Depression, anxiety, and stress among COVID-19 patients in South Sinai, Egypt: prevalence and associated predictors.

Infectious diseases trigger fear and anxiety among patients leading to disturbance in psychological health of patients. Psychological symptoms were found during SARS-COV-1 epidemic which raise the curiosity about their presence with SARS-COV-2 infection. The current study aimed to estimate the prevalence and severity of psychiatric disorders (depression, anxiety, and stress) among COVID-19 patients and their associated significant predictors. A cross-sectional study was conducted among 382 patients infected with COVID-19 in South Sinai governorate, Egypt, during the period June 2021 through January 2022. Patients with positive PCR test for COVID-19 were included if no more than 6 months have passed after being isolated in the hospital or at home. The patients were being contacted after being cured from COVID-19. The Arabic version of the Depression Anxiety Stress was used to assess the psychological status of patients. Multivariate linear regression analysis was done to detect the predictors of psychiatric symptoms among patients. A total of 382 participants with mean age of 41.5 ± 15.0 years old, of whom 72.5% were males were included in the study. 91.6% of participants had all the three studied psychological disorders; depression, anxiety and stress with most of participants had either severe or extremely severe conditions (13.9 and 75.7 for anxiety, 22.8 and 46.3% for depression, 38.5 and % 19.6 for stress, respectively). Healthcare workers had higher prevalence rates of depression, anxiety and stress. In bivariate analysis, educational level, HCWs and visiting healthcare facility were significantly affecting DASS scores. In linear regression analysis, hospital admission was the main predictor of the three psychological disorders. In Conclusion, majority of patients affected with COVID-19 suffered from symptoms of anxiety, depression and stress within six months after being infected. Hospital admission was found to be the main predictor of the presence of psychiatric disorders with prolonged recovery time from COVID-19 infection. More attention should be paid to COVID-19 patient's mental health as psychological care and presence of psychiatric in the isolation hospitals should be considered.

Screening for diabetes in the adult population above the age of 20 years among inhabitants of rural agricultural and rural desert areas of Egypt.

AIMS: The present study focused on identifying the current prevalence of diabetes mellitus (DM) in rural desert and rural agricultural areas of Egypt and comparing these findings to those of previous studies that reported lower prevalence rates of DM in rural desert versus rural agricultural areas. METHODS: The study included a total of 15,000 participants aged 20 years or older; 10,000 were from rural agricultural areas and 5000 were from rural desert areas in Egypt. The prevalence of DM and impaired fasting glucose for each group was recorded, participants were interviewed, medical history was obtained, physical examinations were performed, and fasting plasma glucose was used for diagnosis of DM and IFG using American Diabetes Association criteria. RESULTS: The prevalence of DM was 12.7% in agricultural areas and 4.7% in desert areas. The prevalence of newly diagnosed cases was 15.8% and 9.9% in agricultural and desert areas, respectively. The prevalence of IFG was 11.14% in agricultural and 8.04% in desert areas. These results suggest that living in a rural area makes patients at a higher risk of developing DM (OR = 2.968 CI (2.570-3.428) p < 0.001) and IFG (OR = 1.43, CI (1.272-1.616), p < 0.001). Logistic regression analysis revealed that increased age, living in agricultural areas, higher body mass index and positive family history of diabetes were the significant predictors affecting the prevalence of DM. CONCLUSIONS: The prevalence of DM, IFG, and overall dysglycemia (DM + IFG) in Egypt has generally increased in rural areas, with a lower prevalence in rural desert compared to rural agricultural areas.

Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region.

