COVID-19 Global Crisis Research Articles

Risk Factors of the Severity of COVID-19 Infection in Infants

Background: The global COVID-19 crisis has profoundly affected populations worldwide. While it is widely accepted that older individuals are at greater risk of severe illness, data indicate that in newborns and infants, the disease is generally not fatal. Objectives: This cross-sectional study aimed to examine the roles of laboratory tests and clinical symptoms in determining the severity of COVID-19 infection in infants younger than three months. Methods: This study included all infants less than three months old with positive PCR tests for COVID-19 admitted to the Children's Medical Center between October 2020 and March 2022. We analyzed the association between disease severity and clinical symptoms, as well as laboratory findings. Results: Sixty-four neonates and infants under three months of age with COVID-19 participated in the study. Our findings suggest that lower birth weight and gestational age are associated with increased disease severity. Infants with underlying medical conditions were found to have a higher risk of reaching stage IIb or greater severity. Among laboratory and clinical findings, only white blood cell (WBC) count and cough symptoms showed a significant correlation with disease severity. Conclusions: Clinical evaluations, along with factors such as birth weight, gestational age, and underlying conditions, appear more effective in guiding decision-making for COVID-19 severity in infants. Further studies are necessary to explore the influence of these factors on COVID-19 severity in this age group.

Regionalism under test: justifying initial regional responses to the global Covid-19 crisis in Latin America

ABSTRACT This article explores the distinctive features of Latin American regionalism by examining its rhetorical justifications during the onset of the COVID-19 crisis. The pandemic offered an exceptional opportunity to witness the professed role of regional organizations in the Global South as bridges between national and international systems: how this role is discursively constructed and the practical limitations it faces in times of disruption. We address different attempts to (self-)justify the relevance of regionalist visions, analyzing how three (inter-)regional organizations of the Americas reacted discursively to the global public health crisis: the Common Market of the South (Mercosur), the Organization of American States (OAS), and the Ibero-American Summits (SEGIB). We examine three features that have traditionally shaped Latin American visions of regionalism: coping with world hegemony; striving for regional autonomy; and expressing transnational solidarity. The findings provide insights for further understanding the legitimation of regional and global governance under conditions of uncertainty.

Revealing ferritin's significance: A prognostic marker in COVID-19 at a tertiary care hospital in Rawalpindi

Amid the global COVID-19 crisis with over 762 million cases by 2023, reaching 775 million by 2024, this study examines the critical role of ferritin in diagnosing and managing COVID-19, emphasizing its correlation with disease severity and patient outcomes, especially in Pakistan, where data is scarce. At Benazir Bhutto Hospital in Rawalpindi, this study analyzed medical records of 376 COVID-19 patients aged 25-87 between April 2020 to August 2021, categorizing them by severity. Biochemical parameters, as well as ferritin, AST, ALT, urea, creatinine, and LDH, be assessed using Beckman Coulter AU480, with group differences analyzed via nonparametric tests and SPSS 25. Among 376 patients, predominantly aged 45-65 with a male majority (56.6%), 88.2% had comorbidities and 34.8% deceased during hospitalization. Elevated levels of ferritin, AST, urea, creatinine, and LDH were strongly linked to mortality (p < 0.001). The patients in the 66-90 age group had significantly increased risk of death from COVID-19 than those aged 45-65, by an adjusted odds ratio (AOR = 4.973; 95% CI: 2.517, 9.826; p = 0.0001). Additionally, individuals in the upper ferritin tertile were more susceptible to death, with an AOR of 3.443(95% CI: 2.012, 5.892; p = 0.0001) in contrast to those in middle and lower ferritin tertiles. These findings underscore the predictive value of age and ferritin levels in COVID-19 mortality. Increased ferritin levels stand out as a vital indicator, along with age, for forecasting mortality in COVID-19 patients, highlighting the pressing need for prompt intervention and customized treatment approaches.

