ann Rheum Dis. 2022 Apr;81(4):564-568.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

A novel multidisciplinary approach to the management of end-stage macular disease

Introduction: In 2017, the Royal College of Ophthalmologists UK published 'The Way Forward' describing the effects of the ageing UK population on clinical demand for macular conditions. Although one-stop clinics have become accepted standard practice for combined assessment and injections, there is little guidance regarding eventual discharge of patients, and practice varies between clinicians. In 2018, NHS Lothian started a multidisciplinary one-stop clinic involving an Ophthalmologist, a Medical Photographer, a specialist Low Vision Optometrist, and a Low Vision Counsellor. We aimed to detail our experiences of this novel multidisciplinary discharge clinic for advanced macular disease patients. We also aimed to assess patient-reported anxiety and depression outcomes following this clinic. Retrospective data on 60 patients who attended the clinic from August 2018 to January 2019 were collected and included in analysis. Average age at presentation to the clinic was 85.76 ± 8.18 years old and patients had been followed up in the macula clinic for a mean of 4.80 ± 2.43 years prior to attending the clinic. In all, 31 patients responded to a survey on anxiety and depression using the Hospital Anxiety and Depression score (HADS). Three (10%) of the patients reported scores abnormal for anxiety, and there were no abnormal scores for depression. The clinic provides a holistic approach for end-stage macular disease patients and reduces unnecessary macular anti–vascular endothelial growth factor treatments and clinic review appointments. This is especially important now during the coronavirus SARS-CoV-2 global pandemic. This provides significant benefits to capacity for delivery of clinical services and facilitates a safe and supported discharge for patients.

Engaging university students in online learning: a regional comparative study from the perspective of social presence theory

This study investigates the factors influencing university students' online learning engagement from three distinct aspects, namely, behavioural, cognitive and emotional engagement. A comparison is drawn from university students in Asia who embraced online learning during the COVID-19 pandemic. An online survey was conducted on 495 university students in Mainland China, Hong Kong and Malaysia during the surge of the COVID-19 Omicron variant, which was considered more infectious but less deadly than previous variants. A consistent positive relationship between Satisfaction and Academic Performance is found in all the regions. Malaysia presents a unique situation as compared to Mainland China and Hong Kong whereby no association was found between Social Context and Online communication towards Student Engagement. The novelty of this study is attributed to the integration of Social Presence Theory in Student Engagement through the nature of online learning as a coping strategy to halt the spread of COVID-19 during the Omicron variant surge. © 2023, Beijing Normal University.

EFFICACY AND SAFETY OF DAZODALIBEP (VIB4920/HZN4920) IN SUBJECTS WITH SJÖGREN'S SYNDROME: A PHASE 2, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, PROOF OF CONCEPT STUDY

