Psychological antecedents towards COVID-19 vaccination using the Arabic 5C validated tool: An online study in 13 Arab countries

Background and aimFollowing emergency approval of vaccines, the amount of scientific literature investigating population hesitancy towards vaccination against the novel coronavirus disease (COVID-19) has increased exponentially. Nevertheless, the associated psychological behaviors with this phenomenon are still not clearly understood. This study aims to assess the psychological antecedents of the Arab population toward COVID-19 vaccines. MethodsA cross-sectional, online study using a validated Arabic version of the 5C questionnaire was conducted through different media platforms in different Arabic-speaking countries. The questionnaire included three sections: socio-demographics, COVID-19 related questions, and the 5C scale of vaccine psychological antecedents, namely confidence, complacency, constraints, calculation, and collective responsibility. ResultsA total of 4,474 participants, 40.8% males from 13 Arab countries were included in the study. About 26.7% of participants had confidence in COVID-19 vaccination, 10.7% had complacency, 96.5% had no constraints, 48.8% had calculation and 40.4% had collective responsibility. The 5C antecedents showed variation among countries with confidence and collective responsibility being higher in the United Arab Emirates (UAE) (59% and 58%, respectively), complacency and constraints were higher in Morocco (21% and 7%, respectively) and calculation was higher in Sudan (60%). Regression analysis revealed that sex, age, educational degrees, being a health care professional, getting a COVID-19 infection, having a relative infected or died from COVID-19 can affect the 5C psychological antecedents by different degrees. Conclusion and recommendationsWide variations of psychological antecedents between Arab countries exist. Different determinants can affect vaccine psychological antecedents.

Hypertonic saline for goal-directed therapy guided by Capstesia in gastrointestinal surgery: a randomized controlled study.

INTRODUCTION: Goal-directed fluid therapy (GDT) aims to increase stroke volume and cardiac output and improve gut perfusion. Hypertonic saline (HS) can restore the macro-and micro-circulation, increase myocardial contractility, and reduce tissue edema. Therefore, we aimed to investigate the efficacy of intraoperative HS administration in GDT during gastrointestinal (GI) surgery. MATERIAL AND METHODS: Forty patients who underwent GI surgery under general anesthesia were enrolled in this randomized controlled study. Patients received boluses of either lactated Ringer's (LR) solution, or 3% HS solution guided by an algorithm dependent on a smartphone application for estimations of pulse pressure variation (PPV). The primary outcome was the total amount of administered intraoperative crystalloid fluids in both groups. Serum sodium and time to first bowel movement after surgery were also recorded. RESULTS: In the HS group, patients received 1262.50 ± 318.25 mL of crystalloids compared to 2667.50 ± 670.29 mL received by patients in the LR group (P 0.05. CONCLUSIONS: The use of HS solution for GDT in GI surgery resulted in a beneficial reduction in positive fluid balance and possibly earlier resumption of bowel movements.

Systematic Review and Meta-analysis on COVID-19 Vaccine Hesitancy

BackgroundThe presented meta-analysis was developed in response to the publication of several studies addressing COVID-19 vaccines hesitancy. We aimed to identify the proportion of vaccine acceptance and rejection, and factors affecting vaccine hesitancy worldwide especially with the fast emergency approval of vaccines. MethodsOnline database search was performed, and relevant studies were included with no language restriction. A meta-analysis was conducted using R software to obtain the random effect model of the pooled prevalence of vaccine acceptance and rejection. Eggers regression test was performed to assess publication bias. Quality assessment was assessed using Newcastle-Ottawa Scale quality assessment tool. ResultsThirty-nine out of 12246 articles met the predefined inclusion criteria. All studies were cross-sectional designs. The pooled proportion of COVID-19 vaccine hesitancy was 17% (95% CI: 14-20) while the pooled proportion of COVID-19 vaccine acceptance was 75% (95% CI: 71-79). The vaccine hesitancy and the vaccine acceptance showed high heterogeneity (I2=100%). Case fatality ratio and the number of reported cases had significant effect on the vaccine acceptance as the pooled proportion of vaccine acceptance increased by 39.95% (95% CI: 20.1-59.8) for each 1% increase in case fatality (P<0.0001) and decreased by 0.1% (95% CI: -0.2-0.01) for each 1000 reported case of COVID-19, P= 0.0183). ConclusionTransparency in reporting the number of newly diagnosed COVID-19 cases and deaths is mandatory as these factors are the main determinants of COVID-19 vaccine acceptance.

Ultrasound-guided transversalis fascia plane block versus transmuscular quadratus lumborum block for post-operative analgesia in inguinal hernia repair.

