VASCULITIS DISEASE ACTIVITY SCORES BEFORE AND DURING THE COVID-19 PANDEMIC: A COMPARISON OF FACE-TO-FACE CLINICIAN SCORING AND PROMS COLLECTED USING REMOTE MONITORING IN A SINGLE-CENTRE COHORT

BackgroundDuring the COVID-19 pandemic, asynchronous consultations were introduced for patients with vasculitis. To assess disease activity without of face-to-face clinical reviews and blood testing, patients submitted patient reported outcome measures (PROMs) via electronic survey forms, which were subsequently triaged by clinicians.Objectives1. To investigate how patients' vasculitis disease activity was affected by the COVID-19 pandemic through retrospective comparison of clinician-assessed scores recorded pre-pandemic with intra-pandemic self-reported patient reported outcome measures (PROMs) and disease scores submitted by patients remotely.2. To assess patients' clinical outcomes, including allocation of follow-up and further management/treatment escalation during this period.3. To validate self-reported BVAS scores against an existing PROM.MethodsThis is a retrospectively study of patients with a known diagnosis of vasculitis under the care of the Nuffield Orthopaedic Centre, Oxford. For the purposes of this study, we included patients with all vasculitis diagnoses.Clinician-reported scores (Bristol Vasculitis Activity score v.3, BVAS) were recorded during in-person clinics pre-pandemic (defined as 01/01/2019-31/12/2019) [1].Patients' self-reported BVAS (SR-BVAS) and AAV-PRO (ANCA-associated vasculitis patient-reported outcomes) scores were submitted by patients via electronic forms containing the requisite questionnaires sent out during-pandemic (defined as 01/12/2020-31/03/22) [2].SR-BVAS has not been validated but was collected to allow clinical comparison to disease activity scores completed by clinicians. Response were stored and analysed in a secure database. Score comparison was performed using Wilcoxon Sign Rank testing. Clinical outcome data was collected from the local Electronic Patient Record. Data analysis was performed in Microsoft Excel and R (version 4.2.1).ResultsWe noted a significantly higher overall level of patient-reported disease activity during the pandemic than was recorded in clinics prior. In the total cohort of all vasculitis patients for whom we had data, the median BVAS increased from 2 pre-pandemic (N = 335, range 0-21) to 6 intra-pandemic (N = 143, range 0-42) (p <0.001). The overall proportion of patients with severe/active disease (defined as BVAS ≥4) increased from 27% to 36% during the pandemic period.In a smaller cohort of 64 patients for whom we had paired pre- and during-pandemic scores, increased disease activity was reported (p<0.01). Notably, the number with a BVAS consistent with severe disease increased from 7 (11%) to 19 (30%).There was a significant positive correlation between SR-BVAS and AAV-PRO (r=0.61, p< 0.001) submitted by patients during-pandemic;however, at low BVAS (≤3), the AAV-PRO ranged widely (28-87)Follow-up data was available for all 64 patients in this cohort: 8/19 (42%) with a during-pandemic SR-BVAS ≥4 were seen in clinic within 3 months (telemedicine or face-to-face).ConclusionPatients reported worsening of vasculitis disease activity during the COVID-19 pandemic. This may be attributable to impacts on well-being or access to healthcare services. We note that disease activity scores in vasculitis may be limited in their ability to capture the whole picture disease activity in the absence of clinical assessment [3]. 42% of patients with self-reported high disease activity were seen within 3 months. There was a significant positive correlation between AAV-PRO and SR-BVAS, suggesting it has some use as a PROM.References[1]Mukhtyar C, Lee R, Brown D, Carruthers D, Dasgupta B, Dubey S, et al.. Ann Rheum Dis. 2009 Dec;68(12):1827–32.[2]Malley T, Jackman J, Manderson S, Saldana Pena L, Evans E, Barrett J, et al. Ann Rheum Dis. 2021 Jun 1;80(Suppl 1):289.[3]Luqmani RA. Nephrology Dialysis Transplantation. 2015 Apr 1;30(suppl_1):i76–82.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Comparing Ankylosing Spondylitis Disease Activity during the Covid-19 Pandemic Using Patient-Reported Outcome Measures with Face-Toface Clinical Evaluation of Disease Scores Prepandemic

