Disruptions in Prenatal Care Visits during the Pandemic: A Population-Based Cohort Study in Manitoba, Canada

Background: Limited evidence exists on the pandemic's role in limiting access and use of prenatal care services and the quality of care for pregnant women. We aimed to investigate the impact of the pandemic restrictions on in-person prenatal care visits (PNCV) and the quality of prenatal care. Method(s): Using the mother-infant-linked administrative health databases in Manitoba, Canada, we conducted a province-wide population-based cohort study among independent pregnancies. We examined the quarterly rates of PNCV before (October 2016-March 2020) and during (April 2020-March 2021) the pandemic. Quality of prenatal care was categorized using the Revised Graduated Prenatal Care Utilization Index (R-GINDEX) into inadequate (<50% visits), intermediate (50%-80% visits), adequate (>80% visits), intensive (high-risk), and no care. Interrupted time series analyses were conducted to assess the immediate and lagged changes in PNCV and quality of care after the implementation of pandemic restrictions. Result(s): Amongst 70,931 pregnancies, we observed no significant mean difference in the overall numbers of PNCV during the pandemic compared to prepandemic (8.2 vs. 8.6,p=0.0837). Prenatal care utilization was 3.4% inadequate and 34.7% adequate before the pandemic and 4.8% and 26.6% during the pandemic, respectively. Restrictions were associated with an abrupt decline in adequate and intermediate care during the first trimester by 11.3% (p<0.001) and 11.98%, respectively, followed by non-significant change throughout the pandemic (beta3=-0.25,p=0.694 and beta3=-0.96,p=0.192, respectively). Moreover, restrictions were associated with an increased rate of inadequate care during the first (beta2=1.52,p=0.007) and second trimesters (beta2=0.78,p=0.208), and not among third trimesters (beta2=-0.44,p=0.094). During the pandemic, we found no significant differences in the rates of intensive prenatal care during the first (p=0.478), second (p=0.614), and third (p=0.608) trimesters compared to pre-pandemic. Conclusion(s): Our findings suggest a decline in adequacy levels of prenatal care services after COVID-19 restrictions were enacted, with a higher impact on pregnancies during their first and second trimesters. Although the overall adequacy of care decreased, there were no changes to the rates of intensive visits. This study will further investigate the impact of the pandemic on virtual PNCV and assess the association between the quality of prenatal care and adverse maternal and neonatal outcomes.

Performance of the World Health Organisation suspected COVID-19 case definition in cluster-associated and sporadic SARS-CoV-2 transmission in Malaysia.

INTRODUCTION: Cluster-associated transmission has contributed to the majority of COVID-19 cases in Malaysia. Although widely used, the performance of the World Health Organization (WHO) case definition for suspected COVID19 in environments with high numbers of such cases has not been reported. MATERIALS AND METHODS: All suspected cases of COVID-19 that self-presented to hospitals or were cluster screened from 1st April to 31st May 2020 were included. Positive SARS-CoV-2 rRT-PCR was used as the diagnostic reference for COVID-19. RESULTS: 540 individuals with suspected COVID-19 were recruited. Two-third of patients were identified through contact screening, while the rest presented sporadically. Overall COVID-19 positivity rate was 59.4% (321/540) which was higher in the cluster screened group (85.6% vs. 11.6%, p<0.001). Overall, cluster-screened COVID-19 cases were significantly younger, had fewer comorbidities and were less likely to be symptomatic than those present sporadically. Mortality was significantly lower in the cluster-screened COVID-19 cases (0.3% vs. 4.5%, p<0.05). A third of all chest radiographs in confirmed COVID-19 cases were abnormal, with consolidation, ground-glass opacities or both predominating in the peripheral lower zones. The WHO suspected case definition for COVID-19 accurately classified 35.4% of all COVID-19 patients, a rate not improved by the addition of baseline radiographic data. Misclassification rate was higher among the cluster-associated cases (80.6%) compared to sporadic cases (35.3%). CONCLUSION: COVID-19 cases in Malaysia identified by active tracing of community cluster outbreaks had lower mortality rate. The WHO suspected COVID-19 performed poorly in this setting even when chest radiographic information was available, a finding that has implications for future spikes of the disease in countries with similar transmission characteristics.