Coronavirus disease (COVID-19) booster doses decrease infection transmission and disease severity. This study aimed to assess the acceptance of COVID-19 vaccine booster doses in low, middle, and high-income countries of the East Mediterranean Region (EMR) and its determinants using the health belief model (HBM). In addition, we aimed to identify the causes of booster dose rejection and the main source of information about vaccination. Using the snowball and convince sampling technique, a bilingual, self-administered, anonymous questionnaire was used to collect the data from 14 EMR countries through different social media platforms. Logistic regression analysis was used to estimate the key determinants that predict vaccination acceptance among respondents. Overall, 2327 participants responded to the questionnaire. In total, 1468 received compulsory doses of vaccination. Of them, 739 (50.3%) received booster doses and 387 (26.4%) were willing to get the COVID-19 vaccine booster doses. Vaccine booster dose acceptance rates in low, middle, and high-income countries were 73.4%, 67.9%, and 83.0%, respectively (p < 0.001). Participants who reported reliance on information about the COVID-19 vaccination from the Ministry of Health websites were more willing to accept booster doses (79.3% vs. 66.6%, p < 0.001). The leading causes behind booster dose rejection were the beliefs that booster doses have no benefit (48.35%) and have severe side effects (25.6%). Determinants of booster dose acceptance were age (odds ratio (OR) = 1.02, 95% confidence interval (CI): 1.01-1.03, p = 0.002), information provided by the Ministry of Health (OR = 3.40, 95% CI: 1.79-6.49, p = 0.015), perceived susceptibility to COVID-19 infection (OR = 1.88, 95% CI: 1.21-2.93, p = 0.005), perceived severity of COVID-19 (OR = 2.08, 95% CI: 137-3.16, p = 0.001), and perceived risk of side effects (OR = 0.25, 95% CI: 0.19-0.34, p < 0.001). Booster dose acceptance in EMR is relatively high. Interventions based on HBM may provide useful directions for policymakers to enhance the population's acceptance of booster vaccination.

Exploring enablers and barriers toward COVID-19 vaccine acceptance among Arabs: A qualitative study.

Background: With the emergence of the coronavirus disease 2019 (COVID-19) and rapid vaccine development, research interest in vaccine hesitancy (VH) has increased. Research usually focuses on quantitative estimates which largely neglected the qualitative underpinnings of this phenomenon. This study aimed to explore the beliefs and views towards COVID-19 vaccination among Arabs in different countries. Furthermore, we explored the effect of confidence in the healthcare system, misinformation, and scientific approaches adopted to mitigate COVID-19 on how individuals are following the recommended preventative actions including vaccination. Methods: This study was based on the Strategic Advisory Group of Experts (SAGE)-VH Model: A qualitative design that utilized in-depth, online interviews. The study was conducted in seven Arab countries (Egypt, Qatar, Kingdom of Saudi Arabia, Libya, Sudan, United Arab Emirates and Jordan) from June 2020 to December 2021. Transcripts were analyzed using NVivo 12 Software. Results: A total of 100 participants, 44 males and 56 females, of different age groups (37.1 ± 11.56 years) were interviewed. Findings revealed six themes as enablers and barriers to COVID-19 vaccination. Many participants indicated trusting the vaccines, the healthcare systems, and the vaccination policies were the main driver to get the vaccine. Participants showed concerns towards potential long-term vaccine effects. A consistent inclination towards collective responsibility, which is the willingness to protect others by own vaccination, was also reported. Conclusion: Enablers and barriers of COVID-19 vaccination acceptance in the Arab region, from sociocultural and political perspectives, are critical to guide policymakers in designing target-oriented interventions that can improve vaccine acceptance.

COVID-19 Vaccine Acceptance among Social Media Users: A Content Analysis, Multi-Continent Study.

Vaccine hesitancy (VH) is defined as a delayed in acceptance or refusal of vaccines despite availability of vaccination services. This multinational study examined user interaction with social media about COVID-19 vaccination. The study analyzed social media comments in 24 countries from five continents. In total, 5856 responses were analyzed; 83.5% of comments were from Facebook, while 16.5% were from Twitter. In Facebook, the overall vaccine acceptance was 40.3%; the lowest acceptance rates were evident in Jordan (8.5%), Oman (15.0%), Senegal (20.0%) and Morocco (20.7%) and the continental acceptance rate was the lowest in North America 22.6%. In Twitter, the overall acceptance rate was (41.5%); the lowest acceptance rate was found in Oman (14.3%), followed by USA (20.5%), and UK (23.3%) and the continental acceptance rate was the lowest in North America (20.5%), and Europe (29.7%). The differences in vaccine acceptance across countries and continents in Facebook and Twitter were statistically significant. Regarding the tone of the comments, in Facebook, countries that had the highest number of serious tone comments were Sweden (90.9%), USA (61.3%), and Thailand (58.8%). At continent level, serious comments were the highest in Asia (58.4%), followed by Africa (46.2%) and South America (46.2%). In Twitter, the highest serious tone was reported in Egypt (72.2%) while at continental level, the highest proportion of serious comments was observed in Asia (59.7%), followed by Europe (46.5%). The differences in tone across countries and continents in Facebook and Twitter and were statistically significant. There was a significant association between the tone and the position of comments. We concluded that the overall vaccine acceptance in social media was relatively low and varied across the studied countries and continents. Consequently, more in-depth studies are required to address causes of such VH and combat infodemics.

