Hypofractionated Radiotherapy for Hematologic Malignancies during the COVID-19 Pandemic and Beyond (preprint)

Purpose Radiotherapy is integral in the management of hematological malignancies (HM). Standard radiotherapy dose fractionation regimens range between 20-50 Gy in 10-25 fractions over 2-5 weeks. This study presents the outcomes of patients with HM treated with hypofractionation radiotherapy (HFRT) during the COVID-19 pandemic. Methods Patients (N=36) were treated with HFRT between January 2020 and September 2022. The outcomes measured were the overall response rate (ORR), freedom from local progression (FFLP), and overall survival (OS). Results Median follow-up was 13.2 months. Thirty-three patients (92%) had non-Hodgkin (NHL) or Hodgkin lymphoma (HL). Eighteen patients (50%) had aggressive and 9 (25%) had indolent NHL. Nineteen patients (53%) presented with stage I/II and 15(42%) with stage III/IV disease. Twenty-five (69.4%) and eleven (30%) received consolidative and definitive RT, respectively. Twenty patients (56%) received treatment to the neck and/or thorax, and 9 (25%) to the abdomen or pelvis. Total dose ranged from 18 to 42.5 Gy in 6-17 fractions/ 2.67-5 Gy per fraction. Median dose in 2 Gy fractions for an alpha/beta (α/β) ratio of 10 amounted to 39 Gy (SD ± 13.86), and 43.6 Gy (SD ± 12) for an α/β of 3. The most commonly used fractionation scheme was 39 Gy in 13 fractions. ORR was 94.4% for the entire cohort, and 100, 94.4, and 83.3% for indolent NHL, aggressive NHL, and HL patients. Two-year FFLP was 76% (95% CI: 34-93%) for the entire cohort, and 100, 87 (95%CI: 56.4-96.5%) and 42% (95% CI: 1.1-84.3%) for the indolent NHL, aggressive NHL, and HL patients. Two-year OS for the entire cohort was 80% (95% CI:59.9-90.5%), and 100, 66.1 (95% CI: 36.4-84.4%) and 100% for the indolent NHL, aggressive NHL, and HL patients. Only one patient presented with grade two pulmonary toxicity. Conclusion HFRT in HM provides excellent local control without any increase in toxicity.

Fear of COVID-19 in dentistry students: an evaluation of their knowledge and practices

Background: This study's objective was to analyse the fear of COVID-19 among the dentistry student and the knowledge, attitude, and practices during the COVID-19 pandemic. Methods: It was a cross-sectional questionnaire-based study. An online survey form was designed and distributed to undergraduate dental students via google forms. A previously validated fear of coronavirus scale (FCV-19S) was used to analyse the fear. SPSS 21 was used for data entry and data analysis. Descriptive statistics were applied to calculate the frequencies of different variables. Independent t-test was executed to determine the difference of FCV-19S among gender and between public and private dental colleges. ANOVA was carried out to evaluate the difference in fear among different levels of BDS. Results: Data of 983 individuals from different dental colleges in Karachi, Pakistan, have been analysed. The majority of the students were females in 1st year and private sector dental colleges (P<0.001). The mean FCV-19S was 20.99 +or- 6.48, which is higher than the cut-off value 15. A highly significant difference in mean FCV-19S among the different variables has been observed (P<0.001). A significant difference has been observed among the gender (t (932) = -5.40, p<0.001) in all 4-years of BDS. Conclusion: Despite good knowledge and following the COVID-19 guidelines, fear is prevalent among the students.

Strategies deemed important by frontline healthcare providers for their mental wellbeing during first wave of COVID-19 pandemic (preprint)

We conducted a content analysis of free-text comments of a web-based survey during the first wave of Coronavirus disease 2019 [COVID-19] pandemic. The objective was to understand participants’ emotional experiences and identify their valued aspects of support to inform potential mitigation strategies. This study was part of a larger project; a cross-sectional, web-based survey of healthcare workers managing suspected or confirmed COVID-19 patients in Qatar. A total of 779 staff members were invited to participate in this study and 286 (36.7 %) responded. Extracts and phrases were used to identify potential themes, with relevant ‘quotes’ gathered within identified themes in keeping with best practice qualitative methodology. The results indicate that strategies around infection control practice, personal protective equipment, SARS-CoV-2 testing, workload, financial compensation, religion, psychological support and engaged leadership are deemed important by frontline healthcare workers to maintain their mental wellbeing.

