27th June Research Articles

A Comparative Cross-Sectional Study- Knowledge, behavior and psychological change among Medical and Non-medical Students in Jordan during COVID-19 pandemic

Background: Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, and it was officially declared to be a pandemic by the World Health Organization on March 11, 2020. COVID-19 is associated with increasing morbidity and mortality and has impacted the lives of the global populations.
 Aim: To compare the knowledge of medical and non-medical students at Jordanian universities in issues related to COVID-19 and to evaluate the psychological and behavioural changes in Jordanian students’ lives following directly/indirectly exposure to the COVID-19.
 Methods: A descriptive cross-sectional online survey was sent to a convenience sample in Jordanian universities through social media (Facebook and WhatsApp) between 16th of June and 30th of June 2020. The questionnaire was designed to collect the demographic, participant’s source of information regarding COVID-19, knowledge on COVID-19, the psychological consequences of COVID-19, impact of COVID-19 on participant’s behaviour. The final version of the questionnaire was further tested for content validity by experts in the field. Chi-square test was used to find significant differences between the two groups.
 Results: A total of 912 participants completed the survey, with 507(55.6%) being medical students and 405(44.4%) being non-medical students. About 90% of students believed in the existence of corona virus (n=817), but not in the seriousness of the infection (n=85, 9.3%). The majority 82.2% (n=750) agreed that the fake news on social media caused panic situations. A total of 275 medical students avoided following news as compared to 187 non-medical students, and the difference was statistically significant (p-value = 0.003). There were 438 medical students and 338 non medical students who avoided leaving the house for unnecessary needs (p-value = 0.004).
 Conclusion: Medical students had better knowledge and were more aware on COVID-19 than that of non-medical students; for this reason, medical students tended to change their behaviours in a good way. The current pandemic seems to impact the psychology of the both groups with no difference significant.

Extrahepatic organs in the development of non-alcoholic fatty liver disease in liver transplant patients.

Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in patients who undergo liver transplantation (LT). Whereas there is huge data on NAFLD, little is known about NAFLD in LT. In this review, we aim to explore extrahepatic organs and their potential mechanisms in the development of NAFLD in LT patients and discuss current limitations in preclinical and clinical scenarios with suggestions for future study. The following keywords, such as NAFLD, NASH, liver transplant, therapy, pathogenesis and biomarkers, were set for literature retrieval. The articles which were published articles in English till 25th June 2020 in PubMed database were included, and there is no limit for the study design type. Following LT, there are significant shifts in the microbiota and farnesoid X receptor may be a potential therapeutic target for NAFLD in LT settings. The roles of probiotics and diet on NALFD remain inconclusive in LT background. Nevertheless, the adipokines and cytokines disorder and local insulin resistance of adipose tissue may contribute to NAFLD process. Bariatric surgeries are promising in controlling de novo and recurrent NAFLD with significant reduction in abdominal adipose tissue, despite the optimal timing is inconclusive in LT cases. Furthermore, circumstantial evidence indicates that miRNA-33a may function as a mediator bridging sarcopenia and NAFLD of post-LT. β-Hydroxy-β-Methyl-Butyrate treatment could improve muscle status in graft recipients and shows protective potential for NAFLD in LT settings. Gut, adipose tissue and muscle are intricately intertwined in promoting NAFLD in LT cases. Further animal studies are needed to deepen our understanding of mechanisms in multi-organ crosstalk. High quality clinical trials are warrant for making guidelines and developing management strategies on NAFLD after LT.

Rapid surveillance of COVID-19 by timely detection of geographically robust, alive and emerging hotspots using Particle Swarm Optimizer