BACKGROUND: Inguinal hernia repair is one of the most commonly performed surgical procedures. Regional blocks might provide excellent analgesia and reduce complications in the postoperative period. We aimed to compare the postoperative analgesic effect of the ultrasound-guided transversalis fascia (TF) plane block versus the transmuscular quadratus lumborum (QL) block in patients undergoing unilateral inguinal hernia repair. METHODS: Fifty patients enrolled in this comparative study and were randomly assigned into two equal groups. One group received an ultrasound-guided QL block. In comparison, the other group received an ultrasound-guided TF plane block. The primary outcome was the patient-assessed resting, and movement-induced pain on the numeric pain rating scale (NRS) measured at 30 minutes postoperatively. Secondary outcomes included the percentage of patients receiving rescue analgesia in the first postoperative day, ease of performance of the technique, and incidence of adverse effects. RESULTS: There were no statistically significant differences in NRS at rest and with movement between the groups over the first 24 hours postoperatively. The proportion of patients that received postoperative rescue analgesics during the first 30 minutes postoperatively was 4% (n = 1) in the QL group compared to 12% (n = 3) in the TF group. However, the mean performance time of the TF block was shorter than that of the QL block, and the performance of the TF block appeared easier technically. CONCLUSIONS: The ultrasound-guided TF plane block could be as effective as the QL block in lowering pain scores and decreasing opioid consumption following non-recurrent inguinal herniorrhaphy.

In situ Analytical Quality Control of chemotherapeutic solutions in infusion bags by Raman spectroscopy.

Analytical Quality Control (AQC) in centralised preparation units of oncology centers is a common procedure relying on the identification and quantification of the prepared chemotherapeutic solutions for safe intravenous administration to patients. Although the use of Raman spectroscopy for AQC has gained much interest, in most applications it remains coupled to a flow injection analyser (FIA) requiring withdrawal of the solution for analysis. In addition to current needs for more rapid and cost-effective analysis, the risk of exposure of clinical staff to the toxic molecules during daily handling is a serious concern to address. Raman spectroscopic analysis, for instance by Confocal Raman Microscopy (CRM), could enable direct analysis (non-invasive) for AQC directly in infusion bags. In this study, 3 anticancer drugs, methotrexate (MTX), 5-fluorouracil (5-FU) and gemcitabine (GEM) have been selected to highlight the potential of CRM for withdrawal free analysis. Solutions corresponding to the clinical range of each drug were prepared in 5% glucose and data was collected from infusion bags placed under the Raman microscope. Firstly, 100% discrimination has been obtained by Partial Least Squares Discriminant Analysis (PLS-DA) confirming that the identification of drugs can be performed. Secondly, using Partial Least Squares Regression (PLSR), quantitative analysis was performed with mean % error of predicted concentrations of respectively 3.31%, 5.54% and 8.60% for MTX, 5-FU and GEM. These results are in accordance with the 15% acceptance criteria used for the current clinical standard technique, FIA, and the Limits of Detection for all drugs were determined to be substantially lower than the administered range, thus highlighting the potential of confocal Raman spectroscopy for direct analysis of chemotherapeutic solutions.

Intention of Healthcare Workers to Receive COVID-19 Vaccine: A Cross-Sectional Survey in 10 Countries in Eastern Mediterranean Region

BackgroundWillingness of healthcare workers to be vaccinated is an important factor to be consider for successful COVID-19 vaccination programme. Our study aimed to understand the willingness of health workers to receive COVID-19 vaccine and associated concerns across 10 countries in the Eastern Mediterranean Region (EMRO). MethodA cross-sectional study was conducted in January 2021 among healthcare workers using an online survey. A total of 2806 health workers (Physicians, Nurses and Pharmacists) completed and returned the informed consent along with the questionnaire electronically. Data were analyzed using IBM SPSS software package version 20.0. S ResultsMore than half of the respondents (58.0%) were willing to receive COVID-19 vaccine, even if the vaccination is not mandatory for them. On the other hand, 25.7% of respondents were not willing to undertake COVID-19 vaccination while 16.3 % answered undecided. The top three reasons for not intending to be vaccinated were unreliability of COVID-19 vaccine clinical trials (62.0%), fear of the side effects of the vaccine (45.3%), and that COVID-19 vaccine will not give immunity for a long period of time (23.1%). ConclusionOverall, our study revealed suboptimal acceptance of COVID-19 vaccine among our respondents in the EMRO region. Significant refusal of COVID-19 vaccine among healthcare professionals can reverse hard-won progress in building public trust in COVID-19 vaccination program. Our findings suggest the need to develop tailored strategies to address concerns identified in the study in order to ensure optimal vaccine acceptance among healthcare workers in the EMRO.

Understanding the discrimination and quantification of monoclonal antibodies preparations using Raman spectroscopy.

