Showing papers in "Postgraduate Medical Journal in 2021"

COVID-19: Current understanding of its Pathophysiology, Clinical presentation and Treatment

Abstract: Background The severe acute respiratory syndrome (SARS) coronavirus-2 is a novel coronavirus belonging to the family Coronaviridae and is now known to be responsible for the outbreak of a series of recent acute atypical respiratory infections originating in Wuhan, China. The disease caused by this virus, termed coronavirus disease 19 or simply COVID-19, has rapidly spread throughout the world at an alarming pace and has been declared a pandemic by the WHO on March 11, 2020. In this review, an update on the pathophysiology, clinical presentation and the most recent management strategies for COVID-19 has been described. Materials and Methods A search was conducted for literature and various articles/case reports from 1997 to 2020 in PUBMED/MEDLINE for the keywords coronavirus, SARS, Middle East respiratory syndrome and mRNA virus. Results and Conclusions COVID-19 has now spread globally with increasing morbidity and mortality among all populations. In the absence of a proper and effective antibody test, the diagnosis is presently based on a reverse-transcription PCR of nasopharyngeal and oropharyngeal swab samples. The clinical spectrum of the disease presents in the form of a mild, moderate or severe illness. Most patients are either asymptomatic carriers who despite being without symptoms have the potential to be infectious to others coming in close contact, or have a mild influenza-like illness which cannot be differentiated from a simple upper respiratory tract infection. Moderate and severe cases require hospitalisation as well as intensive therapy which includes non-invasive as well as invasive ventilation, along with antipyretics, antivirals, antibiotics and steroids. Complicated cases may require treatment by immunomodulatory drugs and plasma exchange therapy. The search for an effective vaccine for COVID-19 is presently in full swing, with pharmaceutical corporations having started human trials in many countries.

SARS-CoV-2 and the pandemic of COVID-19.

Abstract: SARS-CoV-2 is a virus that is the cause of a serious life-threatening disease known as COVID-19. It was first noted to have occurred in Wuhan, China in November 2019 and the WHO reported the first case on December 31, 2019. The outbreak was declared a global pandemic on March 11, 2020 and by May 30, 2020, a total of 5 899 866 positive cases were registered including 364 891 deaths. SARS-CoV-2 primarily targets the lung and enters the body through ACE2 receptors. Typical symptoms of COVID-19 include fever, cough, shortness of breath and fatigue, yet some atypical symptoms like loss of smell and taste have also been described. 20% require hospital admission due to severe disease, a third of whom need intensive support. Treatment is primarily supportive, however, prognosis is dismal in those who need invasive ventilation. Trials are ongoing to discover effective vaccines and drugs to combat the disease. Preventive strategies aim at reducing the transmission of disease by contact tracing, washing of hands, use of face masks and government-led lockdown of unnecessary activities to reduce the risk of transmission.

Healthcare workers' (HCWs) attitudes and related factors towards COVID-19 vaccination: a rapid systematic review.

Abstract: Herd immunity through vaccination is a key measure to control COVID-19 pandemic. However, vaccine hesitancy remains a public health threat, which is still common among healthcare workers (HCWs). This systematic review aimed to synthesise evidence on HCWs' attitudes towards COVID-19 vaccination and analyse associated factors to provide information for vaccine policy development and practice. We searched PubMed, Embase, ScienceDirect, Web of Science and three Chinese databases for literature published on 12 February 2021. Two researchers screened the literature independently, and 13 studies were included in the systematic review. Vaccine acceptance varied widely and ranged from 27.7% to 77.3%. HCWs had positive attitudes towards future COVID-19 vaccines, while vaccine hesitancy was still common. Demographic variables such as men, older age and physicians were positive predictive factors. Women and nurses had more vaccine hesitancy. Previous influenza vaccination and self-perceived risk were facilitators. Concerns for safety, efficacy and effectiveness and distrust of the government were barriers. Influences of direct (COVID-19) patient care towards vaccination intention were less conclusive. Tailored communication strategies were needed to increase the uptake rate of COVID-19 vaccines among HCWs. More importantly, more data and information on the safety and efficacy of vaccines should be provided with transparency.

Review of COVID-19 vaccine subtypes, efficacy and geographical distributions.

