Coronaviruses - Online First

Society's information regarding practices, attitudes, and knowledge influences the society's behaviors and practices toward COVID-19 and affects preventive measures and disease control.

This study aims to assess the knowledge, attitude, and practices towards COVID-19 in the young adults of the Iraqi general population.

Cross-sectional study web-based survey conducted between 30^th September 2023 to 31^st January 2024. The data was gathered through an electronic questionnaire. The survey was conducted in the Iraqi population and included male and female participants aged ≥ 18 years. A self-administered structured questionnaire was used for data gathering. The questionnaire consists of items to get information from the participants: risk factors, knowledge, attitudes and practices toward SARS-CoV-2 infection, and social and demographic characteristics. An Arabic version of the questionnaire was prepared. The questionnaire consists of the knowledge part, which includes 11 questions, while attitudes include 10 questions and practices include 8 questions. The knowledge was evaluated on the basis of the correct answer and converted to a score of 5. While for the attitudes, a 5-point Likert-type scoring system was created for responses (1- strongly disagree; 2- disagree; 3-neutral; 4- agree; 5- strongly agree). For the practices, a 5-point Likert score is used for response evaluation (5- always; 4- often; 3- sometimes; 2- rarely; 1-never). The questionnaire link was sent online to the participants via Facebook, Instagram, Telegram, and WhatsApp. The questionnaire participants replied in the Microsoft Excel sheet. An ANOVA test was used to determine the differences in significance between the KAP items and within the section of each KAP. Post-hoc test used for analysis of significance between K and A, K and P, A and P. The significance of the differences between groups was determined using the chi-square test. The analysis was performed using SPSS version 20.

There were 1484 participants, with a survey response rate of 86.7% (1484/1712). The majority of the participants (69.3%) were in the age group of 18 to 25 years, and 85.9% of them were B.Sc., M.Sc., Ph.D., and college students. 90.5% were from urban areas, and 27.6% participated in an online course for COVID-19. The mean score of knowledge was 3.04 ± 0.84, which means that the mean correct answer of the knowledge item was 61%. The highest correctly answered question (87%) was regarding the preventive measures for COVID-19 infection, followed by the main symptoms of COVID-19 (76.5%). The lowest correctly answered question (27%) was regarding the mortality rate of COVID-19, followed by complications of COVID-19 (38.1%). The total knowledge mean score was 61% of the scale (score 3.04/5), and this indicated that 61% of the population has good knowledge regarding the COVID-19 pandemic. Additionally, there were high significance (p < 0.01) differences between the knowledge item score and the correct answer. A post-hoc test indicated a significant difference (p = 0.0305) in item scores between knowledge and practices, but there was no significant difference between knowledge versus attitudes or between attitudes versus practices. Attitudes mean score was 3.6 and 72% frequency of correct answers for the items. A significant number of participants expressed worry about themselves, their family members, friends, or society (64.8%) getting infected. Thus, about 1/3 of the participants were not worried about getting an infection. However, 18.4% of participants did not express any as they gave a neutral answer. It is interesting that 80.3% of the participants believed that an asymptomatic patient could transmit the virus to others. The survey indicated a rate with an average of 12.5% to 36% of neutral responses to the addressed questions. The mean score of practice was 9.98 and the correct answer frequency was 79.6%. The majority of participants (83.3%) reported an acceptable practice. Individual questions were answered correctly in a range of 88.1% to 94.7%, with the exception of carefully removing PPE and discarding it in the proper place (17.1%).

The young adults Iraqi general population had a good KAP standard. Attitudes and practice scores were higher than those of knowledge. The knowledge score mean value was 3.04 and the correct answers frequency was 61%, with the items score range of 1.4 and 4.4, while the correct answers frequency range was 27% and 87%. The mean score of attitudes was 3.6 with a range of 2.8–4.2, while the correct mean frequency was 72% with a range of 56% to 84%. The mean score of practices was 3.98 with a range of 1.6 to 4.5, while the mean frequency of the correct answer was 79.6% with a range of 32% to 90%.

The COVID-19 pandemic, originating in Wuhan, China, swiftly spread globally, wreaking havoc on both personal lives and economic stability.

Its highly contagious nature, transmitted through human contact, necessitated urgent government interventions worldwide. Measures such as quarantine, social distancing, and lockdowns, alongside medical awareness campaigns, were earnestly adopted to mitigate its impact.

While the development of a cure remains a time- consuming endeavor, the focus has shifted towards prevention through diverse strategies, explored in this study.

Presenting a stochastic model, this paper aims to analyze the percentage of affected individuals across various factors, highlighting the efficacy of lockdown measures at different intervals.

