IMPACT of COVID-19 LOCKDOWN on STILLBIRTHS and PRETERM BIRTHS among WOMEN with TWIN PREGNANCIES in MELBOURNE

Background: Melbourne's 2020 pandemic lockdown was associated with an increase in stillbirths and a reduction in preterm births (PTB) among singleton pregnancies. Twin pregnancies may be particularly susceptible due to higher background risk. We aimed to compare the rates of adverse pregnancy outcomes in twin pregnancies exposed and unexposed to Melbourne's lockdown. Method(s): Multicentre retrospective cohort study of all twin pregnancies > 20 weeks birthing in all 12 public maternity hospitals in Melbourne. Multivariable log-binominal regressions were used to compare outcomes between a pre-pandemic control group ('unexposed') independently with two lockdown-exposed groups: exposure 1 from 22 March 2020 to 21 March 2021 (pre-vaccination era) and exposure 2 from 22 March 2021 to 27 March 2022 (vaccination era). Result(s): We included 2259 pregnancies. There were fewer PTBs < 37 weeks during exposure 1 compared with the pre-pandemic era (63.1% vs. 68.3%;adjusted risk-ratio (aRR) 0.95;95% confidence interval (CI) 0.88-0.98, P = 0.01). This lower rate was most prominent in iatrogenic PTB for suspected fetal compromise (13.4% vs. 20.3%;aRR 0.94 95% CI 0.90-0.99, P = 0.01). There were correspondingly fewer special care nursery admissions during exposure 1 (38.5% vs. 43.5%;aRR 0.91 95% CI 0.87-0.95, P < 0.001), but no changes in stillbirth (1.5% vs. 1.4%;aRR 1.00, 95% CI 0.99-1.01, P = 0.85). Compared with the pre-pandemic period, exposure 2 was associated with a trend to more PTB < 28 weeks and significantly higher neonatal intensive care unit admissions (25.0% vs. 19.6%;aRR 1.06 95% CI 1.03-1.10, P < 0.001). Conclusion(s): Melbourne's first lockdown-exposure period was associated with fewer preterm twin births for suspected fetal compromise, without any increase in stillbirth.

Efficacy of low dose whole-lung irradiation for the treatment of moderate to severe COVID-19 pneumonia: Meta-analysis. TT -.

Objective To systematically evaluate the efficacy of low dose whole-lung irradiation in COVID-19 pneumonia based on the present evidence. Methods All literature related to the application of low dose whole-lung irradiation in COVID-19 pneumonia were retrieved from Pubmed, Embase, the Cochrane Library, Web of Science, Google scholar, Scoupus, CNKI, Wanfang database, VIP database until May 2022. Two researchers independently screened the literature. For the literature that met the inclusion criteria, both data extraction and literature quality evaluation were blinded. Revman 5.3 software was used for statistical analysis. Results A total of 5 controlled clinical trials involving 194 patients met the inclusion criteria. No statistically significant differences were detected in the low dose whole-lung irradiation group compared with the best supportive care group for clinical recovery rates, intubation rates, radiographic improvement rates and 28 d-overall survival. Conclusions In patients of COVID-19 pneumonia, low dose whole-lung irradiation conferred no significant benefit to clinical outcomes. Currently, the routine use of low dose whole-lung irradiation for the treatment of moderate to severe COVID-19 pneumonia is not recommended.Copyright © Chinese Medical Journals Publishing House Co.Ltd. All Rights Reserved.