Abstract: As of 1 May 2021, there have been 152 661 445 Covid-19 cases with 3 202 256 deaths globally. This pandemic led to the race to discover a vaccine to achieve herd immunity and curtail the damaging effects of Covid-19. This study aims to discuss the most recent WHO-approved Covid-19 vaccine subtypes, their status and geographical scheduled updates as of 4 May 2021. The keywords "Covid-19, Vaccines, Pfizer, BNT162b2, AstraZeneca, AZD1222, Moderna, mRNA-1273, Janssen, Ad26.COV2.S" were typed into PubMed. Thirty Two relevant PubMed articles were included in the study. The vaccines discussed are Pfizer/BNT162b2, Moderna Vaccine/mRNA1273, AstraZeneca/AZD122/ChAdOx1 n-CoV-19 and the Janssen vaccines/Ad26.COV2.S, as well as their platforms, trials, limitations and geographical distributions. As of 16 May 2021, the number of countries that have approved the use of the following vaccines is Pfizer in 85, Moderna in 46, Oxford/AstraZeneca in 101, and Janssen in 41.

Medical education challenges and innovations during COVID-19 pandemic.

Abstract: COVID-19 pandemic has undoubtedly disrupted the well-established, traditional structure of medical education. Τhe new limitations of physical presence have accelerated the development of an online learning environment, comprising both of asynchronous and synchronous distance education, and the introduction of novel ways of student assessment. At the same time, this prolonged crisis had serious implications on the lives of medical students including their psychological well-being and the impact on their academic trajectories. The new reality has, on many occasions, triggered the 'acting up' of medical students as frontline healthcare staff, which has been perceived by many of them as a positive learning and contributing experience, and has led to a variety of responses from the educational institutions. All things considered, the urgency for rapid and novel adaptations to the new circumstances has functioned as a springboard for remarkable innovations in medical education,including the promotion of a more "evidence-based" approach.

Preparing medical students for a pandemic: a systematic review of student disaster training programmes.

Abstract: Objective To identify pandemic and disaster medicine-themed training programmes aimed at medical students and to assess whether these interventions had an effect on objective measures of disaster preparedness and clinical outcomes. To suggest a training approach that can be used to train medical students for the current COVID-19 pandemic. Results 23 studies met inclusion criteria assessing knowledge (n=18, 78.3%), attitude (n=14, 60.9%) or skill (n=10, 43.5%) following medical student disaster training. No studies assessed clinical improvement. The length of studies ranged from 1 day to 28 days, and the median length of training was 2 days (IQR=1–14). Overall, medical student disaster training programmes improved student disaster and pandemic preparedness and resulted in improved attitude, knowledge and skills. 18 studies used pretest and post-test measures which demonstrated an improvement in all outcomes from all studies. Conclusions Implementing disaster training programmes for medical students improves preparedness, knowledge and skills that are important for medical students during times of pandemic. If medical students are recruited to assist in the COVID-19 pandemic, there needs to be a specific training programme for them. This review demonstrates that medical students undergoing appropriate training could play an essential role in pandemic management and suggests a course and assessment structure for medical student COVID-19 training. Registration The search strategy was not registered on PROSPERO—the international prospective register of systematic reviews—to prevent unnecessary delay.

Prognostic value of elevated lactate dehydrogenase in patients with COVID-19: a systematic review and meta-analysis.

Abstract: Purpose This meta-analysis aimed to evaluate the prognostic performance of elevated lactate dehydrogenase (LDH) in patients with COVID-19. Methods A systematic literature search was performed using PubMed, Embase and EuropePMC on 19 November 2020. The outcome of interest was composite poor outcome, defined as a combined endpoint of mortality, severity, need for invasive mechanical ventilation and need for intensive care unit care. Severity followed the included studies’ criteria. Results There are 10 399 patients from 21 studies. Elevated LDH was present in 44% (34%–53%) of the patients. Meta-regression analysis showed that diabetes was correlated with elevated LDH (OR 1.01 (95% CI 1.00 to 1.02), p=0.038), but not age (p=0.710), male (p=0.068) and hypertension (p=0.969). Meta-analysis showed that elevated LDH was associated with composite poor outcome (OR 5.33 (95% CI 3.90 to 7.31), p Conclusion LDH was associated with poor prognosis in patients with COVID-19. PROSPERO registration number CRD42020221594.

Using Twitter for sentiment analysis towards AstraZeneca/Oxford, Pfizer/BioNTech and Moderna COVID-19 vaccines.