Background/Aims During the COVID-19 pandemic, asynchronous consultations were introduced for patients with ankylosing spondylitis (AS). To assess disease activity in the absence of face-to-face clinical review and blood testing, patients submitted patient-reported outcome measures (PROMs) via electronic survey forms which were subsequently triaged by clinicians. We compared pre-pandemic clinician-reported scores with intra-pandemic self-reported scores and assessed clinical outcomes including allocation of follow-up and further management/ treatment escalation. Methods Clinician-reported scores were obtained in-person pre-pandemic (defined as 01/01/2019-01/03/2020). Self-reported BASDAI scores were submitted by patients via electronic forms sent out duringpandemic (defined as 01/12/2020-31/03/22). The responses were stored and analysed in a secure database. These scores are analogous to disease activity scores completed by clinicians during outpatient appointments. Score comparison was performed using Wilcoxon Sign Rank testing. We used the need for a follow-up within 3 months as target for those with severe disease. Data analysis was performed in Microsoft Excel and R (version 4.2.1). Results We noted a significantly higher overall level of patient-reported disease activity during the pandemic. In the total cohort of AS patients, the median BASDAI Score collected during-pandemic increased from 5.30 (n=124, range 0-10) compared to 2.80 pre-pandemic (n=590, range 0-12) (p<0.001). The proportion of patients with severe/active disease (defined as BASDAI >4) increased from 36% pre- to 65% during pandemic. In a smaller cohort of 34 patients for whom we had both pre- and during-pandemic scores, all patient parameters worsened during the pandemic. Notably, median BASDAI increased from 2.65 to 5.62 (p<0.0001). Patients with severe AS increased from 10 (29.4%) to 21 (61.8%) intra-pandemic. Follow-up data was available for 12/21 patients with severe AS during-pandemic. 7/12 patients (58%) received a follow-up appointment within one month;11/12 (91%) were seen within three months. On subsequent clinician assessment, only 7 (58%) of patients with self-reported severe AS were felt to have active disease;treatment was escalated for 3 patients. Conclusion There was a significantly higher reported level of AS disease activity during the COVID-19 pandemic, with 62 % of patients qualifying for biologic therapy (BASDAI >4). In a focussed sample, 91% of patients with new severe disease during-pandemic were followed up within the target of 3 months. The BASDAI score is independent from clinical examination and inflammatory markers, and therefore self-reported score should reliably reflect a patient's perception of disease activity. Further work is required to determine the reason for the increased disease activity observed during pandemic, and for the disparity between clinician impression and score results.

Evaluating the Use of Patient Reported Outcome Measures to Assess Intra-Pandemic Psoriatic Arthritis Disease Activity and Comparing Them with Pre-Pandemic Clinical Assessments

Background/Aims In our department, patient reported outcome measures (PROMs), including RAPID-3 and PSAID12, were employed during the COVID-19 pandemic in asynchronous consultations for patients with psoriatic arthritis (PsA). We compared pre-pandemic DAS28-CRP with intrapandemic PROMs to assess changes in disease activity since the pandemic. Whilst previous studies have primarily compared PsA PROMs with clinician-assessed scores (e.g. PASDAS), we compare PsA PROMs with clinicians' overall assessment of disease activity;this judgement considers PROMs, serology studies and individual patient feedback. Finally, we assess whether patients with PROMs indicating active disease were followed up appropriately. Methods Clinician-assessed scores were collected between 01/01/2019-01/03/ 2020 (''pre-pandemic''). Between 01/12/2020-31/03/2022 (''intrapandemic''), patient data from electronic surveys were analysed in a secure database for calculation of PROMs. These data, alongside blood results and patient comments, informed clinicians' triage decisions. Clinical outcome data were collected from electronic patient records;>=3 months follow-up appointment allocation was the target for patients with active disease (moderate/high disease activity). Data analysis was performed using r (version 4.2.2). Results In our pre-pandemic cohort (n=393), 79.8% of patients were in remission (per DAS28-CRP). Conversely, the intra-pandemic cohort (n=231) showed remission rates of 14.3% (per PSAID12) and 0% (RAPID-3). Indeed, 33.7% (based on PSAID12) vs 75.8% (RAPID-3) had moderate/ high disease activity. These results were validated in a paired cohort (n=38, score recorded in both windows). Disease activity worsened during the pandemic for 63.2% (PSAID12) and 97.4% (RAPID-3) of patients. PSAID-12 correlated positively with RAPID-3 (r=0.52, p<0.001), especially when RAPID-3 >=6.5 (r=0.75, p<0.001). When comparing PROMs with clinicians' assessment of PsA activity in our paired cohort, PSAID12 and RAPID-3 accurately reflected disease status in 70.6% and 58.8% of patients respectively. 3/9 and 9/27 patients with active disease, based on PSAID12 and RAPID-3 respectively, were seen within three months. Conversely, 7/10 patients who clinicians had deemed to have active disease were seen within three months. Conclusion Despite approximately 80% of patients being in pre-pandemic remission, the majority reported active intra-pandemic PsA. Whilst RAPID-3 skewed patients towards active disease, PSAID12 skewed patients towards remission/low disease activity. PSAID-12 and RAPID- 3 have been previously correlated;however, here we suggest that they could be used interchangeably in patients with high disease activity. PSAID-12 was a better predictor of clinicians' assessment of disease activity, although neither PROM correlated well with >=3 months followup appointment allocation. Although RAPID-3 and PSAID12 helped inform clinicians' decisions, neither alone sufficiently reflects patients' disease states. Remote management is practicable, but future studies should validate these findings across a larger cohort and assess the utility of different PROMs across PsA disease activity categories. Furthermore, multivariate analysis is warranted to ascertain which (combination of) variable(s) (e.g., PROMs, serology results, tender/ swollen joint count) best correlates with clinician judgement.