REDUCTIONS in STILLBIRTHS and PRETERM BIRTH in COVID-19 VACCINATED WOMEN: A MULTI-CENTRE COHORT STUDY of VACCINE UPTAKE and PERINATAL OUTCOMES

Background: We aimed to measure COVID-19 vaccine uptake among women giving birth in Melbourne and to compare perinatal outcomes by vaccination status. Method(s): Routinely-collected data from all 12 public maternity hospitals in Melbourne were extracted on births >=20 weeks' from 01.07.21 to 31.03.22. Sociodemographic characteristics and perinatal outcomes were compared between COVID-19 vaccinated and unvaccinated women. The primary outcomes were stillbirth and preterm birth in singletons >24 weeks. We calculated the adjusted odds ratio of perinatal outcomes among vaccinated versus unvaccinated women using inverse propensity score weighting regression adjustment with multiple covariates;P < 0.05 was considered significant. Result(s): Births from 32 536 women were analysed: 17 365 (53.4%) were vaccinated and 15 171 (47.6%) were unvaccinated. Vaccination status was significantly associated with multiple sociodemographic factors. Vaccinated women had a significantly lower rate of stillbirth compared with unvaccinated women (0.2% vs. 0.8%, aOR 0.18, 95% CI 0.09- 0.37, P < 0.001). Vaccination was associated with a significant reduction in total preterm births <37 weeks (5.1% vs. 9.2%, aOR 0.60, 95% CI 0.51-0.71, P < 0.001), spontaneous preterm birth (2.4% vs. 4.0%, aOR 0.73 95% CI 0.56-0.96, P = 0.02) and iatrogenic preterm birth (2.7% vs. 5.2%, aOR 0.52, 95% CI 0.41-0.65, P < 0.001). There was no significant increase in congenital anomalies or foetal growth restriction among vaccinated women. Conclusion(s): COVID-19 vaccination during pregnancy was associated with a reduction in stillbirth and preterm birth, and not associated with any adverse impacts on foetal growth or development. Vaccine coverage was significantly influenced by known social determinants of health.

Efficacy of low dose whole-lung irradiation for the treatment of moderate to severe COVID-19 pneumonia: Meta-analysis.

Objective To systematically evaluate the efficacy of low dose whole-lung irradiation in COVID-19 pneumonia based on the present evidence. Methods All literature related to the application of low dose whole-lung irradiation in COVID-19 pneumonia were retrieved from Pubmed, Embase, the Cochrane Library, Web of Science, Google scholar, Scoupus, CNKI, Wanfang database, VIP database until May 2022. Two researchers independently screened the literature. For the literature that met the inclusion criteria, both data extraction and literature quality evaluation were blinded. Revman 5.3 software was used for statistical analysis. Results A total of 5 controlled clinical trials involving 194 patients met the inclusion criteria. No statistically significant differences were detected in the low dose whole-lung irradiation group compared with the best supportive care group for clinical recovery rates, intubation rates, radiographic improvement rates and 28 d-overall survival. Conclusions In patients of COVID-19 pneumonia, low dose whole-lung irradiation conferred no significant benefit to clinical outcomes. Currently, the routine use of low dose whole-lung irradiation for the treatment of moderate to severe COVID-19 pneumonia is not recommended.Copyright © Chinese Medical Journals Publishing House Co.Ltd. All Rights Reserved.

Measuring the Effect of Midterm Exam on Final Exam of Online Learning during COVID-19 Pandemic: The Mediating Role of Assignments

This study measures the relationship between midterm exams, assignments, and final exams of online learning on university students during the COVID-19 pandemic. The research subjects were 206 students from six departments at the Faculty of Education, Universitas Negeri Malang. The data was obtained from the database of the Academic Information System of Universitas Negeri Malang. The results showed that the midterm exam had a significant effect on assignments, the midterm exam had a significant effect on the final exam, and the assignments had a significant effect on the final exam. The analysis shows that assignments significantly mediate the effect of the midterm exam on the final exam. © 2022 IEEE.