Abstract: Introduction A worldwide vaccination campaign is underway to bring an end to the SARS-CoV-2 pandemic; however, its success relies heavily on the actual willingness of individuals to get vaccinated. Social media platforms such as Twitter may prove to be a valuable source of information on the attitudes and sentiment towards SARS-CoV-2 vaccination that can be tracked almost instantaneously. Materials and methods The Twitter academic Application Programming Interface was used to retrieve all English-language tweets mentioning AstraZeneca/Oxford, Pfizer/BioNTech and Moderna vaccines in 4 months from 1 December 2020 to 31 March 2021. Sentiment analysis was performed using the AFINN lexicon to calculate the daily average sentiment of tweets which was evaluated longitudinally and comparatively for each vaccine throughout the 4 months. Results A total of 701 891 tweets have been retrieved and included in the daily sentiment analysis. The sentiment regarding Pfizer and Moderna vaccines appeared positive and stable throughout the 4 months, with no significant differences in sentiment between the months. In contrast, the sentiment regarding the AstraZeneca/Oxford vaccine seems to be decreasing over time, with a significant decrease when comparing December with March (p Conclusion Lexicon-based Twitter sentiment analysis is a valuable and easily implemented tool to track the sentiment regarding SARS-CoV-2 vaccines. It is worrisome that the sentiment regarding the AstraZeneca/Oxford vaccine appears to be turning negative over time, as this may boost hesitancy rates towards this specific SARS-CoV-2 vaccine.

COVID-19: lessons for junior doctors redeployed to critical care.

Abstract: Approximately 4% of patients with coronavirus disease 2019 (COVID-19) will require admission to an intensive care unit (ICU) Governments have cancelled elective procedures, ordered new ventilators and built new hospitals to meet this unprecedented challenge However, intensive care ultimately relies on human resources To enhance surge capacity, many junior doctors have been redeployed to ICU despite a relative lack of training and experience The COVID-19 pandemic poses additional challenges to new ICU recruits, from the practicalities of using personal protective equipment to higher risks of burnout and moral injury In this article, we describe lessons for junior doctors responsible for managing patients who are critically ill with COVID-19 based on our experiences at an urban teaching hospital

Lung ultrasound in the COVID-19 pandemic.

Abstract: Lung ultrasound has been described for over a decade and international protocols exist for its application. It is a controversial area among pulmonologists and has had more uptake with emergency as well as intensive care physicians. We discuss the basics and evidence behind the use of lung ultrasound in respiratory failure, and what role we see it playing in the current 2019 novel coronavirus pandemic.

Anticoagulation in COVID-19: current concepts and controversies.

Abstract: Rising incidence of thromboembolism secondary to COVID-19 has become a global concern, with several surveys reporting increased mortality rates. Thrombogenic potential of the SARS-CoV-2 virus has been hypothesised to originate from its ability to produce an exaggerated inflammatory response leading to endothelial dysfunction. Anticoagulants have remained the primary modality of treatment of thromboembolism for decades. However, there is no universal consensus regarding the timing, dosage and duration of anticoagulation in COVID-19 as well as need for postdischarge prophylaxis. This article seeks to review the present guidelines and recommendations as well as the ongoing trials on use of anticoagulants in COVID-19, identify discrepancies between all these, and provide a comprehensive strategy regarding usage of these drugs in the current pandemic.

Will vaccination refusal prolong the war on SARS-CoV-2?

Abstract: Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that appeared in Wuhan, China in January 2020 and caused a global pandemic drastically changing everyday life. Currently, there are vaccine candidates in clinical trials and development, so it is only a matter of time before one is authorised for human use. Materials and methods We collected public opinion survey results about attitudes towards SARS-CoV-2 vaccination conducted in 2020 in 26 European countries. Results The pooled surveys were conducted on a total of 24 970 participants; on average only 58% (n=14 365/24 970) of responders across Europe were willing to get a SARS-CoV-2 vaccine once it becomes available, 16% (n=3998/24 970) were neutral, and 26% (n=6607/24 970) were not planning to vaccinate against SARS-CoV-2. Such a low vaccination response could make it exceedingly difficult to reach the herd immunity threshold for SARS-CoV-2 through vaccination. Conclusion It is very important to start conducting educational public health activities on the topic of vaccination as soon as possible, before a vaccine becomes available, in order to improve attitudes towards SARS-CoV-2 vaccination. Only by educating the general public about the benefits, safety and efficacy of vaccines can we hope to avoid the unnecessary prolongation of the COVID-19 pandemic.

Statin use and clinical outcomes in patients with COVID-19: An updated systematic review and meta-analysis.

