Pride and Prejudice during the COVID-19 Pandemic: The Misfortune of Inappropriate Clinical Trial Design
covid-19, Clinical trials, multicenter, Primary endpoint, Single-arm
Coronavirus Disease 2019 (COVID-19) is a rapidly evolving global pandemic for which more than a thousand clinical trials have been registered to secure therapeutic effectiveness, expeditiously. Most of these are single-center non-randomized studies rather than multi-center, randomized controlled trials. Single-arm trials have several limitations and may be conducted when spontaneous improvement is not anticipated, small placebo effect exists, and randomization to a placebo is not ethical. In an emergency where saving lives takes precedence, it is ethical to conduct trials with any scientifically proven design, however, safety must not be compromised. A phase II or III trial can be conducted directly in a pandemic with appropriate checkpoints and stopping rules. COVID-19 has two management paradigms- antivirals, or treatment of its complications. Simultaneous assessment of two different treatments can be done using 2 × 2 factorial schema. World Health Organization’s SOLIDARITY trial is a classic example of the global research protocol which can evaluate the preferred treatment to combat COVID-19 pandemic. Short of that, a trial design must incorporate the practicality of the intervention used, and an appropriate primary endpoint which should ideally be a clinical outcome. Collaboration between institutions is needed more than ever to successfully execute and accrue in randomized trials.
Shahrukh K. Hashmi, Edward De Vol, Fazal Hussain
Cross-Protection Induced by Encephalitis Vaccines against COVID-19 Might be a Reason for Relatively Lower Mortality Rate in Some Countries
covid-19, Cross-immunity, Encephalitis vaccine
COronaVIrus Disease 2019 (COVID-19), is an ongoing pandemic attributed to a novel virus SARSâ€CoVâ€2. The statistics of the incidence and the death rates between nations reveal that there is a discrepancy amongst compared with even those that share their borders. We herein present information from the literature on how cross-protection against COVID-19 conferred by the encephalitis vaccine could be the reason for lower fatality rate in the countries where immunization against encephalitis is widespread or included in national programs. This may pave way for arriving at efficient strategies of prevention as well as vaccine development.
Shojiro Katoh, Toshihiko Obayashi, Jegatheesan Saravana Ganesh, Masaru Iwasaki, Senthilkumar Preethy, Samuel Abraham
Medical emergencies. Critical care. Intensive care. First aid
COVID-19 and Health Professions Education: A 360° View of the Impact of a Global Health Emergency
Global Health, covid-19, Technology, CURRICULUM, health emergency
COVID-19 and the resulting lockdown policies have far ranging effects on health professions education (HPEd), with an impact in all its aspects, including curricula, teaching methods, student selection processes, educational outcomes, HPEd research, and student, teacher, and school welfare. Adaptations to the pandemic and lockdown measures have leaned heavily on technology. The effects may have differences across various health professions particularly those with an emphasis on psychomotor skills. There may also be differences among populations of students, teachers and schools related to the availability, accessibility and cost of technology. The rapid, forced change in the paradigms of health professions education across the globe may persist as long as lockdown measures and threat of resurgence remains, even as COVID-19 still sweeps across different countries.
Adrian Rabe, Michael Sy, Wayne Yik Wai Cheung, Don Eliseo Lucero-Prisno
ECT for a pregnant patient with bipolar disorder in the COVID-19 Era: A clinical conundrum.
Jessica M Gannon, Priya Gopalan, LalithKumar K Solai, Grace Lim, Jaclyn M Phillips, Stacy Beck, Eydie Moses-Kolko, Donald Miller, K N Roy Chengappa
A one-year hospital-based prospective COVID-19 open-cohort in the Eastern Mediterranean region: The Khorshid COVID Cohort (KCC) study.
The COVID-19 is rapidly scattering worldwide, and the number of cases in the Eastern Mediterranean Region is rising. Thus, there is a need for immediate targeted actions. We designed a longitudinal study in a hot outbreak zone to analyze the serial findings between infected patients for detecting temporal changes from February 2020. In a hospital-based open-cohort study, patients are followed from admission until one year from their discharge (the 1st, 4th, 12th weeks, and the first year). The patient recruitment phase finished at the end of August 2020, and the follow-up continues by the end of August 2021. The measurements included demographic, socio-economics, symptoms, health service diagnosis and treatment, contact history, and psychological variables. The signs improvement, death, length of stay in hospital were considered primary, and impaired pulmonary function and psychotic disorders were considered main secondary outcomes. Moreover, clinical symptoms and respiratory functions are being determined in such follow-ups. Among the first 600 COVID-19 cases, 490 patients with complete information (39% female; the average age of 57±15 years) were analyzed. Seven percent of these patients died. The three main leading causes of admission were: fever (77%), dry cough (73%), and fatigue (69%). The most prevalent comorbidities between COVID-19 patients were hypertension (35%), diabetes (28%), and ischemic heart disease (14%). The percentage of primary composite endpoints (PCEP), defined as death, the use of mechanical ventilation, or admission to an intensive care unit was 18%. The Cox Proportional-Hazards Model for PCEP indicated the following significant risk factors: Oxygen saturation < 80% (HR = 6.3; [CI 95%: 2.5,15.5]), lymphopenia (HR = 3.5; [CI 95%: 2.2,5.5]), Oxygen saturation 80%-90% (HR = 2.5; [CI 95%: 1.1,5.8]), and thrombocytopenia (HR = 1.6; [CI 95%: 1.1,2.5]). This long-term prospective Cohort may support healthcare professionals in the management of resources following this pandemic.