A Meta-Analysis on the Safety and Immunogenicity of Covid-19 Vaccines.

OBJECTIVE: The presented meta-analysis (MA) aims at identifying the vaccine safety and immunogenicity in published trials about SARS-CoV-2 vaccines. METHODS: All relevant publications were systematically searched and collected from different databases (Embase, Scopus, EBSCO, MEDLINE central/PubMed, Science Direct, Cochrane Central Register for Clinical Trials (CENTRAL), Clinical Trials.gov, WHO International Clinical Trials Registry Platform (ICTRP), COVID Trial, COVID Inato, Web of Science, ProQuest Thesis, ProQuest Coronavirus Database, SAGE Thesis, Google Scholar, Research Square, and Medxriv) up to January 10, 2021. The pooled vaccine safety and immunogenicity following vaccination in phase 1 and 2 vaccine clinical trials, as well as their 95% confidence intervals (CI), were estimated using the random-effects model. RESULTS: The predefined inclusion criteria were met in 22 out of 8592 articles. The proportion of anti-severe acute respiratory distress coronavirus 2 (SARS-CoV-2) antibody responses after 7 days among 72 vaccinated persons included in 1 study was 81% (95% CI: 70-89), after 14 days among 888 vaccinated persons included in 6 studies was 80% (95% CI: 58-92), after 28 days among 1589 vaccinated persons included in 6 studies was 63% (95% CI: 59-67), after 42 days among 478 vaccinated persons included in 5 studies was 93% (95% CI: 80-98), and after 56 days among 432 vaccinated persons included in 2 studies was 93% (95% CI: 83-97). Meta regression explains more than 80% of this heterogeneity, where the main predictors were; the inactivated vaccine type (ß = 2.027, P = 0.0007), measurement of antibodies at week 1 (ß = -4.327, P < 0.0001) and at week 3 of the first dose (ß = -2.02, P = 0.0025). Furthermore, the pooled proportion adverse effects 7 days after vaccination was 0.01 (0.08-0.14) for fever, headache 0.23 (0.19-0.27), fatigue 0.10 (0.07-0.13), and 0.18 (0.14-0.23) for muscle pain. CONCLUSION: Immunogenicity following vaccination ranged from 63% to 93% depending on the time at which the antibody levels were measured.

The coronavirus disease 2019 (COVID-19) vaccination psychological antecedent assessment using the Arabic 5c validated tool: An online survey in 13 Arab countries.

BACKGROUND: Following the emergency approval of the coronavirus disease 2019 (COVID-19) vaccines, research into its vaccination hesitancy saw a substantial increase. However, the psychological behaviors associated with this hesitancy are still not completely understood. This study assessed the psychological antecedents associated with COVID-19 vaccination in the Arab population. METHODOLOGY: The validated Arabic version of the 5C questionnaire was distributed online across various social media platforms in Arabic-speaking countries. The questionnaire had three sections, namely, socio-demographics, COVID-19 related infection and vaccination, and the 5C scale of vaccine psychological antecedents of confidence, complacency, constraints, calculation, and collective responsibility. RESULTS: In total, 4,474 participants with a mean age of 32.48 ± 10.76 from 13 Arab countries made up the final sample, 40.8% of whom were male. Around 26.7% of the participants were found to be confident about the COVID-19 vaccination, 10.7% indicated complacency, 96.5% indicated they had no constraints, 48.8% had a preference for calculation and 40.4% indicated they had collective responsibility. The 5C antecedents varied across the studied countries with the confidence and collective responsibility being the highest in the United Arab Emirates (59.0% and 58.0%, respectively), complacency and constraints in Morocco (21.0% and 7.0%, respectively) and calculation in Sudan (60.0%). The regression analyses revealed that sex, age, educational degrees, being a health care professional, history of COVID-19 infection and having a relative infected or died from COVID-19 significantly predicted the 5C psychological antecedents by different degrees. CONCLUSION: There are wide psychological antecedent variations between Arab countries, and different determinants can have a profound effect on the COVID-19 vaccine's psychological antecedents.