Abstract: PURPOSE: Observations studies have shown that prior use of statins is associated with a reduced risk of adverse clinical outcomes in patients with COVID-19 However, the available data are limited, inconsistent and conflicting Besides, no randomised controlled trial exists in this regard Hence, the present meta-analysis was conducted to provide an updated summary and collate the effect of statin use on clinical outcomes in COVID-19 using unadjusted and adjusted risk estimates METHODS: PubMed, Scopus and Web of Science databases were systematically searched using appropriate keywords till December 18 2020, to identify observational studies reporting clinical outcomes in COVID-19 patients using statins versus those not using statins Prior and in-hospital use of statins were considered Study quality was assessed using the Newcastle-Ottawa Scale Unadjusted and adjusted pooled odds ratio (OR) with 95% CIs were calculated RESULTS: We included 14 observational studies pooling data retrieved from 19 988 patients with COVID-19 All the studies were of high/moderate quality Pooled analysis of unadjusted data showed that statin use was not associated with improved clinical outcomes (OR 102; 95% CI 069 to 150, p=094, I2=94%, random-effects model) However, on pooling adjusted risk estimates, the use of statin was found to significantly reduce the risk of adverse outcomes (OR 051; 95% CI 041 to 063, p<00005, I2=0%, fixed-effects model) CONCLUSIONS: Statin use is associated with improved clinical outcomes in patients with COVID-19 Individuals with multiple comorbidities on statin therapy should be encouraged to continue the drug amid the ongoing pandemic

Three waves of the COVID-19 pandemic.

Abstract: COVID-19 was first reported in the UK at the end of January 2020 and lockdown announced on 23 March 2020. Many of us have uttered the words ‘when this is over’, but what does that really mean? As the first-, second- and third-order impacts of the virus manifest over different time frames, this pandemic will not necessarily be ‘over’ until we are through the impact of the ‘third wave’ of the COVID-19 pandemic. We are currently experiencing the effects of the first wave, where deaths and disability are directly linked to COVID-19. Alongside the atrocious death toll, an as yet untold number of people are living with the lasting aftermath of a severe acute respiratory syndrome coronavirus 2 infection—for some, even mild COVID-19 can be debilitating for months on end, even after they are clinically cured of the infection.1 The second wave refers to those who will suffer in the medium-term due to measures taken …

COVID-19 in patients with heart failure: the new and the old epidemic.

Abstract: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has spread in nearly 200 countries in less than 4 months since its first identification; accordingly, the coronavirus disease 2019 (COVID 2019) has affirmed itself as a clinical challenge. The prevalence of pre-existing cardiovascular diseases in patients with COVID19 is high and this dreadful combination dictates poor prognosis along with the higher risk of intensive care mortality. In the setting of chronic heart failure, SARS-CoV-2 can be responsible for myocardial injury and acute decompensation through various mechanisms. Given the clinical and epidemiological complexity of COVID-19, patiens with heart failure may require particular care since the viral infection has been identified, considering an adequate re-evaluation of medical therapy and a careful monitoring during ventilation.

Intercepting the deadly trinity of mucormycosis, diabetes and COVID-19 in India.

Abstract: Of late, several cases of COVID-19-associated mucormycosis (CAM) are being reported worldwide. Although a causal link between COVID-19 and mucormycosis remains unearthed, multiple factors including glucocorticoids, worsening blood glucose control, ketoacidosis, increased serum-free iron (due to hyperferritinemia and acidosis), and viral-induced lymphopenia have been implicated in the pathogenesis of CAM.1 Notably, most of the cases of CAM have been reported from India.2 India, per se , has the highest burden of mucormycosis globally, with an estimated prevalence of 140 cases per million population. Besides, India is home to nearly 77 million people with diabetes; unarguably, diabetes mellitus is a major risk factor for mucormycosis.3 Nevertheless, there has been an unprecedented and alarming upsurge in the number of cases of CAM across several states, as the second wave of the COVID-19 pandemic continues to rampage in India. Until 19 May 2021, approximately 5500 people were affected with CAM in India, resulting in 126 casualties.4 Subsequently, CAM has been declared an epidemic disease in many states across the country. Amid this raging cataclysm, it is crucial to reflect on the possible reasons and ways to tide over the additional crisis of the ‘black fungus ’. As always, prevention is better than cure. …

Impact of coronavirus disease 2019 on healthcare workers: beyond the risk of exposure.

Abstract: In December 2019, a previously unknown coronavirus strain disease, the coronavirus disease 2019 (COVID-2019) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China, and has rapidly spread worldwide1 2 As of 5 April 2020, more than 1 000 000 people have been officially diagnosed and over 60 000 patients have died, while the pandemic is still spreading3 Clinical manifestations range from asymptomatic or very mild to severe illness, sepsis and death While information so far suggests that most COVID-19 illness is mild, severe illness occurs in up to 16% of cases4 5 The clinical presentation is occasionally atypical, but patients usually present with fever (>80%), cough (>60%) and myalgia or fatigue (>40%)1 4 COVID-19 has been associated with high risk of acute respiratory distress syndrome and intensive care unit (ICU) admission1 2 6 Currently, it is hard to predict the long-term impact of the pandemic on healthcare facilities and personnel Healthcare workers, being in the frontline of an ongoing war against the pandemic, should be perceived as a discrete population in terms of both physical and mental health impact During a crisis, similar to the COVID-19 pandemic, shortages of drug and life-saving equipment may occur7 8 COVID-19 has overwhelmed the capacity of healthcare resources and has significantly changed the workplace rules of healthcare workers9 10 It has been recognised that healthcare workers should take appropriate precautions to avoid contracting the disease and prevent spread within the hospital However, during the early stages of the pandemic, the lack of knowledge resulted in high rates of transmission of COVID-19 to healthcare workers, due to inadequate protection11 12 Currently, the unprecedented overwhelming demand of protective equipment, which includes masks, medical gowns, gloves and eye–face protective devices, poses a significant health risk Contracting the infection results …