Classification and Prediction of Significant Cyber Incidents (SCI) using Data Mining and Machine Learning (DM-ML)

The rapid growth in technology and several IoT devices make cyberspace unsecure and eventually lead to Significant Cyber Incidents (SCI). Cyber Security is a technique that protects systems over the internet from SCI. Data Mining and Machine Learning (DM-ML) play an important role in Cyber Security in the prediction, prevention, and detection of SCI. This study sheds light on the importance of Cyber Security as well as the impact of COVID-19 on cyber security. The dataset (SCI as per the report of the Center for Strategic and International Studies (CSIS)) is divided into two subsets (pre-pandemic SCI and post-pandemic SCI). Data Mining (DM) techniques are used for feature extraction and well know ML classifiers such as Naïve Bayes (NB), Support Vector Machine (SVM), Logistic Regression (LR) and Random Forest (RF) for classification. A centralized classifier approach is used to maintain a single centralized dataset by taking inputs from six continents of the world. The results of the pre-pandemic and post-pandemic datasets are compared and finally conclude this paper with better accuracy and the prediction of which type of SCI can occur in which part of the world. It is concluded that SVM and RF are much better classifiers than others and Asia is predicted to be the most affected continent by SCI. Author

Epidemiology of Asthma in Patients with COVID-19: Investigation of Respiratory Allergy as a Risk Factor for COVID-19 Severity

Background: The outcome of coronavirus disease 2019 (COVID-19) is complicated by various comorbidities;asthma, a common chronic disease, may be considered one of these conditions. This study aimed to investigate the effect of asthma as a potential comorbid condition on the COVID-19 prognosis. Material(s) and Method(s): This retrospective study included all RT-PCR confirmed COVID-19 cases recorded on the Shiraz health department's electronic database from January to May 2020. A questionnaire was designed to collect information about patients' demographics, their history of asthma and other comorbidities, and the severity of COVID-19 by contacting them by phone. Result(s): Of 3163 COVID-19 patients, 109 (3.4%) had self-reported asthma with a mean age of 42.7 +/- 19.1 years. Most patients (98%) had mild-to-moderate asthma, while 2% had severe disease. Among asthmatic patients, fourteen (12.8%) were admitted to the hospital, and five (4.6%) died. Univariate logistic regression results showed that asthma had no significant effect on hospitalization (OR 0.95, 95% CI: 0.54-1.63) and mortality (OR 1.18, 95% CI: 0.48-2.94) in patients with COVID-19. Compared living and deceased patients with COVID-19, the pooled OR was 18.2 (95% CI: 7.3-40.1) for cancer, 13.5 (95% CI: 8.2-22.5) for age 40-70 years, 3.1 (95% CI: 2-4.8) for hypertension, 3.1 (95% CI: 1.8-5.3) for cardiac disease and 2.1 (95% CI: 1.3-3.5) for diabetes mellitus. Conclusion(s): This study showed that asthma is not associated with an increased risk of hospitalization and mortality in patients with COVID-19. Further studies are needed to investigate the risk of different asthma phenotypes on the severity of COVID-19 disease.Copyright © 2022 NRITLD,.