Online Peer Teaching in Medical School during a Pandemic Period: A Reflection

Peer-teaching has been rapidly adopted throughout higher education institutions, including medical schools, to provide students with a diverse learning environment and to enhance academic development. Peer assisted study session (PASS) is a peer-teaching program implemented in Monash University Malaysia and was conducted virtually during the COVID-19 pandemic. Perspectives from the viewpoint of peer tutors during the pandemic period are presented in this paper. Throughout the year, peer tutors were confronted with the unique challenges of teaching virtually. Various factors which contribute to changes in the dynamics of group-based discussions in online classes are discussed. On online platforms, students are graced with more privacy and freedom, a double-edged sword that can translate into reduced student engagement. Nonetheless, the practical skills acquired by adapting to the abrupt switch from on-campus to online peer-teaching can be employed in our future practice as health professionals. Copyright © 2021 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

The role of vitamin C in pneumonia and COVID-19 infection in adults with European ancestry: a Mendelian randomisation study.

BACKGROUND: High dose vitamin C infusion has been proposed to treat critically ill patients, including patients with pneumonia and severe COVID-19. However, trials have shown mixed findings. Here we assessed the unconfounded associations of vitamin C with COVID-19 and pneumonia using the Mendelian randomisation approach. METHODS: This is a separate-sample Mendelian randomisation study using publicly available data. We applied single nucleotide polymorphisms (SNPs) that were associated with plasma vitamin C, in a recent genome-wide association study (GWAS) as genetic instruments to the GWAS of severe COVID-19, COVID-19 hospitalisation and any infection in the COVID-19 host genetics initiative and the GWAS of pneumonia in the UK Biobank, to assess whether people with genetically predicted higher levels of plasma vitamin C had lower risk of severe COVID-19 and pneumonia. RESULTS: Genetically predicted circulating levels of vitamin C was not associated with susceptibility to severe COVID-19, COVID-19 hospitalisation, any COVID-19 infection nor pneumonia. Similar results were obtained when a weighted median and MR-Egger methods were used. CONCLUSIONS: Mendelian randomisation analysis provided little evidence for an association of genetically predicted circulating levels of vitamin C with COVID-19 or pneumonia and thus our findings provided little support to the use of vitamin C in prevention and treatment in these patients, unless high dose vitamin C infusion has therapeutic effects via different biological pathways.

Business as usual during the COVID-19 pandemic? Statewide trends in maternity care during lockdown in Victoria and New South Wales

Introduction: The COVID-19 pandemic has resulted in unprecedented changes to the delivery of maternity care across Australia, including RANZCOG-endorsed measures to reduce antenatal visits, and implement telehealth. We analysed trends in maternity consultations and the uptake of telehealth in VIC and NSW since the first COVID-19 pandemic restrictions were introduced in late March 2020. Methods: Episodes of outpatient antenatal and post-natal consultations and obstetric ultrasounds from January 2018 to September 2020 were obtained using Australian Government Medicare Statistics data from NSW and VIC. Run charts using pre-pandemic median from January 2018 were generated. A significant trend was defined as five consecutive months of numbers all going up or down.1 Utilisation of telehealth consultations was compared between VIC and NSW using the z-test for difference in proportions. Results: Despite a decline in monthly face-to-face consultations in Victoria and NSW (16% and 12% decline from pre-COVID medians of 32,413 and 41,848, respectively), there was no significant downward trend in total attendances during the first lockdown. A higher proportion of antenatal and post-natal care was delivered via telehealth/telephone in Victoria compared to NSW (19.4% vs 9.4%, respectively, p < 0.0001). From March 2020 in Victoria, the run chart showed a trend towards increased ultrasound examinations for women with a singleton pregnancy after 22 weeks. Discussion: Widespread uptake of telehealth has been a major contributor to maintaining maternity consultations during Victorian pandemic restrictions. Further research is required to understand the increase in ultrasound billings during lockdown in Victoria.

Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version)

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued "A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based statement. They covered topics of chemoprophylaxis [including agents and Traditional Chinese Medicine (TCM) agents], diagnosis [including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest X-ray, and CT features of asymptomatic infections], treatments [including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, Qingfei Paidu decoction, Lianhua Qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)], and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID-19 patients. © 2020 People's Military Medical Press. All rights reserved.