COVID-19: a comparison to the 1918 influenza and how we can defeat it.

Abstract: This paper is dedicated to Andrew Price Smith for his extensive analysis of the impact of the 1918 influenza and for being the first to investigate the Austrian Spanish Influenza Archives to demonstrate that the virus struck the Axis troops prior to the Alliance, which forced Kaiser to opt for peace. The COVID-19 pandemic has altered the lives of people around the world, with significant death toll in addition to global social, political and economic impact. Many people have wondered how it compares to the seasonal influenza and prior pandemics. In order to better understand and manage the current pandemic, it is useful to compare it to historical pandemics, such as the Spanish influenza of 1918.1 The 1918 Spanish influenza is caused by an H1N1 influenza A virus postulated to be of avian origin.2 The 1918 Spanish influenza lasted from 1918 to 1920 and consisted of four waves. The first wave lasted approximately from 15 February 1918 to 1 June 1918; the second lasted approximately from 1 August 1918 to 2 December 1918; the third lasted approximately from 3 December 1918 to 30 April 1919; and the fourth wave lasted approximately from 1 December 1919 to 30 April 1920.3 It infected about 500 million people, roughly one-third of the world’s population at that time, and resulted in the deaths of 50 million, including 675 000 Americans.2 The first public news of the epidemic appeared in Madrid on 22 May 1918 in Madrid’s ABC newspaper; hence, it became known as the Spanish influenza.4 However, there is no definite evidence of origination, and most epidemiologists and virologists believe that the virus originated in either the USA or France.4 A week later on 28 May 1918, King Alfonso XIII, the Prime Minister and some cabinet members became …

Investigation of adverse reactions in healthcare personnel working in Level 3 barrier protection PPE to treat COVID-19.

Abstract: Purpose of the study The aim of our study was to investigate potential adverse reactions in healthcare professionals working in Level 3 barrier protection personal protective equipment (L3PPE) to treat patients with COVID-19 Study design By using a convenience sampling approach, 129 out of 205 randomly selected healthcare professionals from the First Affiliated Hospital of Zhejiang University School of Medicine were invited to take part in a WeChat messaging app survey, Questionnaire Star, via a survey link Healthcare personnel details were collected, including profession, years of professional experience and adverse reactions while wearing L3PPE Survey results were divided by profession and years of professional experience; differences in adverse reactions were compared Results Among the 129 healthcare professionals surveyed, 21 (1628%) were doctors and 108 (8372%) were nurses A total of 122 (9457%) healthcare professionals experienced discomfort while wearing L3PPE to treat patients with COVID-19 The main reasons for adverse reactions and discomfort include varying degrees of adverse skin reactions, respiratory difficulties, heat stress, dizziness and nausea Doctors had a lower incidence of rashes (χ2=4519, p=0034) and dizziness (χ2=4123, p=0042) when compared with nurses Junior (85 years of experience or fewer) healthcare personnel also experienced a higher rate of heat stress when compared with senior personnel (more than 85 years greater) (χ2=5228, p=0022) Conclusion More attention should be offered to healthcare personnel wearing L3PPE to treat patients with COVID-19 because they are susceptible to developing adverse reactions

Association between IL-6 and severe disease and mortality in COVID-19 disease: a systematic review and meta-analysis.