Outbreaks of SARS-CoV-2 Infections in Nursing Homes during Periods of Delta and Omicron Predominance, United States, July 2021-March 2022.

SARS-CoV-2 infections among vaccinated nursing home residents increased after the Omicron variant emerged. Data on booster dose effectiveness in this population are limited. During July 2021-March 2022, nursing home outbreaks in 11 US jurisdictions involving >3 infections within 14 days among residents who had received at least the primary COVID-19 vaccine(s) were monitored. Among 2,188 nursing homes, 1,247 outbreaks were reported in the periods of Delta (n = 356, 29%), mixed Delta/Omicron (n = 354, 28%), and Omicron (n = 536, 43%) predominance. During the Omicron-predominant period, the risk for infection within 14 days of an outbreak start was lower among boosted residents than among residents who had received the primary vaccine series alone (risk ratio [RR] 0.25, 95% CI 0.19-0.33). Once infected, boosted residents were at lower risk for all-cause hospitalization (RR 0.48, 95% CI 0.40-0.49) and death (RR 0.45, 95% CI 0.34-0.59) than primary vaccine-only residents.

Gender-based incidence, recovery period, and mortality rate of COVID-19 among the population of district Attock, Pakistan.

COVID-19 is reported as an extremely contagious disease with common symptoms of fever, dry cough, sore throat, and tiredness. The published literature on incidence and gender-wise prevalence of COVID-19 is scarce in Pakistan. Therefore, the present study was designed to compare the distribution, incubation period and mortality rate of COVID-19 among the male and female population of district Attock. The data were collected between 01 April 2020 and 07 December 2020 from the population of district Attock, Pakistan. A total of 22,962 individuals were screened and 843 were found positive for RT-qPCR for SARS-CoV-2. The confirmed positive cases were monitored carefully. Among the positive cases, the incidence of COVID-19 was 61.7% among males and 38.2% among females. The average recovery period of males was 18.89±7.75 days and females were 19±8.40 days from SARS-CoV-2. The overall mortality rate was 8.06%. The death rate of male patients was significantly higher (P<0.05) compared to female patients. Also, the mortality rate was higher (P<0.05) in male patients of 40-60 years of age compared to female patients of the same age group. Moreover, the mortality rate significantly increased (P<0.05) with the increase of age irrespective of gender. In conclusion, the incidence and mortality rate of COVID-19 is higher in males compared to the female population. Moreover, irrespective of gender the mortality rate was significantly lower among patients aged <40 years.

A Highly Effective ID Physician and Infection Preventionist-led Interactive Webinar Series for Infection Prevention and Control Training Among Frontline Healthcare Workers

Background. Nebraska Infection Control Assessment and Promotion Program (ICAP) is funded by Nebraska Department of Health and Human Services through Centers for Disease Control and Prevention (CDC) grants to support Infection Prevention and Control (IPC) activities in the state. In early 2022, ICAP launched COVID-19-specific basic infection prevention and control (IPC) training to frontline healthcare providers (HCPs) through a discussion-based webinar series using curricular materials created by the CDC Project Firstline. Here, we report pre- and posttraining survey responses demonstrating improvement in participants' perceived knowledge across a number of IPC domains. Methods. Training was completed over a 14-week period via a weekly, interactive 30-minute webinars with a new topic covered each week. A survey was administered to participants prior to the webinar series and at the conclusion of training to assess effectiveness. The pre-survey evaluated HCP confidence in their knowledge of each of the 14 topics to be covered in the course. The post-survey evaluated both confidence and perceived value in each of the training topics. Results. Prior to the training series, a mean 40.3% of participants judge themselves 'very confident' in IPC topics, versus 52.7% 'somewhat confident' and 7.1% 'not confident' (figure 1);by the end of the training, these levels had improved to 85.4%, 14.3%, and 0.4%, respectively (figure 2). The largest gains in the category 'very confident' concerned 'source control' (+65%) and 'COVID-19 variants' (+63%). A majority of participants perceived each topic covered in the series to be 'very valuable' (figure 3);98% of participants indicated interest in a future IPC training series and 95% indicated that they would recommend the training series to a colleague. Conclusion. This survey data suggests that a discussion-based webinar using CDC Project Firstline materials is highly effective at conveying fundamental concepts in infection control to frontline HCPs. Moreover, HCPs rated themselves as likely to return, suggesting this format is a promising modality for simple and widespread dissemination of IPC training.

