Determinants of Hesitancy Towards COVID-19 Vaccines in State of Kuwait: An Exploratory Internet-Based Survey.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has wrought havoc upon healthcare and economic systems worldwide. COVID-19 vaccines considered a beacon of hope for normal life to return. We wished to understand the willingness of people in Kuwait to be vaccinated against COVID-19. METHODS: An online, exploratory, cross-sectional study was conducted on 16-18 January 2021 using a validated structured questionnaire to collect data from adults aged 18 years or older living in Kuwait by applying a "snowball sampling" method. RESULTS: A total of 7274 people received an online link of the survey on their smartphone or computer, and 6943 people enrolled in this study (95.4%). Kuwaiti nationals represented 79.7% of the study cohort, 54.8% were aged ≥40 years, and 66.7% were females. Hesitancy against a COVID-19 vaccine was remarkably high (74.3%), with 50.8% not planning to take it and 23.5% not sure about taking it. The overall mean perception score was 3.4 ± 2.8, with 66.8% having a negative attitude towards a COVID-19 vaccine. Multiple logistic regression analysis of the factors affecting the decision to take a COVID-19 vaccine was done. The decision to take a COVID-19 vaccine was significantly positively associated with younger age (OR = 1.219), being male (2.169), having a higher education level (1.362), vaccinated against seasonal influenza previously (2.706), being a non-Kuwaiti (1.329), being a healthcare worker (1.366), and working in the private sector (1.228). Options to encourage future COVID-19 vaccination were more studies showing the vaccine to be safe and efficacious (68.6%), physician recommendation (41.8%), mandatory travel requirements (39.8%), if a family or friend vaccinated (34.9%) and compulsory by government (33.1%) or for employment (29.8%). CONCLUSION: Our data suggest that considerable vaccine hesitancy persists despite the widespread availability of highly efficacious and safe COVID-19 vaccines.

An in vitro model for the cultivation of polymicrobial biofilms under continuous-flow conditions.

The airways of people with cystic fibrosis (CF) are often chronically colonised with a diverse array of bacterial and fungal species. However, little is known about the relative partitioning of species between the planktonic and biofilm modes of growth in the airways. Existing in vivo and in vitro models of CF airway infection are ill-suited for the long-term recapitulation of mixed microbial communities. Here we describe a simple, in vitro continuous-flow model for the cultivation of polymicrobial biofilms and planktonic cultures on different substrata. Our data provide evidence for inter-species antagonism and synergism in biofilm ecology. We further show that the type of substratum on which the biofilms grow has a profound influence on their species composition. This happens without any major alteration in the composition of the surrounding steady-state planktonic community. Our experimentally-tractable model enables the systematic study of planktonic and biofilm communities under conditions that are nutritionally reminiscent of the CF airway microenvironment, something not possible using any existing in vivo models of CF airway infection.

Clinical efficacy of Early Administration of Convalescent Plasma among COVID-19 Cases in Egypt

ImportanceEarly and effective treatment of COVID-19 is vital for control of SARS-CoV-2 infection ObjectivesThe primary objective of the study was to assess the degree of clinical improvement in severe and critically ill COVID-19 patients, treated early with early CPT. DesignsAn interventional, single-arm, non-randomized clinical trial conducted in Egypt from April 15 to July 21, 2020. SettingsThis was a multi-centre study conducted in 3 hospitals in Egypt. Participantsa total of 94 COVID-19 laboratory-confirmed patients using qRT-PCR were enrolled in the study. InterventionAll patients were administered with two plasma units (each unit is 200cc). The volume of donated plasma was 800cc. Main Outcome and MeasuresPrimary measure was the degree of clinical improvement among the COVID-19 patients who received CPT within seven days ResultsA total of 94 patients were enrolled who received CPT either within seven days or after seven days of hospitalization. 82 were severely ill, 12 were critically ill. The average age remained 58 years ({+/-}SD 15.1 years). Male were 69% and 49% patients got cured while 51% died with CFR 51%. 75% deaths were above 45years of age. The symptoms were dyspnoea (55%), fever (52%), cough (46%), and loss of taste and smell (21%), and cyanosis (15%). The most common co-morbidities among the <40 years remained Diabetes Mellitus (21%) and Asthma (14%). Among 40-60 years Hypertension (56%), Diabetes Mellitus (39%) and among >60 years age group Hypertension (57%) and Chronic Heart Disease (24%) were reported. CPT within seven days remained significant as compared with the CPT after seven days with the number of days to cure (p=0.007) and ICU stay (P=0.008) among severely ill cured cases. Conclusion and RelevanceAmong patients with COVID-19 and severe or critical illness, the use of CPT along with routine standard therapy resulted in a statistically significant improvement when administered within seven days of hospital admission. However, plasma transfusion, irrespective of days to transfusion may not help treat critically ill patients. The overall mean time to cure in severely ill patients was 15 days if CPT provided within seven days with 65% cure rate. Trial RegistrationClinical Intervention identifier: MOHP_COVID-19_Ver1.1

Study of the efficacy of carboxytherapy in alopecia.