Abstract: Background So far, SARS-CoV-2 is the seventh coronavirus found to infect humans and cause disease with quite a strong infectivity Patients diagnosed as severe or critical cases are prone to multiple organ dysfunction syndrome, acute respiratory distress syndrome and even death Proinflammatory cytokine IL-6 has been reported to be associated with the severity of disease and mortality in patients with COVID-19 Objective This systematic review and meta-analysis were carried out to evaluate the association between IL-6 and severe disease and mortality in COVID-19 disease Methods A systematic literature search using China National Knowledge Infrastructure, Wanfang databases, China Science and Technology Journal Database, Chinese Biomedical Literature, Embase, PubMed and Cochrane Central Register of Controlled Trials was performed from inception until 16 January 2021 Results 12 studies reported the value of IL-6 for predicting the severe disease in patients with COVID-19 The pooled area under the curve (AUC) was 085 (95% CI 0821 to 0931) 5 studies elaborated the predictive value of IL-6 on mortality The pooled sensitivity, specificity and AUC were 015 (95% CI 013 to 017, I2=989%), 073 (95% CI 065 to 079, I2=918%) and 0531 (95% CI 0451 to 0612), respectively Meta-regression analysis showed that country, technique used, cut-off, sample, study design and detection time did not contribute to the heterogeneity of mortality Conclusion IL-6 is an adequate predictor of severe disease in patients infected with the COVID-19 The finding of current study may guide clinicians and healthcare providers in identifying potentially severe or critical patients with COVID-19 at the initial stage of the disease Moreover, we found that only monitoring IL-6 levels does not seem to predict mortality and was not associated with COVID-19’s mortality PROSPERO registration number CRD42021233649

Review on therapeutic targets for COVID-19: insights from cytokine storm

Abstract: Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been caused the greatest pandemic of our century. Many of the deaths related to it are due to a systemic inflammatory response, which has been called ‘cytokine storm’. Objectives We developed a comprehensive review of the pathophysiology mechanisms of COVID-19 and of the rationale for drugs and therapeutics that have been tested in clinical trials. Methods A narrative review of the literature was conducted using PubMed, SciELO, Bireme, Google Scholar and ClinicalTrials. Results SARS-CoV-2 has evolutive mechanisms that made it spread all around the globe, as a higher latency period and a lesser lethality than other coronaviruses. SARS-CoV-2 causes a delay in the innate immune response and it disarranges the immune system leading to an overwhelming inflammatory reaction (the ‘cytokine storm’). In this scenario, high levels of interleukins (IL), notably IL-6 and IL-1, create a positive feedback of chemokines and immune responses, and powers pulmonary and systemic tissue damage, leading to capillary leakage and SARS, the main cause of death in patients with COVID-19. On 17 July 2020, there were 1450 entries on ClinicalTrials.gov of ongoing studies on COVID-19. The mechanisms of the main therapeutic approaches were comprehensively reviewed throughout the text. Therapies focus on blocking viral entry (remdesivir, umifenovir, among others) and blocking of immune system for cytokine storm control (IL-1 and IL-6 inhibitors, glucocorticoids, convalescent plasma, among others). Conclusions Understanding of action mechanisms of SARS-CoV-2 enables us to direct efforts on effective therapeutic targets. This comprehensive review helps to interpret the clinical results of the several trials ongoing.

COVID-19 pandemic: stringent measures of Malaysia and implications for other countries.

Abstract: In December 2019, pneumonia of unknown cause jolted Wuhan city of Hubei province in China, spread across Asia and the world like wildfire, and, by the end of January 2020, was declared as a public health emergency of international concern by the WHO1 New coronavirus (severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2) was identified as the cause of this disease and was named COVID-19 by the WHO1 The symptoms of COVID-19 include fever, cough and breathing difficulties and can lead to death These symptoms appear similar to common influenza, but the spread is way far speedier Despite its low fatality as compared with severe acute respiratory syndrome, its high infection nature has led to a contagion of fear worldwide Originated in China, the COVID-19 has now been spread across many other countries and has escalated as a global pandemic2 As of 9 April 2020, the COVID-19 outbreaks reached 203 countries, affecting 1 476 819 persons, with 87 816 deaths (84 477 of which are outside China) In December 2019, pneumonia of unknown cause jolted Wuhan city of Hubei province in China, spread across Asia and the world like wildfire, and, by the end of January 2020, was declared as a public health emergency of international concern by the WHO1 New coronavirus (severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2) was identified as the cause of this disease and was named COVID-19 by the WHO1 The symptoms of COVID-19 include fever, cough and breathing difficulties and can lead to death These symptoms appear similar to common influenza, but the spread is way far speedier Despite its low fatality as compared with severe acute respiratory syndrome, its high infection nature has led to a contagion of fear worldwide Originated in China, the COVID-19 has now been spread across …

Planning virtual residency interviews as a result of COVID-19: insight from residency applicants and physicians conducting interviews.