Fear and practice modifications among dentists to combat novel coronavirus disease (COVID-19) outbreak

An outbreak of novel coronavirus disease (COVID-19) in China has influenced every aspect of life. Healthcare professionals, especially dentists, are exposed to a higher risk of getting infected due to close contact with infected patients. The current study was conducted to assess anxiety and fear of getting infected among dentists while working during the current novel coronavirus diseases (COVID-19) outbreak. In addition, dentists' knowledge about various practice modifications to combat COVID-19 has been evaluated. A cross-sectional study was conducted using an online survey from 10th to 17th March 2020. The well-constructed questionnaire was designed and registered at online website (Kwiksurveys) and validated. A total of 669 participants from 30 different countries across the world responded. After scrutiny, completed questionnaires (n = 650) were included in the study. Statistical analysis was performed using SPSS version 25. Chi-Square and Spearman correlation tests were applied to control confounders and assess the relation of dentists' response with respect to gender and educational level. More than two-thirds of the general dental practitioners (78%) from 30 countries questioned were anxious and scared by the devastating effects of COVID-19. A large number of dentists (90%) were aware of recent changes in the treatment protocols. However, execution of amended treatment protocol was recorded as 61%. The majority of the dentists (76%) were working in the hospital setting out of which 74% were from private, and 20% were from government setups. Individually we received a large number of responses from Pakistan and Saudi Arabia, but collectively more than 50% of the responses were from other parts of the world. Despite having a high standard of knowledge and practice, dental practitioners around the globe are in a state of anxiety and fear while working in their respective fields due to the COVID-19 pandemic impact on humanity. A number of dental practices have either modified their services according to the recommended guidelines to emergency treatment only or closed down practices for an uncertain period.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic: a dilemma for dental health care professionals

In the light of current research, COVID-19 can be avoided and cured with self-immunity boost, adoption of preventive measures and symptomatic management of sufferers. The first line of defense in this battle are health care workers deployed in the COVID-19 red zones who are working tirelessly to overcome the health perspective of this deadly pandemic. Similarly, amongst the frontline doctors and paramedics, dental care professionals are also in service and are among the most vulnerable to transmission of virus from the host due to working in close contact with patients and involvement in continuous aerosol and microdroplet producing dental procedures. Dental clinics, along with other potential risky fields, were closed in the beginning of the pandemic when it spread from mainland China to other geographical regions.

Statins in Patients with COVID-19: A Retrospective Cohort Study in Iranian COVID-19 Patients (preprint)

Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is spreading at an alarming rate globally. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and many known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results: After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR=0.85, 95% CI=(0.02, 3.93), P =0.762] and lower risk of death [(HR= 0.76; 95% CI=(0.16, 3.72), P =0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR=0.96, 95% CI=(0.61–2.99), P =0.942] and patients on statins had a more normal computed tomography (CT) scan result [OR=0.41, 95% CI= (0.07–2.33), P =0.312]. Conclusions: Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19 , we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

Statins in Patients with COVID-19: A Retrospective Cohort Study in Iranian COVID-19 Patients (preprint)

Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is spreading at an alarming rate globally. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and many known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results: After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study.  Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR=0.85, 95% CI=(0.02, 3.93), P=0.762] and lower risk of death [(HR= 0.76; 95% CI=(0.16, 3.72), P=0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR=0.96, 95% CI=(0.61–2.99), P=0.942] and patients on statins had a more normal computed tomography (CT) scan result [OR=0.41, 95% CI= (0.07–2.33), P=0.312]. Conclusions: Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19 , we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

Knowledge, attitude, and practice towards COVID-19 among general population of Karachi south: a cross-sectional survey

Objective: To assess the knowledge, attitude, and practices of precautionary measures against COVID-19 by the general population of Karachi South, Pakistan.