Determining the Cutoff Points of the 5C Scale for Assessment of COVID-19 Vaccines Psychological Antecedents among the Arab Population: A Multinational Study.

BACKGROUND: One of the newly faced challenges during the COVID-19 is vaccine hesitancy (VH). The validated 5C scale, that assesses 5 psychological antecedents of vaccination, could be effective in exploring COVID-19 VH. This study aimed to determine a statistically valid cutoff points for the 5C sub-scales among the Arab population. METHODS: A cross-sectional study was conducted among 446 subjects from 3 Arab countries (Egypt, United Arab Emirates (UAE), and Jordan). Information regarding sociodemographics, clinical history, COVID-19 infection and vaccination history, and 5C scale were collected online. The 5C scores were analyzed to define the cutoff points using the receiver operating characteristic curve (ROC) and to verify the capability of the questionnaire to differentiate whether responders are hesitant or non-hesitant to accept vaccination. ROC curve analysis was conducted for previous vaccine administration as a response, with the predictors being the main 5 domains of the 5C questionnaire. The mean score of each sub-scale was compared with COVID-19 vaccine intake. RESULTS: The mean age of the studied population was 37 ± 11, 42.9% were males, 44.8% from Egypt, 21.1% from Jordan, and 33.6% from the UAE. Statistically significant differences between vaccinated and unvaccinated participants, respectively, were detected in the median score of confidence [6.0(1.3) versus 4.7(2.0)], complacency [(2.7(2.0) versus 3.0(2.0)], constraints [1.7(1.7) versus 3.7(2.3)], and collective responsibility [6.7(1.7) versus 5.7(1.7)]. The area under the curve of the 5 scales was 0.72, 0.60, 0.76, 0.66, 0.66 for confidence, complacency, constraints, calculation, and collective responsibility at cutoff values of 5.7, 4.7, 6.0, 6.3, and 6.2, respectively. CONCLUSION: The Arabic validated version of the 5C scale has a good discriminatory power to predict COVID-19 vaccines antecedent.

Pattern and risk factors of congenital anomalies in a pediatric university hospital, Alexandria, Egypt.

BACKGROUND: Congenital anomalies (CAs) are structural, functional, or metabolic anomalies that originate during intrauterine life and can interfere with the body functions. In Egypt, the prevalence of CAs is increasing. The study aimed to estimate the frequency, describe the types, and identify the possible risk factors of CAs among infants attending the Pediatric University Hospital, Alexandria, Egypt. METHODS: A retrospective case series and a case-control study were conducted. Patients' records for the years 2010-2015 were reviewed, and a sample of 200 infants (100 cases and 100 controls) was taken from infants presented to Pediatrics, Pediatric Surgery, and Genetics Clinics of the hospital. Data were collected using a record review checklist and a predesigned interviewing questionnaire. RESULTS: The study revealed that congenital anomalies of the digestive system (38.0%), musculoskeletal system (32.9%), and circulatory system (11.0%) were the most common types of CAs. Males were more affected with CAs than females (63% versus 37%). The major risk factors for CAs were old-aged parents, complications during pregnancy, unprescribed medications and excessive vitamin A intake during pregnancy, exposure to chemicals and pesticides during pregnancy, and living near mobile strengthening stations. CONCLUSION: Congenital malformations of the digestive, musculoskeletal, and circulatory systems were the most common types of CAs in the Pediatric Hospital. To prevent CAs, there is a need to restrict the prescription of medications that may have a teratogenic effect.

Pediatric pelvic pyomyositis: initial MRI can be misleading.