A novel virus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly become a pandemic called Coronavirus disease 2019 (COVID-19). According to the World Health Organization, COVID-19 was first detected in Wuhan city in December 2019 and has affected 216 countries with 9473214 confirmed cases and 484249 deaths globally as on June 26th, 2020. Also, this outbreak continues to grow in many countries like the United States of America (U.S.), Brazil, India, and Russia. To ensure rapid surveillance and better decision-making by government authorities in different countries, it is vital to identify alive and emerging hotspots within a country promptly. State-of-the-art methods based on space-time scan statistics (like SaTScan) are not geographically robust. Also, due to the enumeration of many Spatio-temporal cylinders, the computation cost of Spatio-temporal SaTScan (ST-SaTScan) is very high. In the applications like COVID-19 where we need to detect the emerging hotspots daily as soon as the new count of cases gets updated, ST-SaTScan seems inefficient. Therefore, this paper proposes a Particle Swarm Optimizer-based scheme to timely detect geographically robust, alive, and emerging COVID-19 hotspots in a country. Timely detection can help government officials design better control strategies like increasing testing in hotspots, imposing stricter containment rules, or setting up temporary hospital beds. Performance of ST-SaTScan and proposed scheme have been analyzed for four worst-hit U.S. states for the incubation period of 14 days between June 11th, 2020, and June 24th, 2020. Results indicate that the proposed scheme detects hotspots of a higher likelihood ratio (a measure to indicate the significance of hotspot) than ST-SaTScan in significantly less time. We also applied the proposed scheme to detect the emerging COVID-19 hotspots in all states of the U.S. During the study period, the proposed scheme has detected 104 emerging COVID-19 hotspots.

C67A BLITZ-AF CANCER REGISTRY: BASELINE CHARACTERISTICS OF PATIENTS WITH ATRIAL FIBRILLATION AND CANCER

Abstract Background Evidences on atrial fibrillation (AF) in patients with cancer are limited, specifically with respect to antithrombotic therapy. Methods BLITZ-AF Cancer is a prospective, non-interventional study of the epidemiology and management of AF in patients with cancer. Patients were included from 112 cardiology units in Italy, Belgium, Netherlands, Spain, Portugal, and Ireland, based on the following criteria: age ≥18 years; documented cancer other than basal-cell or squamous-cell carcinoma of the skin diagnosed within 3 years; electrocardiographically confirmed AF within 1 year; no concomitant interventional study. Follow-up is ongoing. Results From June 26th, 2019 to Sep. 30th, 2021, 1,514 subjects were enrolled. The most frequent cancer locations were lung (14.9%), colorectal (14.1%), breast (13.9%), prostate (8.8%), and non-Hodgkin lymphoma (8.1%); 463 (30.6%) of participants had metastases. AF was first-detected in 323 (21.3%), paroxysmal in 460 (30.4%), persistent in 192 (12.7%), long-standing persistent in 33 (2.2%), and permanent in 506 (33.4%); 590 (39.0%) patients had symptoms attributable to AF. Baseline characteristics are presented in the Table. Males were more than women and almost half of the subjects was >75 years-old. Cardiovascular risk factors were common and approximately 31% had heart failure or coronary artery disease. Previous thromboembolic and haemorrhagic events had occurred in 14% and 10% of subjects, respectively. The median CHA2DS2VASc score was 3. As shown in the Figure, the prescription of oral anticoagulants, especially direct-acting ones (DOACs), rose after the cardiology assessment, while the percentage of participants without any antithrombotic therapy declined. Among 1,427 patients with non-valvular AF (i.e., no mitral stenosis or prosthetic mechanical valve), 997 (69.9%) were prescribed on DOACs at discharge/after consultation. At multivariable logistic regression analysis, variables associated with DOAC use were female sex (OR 1.58, 95% CI 1.22-2.05), age (OR 2.00, 95% CI 1.39-2.88 and OR 2.63, 95%CI 1.84-3.76, respectively, for 65-74 years and ≥75 years vs <65 years), hypertension (OR 1.43, 95%CI 1.10-1.87), long-standing persistent or permanent AF (OR 1.36, 95%CI 1.05-1.78). Haemoglobin <12 g/dL (OR 0.57, 95%CI 0.45-0.73), and planned cancer treatment (OR 0.72, 95%CI 0.57-0.92) were independently associated with a lower prescription of DOACs. Conclusions BLITZ-AF Cancer provides extensive information on a large, contemporary cohort of individuals with AF and cancer. This baseline snapshot indicates that cardiologists pursue the implementation of DOACs in these patients, although residual use of other antithrombotic therapies or lack of any thrombo-prophylaxis remains substantial.