Rituximab in a Large Uk Centre during the Covid-19 Pandemic: The Effects of Employing a Reduced Dosing Regimen on Clinical Response in Rheumatoid Arthritis Patients

Background/Aims When the COVID-19 pandemic began, steps were taken to minimise risk to those vulnerable to severe outcomes. For immunosuppressed patients with rheumatoid arthritis (RA), consideration was given to reducing risk whilst mindful of compromising control of their underlying condition. At Leeds Teaching Hospitals NHS Trust, patients receiving rituximab (RTX) were considered for a reduced dose regimen. A retrospective study, using real-world data, was undertaken to assess the impact of lower doses of RTX on response to treatment. Methods The clinical records of all patients with RA who had received RTX between March 2020 and March 2021 were reviewed. Demographics and previous RTX exposure were recorded. The dose of RTX given during the specified period was noted. Response to treatment was recorded pragmatically by physicians as good, partial or none, based on patient reported VAS for disease activity and swollen and tender joint counts, given the limitations placed on face-to-face patient review due to the pandemic. The time to subsequent RTX treatment and the need for steroid treatment for flares was also studied. Results The number of patients treated with RTX was 282, of whom 89 patients received full dose (1g x 2 infusions), 192 patients received half dose (500mg x 2 infusions). The mean age was 61 years. 77% were female. 9% were RTX-naive, 80% had previously had full dose. Follow-up data were available for 185/192 of the group receiving 1g and 88/89 of the group receiving 2g. Clinical outcomes were as follows for the two groups (1g RTX vs 2g RTX): no response 10.3% vs 9.1%;partial response:34.9% vs 20% %;good response: 54.8% vs 70.9%. The mean length of response was 7.5 months in the patients receiving 1g of RTX compared to 8.6 months in the group receiving 2g of RTX. Similar number of patients required steroid for a flare after receiving Ig of RTX (23.9%) compare to those receiving 2g of RTX (25.8%). Conclusion A majority of patients receiving RTX for RA at either standard or reduced dose reported clinical response. Those receiving lower dose RTX were more likely to report a partial response whilst those receiving full dose were more likely to report a good response. Duration of response and need for steroid therapy for flare of RA between treatments did not significantly differ between groups. Further analysis of factors that may influence clinical response to lower dose RTX is ongoing, which could guide tailored therapy regimens should the need arise again.

Week 48 results of a phase 3 randomized controlled trial of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) vs dolutegravir 1 emtricitabine/tenofovir disoproxil fumarate (DTG 1 F/TDF) as initial treatment in HIV-1/HBV-coinfected adults (ALLIANCE)

