Traumatic stress in Egyptian doctors during COVID-19 pandemic.

COVID-19 pandemic has heavily burdened healthcare systems throughout the world, causing substantial mental distress to medical professionals. We aim to investigate the associated traumatic stress in a sample of practicing physicians in Egypt during the COVID-19 pandemic. This cross-sectional study assessed depression, and Post-traumatic stress disorder (PTSD) among a sample of Egyptian physicians using an electronic survey. It included demographic and practice-related data, PTSD Checklist - Civilian Version (PCL-C) and the nine-item Patient Health Questionnaire (PHQ-9). Of the 124 respondents, 66.9% were at high risk for depression and 37.9% met criteria for diagnosis of PTSD. Female gender and perceived work-related stress were significantly associated with PTSD. PTSD and depression severity scores were positively correlated. These findings highlight the importance of timely mental support and intervention for medical workers.

Compliance with wearing facemasks by university teaching staff during the second wave of COVID-19 pandemic: a cross sectional study.

Objective: We aimed to explore compliance with and barriers to wearing facemasks at the workplace among university teaching staff in Egypt. Methods: An online survey was shared with teaching staff members at 11 public and 12 private Egyptian universities and high institutes, and 218 responses were received. All participants were asked about beliefs related to wearing facemasks. For participants who taught in-person classes, compliance with and barriers to wearing facemasks at the workplace were assessed. Compliance level was classified into: Non-compliance, inadequate and adequate, based on the degree of adherence to having facemasks on and not taking them off at five main work settings. We compared demographic characteristics, beliefs, and barriers scores across compliance levels. Results: Most participants (81.7%) believed that facemasks reduce infection risk to others and 74.3% believed facemasks can reduce risk to the wearer. Around 80% of the respondents who taught in-person classes wore facemasks, but only 37.8% met the criteria of adequate compliance. Difficulty breathing and impaired communication were cited as major barriers by 42.2% and 30.3% of in-person class tutors respectively. The risk of reporting COVID-19 like symptoms among non-compliant participants was double the risk among those with adequate compliance (45.9% vs 25.7% respectively). Adequate compliance was significantly associated with higher positive beliefs scores and lower barriers scores. Conclusion: Adequate compliance with wearing facemasks at the workplace was low. Addressing negative beliefs may improve compliance. Difficulty breathing, and impaired communication were important barriers, therefore we recommend replacing in-person interactions with online classes whenever applicable. Supplementary Information: The online version contains supplementary material available at 10.1007/s44155-022-00011-3.

Challenges of personal protective equipment use among ophthalmologists during the COVID-19 pandemic: A multicenter international study.

PURPOSE: To explore the possible challenges and difficulties of using Personal Protective Equipment (PPE) in ophthalmic practice during the Coronavirus disease 2019 (COVID-19) pandemic. METHODS: This is a multicenter, international survey among practicing ophthalmologists across different countries. The survey was conducted from September 9th to October 24th, 2020. It included a total of 23 questions that navigated through the currently adopted recommendations in different clinical situations. The survey also assessed the convenience of using various PPE in ophthalmic practice and addressed the clarity of the examination field while using various PPE during clinical or surgical procedures. RESULTS: One hundred and seventy-two ophthalmologists completed the survey (101 from Egypt, 50 from the USA, and 21 from four other countries). The analysis of the responses showed that most ophthalmologists use face masks without significant problems during their examinations, while face shields followed by protective goggles were the most inconvenient PPE in the current ophthalmic practice. Moreover, most of the participants (133, 77.3%) noticed an increase in their examination time when using PPE. Furthermore, a considerable percentage of the respondents (70, 40.7%) stopped using one or more of the PPE due to inconvenience or discomfort. CONCLUSIONS: Due to the unique nature of the ophthalmic examination, certain PPE are not ophthalmologist-friendly. Innovative PPE should be tailored for prompt, more convenient, and clearer ophthalmological practice.

Prevalence of work-related asthma among Egyptian farmers in Great Cairo.