The 2021 Western North American heat dome increased climate change anxiety among British Columbians: Results from a natural experiment

Extreme weather events caused by climate change pose a risk to mental health. Illustrating this reality, this study estimates the impact of the 2021 Western North American heat dome (June 25th, 2021 – July 1st, 2021) on climate change anxiety among British Columbians. We conducted an online survey of British Columbians, aged ≥ 16. Participants were recruited using paid advertisements on social media. Data were collected pre- and post- heat dome between May 12th, 2021 – June 21st, 2021 (n = 439), and July 15th, 2021 – July 18th, 2021 (n = 420), respectively. A multivariable inverse Gaussian regression model tested differences in Climate Change Anxiety Scale (CCAS) scores pre- and post- heat dome. Potential confounders measured included age, gender, ethnicity, education, income, and political orientation. CCAS reliability was assessed using Cronbach's alpha. Most participants indicated that they were much (40.1%) or somewhat (18.4%) more worried about climate change due to the heat dome. Mean CCAS scores increased from 1.66 (standard deviation [SD]= 0.80) to 1.87 (SD = 0.87) pre- and post- heat dome, respectively. In multivariable modeling, this effect was significant after controlling for potential confounders (Estimate = 0.057, standard error = 0.148, p < 0.001). The CCAS reliability was high (Cronbach's alpha = 0.94). Our results found that British Columbians had significantly higher climate change anxiety following the 2021 Western North American heat dome. Ongoing monitoring of climate change anxiety is needed to understand the impact of individual and compounding climate change-related weather events over time.

The impact of an electronic alert to reduce the risk of co-prescription of low molecular weight heparins and direct oral anticoagulants

ObjectiveTo use the electronic prescribing system to identify how prescribers have responded to the duplicate ‘Anticoagulant Alert’ and the extent to which the system has prevented unintentional prescription of Low Molecular Weight Heparins (LMWHs) to patients prescribed Direct Acting Anticoagulants (DOACs). To determine the clinical appropriateness of the actions taken by the prescriber following the alert override and the impact this has on patient safety. Material and methodsA retrospective service evaluation was conducted to determine the impact of a duplicate ‘Anticoagulant Alert’ on the prevention of prescription of LMWHs to patients already prescribed DOACs at a 950-bed acute teaching hospital in the UK. The number of alert overrides, actions taken by the prescriber following the alert override, and the clinical appropriateness of prescribers’ actions over the 15-month period 26th June 2017 – 8th October 2018 were evaluated. ResultsOf the 894 alerts that triggered over the study period 111 were in response to attempts to prescribe a LMWH to a patient prescribed a DOAC. The alert was overridden in 65 (58.6%) cases but accepted, preventing co-prescription of duplicate anticoagulants, in 46 (41.4%) cases. Overrides were appropriate and justified in 44/65 cases. In 6 cases duplicate anticoagulants were prescribed and administered but without patient harm. ConclusionThe anticoagulant alert prevented duplicate anticoagulant prescribing for 46 patients reducing the risk of patient harm from duplicate-anticoagulation. The 58.6% of alerts that were overridden were appropriate and justified in the majority of cases. Where duplicate doses were administered, no harm was observed. The electronic alert has improved the safe use of anticoagulants within our organisation.

Racing the clock: Recent developments and open environmental regulatory issues at the International Seabed Authority on the eve of deep-sea mining

With a letter dated 25th June 2021, Nauru has triggered section 1, paragraph 15, of the 1994 Agreement relating to the Implementation of Part XI of the United Nations Convention on the Law of the Sea, by which it requested the Council of the International Seabed Authority to adopt the regulations to facilitate the approval of a plan of work for the exploitation of the mineral resources of the Area within 2 years.The two-year rule rises many legal and policy issues that the Authority is required to deal with in the next months. Among them, this communication dwells upon the consequences of the provisional approval of plans of work, in case the Authority was unable to approve the exploitation regulations by 2023. It then considers the outstanding environmental regulatory issues of the mining code that are still under discussion, with peculiar regard to the precautionary principle, the environmental impact assessment, and the need for an inspection mechanism and suggests possible ways forward.

Assessing Impact of Projected Climate Change on Sali Rice in a Representative District of Upper Brahmaputra Valley Zone of Assam