Background/Aims: The clinical course of hepatitis B virus (HBV) infection in individuals with HIV-1 coinfection is marked by accelerated disease progression. A tenofovir-containing antiretroviral regimen is recommended in most people with HIV-1/HBV-coinfection, but there have not been randomized studies of tenofovir disoproxil fumarate (TDF) vs tenofovir alafenamide (TAF) in treatment- naive HIV-1/HBV-coinfected individuals. We report primary endpoint results from a Phase 3 study comparing bictegravir/emtricitabine/ TAF (B/F/TAF) vs dolutegravir + emtricitabine/TDF (DTG + F/TDF) at Week (W)48 in participants initiating treatment for both viruses. Method(s): Adults with HIV-1/HBV coinfection were randomized 1:1 to initiate blinded treatment with B/F/TAF or DTG + F/TDF (with placebo). Primary endpoints were the proportion of participants with HIV-1 RNA<50 copies/mL (FDA Snapshot) and plasma HBV DNA<29 IU/mL (missing = failure) at W48. Noninferiority was assessed with 95% CI (12% margin). Secondary and other endpoints included change from baseline cluster of differentiation 4 (CD4) count, proportion with hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) loss/seroconversion, and alanine transaminase (ALT) normalization (AASLD criteria). Result(s): Participants (N = 243) were randomized and treated (B/F/ TAF [n = 121], DTG + F/TDF [n = 122]) from 11 countries in Asia, Europe, North, and Latin America. Baseline characteristics were median age of 32 years, 4.5% female, 88% Asian, 30% HIV-1 RNA>100,000 c/mL, 40% CD4<200 cells/lL, median HBV DNA 8.1 log10 IU/mL, 78% HBeAg+. At W48, B/F/TAF was noninferior to DTG + F/TDF at achieving HIV-1 RNA<50 copies/mL (95% vs 91%, difference 4.1%;95% CI -2.5%-10.8%;P = 0.21), with mean CD4 gains of + 200 and + 175 cells/lL, respectively. B/F/TAF was superior to DTG + F/TDF at achieving HBV DNA<29 IU/mL (63% vs 43%, difference 16.6%;95% CI 5.9%-27.3%;P = 0.0023). Participants treated with B/F/TAF vs DTG + F/TDF had numerically higher HBsAg loss (13% vs 6%;P = 0.059), HBeAg loss (26% vs 14%;P = 0.055), HBeAg seroconversion (23% vs 11%;P = 0.031), and ALT normalization (73% vs 55%;P = 0.066). The most frequent adverse events among participants treated with B/F/TAF vs DTG + F/TDF were upper respiratory tract infection (17% vs 11%), COVID- 19 (13% vs 11%), pyrexia (9% vs 12%), ALT increase (7% vs 11%), and nasopharyngitis (11% vs 4%). ALT flares (elevations at >= 2 consecutive postbaseline visits) occurred in 11 participants (7 B/F/ TAF, 4 DTG + F/TDF), and all resolved. Conclusion(s): Among adults with HIV-1/HBV-coinfection starting antiviral therapy, both B/F/TAF and DTG + F/TDF had high HIV-1 suppression at year 1, with B/F/TAF resulting in superior HBV DNA suppression and significantly more HBeAg seroconversion. Safety findings were similar between groups.

Hydroxychloroquine for COVID-19: A Single Center, Retrospective Cohort Study

Introduction: The outbreak of coronavirus disease (COVID-19) in December 2019 called for a rapid solution, leading to repurposing of existing drugs. Due to its immunomodulatory effect and antiviral properties, hydroxychloroquine (HCQ) has been used in early 2020 for treatment of COVID-19 patients. This study was conducted to evaluate the treatment outcome of HCQ monotherapy in Malaysia. Methods: A retrospective cohort study was conducted in COVID-19 ward in Hospital Kuala Lumpur (HKL), from March to April 2020. A total of 446 COVID-19 patients were recruited, only 325 patients were finally included for analysis. Statistical analysis was done using SPSS, with a significant value set at p<0.05. Results: The mean age of the patients were 38.5 ±15.5. They were majority male, (n=210, 64.6%) Malaysian (n=239, 73.5%) and Malay ethnicity (n=204, 62.8%). Ninety-one (28%) patients received HCQ monotherapy. HCQ monotherapy was associated with worse outcome (OR: 10.29, 95% CI 1.17-90.80). There was a significant difference in mean length of stay between those with and without HCQ treatment (t323=5.868, p<0.001, 95% CI, 2.56-5.31). The average length of stay for HCQ treated group was 3.84 days longer than those without treatment. 6.6% of the patient receiving HCQ monotherapy encountered adverse drug effects. Conclusion: Similar to study reported worldwide, our study demonstrated that HCQ did not improve length of stay and the outcome of COVID-19 patients. © 2023 Authors. All rights reserved.

Non-Invasive Assessment of Lung Water Content Using Chest Patch RF sensors: A Computer Study Using NIH Patients CT Scan Database and AI Classification Algorithms