Abstract: Background In response to the COVID-19 pandemic, the 2020–2021 residency interview process will undergo significant changes. Residency programme stakeholders would benefit from knowledge on what students and physicians expect from this process. Objective The purpose of the study was to describe and contrast the perspectives of student applicants and interviewing physicians related to the residency programme virtual interview process. Methods A survey consisting of 24 Likert statements was administered across listservs in summer 2020 to physicians (attendings and residents who interview medical students). Medical students also received an anonymous survey and were recruited via email to participate. Results A total of 155 individuals (104 fourth-year medical students and 51 physicians) completed a survey. Results showed students would prefer in-person interviews over virtual. Residency applicants had high agreement on the limited ability to fully assess the programme and city due to virtual interviews. Individuals with lower step 1 scores had higher agreement on preferring in-person interviews. Individuals in the lowest and highest scoring groups appear more worried about the representation of themselves as a result of virtual interviews. Furthermore, applicants feel that more weight will be placed on steps 1 and 2 scores and class ranks, and they may not be able to fully demonstrate their personality compared with interviewers. Conclusion The result of COVID-19 has created challenges and subsequent reshuffling of medical education requiring careful preparation and planning. This study provides insight for residency programmes to better understand the applicants’ expectations for the 2020–2021 residency interview and matching process.

Is HbA1c an ideal biomarker of well-controlled diabetes?

Abstract: HbA1c is a biomarker with a central role in the diagnosis and follow-up of patients with diabetes, although not a perfect one. Common comorbidities encountered in patients with diabetes mellitus, such as renal insufficiency, high output states (iron deficiency anaemia, haemolytic anaemia, haemoglobinopathies and pregnancy) and intake of specific drugs could compromise the sensitivity and specificity of the biomarker. COVID-19 pandemic poses a pressing challenge for the diabetic population, since maintaining optimal blood glucose control is key to reduce morbidity and mortality rates. Alternative methods for diabetes management, such as fructosamine, glycosylated albumin and device-based continuous glucose monitoring, are discussed.

COVID-19 impact on junior doctor education and training: a scoping review.

Abstract: COVID-19 has had a significant impact on healthcare resources and the medical workforce. Clinically-based medical education is the principal source of learning, and this has been profoundly impacted by restrictions due to COVID-19. It follows that junior medical staff and their education would be significantly impacted due to the altered volume and breadth of their clinical exposure. Some literature has been published regarding the impact to medical training during COVID-19. This study sought to review junior medical staff perceptions and their reported impact of the COVID-19 pandemic on their education and training.Nine databases (three Ovid MEDLINE databases, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Centre and PsychINFO) were searched for studies published in 1 January 2020 through 24 August 2020. Via a scoping review protocol, an iterative process was used to perform the identification, review and charting analysis of the reported outcomes and themes. Descriptive analysis was performed using quantitative and qualitative methods.Of the 25 343 sources identified, 32 were included in the review. There were studies published from nearly all continents, predominantly in surgical journals, with a wide spread of specialties. Themes identified included the current impact of the pandemic in relation to continuation of and modifications to training programmes, as well as the future impact due to training requirements and career progression.Junior medical staff report that the COVID-19 pandemic has had a significant impact on their education and training. Whether the changes imposed by the pandemic on education are temporary measures or permanent fixtures, and whether standards of competence may be impacted, is not yet known. This scoping review forms a basis for further investigation in the field.

BAME community hesitancy in the UK for COVID-19 vaccine: suggested solutions.

Abstract: COVID- 19 vaccination drive has been launched throughout the world in the past months with the aim to initially cover healthcare professionals and elderly population who are at high risk of COVID-19 infection due to occupational exposure and comorbidities, respectively. The vaccination drive was launched in the UK on 8 December 2020. The UK has ordered 100 million doses of the Oxford-AstraZeneca adenovirus vaccine and 40 million of the Pfizer-BioNTech messenger RNA (mRNA) vaccine—both are currently being rolled out in the UK. Another 17 million doses of the Moderna vaccine, an mRNA vaccine that has been approved by the Medicines and Healthcare products Regulatory Agency in early January, are expected in the spring.1 Vaccination for COVID-19 has multiple advantages as it helps to prevent COVID-19 infection, decreases the severity and transmission of the disease. It will provide a cost-effective intervention to achieve herd immunity.2 Thus, it is the right and duty of everyone to support the vaccination drive for COVID-19 as per guidelines laid down by each country depending on logistics and availability. Vaccine hesitancy - Vaccine hesitancy is a known term and implies a delay in acceptance or refusal to take the vaccine, despite its availability.3 It is not restricted to any specific country or religion but is found across the population in the world. The Black, Asian and Minority Ethnic (BAME) communities in the UK have shown hesitancy4 for this vaccination drive, particularly the black community followed by members of the Asian lineage. This hesitancy has led to slow …

Gender bias in reference letters for residency and academic medicine: a systematic review.