Development of functional cotton fabric by simultaneous dyeing and finishing with a novel bioactive reactive dye

Bioactive textiles garnered considerable attention during the COVID-19 pandemic owing to their antimicrobial properties. However, the fabrication and utilization of bioactive textiles have had a toxic impact on the environment due to the leaching of bioactive agents during laundering. In this study, a novel functional bioactive reactive dye was synthesized using an antibacterial agent covalently linked to a triazine reactive group for the simultaneous dyeing and finishing of cotton fabric. The molecular structure of the synthesized dye was characterized using FTIR, H-1-NMR, C-13-NMR, MS, and UV-vis spectroscopy. The dye was applied to the cotton fabric using the exhaust dyeing method. The antibacterial efficacy of the powder dye and dyed fabric against Staphylococcus aureus and Escherichia coli was estimated according to standard test protocols. The color strength (K/S), colorimetric data (L*, a*, b*, C*, H*) measurement, ultraviolet protection, and colorfastness properties of the dyed fabric were also evaluated. The synthesized powder dye revealed an outstanding antibacterial activity and killed 99.99% of bacteria (E. coli and S. aureus). The dyed fabric showed excellent antibacterial activity before washing as well as after 20 industrial laundry cycles and showed that there was no significant reduction in antibacterial activity, establishing non-leaching of the antibacterial agent into the environment. The dyed fabrics before and after washing showed excellent ultraviolet protection values (>50), better dye fixation, and fastness properties. The current study has established a sustainable process to develop bioactive textiles that do not leach bioactive agent into the environment.

Prevalence and predictors of respiratory symptoms in Karachi, Pakistan

Objective: To determine the trends of respiratory symptoms and identify their predictive factors. Methodology: This cross-sectional study was conducted in Karachi in 2020. The sample size was calculated to be 354, with a prevalence of respiratory diseases of 35% at a 95% confidence interval and a 5% of non-response rate. An online survey included a designed questionnaire keeping the recall period before the COVID-19. Statistical analysis was conducted through SPSS 20. Result(s): Out of 354 respondents, 63 (18%) reported suffering from chronic respiratory symptoms. The key predictors indicate that smokers were twice at risk of developing chronic symptoms compared to non-smokers;females were 0.4 times more likely to develop respiratory symptoms than males. Wearing a mask is protective and prevents the development of respiratory symptoms. Those participants who reported flu were twice likely to suffer from chronic respiratory symptoms. The allergic problems and difficulty breathing were relatively more common, especially among females and young adults. Conclusion(s): This study established a significant prediction of respiratory symptoms with demographic and behavioral characteristics. However, more research is needed to identify the risk factors for respiratory symptoms. Copyright © 2022, Pakistan Medical Association. All rights reserved.

Endothelial Monocyte-Activating Polypeptide-II Is an Indicator of Severity and Mortality in COVID-19 Patients.

Data for predicting the severity and mortality of coronavirus disease 2019 (COVID-19) are limited, and investigations are ongoing. Endothelial monocyte-activating protein II (EMAP-II) is a multifunctional polypeptide with pro-inflammatory properties. EMAP-II is a significant pathogenic component in chronic inflammatory lung diseases and lung injury. In this study, we aimed to assess the potential utility of EMAP-II as a predictor of COVID-19 severity and mortality. This study included 20 healthy volunteers and 60 verified COVID-19 patients. Nasopharyngeal samples from COVID-19-positive subjects and normal volunteers were collected at admission. The nasopharyngeal samples were subjected to EMAP-II real-time polymerase chain reaction (RT-PCR). EMAP-II RNA was not detected in nasopharyngeal swabs of normal controls and mild to asymptomatic COVID-19 patients and was only detectable in severe COVID-19 patients. EMAP-II critical threshold (Ct) was positively associated with lymphocyte percentages and oxygen saturation (p < 0.001) while being negatively associated with age (p = 0.041), serum CRP, ferritin, and D-dimer levels (p < 0.001). EMAP-II Ct cutoff ≤34 predicted a worse outcome in COVID-19 illness, with a sensitivity and specificity of 100%. Our study suggests that EMAP-II could be considered a potential biomarker of COVID-19 severity. EMAP-II can predict the fatal outcome in COVID-19 patients.