Three years of field trial along with DSSAT v4.6 CERES-Rice model-based simulation experiment was carried out to study the impact of climate change on Sali rice yield under various Representative Concentration Pathways (RCPs) in the agro-climatic conditions of Jorhat, Assam. Field experiments were conducted during kharif, 2017, 2018 and 2019 at the Instructional-Cum-Research (ICR) farm of Assam Agricultural University, Jorhat with three varieties viz., Mahsuri (150 days), Swarna Sub-1 (140-145 days) and TTB-404 (140-145 days); transplanted under three different micro-climatic regimes created by manipulating date of transplanting i.e., 26th June (early), 11th July (mid) and 26th July (late) under split plot experimental design with four replications. The validated model showed a good agreement for estimation of days required to attain different phenological stages with RMSE value 3.5, 2.9 and 2.9 days for Swarna sub-1; 2.4, 3.3 and 4.1 days for Mahsuri and 3.7, 2.6 and 2.4 days for TTB-404, respectively for panicle initiation, anthesis and physiological maturity. The overall d-stat value varied within 0.53 to 0.85 for phenology and 0.68 to 0.79 for grain yield. The ensemble weather data under four RCPs revealed an increase in mean maximum (0.3 to 3.0°C) and minimum (0.8 to 3.5°C) temperatures along with rainfall (11.8 to 43.4%) during the crop growing period compared to experimentation period (i.e. 2017-19) in three projected years. The grain yield of Sali rice showed positive deviation in all four RCPs and projected years under successive transplanting dates. The overall results reveal an increase in mean temperature up to 3°C during the crop growing period has no substantial adverse impact on grain yield of Sali rice under the agro-climatic condition of Jorhat, Assam.

Treatment strategy, overall survival and associated risk factors among patients with unresectable stage IIIB/IV non-small cell lung cancer in China (2015–2017): A multicentre prospective study

SummaryBackgroundThere are limited studies on treatment and survival analysis among patients with unresectable Stage IIIB or IV non-small cell lung cancer (NSCLC) in routine practice in China. To address this gap, we conducted a prospective observational study in a cohort of patients treated at 11 hospitals in China.MethodsThis was a multicentre, prospective cohort study including patients with newly diagnosed unresectable Stage IIIB or IV NSCLC from June 26th, 2015 to April 28th, 2017. Patient baseline characteristics, disease characteristics, and anti-cancer treatments were obtained by medical chart review. The overall survival (OS) from the initiation of first-line treatment was analysed by the Kaplan-Meier method. Factors associated with survival were analysed by univariate and multivariate Cox regression models.FindingsAmong 1324 patients enrolled with median follow-up duration of 15·0 (range: 0·0–42·1) months, 83·5% (1105/1324) of them received first-line chemotherapy of which platinum-based compounds were the dominated agents. Overall, 30·9% (409/1324) of patients received targeted therapy as 1st-line treatment including 65·0% (266/409) EGFR-TKIs and 5·1% (21/409) ALK-TKIs. Of all eligible patients, gene testing rates were 44·0% (583/1324) for EGFR mutations, 17·0% (225/1324) for EML4-ALK gene fusions, and 8·3% (110/1324) for ROS1 gene fusions. The EGFR-TKIs were administered to 63·9% (179/280) of EGFR mutated patients as first-line treatment. The overall median OS was 23·2 (95%CI 19·5-25·5) months, and patients treated at tier 1 cities had better OS than that of tier 2 cities. Also, the OS in patients with EGFR mutation was longer than those with EGFR wild type. Multivariate Cox regression models suggested that male, education below high school, tier 2 cities, smoking history, and multiple metastases were associated with poor survival.InterpretationThe gene test coverage was relatively low among the studied population, and over half of EGFR mutated patients received EGFR-TKIs, suggesting that the result of genetic tests in real-world settings may not always indicate the selection of treatment. The OS benefit observed from patients treated in tier 1 cities and those with EGFR mutation may indicate a need for broader gene test coverage, providing NSCLC patients with personalized treatment according to the results of genetic tests.FundingRoche Holding AG.TRANSLATED ABSTRACT: This translation in Chinese was submitted by the authors and we reproduce it as supplied. It has not been peer reviewed. Our editorial processes have only been applied to the original abstract in English, which should serve as reference for this manuscript.摘要背景介绍:目前针对中国不可切除的IIIB期或IV期非小细胞肺癌(NSCLC)患者在临床实践中的治疗模式和生存分析的研究有限.为了填补这一空白, 我们开展了一项前瞻性,观察性研究, 纳入来自11家医院的患者.方法:这是一项多中心,前瞻性队列研究, 纳入了2015年6月26日至2017年4月28日新诊断为不可切除的IIIB期或IV期NSCLC患者.通过病历筛查获得基线特征,临床肿瘤特征和抗肿瘤治疗.采用Kaplan-Meier法分析从开始一线治疗后的总生存期(OS), 并通过单因素和多因素Cox回归模型分析与生存相关的影响因素.结果:在入组的1324例患者中, 中位随访时间为15.0个月(范围:0.0-42.1), 其中83.5%(1105/1324)的患者接受了一线化疗, 以铂类化合物为主.总体而言, 30.9%(409/1324)的患者接受靶向治疗作为一线治疗, 其中包括65.0%(266/409)的患者接受了EGFR-TKI治疗和5.1%(21/409)的患者接受了ALK-TKI治疗.在所有符合条件的患者中, EGFR突变,EML4-ALK基因融合和ROS1基因融合的基因检测率分别为44.0%(583/1324),17.0%(225/1324)和8.3%(110/1324).63.9%(179/280)的EGFR突变患者接受EGFR-TKI作为一线治疗.全组患者的中位总生存期为23.2 (95%置信区间 19·5-25·5) 个月, 在一线城市治疗的患者的总生存期优于二线城市的患者.此外, EGFR突变患者的总生存期长于EGFR野生型患者.多因素Cox回归模型分析表明, 男性,高中以下文化程度,二线城市,吸烟史及肿瘤转移与较低的生存率相关.解释:本研究人群中的基因检测覆盖率相对较低, 其中超过一半的EGFR突变患者接受了EGFR-TKI治疗, 这表明在真实世界诊疗中, 基因检测的结果可能并不完全指导治疗选择.总生存期在一线城市接受治疗的患者和EGFR突变的患者中更佳的现象, 可能提示需要更广泛的基因检测覆盖, 并根据基因检测结果为NSCLC患者提供个体化治疗.