Chronic heart failure, pulmonary hypertension, acute respiratory distress syndrome (ARDS), coronavirus disease (COVID), and kidney failure are leading causes of death in the U.S. and across the globe. The cornerstone for managing these diseases is assessing patients’volume fluid status in lungs. Available methods for measuring fluid accumulation in lungs are either expensive and invasive, thus unsuitable for continuous monitoring, or inaccurate and unreliable. With the recent COVID-19 epidemic, the development of a non-invasive, affordable, and accurate method for assessing lung water content in patients became utmost priority for controlling these widespread respiratory related diseases. In this paper, we propose a novel approach for non-invasive assessment of lung water content in patients. The assessment includes quantitative baseline assessment of fluid accumulation in lungs (normal, moderate edema, edema), as well as continuous monitoring of changes in lung water content. The proposed method is based on using a pair of chest patch radio frequency (RF) sensors and measuring the scattering parameters (S-parameters) of a 915-MHz signal transmitted into the body. To conduct an extensive computational study and validate our results, we utilize a National Institute of Health (NIH) database of computerized tomography (CT) scans of lungs in a diverse population of patients. An automatic workflow is proposed to convert CT scan images to three-dimensional lung objects in High-Frequency Simulation Software and obtain the S-parameters of the lungs at different water levels. Then a personalized machine learning model is developed to assess lung water status based on patient attributes and S-parameter measurements. Decision trees are chosen as our models for the superior accuracy and interpretability. Important patient attributes are identified for lung water assessment. A “cluster-then-predict”approach is adopted, where we cluster the patients based on their ages and fat thickness and train a decision tree for each cluster, resulting in simpler and more interpretable decision trees with improved accuracy. The developed machine learning models achieve areas under the receiver operating characteristic curve of 0.719 and 0.756 for 115 male and 119 female patients, respectively. These results suggest that the proposed “Chest Patch”RF sensors and machine learning models present a promising approach for non-invasive monitoring of patients with respiratory diseases. Author

Monitoring COVID-19 Patients Using Cardio-Pulmonary Stethoscope RF Technology: Computer Simulation Study Using CT Scans of Patients

In 2020, the COVID-19 pandemic claimed 3 million lives worldwide in span of a year;the death toll is still on rise as of writing of this article. Hospitals around the globe overwhelmed with COVID-19 patients faced medical resource shortages preventing them from providing services to even severe cases, leaving patients to selfcare. The identified COVID-19 patients had to observe the symptoms escalation or take imaging tests such as CT scans to determine the disease progression. While these imaging methods provide detailed accounts of damage inflicted to lungs by COVID-19, they have their own limitations and risks. In this article, we use computer simulations to examine the possibility of using the Cardio-Pulmonary Stethoscope (CPS) to continually monitor the COVID-19 afflicted lungs. Using a CT scan of a real COVID-19 patient, an infection was introduced in the lungs of an anatomically correct digital human model to be studied using simulation method. The preliminary results of simulations showed that the least detectable size of infection was an ellipsoid of 0.9 cubic cm, and the CPS was most sensitive while detecting infection in the lungs without preexisting conditions like edema. Based on the results and resolution, signal sensitivity of the CPS to COVID-19 infection is established and it can be argued that CPS could be an alternative method for continuous monitoring of COVID-19 disease.

Changes in Adiposity as Measured by Modified BMI Z-scores Associated with the COVID-19 Pandemic Among Well Children and Adolescents Within a Large Urban Health System

Background: To control the spread of COVID-19 in NYC, a stay-at-home order was issued for March 22, 2020-June 13, 2020 followed by ongoing restrictions and only partial school reopening. The health impacts of these unprecedented restrictions on children are not yet known. Our objective was to examine whether BMI change during the COVID-19 period differed from the prior year among healthy children. Methods: This is a multicenter retrospective observational study of children aged five to eighteen years who received care within the NYC public hospital system between 2018 and 2020 encompassing all the five boroughs of the city. Using the system's electronic medical records, we identified patients who had a well-child visit between June 13, 2020 and December 31, 2020. Patients were included if they had annual well-child visits in the two previous years with anthropometric data recorded at all three visits. Patients with diagnoses that may affect adiposity (e.g. hypothyroidism) were excluded. We collected sociodemographic and anthropometric data for each year and calculated a modified body mass index z-score (mBMIz), which is a measure of relative BMI adjusted for age and sex. We compared change in mBMIz/month between the 2019 and 2020 visits (which included the pandemic) with the change in mBMIz/month between the 2018 and 2019 visits using generalized estimating equations (GEE). We examined whether the mBMIz/month change differed between the two periods and whether 2018 BMI category (underweight (5%), normal (5-85%), overweight (85-95%), obese (95-99%), extremely obese(>99%))modified this effect. Analyses were conducted using STATA software. Results: Of 23,458 patients seen between June 13, 2020 and December 31, 2020, 7,575 (32.3%) met our inclusion and exclusion criteria. The mean mBMIz was 0.68 in 2018, 0.69 in 2019 and 0.90 in 2020. (Table 1). In GEE analysis, the change in mBMIz/month was statistically significantly higher in 2019-2020 than in 2018-2019 (mean difference in mBMIz/month change=0.0152, p < 0.0001). While the change in mBMIz/month in 2019-2020 was lowest in patients in the extremely obese category, the difference in mBMIz/month between the two periods was greatest in this group (interaction effect of period and 2018 baseline category p < 0.0001). (Table 2). Conclusion: Our study suggests that the activity restrictions due to the COVID-19 outbreak are associated with greater excess weight gain in a diverse NYC population of healthy children as measured by mBMIz relative to the year prior to the outbreak. These findings correspond to the mean BMI percentile of our population changing from approximately 75th to the 82nd. These findings require further monitoring to better understand the specific reasons for the observed patterns across children in different BMI categories, assessment of longer-term health impact on this population and interventions to modify or reverse these worrisome trends. (Table Presented).