BackgroundSjögren's syndrome (SS) is a chronic, systemic autoimmune disease affecting exocrine glands, primarily the salivary and tear glands, with potentially severe manifestations in multiple organs. No approved disease-modifying therapies exist. Dazodalibep (DAZ) is a biologic antagonist of CD40L.ObjectivesThe objective of this study was to evaluate the efficacy and safety of DAZ therapy in adult SS subjects with moderate-to-high systemic disease activity (NCT04129164).MethodsWe conducted a randomized, double-blind, placebo-controlled, crossover study to evaluate DAZ therapy in adult SS subjects with moderate-to-high systemic disease activity, as defined by a EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) score ≥ 5. Eligible subjects were randomized 1:1 to receive intravenous DAZ 1500 mg or placebo (PBO) Q2W x 3 doses, then Q4W x 4 additional doses. Starting on Day 169, subjects initially randomized to DAZ received PBO Q4W x 5 doses and subjects randomized to PBO received DAZ Q4W x 5 doses and were then followed for 12 weeks. The primary endpoint was the change from Baseline in ESSDAI at Day 169. Safety assessments included the incidence of adverse (AEs), serious AEs (SAEs), and AEs of special interest (AESIs).ResultsThe 74 randomized subjects all received ≥1 dose of study medication (DAZ, N=36;PBO, N=38). The baseline demographics and disease characteristics were balanced between the two groups. The change from Baseline to Day 169 in ESSDAI score (LS mean ± SE), was -6.3 ± 0.6 in DAZ-treated subjects compared to -4.1 ± 0.6 in the PBO group, a difference of -2.2 (p = 0.0167). Compared to the PBO group, the DAZ group showed positive trends in the EULAR Sjögren's Syndrome Patient Reported Index score, and Functional Assessment of Chronic Illness Therapy-Fatigue score at Day 169. A post-hoc responder analysis of subjects achieving high levels (5 and 6 points) of improvement on ESSDAI favored DAZ (61.1% and 60.0%) over PBO (35.1% and 34.3%).The reported AEs were generally mild through Day 169 and similar in frequency between treatment groups. The most frequently reported AEs occurring in ≥5% of DAZ-treated subjects and >PBO were COVID-19, diarrhea, dizziness, ligament sprain, upper respiratory tract infection, contusion, device allergy, fatigue, hypertension, and oropharyngeal pain. Two SAEs were reported in a single DAZ-treated subject: this subject was a 59-year-old female who experienced a grade 3 SAE of COVID-19 infection and later died of unknown cause 46 days after last administration of DAZ (12 days after COVID-19 diagnosis). There was a single AESI of herpes zoster in a DAZ-treated subject.ConclusionDAZ is a potential new therapy for the treatment of systemic disease activity in patients with SS. SS subjects with moderate-to-high systemic disease receiving DAZ experienced a statistically significant reduction in disease activity relative to PBO as measured by the improvement in ESSDAI score. Except for a case of severe COVID-19 infection, DAZ therapy in SS subjects appeared to be well tolerated. Larger controlled trials of DAZ therapy for SS are warranted to further explore its safety profile and confirm its clinical efficacy.Table 1.Efficacy and Safety DataPBO N=38DAZ 1500 mg N=36EfficacyΔESSDAI, LS mean (SE) †-4.1 (0.6)-6.3 (0.6)*ΔESSPRI, LS mean (SE) †-1.12 (0.29)-1.80 (0.31)ΔFACIT-Fatigue, LS mean (SE) †5.8 (1.6)8.1 (1.6)AE Summary, n (%)≥1 AE23 (60.5)28 (77.8)≥1 related AE8 (21)10 (27.8)≥1 SAE01 (2.8)≥1 related SAE00≥1 AE leading to discontinuation00≥1 AESI01 (2.8)≥1 Death01 (2.8)Efficacy endpoints as of Day 169;† Analyzed using MMRM;Comparisons vs PBO;*p<0.05;AE summaries based on AEs that occurred through Day 169;AE, adverse event;AESI, adverse event of special interest;ESSDAI, EULAR Sjögren's Syndrome Disease Activity Index;ESSPRI, EULAR Sjögren's Syndrome Patient Reported Index;FACIT-Fatigue, Functional Assessment of Chronic Illness Therapy-Fatigue;PBO, placebo;SAE, serious adverse eventFigure 1.AcknowledgementsFunded by Horizon herapeutics. Medical writing support provided by B Lujan, PhD, an employee of Horizon Therapeutics.Disclosure of InterestsE. William St. Clair Consultant of: Horizon Therapeutics, Bristol Myers Squibb, CSL Behring, Resolve Therapeutics, Sonoma Biotherapeutics. Royalties: UpToDate, Liangwei Wang Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Ilias Alevizos Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, William Rees Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Alan Baer Consultant of: Bristol Myers Squibb, Wan Fai Ng Consultant of: Novartis, GlaxoSmithKline, Abbvie, BMS, Sanofi, MedImmune, Janssen and UCB, Ghaith Noaiseh Consultant of: Novartis, Chiara Baldini Consultant of: GSK, and Sanofi.

REFERRAL BEHAVIOUR OF PRIMARY CARE DOCTORS TO RHEUMATOLOGY CLINIC IN MALAYSIA

BackgroundThe workload at rheumatology clinics have been growing relentlessly and an audit on new.referrals helps to identify referral behaviour of primary care doctors and improvement can be done by providing further training.ObjectivesTo audit on new referral cases to rheumatology clinic from 2020-2022 and to identify new cases with misdiagnosis for future training purpose.MethodsThis was a retrospective study. The medical records of all new referral to rheumatology clinic Hospital Sultan Ismail and Hospital Pakar Sultanah Fatimah from 1st January 2020 to 31th November 2022 were reviewed. The referral diagnosis and final diagnosis were identified and analysed.ResultsThere were total of 927 new cases referral throughout the 35 months during Covid-19pandemic. Majority of them were diagnosed to have rheumatoid arthritis (217/927)followed by systemic lupus erythematosus (190/927), psoriatic arthritis (147/927),gout (62/927), osteoarthritis (58/927), systemic sclerosis (25/927), ankylosing spondylitis (25/927), soft tissue rheumatism (24/927), Sjogren syndrome (24/927),mixed connective tissue disease (14/927), vasculitis (11/927), fibromyalgia (10/927),polymyositis (7/927) and miscellaneous (39/927).45 out of the new cases were diagnosed as unlikely rheumatic diseases. There were 29pending cases awaiting final diagnosis.212 of the referrals were identified as misdiagnosis with the highest as nodal osteoarthritis.(55/212) followed by unlikely rheumatic disease (43/212), soft tissue rheumatism (24/212),psoriatic arthritis (20/212), Sjogren syndrome (14/212), gout (8/212), rheumatoid arthritis (7/212), fibromyalgia (6/212), systemic lupus erythematosus (5/212), ankylosing spondylitis (4/212), mixed connective tissue disease (3/212), systemic sclerosis (2/212), polymyositis (2/212) and others (19/212): diffuse idiopathic skeletal hyperostosis, hypermobility syndrome, RS3PE syndrome, idiopathic uveitis, graft versus host disease, juvenile idiopathic arthritis, antiphospholipid syndrome, hypothyroidism, post streptococcal arthritis, prolapsed intervertebral disc, cerebrovascular disease, traumatic sternoclavicular joint subluxation, ledderhose disease, paraspinal muscle spasm and viral myalgia).ConclusionNodal osteoarthritis and soft tissue rheumatism can be great mimicker for inflammatory.arthritis and if wrongly diagnosed will lead to unnecessary anxiety or wrong treatment. More training is needed to improve clinical skills amongst primary care doctors.ReferencesNA.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Healthcare facilities' level of preparedness response on COVID-19 preventive measures in selected regions of Tanzania: A perspective of healthcare workers