Evaluating current practice and knowledge about antibiotic stewardship principles in paediatric tertiary hospitals to identify target areas for future teaching activities

PurposeAntibiotic exposure among hospitalized children is very high. With inappropriate antimicrobial use resulting in increased rates of antimicrobial resistance, the implementation of antibiotic stewardship programs is critically needed. This survey study aimed to identify current practice and knowledge about antibiotic stewardship and infection control among paediatricians in tertiary care paediatric hospitals in and around Munich, Germany.MethodsA prospective cross-sectional study based on an anonymous questionnaire, structured into different sub-sections regarding antibiotic use, antimicrobial resistance, antibiotic stewardship and infection control, was conducted between 1st of May and 30th of June 2016 in five paediatric hospitals.ResultsIn total, 111 paediatricians across all grades were eligible for participation. The overall proportion of correct answers for all sub-sections of the survey ranged from 54.1% correct answers in the antibiotic handling and bacterial resistance section to 72.9% correct answers in the hospital hygiene/infection control section. In general, knowledge across all categories was similar for junior doctors, middle-grade doctors or consultants. Advocating empiric use of narrow-spectrum instead of broad-spectrum antibiotics was considered to be the most difficult measure to implement in daily practice (36.9%). De-escalation from broad-spectrum empirical therapy to targeted treatment was considered the easiest measure to achieve (43.2%).ConclusionOur results demonstrate that principles of antimicrobial stewardship and aspects of hospital hygiene/infection control are not satisfactorily known among hospital-based paediatricians in and around Munich. We identified four important target areas for future educational interventions that should play a more prominent role in both pre- and postgraduate medical training.

A region-wide all-hazard training program for pre-hospital mass casualty incident management: a real-world case study.

We report the development, implementation and results of a sustainable region-wide mass-casualty management pre-hospital training program implemented by the Regione Lombardia emergency medical services (EMS) agency AREU in Italy. The educational program learning objectives are: 1) Command and control, communications and resource management. 2) Mass casualty triage and the START triage protocol. 3) On-scene management 4) Regione Lombardia and AREU Mass Casualty standard operating procedures 5) Inter-agency communications and relations. For each course edition data on participants summative assessment, participants feedback and costs were collected. Between June 26th,2013 and December 31st,2020 a total of 84 editions of the provider training event were delivered, training an overall 1329 prehospital providers. 1239 (93%) passed the summative assessment and were qualified as being operationally "ready". Regarding participants' feedback, the overall program was rated 4.4±0.7out of 5. The overall cost of running the provider program during the study period was € 321,510 (circa US$ 382,000). The average cost per edition was € 3,828 and € 242 per participant. We have described a simple yet interactive simulation and blended-learning approach, which has yielded good pass rates, good participant satisfaction and contained costs to systematically train emergency medical service personnel.