Assessing the Relationship between Political Financing and Policy Bias in B40 Welfare Policies during COVID-19

This conceptual paper delves into the intricate relationship between political financing and policy bias in the implementation of welfare policies for the B40 (Below 40 is the 40% of the total population that earns the lowest tier of household income compared to the first group of T20-Top 20% and second category M40-Middle 40%) cluster in Kuala Lumpur Malaysia amidst the COVID-19 pandemic. The B40 cluster comprises the most economically vulnerable segment of the population residing in public housing (the heavily subsidized government-owned residential areas for underprivileged citizens with certain household income categories). This study aims to unravel how political financing influences the formulation and execution of welfare policies, potentially leading to bias in resource allocation and support provision. Through an exhaustive review of existing scholarly literature and analysis of pertinent case studies, this paper embarks on examining the degree to which political financing impacts the decision-making process concerning welfare policies. The analysis focuses on identifying potential biases in policy formulation that may favor the interests of political entities providing financial backing to policymakers. Furthermore, the study also explores the implications of such biases on the equitable distribution of resources to the B40 cluster during the global COVID-19 crisis. The conceptual framework employed in this paper draws from theories of political economy, corruption, and public policy. By dissecting the extant body of literature, the paper aims to offer a nuanced comprehension of the dynamics between political financing and policy bias in the realm of welfare policies for the B40 cluster. The eventual findings are poised to enrich the theoretical understanding of the influence exerted by political financing on the formulation and execution of welfare policies, particularly during periods of global crisis. By identifying policy biases stemming from political financing, this study aspires to catalyze critical discussions on the imperative of transparent and accountable decision-making processes. Such deliberations are vital to ensuring the fair and effective implementation of welfare policies for the B40 cluster in Kuala Lumpur amidst the COVID-19 pandemic. This paper thus serves as a clarion call for enhanced governance mechanisms and institutional reforms to uphold the principles of fairness, equity, and social justice in welfare policy formulation and implementation. This study contributes to the existing literature by shedding light on the nexus between political financing and policy bias in the context of welfare policies for vulnerable populations. It underscores the importance of addressing systemic flaws in governance and decision-making processes to mitigate the adverse effects of political influence on welfare policy outcomes. Moreover, the findings of this study have practical implications for policymakers, advocacy groups, civil society organizations and other stakeholders involved in shaping welfare policy agendas and advocating for reform initiatives. In conclusion, this paper calls for a concerted effort to promote transparency, accountability, and integrity in the formulation and implementation of welfare policies. By fostering a culture of ethical governance and democratic participation, policymakers can ensure that welfare programs serve the interests of the most vulnerable members of society and contribute to equitable and sustainable development outcomes.

The economic impact of COVID-19 on Syrian Refugees in Jordan: A review of existing evidence and policies

The global COVID-19 crisis has precipitated an economic downturn in many countries, subsequently raising concerns about the potential challenges faced by marginalized populations, such as refugees, in accessing essential healthcare, hygiene facilities, and critical health information and safety guidelines within the context of Jordan. Consequently, it is of paramount importance to investigate and evaluate the specific economic hurdles related to COVID-19 that refugees are encountering. This inquiry will serve as a valuable foundation for shaping public health interventions aimed at containing the virus’s spread and guiding policymakers on strategies to enhance the well-being of refugees in Jordan. This paper offers a comprehensive examination of Syrian refugees in Jordan, including an analysis of the policies implemented by Jordan concerning Syrian refugees in the context of the COVID-19 pandemic. Moreover, the report assesses whether international assistance, both through bilateral and multilateral channels, can mitigate the impact of COVID-19 on Jordan’s capacity to continue hosting Syrian refugees. It also delves into the economic consequences of COVID-19, covering aspects such as poverty, education, the health sector budget, healthcare accessibility, essential needs, livelihoods, the labor market, and food security among Syrian refugees in Jordan.