Identifying Factors Influencing Recreational Travel during the COVID-19 Pandemic

This study aims to identify the psychological constructs that are antecedents to people's intention to travel to a tourist destination during the COVID-19 pandemic using the extended theory of planned behavior (ETPB) and necessary condition analysis (NCA). Online survey responses collected from 1,259 participants in the United States in May-June 2021 are used for the study. We find a moderating effect of public trust towards the government on the relationship between travel concerns and intentions. Results suggest that certain levels of public trust, subjective norm, perceived benefit of travel, perceived behavioral control, and perceived knowledge of the pandemic are necessary to manifest travel intentions. We uncover that providing travel incentives and better dissemination of the pandemic-related information can potentially encourage people to regain their original travel intention that was lost due to the pandemic. Furthermore, the bottlenecks obtained using NCA show that travel intentions are more easily manifested by perceived knowledge of the pandemic versus others. This study demonstrates the application of NCA, which can be further extended to make policy-level decisions for transportation systems. © 2022 American Society of Civil Engineers.

Estimation of emerging diagnostic parameters for Coronavirus Disease 2019 patients severity and fatality.

OBJECTIVE: To identify various emerging diagnostics parameters of coronavirus disease 2019 related to disease progression and fatality. METHODS: The cross-sectional study was conducted at Mardan Medical Complex, Khyber Pakhtunkhwah, Pakistan, from February 9, 2021, to April 21, 2021, and comprised patients of either gender aged >18 years diagnosed with coronavirus disease 2019 on the basis of polymerase chain reaction testing and who were admitted to the hospital using the World Health Organisation interim guidelines. Disease progression was categorised as mild, moderate, severe and critical, and they were monitored closely till the final outcome. Data was analysed using SPSS 26. RESULTS: Of the 408 patients, 215(52.69%) were male and 193(47.30%) were female. The overall median age of the sample was 55 years (interquartile range: 18-84 years). Symptoms included cough 92(22.54%), fever 80(19.60%), shortness of breath 78(19.60%), fatigue 60(14.70%) and loss of smell and test 52(12.74%), while 46(11.27%) were asymptomatic. Azithromycin was the most used drug 304(74.50%), while antiviral Remdesivir was given to 279(68.38%) patients and hydrocortisone to 143(35.04%). Plasma treatment was given to 55(13.48%) patients and mechanical ventilation to 87(21.32%). Compared to baseline, disease progression was mild in 72(17.64%) patients, moderate 96(23.52%), severe 98(24.01%) and critical in 89(21.81%), while no change was seen 53(12.99%) cases. Severity level was significantly associated with liver and renal function parameters (p<0.05). Overall, 47(11.51%) patients died. CONCLUSIONS: Different severity levels during hospitalisation among patients of coronavirus disease 2019 were noted, and severity level was significantly associated with liver and renal function parameters.

COVID-19 diversity: A case of multisystem inflammatory syndrome in children masquerading as juvenile systemic lupus erythematosus.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may present with some systemic lupus erythematosus (SLE) manifestations intermingled with Kawasaki disease features. These emerging presentations were dubbed under the umbrella term 'multisystem inflammatory syndrome in children (MIS-C)'. A one and half-year-old girl, admitted to Mansoura University Children's Hospital (MUCH) with fever, bad general condition, vomiting, widespread maculopapular, vasculitic rash, hands and feet oedema, oral ulceration, arthralgia and lymphadenopathy. Moreover, bicytopenia, positive antinuclear, anti-double-stranded DNA antibodies and low C3 qualified her as a case of juvenile SLE. Despite the child received the initial therapy of immunosuppressive medication, her general condition deteriorated with fever persistence and rash exacerbation. At that time, the skin of her hands and feet started to peel. Thus, an expanded study for other alternatives was obligatory; SARS-CoV-2 infection testing revealed positive IgG serology, and retesting for lupus autoantibodies turned negative. HRCT chest showed bilateral basal consolidation with ground-glass appearance. Furthermore, Echo exhibited coronary artery dilation with thrombus inside. This evolution raised the concern for COVID-related MIS-C syndrome. This report provides a model of COVID-19 heterogeneity with protean immune-related manifestations. This case has a unique presentation that necessities its description, in order to provide a nidus for future studies in this new entity.