Background: After the first patient of COVID-19 was announced by the Ministry of Health in Tanzania from Arusha region, the hottest discussion in the community was the fear on how our health facilities were prepared against the spread of coronavirus disease. Objective and significance: This study aims at assessing healthcare facilities level of preparedness response on preventive measures against COVID-19 in selected regions of Tanzania through the contributions of healthcare workers. This study will add value in building capacity to fight COVID-19 pandemic and possibly any other pandemic of similar significance in the future. Methods: Analytical cross-sectional study design which applied quantitative research strategy was conducted from August to October 2022. A total of 596 healthcare workers were involved in the study from 40 healthcare facilities in Dar es Salaam, Mwanza, Arusha, and Dodoma regions of Tanzania. Descriptive statistics were analyzed by a statistical package SPSS version 26 (IBM Corp., Armonk, NY) giving frequencies, percentages, and significant association between variables. Results: Overall level of preparedness was poor at 52%, only 25% of preventive measures were good prepared and 23% moderately prepared. Availability of hand washing station with soap and water to ensure hand hygiene for healthcare workers was most prepared by 87.1% while designated ambulance facility for transporting patients from isolation area to other COVID-19 referral facilities was less prepared by 30.4% in this study. Conclusion: The preparedness responses was poor in selected regions of Tanzania which cause less capacity to fight against COVID-19 whenever it emerges. © 2020 The author (s).

Factors Influencing Knowledge Level of COVID-19 among Healthcare Workers: A Cross-sectional Survey in Four Regions of Tanzania

Up to April 24th 2020, the Government of Tanzania announced 284 cases of COVID-19, among them 7 were in intensive care, 37 recoveries, 10 deaths and the rest in stable condition while Dar es Salaam region was leading in number of infected cases followed by Mwanza, Arusha and Dodoma regions. This study was conducted to evaluate level of COVID-19 knowledge among healthcare workers in selected regions of Tanzania in order to identify the existing gap of knowledge in combating COVID-19. This study applied a quantitative analytical cross-sectional survey design in Dar es Salaam, Arusha, Mwanza and Dodoma regions of Tanzania from 24th of August till 3rd October, 2022. A total of 596 healthcare workers from 40 healthcare facilities were involved. Frequencies and percentages were analyzed for categorical variables. Association between categorical variables were analyzed by using Chi-square and variables were significant at P-value < 0.05. This study found that, healthcare workers have an average of 79.4% correct answers with overall level of knowledge at 70%, 24% and 6% of healthcare workers holding good, moderate and low levels of knowledge respectively. Multinomial logistic regression showed significant associations with service experience of 1-5 years (OR = 0.093, 95% CI, 0.011-0.759, P-value= 0.027) when good and poor knowledge compared. This study found moderate knowledge among healthcare workers. Significant association with level of knowledge reported in age, field profession, level of education, category of healthcare facility and situation of caring COVID-19 patients in facility. [ FROM AUTHOR] Copyright of Journal of Pure & Applied Microbiology is the property of Dr. M. N. Khan 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.)

Did A Fruit and Vegetable Incentive Program Support low-income Households in North Carolina during the COVID-19 Pandemic? A Mixed Methods Assessment of the Healthy Helping Program and Other Pandemic-Related Food Assistance

In 2020, the Healthy Helping Fruit and Vegetable Program provided SNAP-eligible beneficiaries with $40/month, for up to 3 months, to purchase fruits and vegetablesata chainsupermarket inNorthCarolina.A survey to describeparticipants' experiences with the program and interviews to explore whether these experiences were shaped byparticipating inotherpandemic-related food access programs were conducted.In conjunction with other food access programs,programs that allow participants freedom to choose what they purchase mayalleviate household hardships and provide greater access tonutrient-dense foods during the COVID-19 pandemic and beyond..Copyright © 2022 Taylor & Francis Group, LLC.