Essential Factors on Effective Response at the Onset of the COVID-19 Pandemic; Comment on "Experiences and Implications of the First Wave of the COVID-19 Emergency in Italy: A Social Science Perspective"

The COVID-19 pandemic in Italy is a stark reminder of the necessity of incorporating the social, economic, and political context in planning responses to public health emergencies. During the ongoing global COVID-19 crisis, it's not just crucial but a shared responsibility to supplement epidemiological approaches with insights from the social sciences. This ensures effective and equitable policies, and it's a responsibility that each of us in the field shares. This discussion is relevant and timely, relating directly to the current global crisis and its potential implications for future public health strategies. This comment underscores the key points of Masino and Enria's paper (2023), illuminating the importance of integrating social sciences into public health strategies, the pivotal role of inequalities in shaping pandemic experiences, and, most importantly, the profound and urgent implications for future epidemic preparedness and response. The urgency of these implications cannot be overstated, and we must act on them swiftly and decisively.

Anti-SARS-CoV-2 Neutralizing Responses in Various Populations: Use of a Rapid Surrogate Lateral Flow Assay and Correlations with Anti-RBD Antibody Levels.

After the global COVID-19 crisis, understanding post-infectious immunity and vaccine efficacy remains crucial. This study aims to assess anti-SARS-CoV-2 immunity through a quantitative analysis of anti-receptor-binding domain (RBD) antibodies and rapid functional testing of the neutralizing humoral response. A retrospective analysis was conducted on samples from various cohorts, including partially vaccinated, fully vaccinated, post-COVID/no-vaccination, and post-COVID/vaccination individuals with various immune-competency statuses. The anti-RBD antibodies were measured using an automated chemiluminescence assay, while the neutralizing antibodies' (NAbs') activity was assessed through the lateral flow ichroma COVID-19 nAb test (LFT), a surrogate neutralization assay. The analysis revealed various levels of anti-RBD antibodies and seroneutralization responses across cohorts, with the post-COVID/vaccination group demonstrating the most robust protection. A correlation between anti-RBD antibodies and seroneutralization was observed, albeit with varying strength depending on the subgroup analyzed. Longitudinal assessment following natural infection showed an initial surge followed by a decline in both measures. A cutoff of 3.0 log10 BAU/mL was established to predict significant seroneutralization. The ichroma™ COVID-19 nAb test displayed high specificity and emerged as a valuable tool for monitoring anti-SARS-CoV-2 immunity. These findings contribute to understand the antibody response dynamics and underscore the potential of rapid tests in predicting protection against SARS-CoV-2 infection.

Makkah healthcare cluster response, challenges, and interventions during COVID-19 pandemic: A qualitative study

BackgroundThe global COVID-19 crisis has underscored the critical role of effective decision-making in healthcare systems. Saudi Arabia has shown resilience by implementing comprehensive testing, tracing, and vaccination measures. Given the unique cultural and religious characteristics of Makkah, specific challenges have prompted efforts to uncover local pandemic responses. This qualitative assessment aims to delineate the challenges faced by decision-makers during COVID-19 in Makkah and identify key interventions implemented by the Makkah healthcare cluster to manage and coordinate care. MethodUtilizing a purposive sampling approach, executive leaders within the Makkah Healthcare Cluster were invited for semi-structured interviews during the COVID-19 period. Thematic analysis was carried out in five steps, ensuring rigor and trustworthiness through multiple checks, and employing a critical and collaborative approach. ResultThroughout the COVID-19 outbreak in Makkah, participants revealed Several factors that have hindered healthcare organizations' ability to effectively manage the pandemic, including testing difficulties, resource shortages, vaccination misconceptions, continuity of care issues, infections among healthcare workers, and the need for consistent protocols. The participant leaders in Makkah's healthcare cluster specified implemented strategies that helped in overcoming the encountered challenges, such as adopting new technologies, enhancing communication, managing supply and demand, and improving workforce adaptability and development. Their experience in managing Hajj and Umrah provided valuable insights for handling the pandemic effectively. ConclusionThe study emphasizes the significance of technology adoption, effective communication, supply management, workforce development, and lessons from managing religious events. Its findings have implications for healthcare systems globally, emphasizing the importance of preparedness, response, and resilience in diverse cultural contexts.