Abstract: Reference letters play an important role for both postgraduate residency applications and medical faculty hiring processes. This study seeks to characterise the ways in which gender bias may manifest in the language of reference letters in academic medicine. In particular, we conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched Embase, MEDLINE and PsycINFO from database inception to July 2020 for original studies that assessed gendered language in medical reference letters for residency applications and medical faculty hiring. A total of 16 studies, involving 12 738 letters of recommendation written for 7074 applicants, were included. A total of 32% of applicants were women. There were significant differences in how women were described in reference letters. A total of 64% (7/11) studies found a significant difference in gendered adjectives between men and women. Among the 7 studies, a total of 86% (6/7) noted that women applicants were more likely to be described using communal adjectives, such as “delightful” or “compassionate”, while men applicants were more likely to be described using agentic adjectives, such as “leader” or “exceptional”. Several studies noted that reference letters for women applicants had more frequent use of doubt raisers and mentions of applicant personal life and/or physical appearance. Only one study assessed the outcome of gendered language on application success, noting a higher residency match rate for men applicants. Reference letters within medicine and medical education exhibit language discrepancies between men and women applicants, which may contribute to gender bias against women in medicine.

Hypertension as an independent risk factor for severity and mortality in patients with COVID-19: a retrospective study.

Abstract: Purpose of the study Hypertension is one of the most common comorbidities in COVID-19 pneumonia. However, whether it is an independent factor on the severity and mortality of COVID-19 has not been studied. Study design In this study, 736 patients with a PCR-confirmed diagnosis of COVID-19 were included from 12 January 2020 to 25 March 2020. All patients were divided into two groups according to whether or not they were hypertensive. After propensity score matching (PSM) to remove the interference of mismatches in the baseline data, the clinical characteristics and outcomes of angiotensin II receptor blocker (ARB)/ACE inhibitors application were analysed. Results A total of 220 (29.9%) patients were hypertensive, and 516 (70.1%) patients were not hypertensive. PSM eliminated demographic and comorbidity differences between the two groups. Of all participants, 32 patients died (4.3% mortality), including 17 out of 220 in the hypertension group (7.7%) and 15 out of 516 in the non-hypertension group (2.9%). The incidence of intensive care unit (ICU) stay in the hypertension group (12.8%) was higher than in the non-hypertension group (5.3%) (p 0.05). Conclusion Hypertension was an independent risk factor for the severity and mortality of patients with COVID-19. ARBs/ACE inhibitors should not be discontinued in hypertensive patients with COVID-19.

Application of Failure Mode and Effect Analysis (FMEA) to improve medication safety: a systematic review.

Abstract: Medication safety is a phenomenon of interest in most healthcare settings worldwide. Failure Mode and Effect Analysis (FMEA) is a prospective method to identify failures. We systematically reviewed the application of FMEA in improving medication safety in the medication use process. Electronic databases were searched using keywords ((failure mode and effect analysis) AND (pharmacy OR hospital)). Articles that fulfilled prespecified inclusion criteria were selected and were then screened independently by two researchers. Studies fulfilling the inclusion criteria and cited in articles selected for the study were also included. Selected articles were then analysed according to specified objectives. Among 27€706 articles obtained initially, only 29 matched the inclusion criteria. After adding four cited articles, a total of 33 articles were analysed. FMEA was used to analyse both existing systems and new policies before implementing. All participants of FMEA reported that this process was an effective group activity to identify errors in the system, although time-consuming and subjective.

Influence of the Peltzman effect on the recurrent COVID-19 waves in Europe

Abstract: Epidemiologists report there is no precise definition for what is or is not an epidemic wave. ‘Waves’ are a phenomenon of infections that can develop during a pandemic. A wave implies a rising number of sick patients, a characteristic peak of illness and then a dramatic or sustained decline of infections reaching a baseline.1 Previous experiences with the Spanish influenza pandemic (1918) and seasonal influenza epidemics suggest further waves of COVID-19 are inevitable.2 The UK has endured the first two waves of the COVID-19 pandemic with widespread socioeconomic consequences and mortality.3 The WHO regional office for Europe has recently reported that incidence, hospitalisations and deaths in Central Europe, the Balkans and the Baltic states are among the highest globally suggesting a third wave of COVID-19.4 The reason for this third wave in Europe and anticipated further waves in countries with vaccine roll-out including the UK could be due to the Peltzman effect. The Peltzman effect is named after Sam Peltzman, professor of economics at the University of Chicago Booth School of Business. It describes the concept of ‘Risk Compensation’.5 In this concept, it is argued that highway safety regulations were not reducing highway deaths. ‘Risk compensation’ is a theory that suggests that people typically adjust their behaviour in response to perceived levels of risk. It postulates that people become more …