Pelvic pyomyositis is an infection of the skeletal muscles around the hip joint. Fever, hip pain, limp, and leukocytosis are common; however, the clinical picture is often vague. MRI is the current gold-standard imaging for pyomyositis. No studies in the current literature have reported an unremarkable initial MRI in a patient with symptomatic pyomyositis. An adolescent female presented with symptomatic pelvic pyomyositis, but admission MRI was normal. A follow-up MRI indicated development of pelvic pyomyositis. The patient was successfully managed nonoperatively. The initial MRI in pyomyositis can be misleading. Patients should be admitted and MRI should be repeated, as indicated clinically.

Effect of culling and vaccination on bovine tuberculosis infection in a European badger (Meles meles) population by spatial simulation modelling.

The control of bovine tuberculosis (bTB) in cattle herds in the Republic of Ireland (ROI) is partially hindered by spill-back infection from wild badgers (Meles meles). The aim of this study was to determine the relative effects of interventions (combinations of culling and/or vaccination) on bTB dynamics in an Irish badger population. A spatial agent-based stochastic simulation model was developed to evaluate the effect of various control strategies for bovine tuberculosis in badgers: single control strategies (culling, selective culling, vaccination, and vaccine baits), and combined strategies (Test vaccinate/cull (TVC)), split area approaches using culling and vaccination, or selective culling and vaccination, and mixed scenarios where culling was conducted for five years and followed by vaccination or by a TVC strategy. The effect of each control strategy was evaluated over a 20-year period. Badger control was simulated in 25%, 50%, and 75% area (limited area strategy) or in the entire area (100%, wide area strategy). For endemic bTB, a culling strategy was successful in eradicating bTB from the population only if applied as an area-wide strategy. However, this was achieved only by risking the extinction of the badger population. Selective culling strategies (selective culling or TVC) mitigated this negative impact on the badger population's viability. Furthermore, both strategies (selective culling and TVC) allowed the badger population to recover gradually, in compensation for the population reduction following the initial use of removal strategies. The model predicted that vaccination can be effective in reducing bTB prevalence in badgers, when used in combination with culling strategies (i.e. TVC or other strategies). If fecundity was reduced below its natural levels (e.g. by using wildlife contraceptives), the effectiveness of vaccination strategies improved. Split-area simulations highlighted that interventions can have indirect effects (e.g. on population size) in non-treatment areas. Our model suggests that mixed control strategies could maintain infection prevalence to a low level for a considerable period even with a growing population. The model supported the hypothesis that culling strategies appeared to be the most effective method for the control of bTB in badgers using parameters, where available, from ROI, either singly or in combination with other strategies. In this model, the success of a vaccination strategy depended partially upon population density and the proportion of the population infected, therefore an initial culling program (to reduce density and/or remove infected badgers) followed by long-term vaccination may be effective in controlling bTB in badgers.

Dog bites to the upper extremity in children.

AIM: Dog bites are common injuries in children. A large percentage of these dog bites affect the upper extremity. There is little information describing the results of treatment of upper extremity injuries in children. METHODS: We retrospectively reviewed the medical records for all children less than 19 years old who presented to the emergency department in our level one trauma centre because of dog bites from 2005 to 2011. RESULTS: During the study period, there were 254 paediatric emergency department visits for animal bites, among these there were 118 dog bites, two were excluded because of inadequate documentation leaving 116 patients; 26 of them (22.4%) had bites to the upper extremity. Among the 26 children with dog bites to the upper extremity, 6 (23.1%) were admitted to the hospital for surgery (four patients) or parenteral antibiotics (two patients). Among the four surgeries, two were for extensive laceration and two were for abscess debridement. Of the 41 who presented with bites to the lower extremities, none were admitted to the hospital (P = 0.002). Compared with those who presented the same day they were injured, the relative risk of hospitalization or surgery in patients who presented 1 and 2 days after their injury was 3.5 and 7.0, respectively. CONCLUSION: Dog bites at the upper extremity are more prone to require surgical intervention and develop infection than those at the lower extremity, and delayed presentation of these injuries is associated with higher incidence of developing infection.