Psychometric Properties of the Depression, Anxiety, Stress Scales-21 (DASS-21) in a Portuguese Sample during the early stage of the COVID-19 pandemic

IntroductionThe COVID-19 global crisis has resulted in significant disruptions in the lives of students in higher education, leading to negative consequences for their academic achievements and general psychological well-being.ObjectivesIn this study, we sought to examine the psychometric properties of the Depression Anxiety Stress Scale-21 (DASS-21) among students in Portuguese higher education institutions during the initial phase of the COVID-19 pandemic and its efficacy in capturing mental health symptoms due to a global health crisis.MethodsIn this cross-sectional study, a convenience sampling method was used to enlist a total of 1522 participants. The sample consisted of 75.1% women and 79.2% undergraduate students. Participants completed an electronic survey that was designed using the Depression Anxiety Stress Scale-21 (DASS-21) — a self-report instrument measuring anxiety, depression, and stress.ResultsThe findings of the study indicated a significant occurrence of depressive symptoms [≥10] (N = 434, 28.5%), anxiety symptoms [≥7] (N = 551, 36.2%), and stress symptoms [≥11] (N = 544, 35.7%). Based on the collected data, a Confirmatory Factor Analysis (CFA) was conducted in order to examine the factor structure of the scale. The analysis revealed a three-factor solution that corresponded to the three subscales of the DASS-21. The Heterotrait-Monotrait (HTMT) correlation ratio was then used to assess the discriminant validity, with good results. Results showed that the DASS21 has satisfactory reliability indexes (Cronbach’s α > 0.90).ConclusionsIn light of the notable changes in living conditions brought by the COVID-19 pandemic, the present study has shown that the DASS-21 instrument has maintained its reliability and validity. Consequently, this finding supports the appropriateness of using the DASS-21 as a screening tool for assessing mental health among students in Portugal. Moreover, it is recommended that academics and healthcare practitioners use the DASS-21 as a tool for assessing the levels of psychological distress experienced by students. Additional validation studies of this scale are required, using bigger and more representative populations.Disclosure of InterestNone Declared

Tales of Turbulence: BERT-based Multimodal Analysis of FED Communication Dynamics Amidst COVID-19 Through FOMC Minutes

AbstractThis study analyzes Federal Open Market Committee (FOMC) minutes using state-of-the-art Natural Language Processing techniques. We sought to investigate the effect of the global COVID-19 crisis on the FOMC minutes’ pattern and the strength of the Federal Reserve to influence inflation expectations through its primary press releases. To this end, we first quantified minutes leveraging domain-specific pre-trained Bidirectional Encoder Representations from Transformers models (FinBERTs). Then, we applied dynamic time warping to measure temporal sequence proximity over time. In addition, we built multivariable autoregressive integrated moving average models to verify our findings by injecting exogenous variables as indicator functions into the time series. The results suggest that the Federal Reserve has abstained from adjusting its tone and the forward-lookingness settings of its statements for the global pandemic. Therefore, the longstanding association of the FED's tone and forward-lookingness with consumers’ inflation expectations index has weakened during the global health crisis.

Perceptions of religious Israeli high school principals regarding school climate after the COVID-19 pandemic, and its connection to their management style

PurposeThe global COVID-19 crisis posed many managerial and leadership challenges for principals. More specifically, after the crisis passed noticeable changes in school climate manifested and affected principal management style. The present study examined perceptions of principals regarding school climate and its impact on management style. The research literature clearly affirms the profound impact of school climate in terms of the relationship between students and school leaders. The study focused solely on religious high schools because, in Israel, the negative impact of the pandemic was most marked there.Design/methodology/approachThe study was qualitative in nature, and included semi-structured interviews with 10 religious school principals in Israel. Study participants were asked about the existing school climate and their management style in light of the COVID-19 period.FindingsThis study indicated that positive school climate and interpersonal relationships between principals and students were affected by the COVID-19 crisis. Study participants reported that principals had to work arduously in the post-COVID-19 period to restore and improve positive school climate and consequently their management style also needed altering. Specifically, restoring open lines of communication and a sense of belonging as the main components of the school climate were the main foci of principal work. The principals' management style had to be more open and inclusive to restore a sense of belonging and security among students.Originality/valueThe study highlights the importance of an open and inclusive management style to restore positive school climate after crises.