The use of Raman spectroscopy for analytical quality control of anticancer drug preparations in clinical pharmaceutical dispensing units is increasing in popularity, notably supported by commercially available, purpose designed instruments. Although not legislatively compulsory, analytical methods are frequently used post-preparation to verify the accuracy of a preparation in terms of identity and quantity of the drug in solution. However, while the rapid, cost effective and label free analysis achieved with Raman spectroscopy is appealing, it is important to understand the molecular origin of the spectral contributions collected from the solution of actives and excipients, to evaluate the strength and limitation for the technique, which can be used to identify and quantify either the prescribed commercial formulation, and/or the active drug itself, in personalised solutions. In the current study, four commercial formulations, Erbitux®, Truxima®, Ontruzant® and Avastin® of monoclonal antibodies (mAbs), corresponding respectively to cetuximab, rituximab, trastuzumab and bevacizumab have been used to highlight the key role of excipients in discrimination and quantification of the formulations. It is demonstrated that protein based anticancer drugs such as mAbs have a relatively weak Raman response, while excipients such as glycine, trehalose or histidine contribute significantly to the spectra. Multivariate analysis (partial least square regression and partial least square discriminant analysis) further demonstrates that the signatures of the mAbs themselves are not prominent in mathematical models and that those of the excipients are solely responsible for the differentiation of formulation and accurate determination of concentrations. While Raman spectroscopy can successfully validate the conformity of mAbs intravenous infusion solutions, the basis for the analysis should be considered, and special caution should be given to excipient compositions in commercial formulations to ensure reliability and reproducibility of the analysis.

Factors influencing intention to adhere to precautionary behavior in times of COVID- 19 pandemic in Sudan: an application of the Health Belief Model

BackgroundCorona virus disease (COVID-19) is highly infectious disease caused by the novel corona virus (SARS-CoV-2). Several public health and social protective measures that may prevent or slow down the transmission of COVID-19 were introduced. However, these measures are unfortunately neglected or deliberately ignored by some individuals. MethodsWe did a cross sectional online based survey to identify possible factors influencing intention to adhere to precautionary measures and preventive guidelines against COVID-19 during lockdown periods in Sudan. The questionnaire was used to collect socio-demographic data of study participants, their health beliefs and intention regarding adherence to precautionary measures against COVID-19 based on the constructs of the Health Belief Model. ResultsTotal of 680 respondents completed and returned the online questionnaire. Significant predictors of intention to adhere to the precautionary measures against COVID-19 were gender ({beta} =3.34, P <0.001), self-efficacy ({beta}= 0.476, P<0.001), perceived benefits ({beta}= 0.349, P<0.001) and perceived severity ({beta}= 0.113, P=0.005). These factors explained 43% of the variance in respondents intention to adhere to COVID-19 precautionary measures. Participants who were female, confident in their ability to adhere to the protective measures when available, believing in the benefits of the protective measures against COVID-19 and perceiving that the disease could have serious consequences were more likely to be willing to adhere to the protective measures. ConclusionFemale respondents and respondents having higher self-efficacy, higher perceived benefits and higher perceived severity were more likely to be willing to adhere to the protective measures against COVID-19 in Sudan.

Qualitative and quantitative analysis of therapeutic solutions using Raman and infrared spectroscopy.

Anticancer drugs are prescribed and administrated to an increasing number of patients on a daily basis. As a consequence, a number of concerns have been raised about the patient health and safety in the case that the drugs administered are not at the required concentration or even worse not the correct ones. Quality control of therapeutic solutions has therefore been extensively implemented in hospital environments, in order to avoid any failure in the intense workflow faced by administering pharmacists. In the present study, infrared (IR) and Raman spectroscopy have been employed for the analysis of 3 commercially available therapeutic solutions TEVA®, MYLAN®, CERUBIDINE®, respectively containing doxorubicin, epirubicin and daunorubicin. They perfectly illustrate the analytical difficulties encountered, as these 3 chemotherapeutic drugs are isomers, hardly distinguishable with conventional approaches such as UV/VIS spectrometry. Any analytical failure to identify these molecules can lead to delays in patient treatment. While Partial Least Squares Regression analysis demonstrates that both Raman and IR can deliver satisfactory quantitative analysis in the clinical range, with respective Root Mean Square Error of Cross Validation (RMSECV) between 0.0127 - 0.0220 g·L-1 and 0.0573 - 0.0759 g·L-1, the identification rate between the 2 techniques differs substantially. Indeed, Principal Component Analysis - Factorial Discriminant Analysis (PCA-FDA) highlights that, depending on the data preprocessing applied to Raman spectra, the discrimination between the 3 drugs is decreased, with in some cases specificity and sensitivity below 50%. However, IR analysis displays encouraging results with an overall specificity and sensitivity between 99 and 100%, suggesting that reliable validation of the therapeutic solution for administration to patients can be achieved. IR and Raman spectroscopy could assist and support quality control of chemotherapeutic solutions prepared in personalised concentrations for each patient. The effective and reliable characterisation of therapeutic solutions could have a lot to offer to improve current practices in a near future.