Causes of primary cesarean section in Abo Ghraib general hospital

Aim of the study: To evaluate the causes of primary cesarean section in Abu Ghraib general hospital with the intention to reduce cesarean section rate. Patients and methods: A descriptive study done prospectively in Abo Ghraib general hospital in Baghdad, Iraq during the period from first of January till 30th of June 2021, there were 2799 of deliveries (beyond 28 weeks of gestation), 466 of them delivered by cesarean section. The study included all cesarean sections that collected from labor ward, general and private sector. Results: The most common primary Cs (57.4%) was found in age group between (21-30) years old, then (31.4%)) in age ?20 years, (9.9 %) in age between (31-40) years, and only (1.3%) in group of age &gt;40 years. the most common indication was fetal distress in 65 (29.1%), then FTP in 57 (25.6%), then malpresentation in 27 (12.1%) and the least cause was preeclampsia and rupture uterus in 4 (1.8 %) for each cause. Conclusion: The most common causes of primary cesarean section in Abo Ghraib general hospital was fetal distress this may be due to low hospital resources.

Healthcare workers’ views on mandatory SARS-CoV-2 vaccination in the UK: A cross-sectional, mixed-methods analysis from the UK-REACH study

SummaryBackgroundSeveral countries now have mandatory SARS-CoV-2 vaccination for healthcare workers (HCWs) or the general population. HCWs’ views on this are largely unknown. Using data from the nationwide UK-REACH study we aimed to understand UK HCW's views on improving SARS-CoV-2 vaccination coverage, including mandatory vaccination.MethodsBetween 21st April and 26th June 2021, we administered an online questionnaire via email to 17 891 UK HCWs recruited as part of a longitudinal cohort from across the UK who had previously responded to a baseline questionnaire (primarily recruited through email) as part of the United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) nationwide prospective cohort study. We categorised responses to a free-text question “What should society do if people do not get vaccinated against COVID-19?” using qualitative content analysis. We collapsed categories into a binary variable: favours mandatory vaccination or not, using logistic regression to calculate its demographic predictors, and its occupational, health, and attitudinal predictors adjusted for demographics.FindingsOf 5633 questionnaire respondents, 3235 answered the free text question. Median age of free text responders was 47 years (IQR 36–56) and 2705 (74.3%) were female. 18% (n = 578) favoured mandatory vaccination (201 [6%] participants for HCWs and others working with vulnerable populations; 377 [12%] for the general population), but the most frequent suggestion was education (32%, n = 1047). Older HCWs (OR 1.84; 95% CI 1.44–2.34 [≥55 years vs 16 years to <40 years]), HCWs vaccinated against influenza (OR 1.49; 95% CI 1.11–2.01 [2 vaccines vs none]), and with more positive vaccination attitudes generally (OR 1.10; 95% CI 1.06–1.15) were more likely to favour mandatory vaccination, whereas female HCWs (OR= 0.79, 95% CI 0.63–0.96, vs male HCWs) and Black HCWs (OR=0.46, 95% CI 0.25–0.85, vs white HCWs) were less likely to.InterpretationOnly one in six of the HCWs in this large, diverse, UK-wide sample favoured mandatory vaccination. Building trust, educating, and supporting HCWs who are hesitant about vaccination may be more acceptable, effective, and equitable.FundingMRC-UK Research and Innovation grant (MR/V027549/1) and the Department of Health and Social Care (DHSC) via the National Institute for Health Research (NIHR). Core funding was also provided by NIHR Biomedical Research Centres.

Clinical outcomes and associated risk factors of Corona Virus Disease 2019 in healthcare workers of KP, Pakistan

Introduction: Khyber Pakhtunkhwa (KP), is geographically the smallest province, characterized by high population growth and a large refugee population. It faces a set of unique obstacles in the health sector including limited human resources, low financial protection, and weak governance.&#x0D; Objective: To explore clinical outcomes and factors associated with mortality among Health Care Workers (HCWs) of KPK.&#x0D; Materials &amp; Methods: It was a cross sectional study conducted over 32 district of KP. A format containing 70 variables, including demographics, comorbidity, symptoms and outcomes, was developed and shared with rapid response teams (RRT) of each district and orientation was given for its use to the teams. Data were collected onto the software IPMS (Integrated Performance Monitoring System). We obtained this information from Health Department KP.&#x0D; Results: From February 2020 to 27th June 2020, 1813 HCWs reported COVID-19 positive; 669 had active infection, 1133 recovered while 11 died. Median age was 34 (IQR=14) years, and 76.1% were males. Fever, cough and sore throat were present in 40.5%, 33.5% and 19.1% while comorbidity was present in ~2% of patients. 6 patients were admitted to ICU and 4 patients received invasive ventilation- none survived. After adjusting for potential confounders, age, cough, Shortness of breath (SOB), headache, diabetes and chronic lung disease were significantly associated with mortality (all p&lt;0.05).&#x0D; Conclusion: HCWs, with COVID-19, were young; predominantly males, mostly asymptomatic, and a small proportion had comorbidity. Fever, cough and sore throat were top 3 symptoms. Mortality rate was 0.6%. The outcome was poor in patients who received intensive care/invasive ventilation.