Work related asthma (WRA) refers to asthma induced by exposure to sensitizing agents and/or irritants in the workplace leaving health and economic consequences. Early diagnosis can improve the prognosis of WRA permitting sometimes full recovery. This study aimed to assess the prevalence of WRA among Egyptian adult agriculture workers. A multi-center cross sectional study included 150 adult workers from 4 different farms, during the period from 2019 and 2021. All participants were subjected to full medical history, clinical examination, chest x-ray, skin prick test and CBC to detect absolute eosinophilic count. Spirometry with post bronchodilatation test (reversibility test) at the farm (in the day of insecticide aerosol and without aerosol) and after a week off the farm was also done. Age, median ± SD, was 37.67 ± 9.75 years, duration of farming occupation was 21.84 ± 10.18 years. Of the 150 participants, 11 had WRA. Of these, 6 had allergic occupational asthma, 3/11 had work exacerbated asthma and only 2/11 had irritant occupational asthma. Of the allergic subjects, 7.3% tested positive to mixed pollens, 4.7% to Alternaria, 2% to penicillium and 2% to the farm pollens. The onset of respiratory symptoms was 13.45 ± 6.93 months after start working in the farm. A statistical significance was observed between WRA and non-WRA individuals regarding age, duration of farming occupation and asthma symptoms during workday (P < 0.001). There was a statistical significance between WRA group and non-WRA group regarding FEV1, FEV1/FVC ratio carried out at work, during holidays and during spraying (P < 0.001). Absolute eosinophilic count, mean among WRA group was 0.55 ± 0.13 (×103cells/mm3) with significance between WRA and non-WRA (P= 0.001). Farming occupation may cause WRA, therefore, more attention should be given to minimize exposure and risk of inducing WRA.

Consensus Meeting Report "Technology Enhanced Assessment" in Covid-19 Time, MENA Regional Experiences and Reflections.

PURPOSE: Majority of the assessments, appraisals and placements have been disturbed, with some being cancelled, postponed, or modified in design. New approaches for assessment should be well-thought-out. This work attempts at capturing the collective wisdom of educators in the Middle East and North Africa region (MENA), providing an understanding of the online assessment conceptual framework in the era of COVID-19 that tells the story rather than determining cause and effect, and identifying the biggest gaps that derail the digital transformation. METHODS: A qualitative inductive study using the grounded theory approach was implemented following a synchronous virtual online meeting, a summary of the reflections as well as experiences of medical education experts was prepared. Data for this qualitative study were collected from the meeting. The meeting was video-recorded and transcribed by the researchers. Thematic analysis was performed by three separate researcher coders. The authors then discussed together until they reached a consensus. RESULTS: Three main thematic areas were identified: 1) feasibility, 2) exam fairness/equity and 3) acceptable graduate attributes, society/community acceptance. CONCLUSION: The COVID-19 era necessitated revisiting of our assessment strategies to cope with new changes within the available context. Rapid adaptation is required.

SARS-CoV-2 seroconversion among 4040 Egyptian healthcare workers in 12 resource-limited healthcare facilities: A prospective cohort study.

BACKGROUND: We examined Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) seroconversion incidence and risk factors 21 days after baseline screening among healthcare workers (HCWs) in a resource-limited setting. METHODS: A prospective cohort study of 4040 HCWs took place at 12 university healthcare facilities in Cairo, Egypt; April-June 2020. Follow-up exposure and clinical data were collected through online survey. SARS-CoV-2 testing was done using rapid IgM and IgG serological tests and reverse transcriptase-polymerase chain reaction (RT-PCR) for those with positive serology. Cox proportional hazards modelling was used to estimate adjusted hazard ratios (HR) of seroconversion. RESULTS: 3870/4040 (95.8%) HCWs tested negative for IgM, IgG and PCR at baseline; 2282 (59.0%) returned for 21-day follow-up. Seroconversion incidence (positive IgM and/or IgG) was 100/2282 (4.4%, 95% CI:3.6-5.3), majority asymptomatic (64.0%); daily hazard of 0.21% (95% CI:0.17-0.25)/48 746 person-days of follow-up. Seroconversion was: 4.0% (64/1596; 95% CI:3.1-5.1) among asymptomatic; 5.3% (36/686; 95% CI:3.7-7.2) among symptomatic HCWs. Seroconversion was independently associated with older age; lower education; contact with a confirmed case >15 min; chronic kidney disease; pregnancy; change/loss of smell; and negatively associated with workplace contact. CONCLUSIONS: Most seroconversions were asymptomatic, emphasizing need for regular universal testing. Seropositivity was three-fold that observed at baseline. Cumulative infections increased nationally by a similar rate, suggesting HCW infections reflect community not nosocomial transmission.

Universal COVID-19 screening of 4040 health care workers in a resource-limited setting: an Egyptian pilot model in a university with 12 public hospitals and medical centers.