BACKGROUND: Management of alopecia areata (AA) and androgenetic alopecia (AGA) is often challenging. The use of carboxytherapy may be a novel therapeutic option for such cases. OBJECTIVE: To evaluate the clinical efficacy and safety of carboxytherapy in alopecia areata and androgenetic alopecia. PATIENTS AND METHODS: This study was conducted on 80 patients with alopecia divided into two groups; Group I included 40 AA patients (Group IA received carboxytherapy and Group IB control received placebo), and Group II included 40 AGA patients (Group IIA received carboxytherapy and Group IIB control received placebo), and followed up monthly for 3 months. They were evaluated clinically (by assessment of Severity of Alopecia Tool (SALT) score in group I, and Sinclair scale and Norwood-Hamilton scale in group II), by dermoscopy and digital dermoscopy at each visit. RESULTS: Group IA patients showed significant clinical improvement in SALT score and dermoscopic improvement after carboxytherapy and at the end of follow-up period with significant reduction in dystrophic hair, black dots, yellow dots, and tapered hair coinciding with significant emergence of regrowing hair. Group IIA patients showed significant clinical and dermoscopic improvement after carboxytherapy with significant increase in hair density measured by digital dermoscopy. However, regression of these results was observed during the follow-up period but was still significantly better than before treatment. There were statistically significant improvements in clinical score, global assessments, dermoscopic, and digital dermoscopic findings in both group IA and group IIA received carboxytherapy in comparison with group IB and group IIB received placebo injections, respectively. CONCLUSION: Carboxytherapy seems to be a promising therapeutic option for patchy AA and could be helpful as an adjuvant therapy of AGA but more than 6 sessions are required and adjuvants are recommended for maintenance of the results.

Immunohistochemical study of the expression of matrix metalloproteinase-9 in skin lesions of mycosis fungoides.

Matrix metalloproteinase-9 (MMP-9) has been correlated with poor clinical outcome in various malignancies and is associated with enhanced tumor growth and dissemination through its role in angiogenesis. This study was carried out to review the immunohistological staining of MMP-9 in skin lesions of different stages of mycosis fungoides (MF). The study was carried on 22 patients with MF and 10 healthy controls. Immunohistochemical staining using MMP-9 monoclonal anti-human antibodies was performed to determine the intensity of expression and distribution pattern of MMP-9 in MF lesions and in normal control skin. The general intensity of expression of MMP-9 was found to be significantly higher in cases with MF than in controls, and it increased in direct proportion to the increase in disease severity, being greatest in the tumor stages. A significantly greater number of blood vessels were found in cases with MF when compared with controls, and the MMP-9 expression by endothelial cells was significantly higher in endothelial cells within tumor cell aggregates than in endothelial cells outside the tumor cell aggregates. This study raises the possibility that MMP-9 may play an important role in the development of MF lesions, and its significantly higher expression in tumor stages may point to a possible role in disease progression. Further studies are needed to validate these findings and to assess the possible therapeutic role of drugs targeting MMP-9 in the treatment of MF.

Vitiligo vs. hypopigmented mycosis fungoides (histopathological and immunohistochemical study, univariate analysis).

Vitiligo is a common skin disease characterized by the presence of well circumscribed, depigmented milky white macules devoid of identifiable melanocytes. On the other hand, hypopigmented mycosis fungoides (MF) is a rare variant of MF which presents clinically as persistent hypopigmented macules and patches. Both disorders show a predominance of CD8+ T cells in tissue samples and hence the differentiation between the two diseases on clinical, histopathological and even immunohistochemical grounds may offer great difficulty. The aim of this work is to identity certain histopathological clues which might help to differentiate between the two diseases. The study included 54 patients (26 vitiligo patients and 28 patients with Hypopigmented MF). Skin biopsies were taken and examined by hematoxylin and eosin and CD3, CD4 and CD8 markers were performed for ten vitiligo and nine MF patients. We have found that epidermotropism, hydropic degeneration of basal cells, partial loss of pigment, preservation of some melanocytes, presence of lymphocytes within the papillary dermis, increased density of the dermal infiltrate and wiry fibrosis of the papillary dermal collagen were detected with a significantly higher incidence in hypopigmented MF rather than vitiligo (P-values < 0.0001, < 0.00011, < 0.00011, = 0.001, = 0.008 and = 0.001 respectively). On the other hand, focal thickening of the basement membrane, complete loss of pigmentation, total absence of melanocytes, as well as absence or sparsness of lymphocytes in the dermal papillae were seen much more frequently in vitiligo. Statistical analysis of these differences was significant with P-values < 0.00011, < 0.00011, < 0.00011, = 0.008 respectively, regarding these pathological criteria. We conclude that differentiation of hypopigmented MF from vitiligo is possible by relying on the histopathological clues described in this study. This is particularly useful in areas of the world where cost benefit is crucial.