Community Engagement in the Telehealth Service for Aged People with Diabetes: Covid-19 Response in Bangladesh

PURPOSE: The purpose of this study is to present a better understanding of the specialized telehealth service in Bangladesh from the service provider and service recipients by aged people METHOD: Both quantitative and qualitative methods were used to collect data from Diabetes Mellitus (DM) patients. Data were collected by online telephone interviewing with an interview schedule. A total of 100 aged people with diabetes were selected purposively for a quantitative interview and 10 In-depth Interviews (IDIs) & Key Informant Interviews (KIIs) were conducted. RESULT: The majority of patients aged was between 61 to 68 years with a mean age of 63.6 +/- 7.01years. The difference of age of DM patients by sex was found statistically significant (x2 = 39.49, df = 31;Cramer's V = .032;P=<.003). The main source of information about digital health was: relatives (55%), neighbors (31%), television (12%), newspaper (10%), social media (9%), and healthcare providers (6%). Strong relationship was found between age of respondents and sources of information (x2= 77.08;Cramer's V= .032, df = 13;Sig;P= < .009). About 59% of DM patients were benefited from telehealth services during COVID-19, however;they encountered some difficulties like effective access to digital technology, cost, and diagnosis facilities. About 83% of respondents suggest formalizing community engagement programs to extend the digital health services during a health emergency. The common barriers to the engagement of community people in digital health care are lack of social awareness, lack of peer group support, and gender disparities. Poor counseling, language barrier, bad internet signal, and lack of family members' support were the key barriers during teleconsultation services. CONCLUSION: Telehealth has the potential to address critical health issues of aged people and effective community engagement may be the best option to reach older people with diabetes in Bangladesh during any health emergency.

EVALUATING HOW EFFECTIVELY PATIENTS with A NEW INFLAMMATORY ARTHRITIS ARE BEING TRIAGED into the APPROPRIATE CLINIC at A TERTIARY CARE HOSPITAL in the UK: A RETROSPECTIVE AUDIT

Background: Infammatory arthritis is associated with signifcant morbidity and costs to the NHS, social care, and wider economy. Early diagnosis and treatment are essential to reduce the impact of the disease. Therefore, it is important that referrals for a new infammatory arthritis are appropriately triaged to be seen in the early infammatory arthritis (EIA) clinic so that they can be seen and started on disease modifying anti-rheumatoid drugs (DMARDs) without delay. The British Society of Rheumatology guidance for infammatory arthritis states that patients must be seen within three weeks of referral and started on DMARDs within six weeks. Objectives: To evaluate how effectively people referred with a new EIA are currently being triaged. To evaluate whether we are meeting the national standards. Methods: We performed a retrospective review of the medical notes of all new patients who were seen in the EIA clinic from 01/09/21-31/11/21. During this same time period, we will also reviewed all the patients who had been newly diagnosed and started on a DMARD in the other Rheumatology clinics (e.g., general rheumatology, vasculitis). We collected data on referral date, referral source (e.g., GP), date of clinic assessment, clinic type (e.g., EIA clinic or other Rheumatology clinic), diagnoses made, days' wait from referral to assessment and days' wait from referral to commencing DMARD. We then calculated the conversion rate (percentage of referrals triaged to the EIA clinic that have an EIA) and detection rate (percentage of new EIA patients that are seen in the EIA clinic (as opposed to in non-urgent clinics)). The standard for conversation rate (CR) was 50% and for detection rate (DR) was 95%. Results: Of all the patients seen in the EIA clinic (n=73), 36 had a new diagnosis of an EIA, giving a CR of 49%. Of all the new diagnoses of EIA made during that time-period (n=53), 36 were appropriately triaged to be seen in the EIA clinic, giving a detection rate 68%. Those new referrals who had been appropriately seen in the EIA clinic had an average of 5 weeks wait from referral to assessment/commencement of DMARD. In contrast, those new referrals who had been seen in other clinics had an average of 10 weeks from referral to assessment/commencement of DMARD. A previous audit performed before the COVID-19 pandemic (01/11/19-01/01/20) showed a CR of 25% (115 patients seen in EIA clinic, 29 new diagnoses) and a DR of 69% (29 new diagnoses, 20 seen in EIA clinic). Conclusion: Those patients with a new EIA who are appropriately seen in the EIA clinic do not meet the national guidance for being seen within three weeks of referral but do meet the guidance for starting a DMARD withing six weeks. However, those new EIA who are seen outside the EIA clinic do not meet either of these standards, with a delay of 10 weeks to be seen/started on a DMARD. Given that only 68% of people with a new EIA are being correctly triaged to be seen in the EIA clinics, it highlights that there is a need for an improvement in the triage process (currently being done manually by Rheu-matologists). Interestingly, when comparing our findings to the audit done pre-COVID-19 pandemic, the CR has improved whilst the DR has stayed steady. The next steps include exploring using additional data collected from patients electronically to improve the CR/DR rates, as well as artificial intelligence informed modelling.