Resilience in the Face of Crisis: A Literary Exploration of Pandemic Novels (Remnants of Resiliency and Survival: A Thematic Analysis on Pandemic Novels)

In the midst of the global COVID-19 crisis, this qualitative study undertakes an examination of pandemic novels, taking out insights from a selection of ten prominent novels as its primary dataset. Employing both narrative and thematic analyses, the research delves into the portrayal of resilience and trauma processing within these literary works, with the ultimate goal of formulating a practical, yet handy, literary module designed to enhance student engagement. The analytical framework encompasses Resilience theory, Postmodernism, and Marxism, providing a comprehensive lens through which to explore how fictional survivors navigate and depict resilience. Symbolism takes center stage, notably through the metaphorical use of an infected rat, shedding light on the delicate balance between nature and civilization. The discussion on causative factors injects a sense of urgency and unpredictability, mirroring the intricate dynamics of real-world health crises and encouraging nuanced comprehension. The study goes beyond individual adaptability to scrutinize societal responses, contributing significantly to academic discussions. As the study concludes, the derived insights aim to facilitate readers in coping with the trauma induced by the COVID-19 pandemic, offering valuable perspectives on how fictional characters navigate and endure the challenges posed by the pandemic.

Relationship Between Structure and Pathogenicity

The global COVID-19 crisis caused by the SARS-CoV-2 virus has led to the emergence of multiple variants, capturing substantial international attention. This extensive study offers a comprehensive examination of the structural attributes and disease-causing potential of the original SARS-CoV-2 strain and its primary variants, namely Alpha, Beta, Delta, Gamma, and Omicron.

Harnessing Deep Learning in Computer Vision for Effective Face Mask Detection in the Global COVID-19 Crisis

Objective: This study aims to explore the use of deep learning algorithms in computer vision to address the effective detection of face mask use in the global COVID-19 crisis.
 Results: Deep learning techniques enable the execution of tasks by computers and smart devices without human intervention, including image identification and predictions. Its applications have demonstrated significant advances in several areas, particularly in engineering and health research. The study highlights that computer vision scientists can contribute to the prevention, control and management of the fight against COVID-19 and other airborne viruses. Computer vision employs algorithmic tools to process images, perform associations and transmit relevant information.
 Implications for Research, Practice and Social: Construction of a deep learning model using a dataset of people with and without face masks. The developed model, implemented in Python with the help of OpenCV, Keras and TensorFlow libraries, presented highly promising results, reaching an accuracy of 99% in predictions in test images.
 Originality/Value: This study highlights the originality and value of deep learning techniques in computer vision as an effective means of tackling virus-borne pandemics such as COVID-19, and contributing to a preventive, efficient and cost-effective approach to use of face masks.
 Keywords: Computer vision; Convolutional Neural Network; Face mask.

Digital Communication During Crisis: The Example of The World Health Organization and The Ministries of Health in The Covid-19 Global Crisis

This study focuses on examining the crisis communication efforts of public institutions, specifically health ministries, over social media during the Covid 19 period, in terms of word use and sentiment analysis. In the study, content and sentiment analysis was carried out by text mining method, focusing on the Twitter posts of the ministries of health of the countries with the highest number of cases in the world, especially on the social media pages used within the framework of crisis communication. According to the results of the study, it has been found that the health ministries of the countries have different crisis communication orientations and integrate with different words and emotions during the Covid global crisis. According to the results, while the US Ministry of Health and Human Services came to the fore as the ministry with the most content consistency with the World Health Organization, it is found that the Ministry of Health of the Republic of Turkey approached the crisis with a broad perspective, and the Ministry of Health and Family Welfare of India carried out activities for perception management. When the results were examined in terms of sentiment analysis, it was found that the sentiments in the posts of the health ministries of the countries differed significantly from each other.