BACKGROUND: The scale of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health care workers (HCWs), particularly in resource-limited settings, remains unclear. To address this concern, universal (non-symptom-based) screening of HCWs was piloted to determine the proportion of SARS-CoV-2 infection and the associated epidemiological and clinical risk factors at a large public health care facility in Egypt. METHODS: Baseline voluntary screening of 4040 HCWs took place between 22 April and 14 May 2020 at 12 hospitals and medical centres in Cairo. Epidemiological and clinical data were collected using an online survey. All participants were tested for SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) and rapid IgM and IgG serological tests. RESULTS: Of the 4040 HCWs screened, 170 [4.2%; 95% confidence interval (CI): 3.6-4.9] tested positive for SARS-CoV-2 by either of the three tests (i.e. infected); 125/170 (73.5%) tested PCR-positive. Most infected HCWs were nurses (97/170, 57.5%). Median age of infected HCWs was 31.5 [interquartile range (IQR): 27.0-41.3] years. Of infected HCWs, 78 (45.9%) reported contact with a suspected case and 47 (27.6%) reported face-to-face contact within 2 m with a confirmed case. The proportion of infection among symptomatic HCWs (n = 54/616) was 8.8% (95% CI: 6.7-11.3); 6/54 (11.1%) had fever ≥38°C and 7/54 (13.0%) reported severe symptoms. Most infected HCWs were asymptomatic (116/170, 68.2%). The proportion of infection among asymptomatic HCWs (n = 116/3424) was 3.4% (95% CI: 2.8-4.0). CONCLUSIONS: The high rate of asymptomatic infections among HCWs reinforces the need for expanding universal regular testing. The infection rate among symptomatic HCWs in this study is comparable with the national rate detected through symptom-based testing. This suggests that infections among HCWs may reflect community rather than nosocomial transmission during the early phase of the COVID-19 epidemic in Egypt.

Mental health status of health-care professionals working in quarantine and non-quarantine Egyptian hospitals during the COVID-19 pandemic.

BACKGROUND: Variable models of care have been adopted in different countries in response to the COVID-19 pandemic. Egypt has assigned certain hospitals specifically for the quarantine of COVID-19 patients, where operational medical teams work continuously for 14 days, after which they are released for self-isolation at home for a similar period. AIMS: The study aimed to evaluate and compare perceived adverse psychological symptoms (stress, anxiety, depression), and insomnia by health-care professionals working in quarantine and non-quarantine hospitals during the COVID-19 pandemic in Egypt, and to explore associated factors with adverse psychological symptoms and insomnia. METHODS: An online cross-sectional survey was performed in April 2020, using a snowball sampling method. Sociodemographic information perceived general health, healthy lifestyle, insomnia (using Insomnia Severity Index), adverse psychological symptoms (using the Depression, Anxiety and Stress Scale-21), worries and concerns about COVID-19, future perspective about COVID-19, and coping strategies were collected. RESULTS: Five hundred and forty health-care professionals participated; 10.2% (n=55) worked in quarantine hospitals. Younger age (ORa=0.96, 95% CI:0.93-0.99, ORa=0.95; 95% CI:0.92-0.97; ORa=0.96 CI:0.93-0.99), being not ready/sure of readiness to work in quarantine hospital (ORa=1.91, 95% CI:1.22-3.00; ORa=2.01, 95% CI:1.28-3.15; ORa=1.91, 95% CI:1.22-2.98), and insomnia (ORa=5.22, 95% CI:3.38-8.05; ORa=7.58, 95% CI:4.91-11.68; ORa=6.38 95% CI:4.19-9.73) significantly predicted stress, depression and anxiety, respectively. Being female (ORa=1.59, 95% CI:1.04-2.42; ORa=2.09, 95% CI:1.38-3.16) could also significantly predict stress and anxiety. CONCLUSION: Female and younger age health care professionals were more prone to report adverse psychological symptoms. More and earlier screening for health-care professionals dealing with COVID-19, in addition to providing psychological support, is highly encouraged.

Stop Turning a Blind Eye: Tobacco Smoking Among Egyptian Patients With Schizophrenia.

Background: Patients with schizophrenia have considerably higher rates of mortality than general population. Multiple factors may play a role in this. Despite being a major preventable cause of death, smoking is usually overlooked when dealing with patients with schizophrenia. Understanding the pattern of smoking, its severity, and the reasons to quit might be helpful in managing patients with schizophrenia and decreasing the mortality gap. Subjects and Methods: The study included smokers divided into two groups; the first included 346 patients with schizophrenia while the second group had 150 smokers with no mental illness. Both groups were assessed and compared regarding sociodemographic variables, pattern of smoking, severity of nicotine dependence, and motivation to quit smoking. Results: Earlier age of starting to smoke, higher number of cigarettes per day, and lower dependency scores were noted in patients with Schizophrenia. Positive correlation was found between positive symptoms and severity of dependence. Specific positive symptoms were correlated to number of cigarettes per day and time before first cigarette. Patients with Schizophrenia showed a significant difference in intrinsic reasons to quit (health concerns and self-control), which were also positively correlated to their positive symptoms score. Linear regression analysis for predictors of FTND score revealed that only age, sex, and schizophrenia were significant predictors of FTND score. Conclusion: Patients with schizophrenia smoke at earlier ages and smoke more cigarettes per day, yet, have less severe dependence than non-schizophrenic counterparts. Positive symptoms play a role in their smoking pattern and severity. Health concerns and self-control are their main motives to quit smoking.