Ramin Sami, Forogh Soltaninejad, Babak Amra, Zohre Naderi, Shaghayegh Haghjooy Javanmard, Bijan Iraj, Somayeh Haji Ahmadi, Azin Shayganfar, Mehrnegar Dehghan, Nilufar Khademi, Nastaran Sadat Hosseini, Mojgan Mortazavi, Marjan Mansourian, Miquel Angel Mañanas, Hamid Reza Marateb, Peyman Adibi
Factors Associated With Job Satisfaction of Frontline Medical Staff Fighting Against COVID-19: A Cross-Sectional Study in China
covid-19, influencing factors, job satisfaction, Workload, frontline medical staff
Purpose: The current research on frontline medical staff in China fighting against COVID-19 has not yet addressed job satisfaction. The purpose of this study is to investigate the job satisfaction of those who were sent to support Hubei province, China, or worked in local designated hospitals, and then analyze the associated influencing factors.Materials and Methods: A total of 455 medical staff who worked at the frontline of the prevention and control of COVID-19 in Hubei province was selected using simple random sampling. They were asked to fill out a self-developed general information questionnaire as well as the Minnesota Satisfaction Questionnaire (MSQ), from 10 January to 10 March 2020.Results: The average job satisfaction score of the participants was 82.58 ± 11.11. The influencing factors include education (P = 0.002), years of work experience (P = 0.006), anti-epidemic work duration (P = 0.048), daily sleep duration (P < 0.001), and the form of participation (P < 0.001).Conclusions: This study, for the first time, measures the job satisfaction of frontline medical staff in fighting against COVID-19 in China. The job satisfaction of frontline medical staff was at a “relatively decent” level, higher than the previous similar measures among medical staff. Related management departments should further improve the job satisfaction of frontline medical staff by meeting their reasonable demands, strengthening the emergency response and practical operation training of junior staff, and ensuring their ample time for sleep and rest. This study is of great reference value for improving the job satisfaction level of frontline medical staff during public health emergencies, developing medical staff security policies, and promoting the establishment of emergency response teams.
Huilan Xu, Xiaoyan Yu, Xiaoyan Yu, Yuxi Li, Yuxin Zhao, Xianmei Zhao, Chao Hu, Jin Huang
A Covid-19 e a volta às aulas: ouvindo as evidências
covid-19, interrupção do calendário escolar, educação baseada em evidências
Paralisadas pelo pânico decorrente da pandemia provocada pela Covid-19, o fechamento das escolas trará consequências para a aprendizagem dos alunos. Este artigo examina situações de paralisação, uso do tempo e impacto de tecnologias no desempenho escolar. O exame das evidências sugere como pouco promissoras as estratégias de aumento intensivo de tempo ou recurso a tecnologias. Caminhos mais promissores estariam associados a diagnósticos, intervenções estruturadas mais adequadas ao perfil dos professores, melhor aproveitamento do tempo, uso judicioso dos deveres de casa, redução do absenteísmo e tutoria intensiva de alta qualidade focada nos alunos de maior risco.
João Batista Araujo e Oliveira, Matheus Gomes, Thais Barcellos
Kebugaran Jasmani Bagi Lansia Saat Pandemi Covid-19
Pandemic Covid-19 menimpa semua negara di dunia termasuk Indonesia dan terjadi mortalitas sebagian besar adalah lansia. Upaya meningkatkan penampilan, kesejahteraan, dan kebugaran lansia melalui olahraga. Senam aerobic dengan instensitas ringan adalah mudah, murah, dan dapat meriah serta bermanfaat karena dilakukan di dalam rumah dan akan menyebabkan denyut jantung lansia masuk ke dalam training zone sehingga akan memenuhi tuntutan dan persyaratan pelatihan. Para lansia selama pandemic Covid-19 diarahkan melakukan senam dan berusaha mencapai target, yaitu berlatih tiga sampai lima kali seminggu dengan waktu latihan 30 sampai 60 menit.
Modeling the Effect of COVID-19 Lockdown on Mobility and NO2 Concentration in the Lombardy Region
coronavirus, Pandemic, Air quality, Po Valley, road traffic, anthropogenic emissions
Recent observation and modeling-based studies have shown how air quality has been positively affected by the containment measures enforced due to the COVID-19 outbreak. This work aims to analyze Lombardy’s NO2 atmospheric concentration during the spring lockdown. The region of Lombardy is known for having the largest number of residents in Italy and high levels of pollution. It is also the region where the first European confinement measures were imposed by the Italian government. The modeling suite composed of CAMx (Comprehensive Air Quality Model with Extensions) and WRF (Weather Research and Forecasting model) provides the setting to compare the atmospheric NO2 concentration from mid-February to the end of March with a business as usual situation. The main interest in this work is to investigate the response of NO2 atmospheric concentration to increasingly reduced road traffic. We can simulate, for the first time, a real circumstance of progressively reduced mobility, as well as validating it with measured air quality data. Focusing on the city of Milan, we found that the decrease in NO2 concentration reflects progressively reduced traffic contraction. In the case of a large traffic abatement (71%), the concentration level is reduced by one third. We also find that industrial activities have a relevant impact on NO2 atmospheric concentration, especially in the provinces of Brescia and Bergamo. This study provides an overview of how incisive policies must be implemented to achieve the set environmental targets and protect human health.
Andrea Piccoli, Valentina Agresti, Alessandra Balzarini, Marco Bedogni, Riccardo Bonanno, Elena Collino, Filippo Colzi, Matteo Lacavalla, Guido Lanzani, Guido Pirovano, Federico Riva, Giuseppe Maurizio Riva, Anna Maria Toppetti
Liver Injury in Liver Transplant Patients With COVID-19: A Histopathologic Analysis.
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association