Do They Really Intend to Adopt E-Wallet? Prevalence Estimates for Government Support and Perceived Susceptibility

This study proposed a novel attempt to explain the effect of government support and individual’s perceived susceptibility to COVID-19 in adopting e-Wallet by integrating technology acceptance model (TAM) and health belief model (HBM). A total of 232 valid responses were collected through online survey. The hypotheses were analysed and validated by using the partial least square structural equation modelling (PLS-SEM) approach. The study found that the HBM construct, which is perceived susceptibility, was only mediated by perceived usefulness. Meanwhile, government support was fully mediated by both perceived usefulness and perceived ease of use. The FinTech practitioners should consider the ease of use and usefulness of e-Wallet in fulfilling the needs of the consumers. In addition, instead of subsidising the consumers, the Government should also focus on the public facilities such as the stable connectivity that allow the consumers to stay connected and trust on the connectivity for e-Wallet. This study adopted holistic and integrative modesl which are TAM and HBM to explain the intention to adopt e-Wallet services during COVID-19 pandemic. © 2022, Asia Business Research Corporation. All rights reserved.

RADIATION THERAPY OF ELDERLY PATIENTS WITH SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK - INSIGHTS FROM THE ANALYSIS OF THE BC CANCER REGISTRY 2007-2017

Purpose: The management of elderly patients with squamous cell carcinoma (HNSCC) of the head and neck presents unique challenges. We examined the radiation therapy (RT) management and outcomes of a large-scale registry population spanning 10 years. Materials and Methods: 1029 HNSCC patients (>70yo) treated with definitive RT from 2007-2017 were identified from the provincial registry. Patient characteristics were analyzed in relationship to hypofractionated (HF) and conventionally fractionated (CF) RT. KM analysis was carried out for overall survival (OS). Results: Two hundred sixty-four (26%) female and 765 (74%) male. Four hundred twenty-seven (41%) aged 70-74, 297(29%) 75-79, remainder >80. Stages: I (200(19%)), II (192(19%)), III (146(14%)), IV (366(36%)). ECOG: 0/1 (347(34%)), 2/3 (142(14%)), unknown 542(53%). Sites: oropharynx 379 (37%), larynx 366 (36%), oral cavity 230(22%), other 56(5%). Patients were more likely to be aged 70-74, have Stage IV disease, and present with laryngeal or oropharyngeal cancer (p<0.0001). 578(56%) and 451(44%) received HF and CF, respectively. Median RT dose was 6000cGy (range 200-7400). Median OS was 48 months for both HF and CF (p=0.9). A poorer performance status (two versus 0 (HR 2.095 (CI 1.5-2.9)), three versus 0 (HR 2.89 (CI 2-4.2)) (p<0.0001)), increasing age (80-84 (HR 1.5 (CI 1.2-1.9)), 85-89 (HR 1.7 (CI 1.2-2.4)), 90-94 (HR 2.7 (CI 1.8-4.2)) (p<0.0001)), advanced stage (Stage II HR 1.4 (CI 1.1-1.9) (p=0.0064), Stage III HR 1.6 (CI 1.2-2.2) (p=0.0011), Stage IV HR 2.5 (CI 1.9-3.3) (p<0.0001)), and oral cavity (HR 1.5 (CI 1.31.9) (p<0.0001)) were prognostic for increased risk of death. HF versus CF was not statistically significant for a difference in OS. Conclusions: There was no difference in OS between HF and CF RT in elderly patients with HNSCC. HF regimens are a feasible RT option that reduces the number and frequency of hospital visits and the total treatment duration, which is of particular interest during the COVID-19 pandemic.