Right-Wing Authoritarian Attitudes, Fast-Paced Decision-Making, and the Spread of Misinformation About COVID-19 Vaccines

ABSTRACT Social media played a prominent role in the spread of vaccine-related fake news during the global COVID-19 crisis. Previous work has shown that both trait-related and situational factors influence the spread of fake news on social media. However, we have limited insight into how the specific contextual conditions that shape information processing on social media contribute to the proliferation of misinformation. In this article, we posit that people are more susceptible to spreading misinformation because they engage selectively, briefly, and heuristically with political news on social media. To test our argument, we rely on a pre-registered online experiment conducted in two Central and Eastern European (CEE) countries, Hungary and Romania. We designed this experiment to reflect the fast and impulsive decision-making that is characteristic of online behavior on social media platforms. The results support the idea that individuals’ tendency to disseminate fake news is amplified by conditions of fast-paced and impulsive decision-making. The effect is particularly pronounced among respondents with higher right-wing authoritarian attitudes. This suggests that the fast and intuition-reliant nature of decision-making on social media encourages the spread of such misinformation that is in line with individuals’ ideological beliefs, which could increase social polarization in societies.

A Tail Within a Tale, Within a Tale: An Autoethnographic Account for Dog Lovers, Cat Lovers, and Story Lovers

It was March-April 2020. The first few weeks of the first COVID-19 pandemic lockdown had just begun. Anxiety levels were high, and being locked up at home was an unfamiliar and eerie situation. A music therapist sent her clients (elementary school children on the autism spectrum) daily videos of her dog, Robben, during his daily routines. She dubbed the dog as if he told the children a story about a tail-less cat. This endeavor resulted in a series of 27 storytelling episodes titled “Robben’s Pandemic Adventures”, which the clients awaited day by day. The current autoethnographic report unveils this music therapist’s storytelling experience. Every day she had to produce new creative content for the next episodes of her dog’s “adventures”, connecting his daily routines, character, and hobbies to the pandemic reality. In this process, she gave her dog a voice, and he “told” daily chapters in an allegoric story about one very unusual cat. The reflections focus on personal and professional lessons learned in the process for the therapist herself and her clients. In addition, the value of children’s stories during times of crisis and turmoil - to both the adult storyteller and the children listening - is discussed and connected to the global COVID-19 crisis.

Worker flows by gender and industry in Japan

After the late 2000s, there were substantial fluctuations in unemployment during the Global Financial Crisis (GFC), Abenomics, and COVID-19 crisis, and their impact was uneven by gender and industry. This study examines the property of worker flows in Japan by focusing on gender and industry perspectives using monthly data from the Labour Force Survey. During the COVID-19 crisis, the transition probability from employment to inactivity rose sharply compared to the period of the GFC, mainly driven by women in the service sectors. The contribution of inflows to the dynamics of unemployment was on the rise for both men and women until around 2018, and the decreased unemployment rate during Abenomics can be accounted for by the decline in separation rates.

Eltrombopag Plus Rhtpo for Corticosteroid-Resistant or Relapsed ITP: A Prospective Observed Study