Social Media Networking Sites Usage and Depression Among University Students During the COVID-19 Pandemic: The Mediating Roles of Social Anxiety and Loneliness

The current COVID-19 pandemic has resulted in increased psychological issues such as excessive social media networking sites usage (SMNSU), loneliness, social anxiety, and depression. In this quantitative study, we examined how SMNSU can directly and indirectly influence depression, with loneliness and social anxiety examined as mediator variables. A 39-item questionnaire was used to collect survey data on SMNSU, loneliness, social anxiety, and depression from 244 blended learning undergraduate students from universities in the Hunan province in China. Partial least squares structural equation modeling was conducted using SmartPLS 3.3.3 to measure the relationships between the stated variables of interest. Results indicated that SMNSU has a direct, significant, and positive relationship with depression. In terms of mediating effects, both loneliness and social anxiety have an intervening role in the association between SMNSU and depression. This study focused on the higher education sector of China by recruiting students who were enrolled in blended learning courses during the COVID-19 pandemic and experiencing psychological problems. We found that excessive SMNSU is associated with depression. Loneliness and social anxiety also increase depression along with excessive SMNSU among blended learning students during unprecedented situations, in this case, the COVID-19 pandemic. The valuable implications of these findings for teachers, counselors, and university managers are discussed, along with a consideration of future research directions.

Effectiveness of BBIBP-CorV vaccine against severe outcomes of COVID-19 in Abu Dhabi, United Arab Emirates.

The effectiveness of the inactivated BBIBP-CorV vaccine against severe COVID-19 outcomes (hospitalization, critical care admission and death due to COVID-19) and its long-term effectiveness have not been well characterized among the general population. We conducted a retrospective cohort study using electronic health records of 3,147,869 adults, of which 1,099,886 vaccinated individuals were matched, in a 1:1 ratio to 1,099,886 unvaccinated persons. A Cox-proportional hazard model with time varying coefficients was used to assess the vaccine effectiveness adjusting for age, sex, comorbidity, ethnicity, and the calendar month of entry into the study. Our analysis showed that the effectiveness was 79.6% (95% CI, 77.7 to 81.3) against hospitalization, 86% (95% CI, 82.2 to 89.0) against critical care admission, and 84.1% (95% CI, 70.8 to 91.3) against death due to COVID-19. The effectiveness against these severe outcomes declined over time indicating the need for booster doses to increase protection against severe COVID-19 outcomes.

Hypoalbuminemia in COVID-19 patients: A Predictor of Poor Outcome

Background: The coronavirus disease 2019 (COVID-19) has quickly spread to become a pandemic. Most studies demonstrate that increased liver enzymes in COVID-19 have little clinical relevance. In severe COVID-19, lower albumin levels are seen. Aim: To see how hypoalbuminemia levels affect the COVID-19 patients. Study design: Retrospective cohort study. Place and duration of study: Services Institute of Medical Sciences Lahore and Bahria International Hospital, Lahore from 10th January 2021 to 17th September 2021. Methodology: Sixty-seven confirmed cases of COVID-19 on RT-PCR were recruited. They were further divided into two groups. Group N (normal albumin levels) had thirty-six participants whereas group HA (hypoalbuminemia) contained thirty-one participants. Both males and females of all age groups, having complete medical records were included. Biochemical variables were noted from the medical record within 48 to 72 hours after admission. Twenty eight days follow up was done to note the mortality. Patients having incomplete medical records who expired within 2 days after admission were excluded. Results: A significantly higher number of deaths, lymphopenia, hypertensive, diabetics, and asthmatic participants were found in Group HA as compared to Group N. Hypoalbuminemia is mostly seen in older age and biochemical variables such as total leukocyte count and, neutrophils were elevated, whereas lower levels of lymphocytes were found in group HA. Lower lymphocytes and higher creatinine levels are the most prevalent predictors of mortality. The Pearson’s correlation of albumin with lymphocytes showed a positive correlation and inverse correlation with TLC, Neutrophil counts, CRP levels Conclusion: The group HA is associated with higher mortality and increased levels of prognostic factors of mortality.