YouTube as a Source of Information About Physical Exercise During COVID-19 Outbreak

Context: Physical inactivity levels in the course of the corona virus disease 2019 (COVID-19) outbreak increased significantly. Our aim was to address how the information related to the physical exercise and COVID-19 posted on YouTube reaches the general public during COVID-19 outbreak. Evidence Acquisition: For this, research was carried out crossing the terms covid 19 and physical exercise in the YouTube database. The search was conducted only in the English language and was established/closed on April 26th (2020) to June 26th (2020) in order to observe the dynamics of video production on YouTube. Results: The main terms and concepts mentioned in the analysis of YouTube videos were COVID-19, pandemic, quarantine, social isolation and distance, physical activity, physical exercise, home-based physical exercise, physical inactivity, sedentary lifestyle, and mental health. The information was posted and supported by renowned health and physical exercise experts and entities. The recommendations for physical exercise in the current scenario focused on programs that require little equipment and space (carried out indoors and at home) and at low cost in an attempt to maintain and improve physical and mental health from different population groups. Conclusions: Information about COVID-19 and exercise was growing and progressive throughout the pandemic on YouTube. However, care and guidance are needed in using the information provided by YouTube as a source of reference for the practice of physical exercise during the COVID-19 outbreak.

Geoff Harcourt 27th June 1931–7th December 2021

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Co-infection of Uropathogenic Escherichia coli among COVID-19 Patients Admitted to a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Simultaneous infection of antibiotic-resistant uropathogens in patients with COVID-19 has necessitated the revision of the prescription of broad-spectrum antibiotics on the grounds of evidence-based studies and antimicrobial stewardship principles. The objective of this study was to find out the prevalence of uropathogenic Escherichia coli co-infection among hospital-admitted COVID-19 patients of a tertiary care centre. This descriptive cross-sectional study was conducted in urinary tract infection suspected COVID-19 patients admitted to a tertiary care hospital, from 25th June to 24th December 2021 after ethical clearance from the Institutional Review Committee with registration number 207707860. Convenience sampling was used. Serum procalcitonin levels were also measured. Data analysis was performed using the Statistical Package for the Social Sciences software version 17.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data, and mean and standard deviation for continuous data. Among the 49 hospital-admitted COVID-19 patients, 3 (6.12%) (0.59-12.83 at 95% Confidence Interval) were co-infected with uropathogenic Escherichia coli. Absolute non-susceptibility of Escherichia coli to antibiotics such as ceftriaxone, cotrimoxazole, nalidixic acid, gentamicin, and ampicillin was observed. All isolates were multidrug-resistant. All co-infected patients were female and had a median age of 35 years. Mean±SD value for procalcitonin in patients with co-infection (6.13±7.88 ng/ml) was six times higher than for the patients without co-infection (0.95±1.11 ng/ml). Escherichia coli co-infection in hospitalised COVID-19 patients was less frequent as compared to published literature. The serum procalcitonin value in patients with co-infection was substantially higher than that of patients without co-infection. antimicrobial drug resistance; co-infection; COVID-19; Escherichia coli; procalcitonin.

Epidemiological Surveillance of COVID-19, in the Province of Callao in Peru, from March 2020 to June 2021