Motivation Factors Driving Travel Intention in the Controlled Pandemic Context: Perspectives from Malaysian and Taiwanese Travellers

Travelling is considered one of the best ways to escape one’s day-to-day routine activities. Tourists’ travel is driven by several motivational factors, which lead them to plan or continue on a travel trip. However, since the emergence of COVID-19, travelling has become a major issue for the whole travel industry. The recent spread of Omicron makes most post-pandemic studies futile. Therefore, the purpose of this study was to examine the influence of motivation factors that affect tourists’ travel intention in the controlled pandemic context. The mediating role of perceived value and the moderating role of perceived travel risk were examined as well. The Stimulus-Organism-Response (S-O-R) theory was adopted as the theoretical foundation of the research framework. A quantitative online survey was used to collect data from 388 Malaysian and Taiwanese travelers. Partial least squares structural equation modelling (PLS-SEM) was employed to analyse the data. The results show that escape, kinship, and people are direct and indirect motivation factors that influence tourists’ intention to travel via perceived value. Notably travel risk indicated no moderating effect. The results of this study provide useful insights into tourists’ post-pandemic behaviour that offer practical implications for Asian business. © 2021, Asia Business Research Corporation. All rights reserved.

Radiation Therapy in Elderly Patients With Squamous Cell Carcinoma of the Head and Neck — Insights From Real World Registry DATA (2007-2017)

Purpose/Objective(s): The management of elderly patients with squamous cell carcinoma (HNSCC) of the head and neck presents unique challenges. We examined the radiation therapy (RT) management and outcomes of a large-scale registry population spanning 10 years. We hypothesize that there is no significant difference in the overall survival (OS) of elderly patients with HNSCC who received conventionally fractionated (CF) RT compared to hypofractionated (HF) RT. Materials/Methods: 1029 HNSCC patients (> 70 yo) treated with definitive RT from 2007-2017 were identified from the provincial registry. Patient characteristics were analyzed in relationship to HF and CF RT. KM analysis was carried out for OS. Results: 264 (26%) and 765 (74%) were female and male, respectively. 427 (41%) were 70-74 yo, 297 (29%) were 75-79, and the remainder were > 80 yo. Stages included were: I (200 (19%)), II (192 (19%)), III (146 (14%)), IV (366 (36%)). ECOG were: 0/1 (347 (34%)), 2/3 (142 (14%)), unknown 542 (53%). Sites were: oropharynx 379 (37%), larynx 366 (36%), oral cavity 230 (22%), other 56 (5%). Patients were more likely to be aged 70-74, have stage IV disease, and present with laryngeal or oropharyngeal cancer (P < 0.0001). 578 (56%) and 451 (44%) received HF and CF, respectively. Median RT dose was 6000 cGy (range 200-7400). Median OS was 48 months for both HF and CF (P = 0.9). A poorer performance status (2 vs 0 (HR 2.095 (CI 1.5-2.9)), 3 vs 0 (HR 2.89 (CI 2-4.2)) (P < 0.0001)), increasing age (80-84 (HR 1.5 (CI 1.2-1.9)), 85-89 (HR 1.7 (CI 1.2-2.4)), 90-94 (HR 2.7 (CI 1.8-4.2)) (P < 0.0001)), advanced stage (Stage II HR 1.4 (CI 1.1-1.9) (P = 0.0064), Stage III HR 1.6 (CI 1.2-2.2) (P = 0.0011), Stage IV HR 2.5 (CI 1.9-3.3) (P < 0.0001)), and oral cavity (HR 1.5 (CI 1.3-1.9) (P < 0.0001)) were prognostic for increased risk of death. HF vs CF was not statistically significant for a difference in OS. Conclusion: There was no significant difference in OS between HF and CF RT in elderly patients with HNSCC. Real world data suggests that HF regimens are a feasible RT option that reduces the number and frequency of hospital visits and the total treatment duration, which is of particular interest during the COVID-19 pandemic.