During the COVID-19 pandemic, the classical subsequent treatment regimen for immune thrombocytopenia (ITP) of immunosuppressants and/or steroids might increase patients' susceptibility of virus infections. To minimize ITP patients' risk during the COVID-19 global crisis and to improve treatment efficacy, non-immunosuppressive therapies, mainly including thrombopoietin mimetics, such as eltrombopag or recombinant human thrombopoietin (rhTPO), may be better for them. Eltrombopag, a small molecule agonist of thrombopoietin receptor (TPO-RA), was recommended as the subsequent treatment for ITP patients, which also already showed robust efficacy. However, inefficacy, loss of response and fluctuation of platelet counts during treatment were the serious problems in eltrombopag treatment for corticosteroid-resistant or relapsed ITP.RhTPO is a full-length glycosylated-TPO produced by Chinese hamster ovary cells, which showed its effectiveness in ITP in a variety of studies.For the difference of rh-TPO and eltrombopag , it had distinct molecular structures, treatment mechanisms, and pharmacokinetic characteristics and thus different response patterns and side effect profile. Previous studies have confirmed the safety and effectiveness of switching between rh-TPO and eltrombopag for ITP patients who had no response to or experienced adverse events with their first TPO-RA.However, no study has focused on the safe and effectiveness of the combination therapy of eltrombopag and rhTPO.The investigators hypothesized that the combination of these two agents could be a promising option for ITP treatment. Methods This is a prospective observed study to investigate the efficacy and safety of eltrombopag plus rhTPO as treatment for corticosteroid-resistant or relapsed ITP during the COVID-19 pandemic. Participation Criteria The inclusion criteria were as follows:Clinically confirmed corticosteroid-resistant or relapsed primary ITP;Platelet count less than 30×10^9/L on two occasions or platelets above 30×10^9/L combined with bleeding manifestation (WHO bleeding scale 2 or above);≥ 18 years. Exclusion Criteria: with secondary ITP such as drug-related thrombocytopenia, viral infection-induced thrombocytopenia, or a known diagnosis of another autoimmune disease; with other possible causes of thrombocytopenia, such as leukaemia, myelodysplastic syndrome, and aplastic anaemia; impaired renal function as indicated by a serum creatinine level > 2.0 mg/dL;inadequate liver function as indicated by a total bilirubin level > 2.0 mg/dL and/or an aspartate aminotransaminase or alanine aminotransferase level > 3×upper limit of normal; with a New York Heart Classification III or IV heart disease; with a history of severe psychiatric disorder or are unable to comply with study and follow-up procedures; pregnant or lactating women, or plan to become pregnant or impregnated within 12 months of receiving study drug; previous splenectomy; with previous or concomitant malignant disease; expected survival of < 2 years;not willing to participate in the study. Procedure For the patients with the combination therapy of eltrombopag and rhTPO, they received eltrombopag 25-75 mg oral daily and rh-TPO 300U/kg subcutaneous injection once daily for 7 consecutive days, followed by a tapering dose in maintenance therapy to maintain the platelet count between 50-150×10 9/L. Results From September 2nd, 2020, to July 1st, 2023, a total of 29 patients with corticosteroid-resistant or relapsed ITP were enrolled to receive eltrombopag plus rhTPO treatment, which included 11 male and 18 female patients.The median age were 55 (23-91) years old. The baseline platelete count was 7 (1-17)×10 9/L. Most patients (69.0%) were with severe ITP (platelet counts≤10×10 9/L or bleeding score ≥5).Response was defined as the achievement of platelet counts ≥30 × 10 9/L and ≥2 times the baseline platelet count at least once with treatment.The response rates at 1 week (early response) and 1 month ( initial response) were 37.9%(11/29) and 62.1%(18/29), respectively. After 6 weeks' treatment, 82.8% (25/29) of patients achieved response, and the improvement of bleeding symptoms were observed in most patients (89.7%).No thromboembolic events occurred during treatment. Conclusion Elrtombopag and rhTPO was a safe and effective therapy for corticosteroid-resistant or relapsed ITP, especially for severe ITP.

Are investment grade Sukuks decoupled from the conventional yield curve?

We study the relationship between the US yield curve components and returns on investment grade Sukuks. The data cover the period from 07 September 2007 to 12 March 2021. The results show that the spillover between Sukuks and conventional fixed-income securities is time-varying that slightly rises during distress periods and reduces otherwise. Also, the long-term conventional yield curve components and the lower rated investment Sukuks contribute more to spillovers. On the other hand, the portfolio implications using investment grade Sukuks confirm diversification properties of the most sukuk categories and the safe-haven properties in lower rated investment sukuk during global financial crisis (GFC) and COVID-19 crisis. Our findings have implications for regulators and potential investors around the world.