PurposeEpidemiological surveillance of novel Coronavirus SARS CoV-2 in the Constitutional Province of Callao in Perú.Methods & MaterialsWe used the data collection about the notifications of cases of COVID-19. The database was uploaded from the application of the national notification system (Notiweb). We analyzed the information from 13th March in 2020 to 27th June in 2021. Concerning deaths, the names and dates also corroborated by the death notification system (Sinadef).ResultsThe first notified confirmed case in the region was a female patient on 13th March in 2020. We have 154 977 notifications cases as accumulated total; 97 381 confirmed cases (with laboratory analyzes that confirm infection), 43 970 suspected cases (compatible symptoms of COVID-19), 12 646 discarded cases and 984 compatible cases (suspected case more epidemiological criteria or suspected case more radiological criteria). The districts with more cases are Callao and Ventanilla. The group of age more affected was an adult (30-59 years old) with 43 702 cases (54.60%). The primary care is provided by three “Redes de Salud”, the Red de Salud Ventanilla report 17 421 confirmed cases of COVID-19, Red de Bonilla 13 706 confirmed cases and Red de Salud BEPECA 10 786 confirmed cases. The hospitals, private clinics and others notification centres report the rest of the cases. From 9290 deaths as confirmed cases, the majority occur at the big hospitals; 6948 deaths occur at Essalud Hospitals, 1175 deaths at National Hospitals, 977 deaths at the Navy Army hospital, 45 deaths at private clinics. The rest outside third-level establishments; 92 deaths on their residence place, 45 on temporary isolation services, 06 on public roads and 02 on primary care's centres.ConclusionThe province of Callao is a remarkable region in Peru because it has two points of entry to the country, the International Airport “Jorge Chavez” and the international seaport “Terminal Portuario del Callao”, and also have 01 prisons. The curve of the total number of reported cases of COVID-19 shows two waves; this second wave is currently decreasing, with 9290 deaths over 97 381 confirmed cases, we have a Lethality rate of 9.54%

EVERY CLOUD HAS A SILVER LINING: SHORT-TERM PSYCHOLOGICAL EFFECTS OF COVID-19 ON BRITISH UNIVERSITY STUDENTS

ABSTRACT There are widespread concerns about the mental health implications of the pandemic, particularly among university students, an already at-risk population for poor mental health. This study looked at 1,281 UK university students, recruited through the Prolific website. Participants were asked to complete the Attitudes towards COVID-19 Scale, the CORE-10, the PERMA Profiler, the GAD-7 and the Office for National Statistics wellbeing questions (ONS4). The first survey was conducted between May 14th and 16th, when the UK was in national lockdown. The second survey was carried out between June 26th and July 15th. There was only an 11% attrition rate between the two time points. Well-being improved overall between the two time points. Some findings were contradictory as overall well-being, anxiety and levels of flourishing improved, but reports of psychological distress increased. It is also important to note that levels of positivity about the pandemic increased as time went on. There was evidence that higher levels of positivity were linked to better mental health outcomes. Encouraging a positive mindset and outlook in students, probably through positive psychology-based interventions, might act as a protective factor against severe mental illness. The wider relevance and practical implications for higher education are discussed.

Pengaruh Terapi Bekam terhadap Penurunan Tekanan Darah pada Penderita Hipertensi di Rumah Sehat Ibnu Sina Palembang

The prevalence of hypertension in 2015 was 34.1%, and in 2018 it increased by 34.1%. Hypertension was caused by an increase in blood pressure. Prevention of hypertension can be done by nonpharmacological treatment with cupping therapy. This study aimed to determine the effect of cupping therapy to decrease blood pressure of patients with hypertension at Ibnu Sina clinic Palembang. The quantitative pre-experimental research with a one-group pretest-posttest design approach. The sample of this study was 45 patients with hypertension. The study was done at the Ibnu Sina clinic on the 20th –30th of June 2021. The results showed that the systolic blood pressure before cupping therapy was 153.20 mmHg and the average diastolic blood pressure was 98.60 mmHg. In contrast, after cupping therapy, the results showed that the mean systolic blood pressure was 98 .60 mmHg and the mean diastolic pressure was 91.20 mmHg. Based on the statistical test, it was found that the p-value was 0.000. it means that systolic blood pressure was affected before and after cupping therapy. It is hoped that the results of this study can improve services for patients with hypertension-related to cupping therapy in lowering blood pressure and can provide knowledge for therapists about the effect of cupping therapy on decreasing blood pressure in patients with hypertension. The sample was 18 respondents who were postoperative appendectomy patients at the AR Bunda Prabumulih Hospital. This research was conducted in 2021. The observation sheet was used to collect the data. The research data were analyzed using the Wilcoxon Signed Ranks Test. Based on the results of data analysis with the Wilcoxon test, it showed a significant effect between the average pain scale before and after giving back massage with a p-value of 0.000 &lt; (0.05) Ha accepted. In other words, it can be concluded that there was an effect of back massage on the pain scale in postoperative appendectomy patients at the AR Bunda Prabumulih Hospital. Based on this research, it is recommended for health practitioners to apply nonpharmacological therapy techniques and pharmacological treatment; one of those techniques is back massage, which effectively reduces pain scale.