The COVID-19 pandemic is having a devastating impact on public health, with a higher risk of severe illness and mortality in vulnerable groups. Individuals with a history of diabetes are more prone to severe COVID-19. A collection of hyperglycemia, inflammation, and impaired immunity in diabetes, especially in poor glycemic control, notably increases the risk of COVID-19 severity. Hyperglycemia can trigger the release of inflammatory cytokines, highlighting the intricate relationship between glucose metabolism and inflammation, and contributing to cytokine storms that worsen COVID-19 severity. Understanding this relationship enables healthcare providers to develop personalized care strategies for managing blood glucose in diabetic patients, thereby reducing the risk of severe COVID-19 outcomes. This study aims to identify the factors that contribute to the severe outcomes of COVID-19 in patients with diabetes, to better understand and manage this critical combination.

A total of 411 patients with COVID-19 infection referred to the Teaching Hospital of Mazandaran University of Medical Sciences, Sari, were included in this study. The COVID-19 severity was evaluated according to the World Health Organization (WHO) guidelines. All information including demographic, clinical, and laboratory data as well as severity and outcome of the disease were compared between diabetic and non-diabetic patients.

The diabetic patients had higher blood glucose (210.3 ±114.9 mg/dl) compared to non-diabetics (118.74 ±3.8 mg/dl) upon admission (p=0.0001). Diabetics also experienced more severe COVID-19 infection (p=0.048). Patients with severe COVID-19 had significantly higher blood glucose (168.5 ±12.8 mg/dl) than those with non-severe infection (136.6± 6.3 mg/dl) (p=0.013). Diabetics had higher erythrocyte sedimentation rates (ESR) compared to non-diabetics (52.25±2.4 vs. 43.81±1.8 mm/h, p=0.006). Diabetic patients taking ACEIs/ARBs had more severe COVID-19 infection (p=0.031).

The study discovered a positive relationship between hyperglycemia and COVID-19 severity, as well as a higher risk of severe COVID-19 among patients taking ACEIs or ARBs.

This study aimed to investigate the severity of disease and length of hospital stay for COVID-19 patients admitted to a hospital in southeastern Iran.

This cross-sectional study was conducted in Kerman, Iran. Data were collected from patients who visited Afzalipour Hospital in Kerman more than twice during the COVID-19 epidemic from the end of February 2020 to March 21, 2021. We conducted two key analyses: 1. Mixed effect logistic regression was used to check the relationship between the variables and COVID-19 severity. 2. Mixed effect linear regression was used to check the relationship between the variables and the length of stay in the hospital.

The findings indicated that the most important risk factors for the severity of COVID-19 were heart diseases (OR=1.67,95%CI:1.20-2.30), increasing age (OR=2.23 for age>54, 95%CI:1.70-2.90), male gender (OR=1.47,95%CI:1.10-1.96), respiratory diseases other than asthma, and frequency of admission (OR=1.60,95%CI:1.20-2.15). All patients who underwent readmission experienced a shorter duration of hospitalization during their subsequent admission (OR=0.94,95%CI:0.91,0.96) and had a higher mortality rate (30% within 14 days, 26.6% between 14-90 days). Patients readmitted at intervals of 14-90 days and greater than 90 days exhibited lower disease severity compared to those readmitted within the 0-14 day period.

Examining readmissions, the severity of COVID-19, and the length of hospital stay in affected patients are important factors for planning and allocating resources for COVID-19 management and treatment. These factors can help policymakers develop effective clinical guidelines for hospitalization or outpatient treatment of COVID-19 patients and contribute to reducing the burden of disease in the community.

Postpartum depression has a profound impact, both physically and psychologically, on both the mother and her newborn. With a focus on the prevalent psychological complications following the onset of this condition, this study aimed to explore the correlation between antenatal depression and Corona disease anxiety, personality traits, and postpartum depression during the COVID-19 pandemic.

This cross-sectional descriptive-analytical study investigated women receiving care at health centers affiliated with Kerman University of Medical Sciences during the last month of their pregnancy and the postpartum period in 2022. Following the acquisition of informed consent, participants were assessed using various measures, including demographic and obstetric information, the Edinburgh Postnatal Depression Scale, the Corona Disease Anxiety Scale (CDAS), and the NEO Personality Inventory-Revised during their third trimester of pregnancy. The same group of participants completed the Edinburgh Depression Scale and the Corona Disease Anxiety Scale (CDAS) 4-6 weeks after childbirth.

There was a significant correlation between family income, unwanted pregnancy as perceived by both the mother and father, and antenatal depression. Additionally, marital satisfaction played a significant role in postpartum depression. Furthermore, antenatal depression was significantly associated with neuroticism, agreeableness, and physical symptoms related to Corona disease anxiety. Personality traits, with the exception of extroversion and conscientiousness, and various domains of Corona disease anxiety, excluding psychological symptoms, were also significantly associated with postpartum depression.

During pandemics or epidemics, such as the COVID-19 outbreak, experiencing mental distress during pregnancy can contribute to mental health issues during the postpartum period. This risk is particularly true in individuals with unique personality traits, emphasizing the need for increased focus on mental health within prenatal care during these crises.

This study presents a comprehensive strategy for combating cholera in Syria, with a focus on clean water initiatives, treatment, surveillance, and vaccination, and the critical role of clean water in halting disease transmission.

The review design has involved a thorough research and review of existing literature and data on cholera outbreaks in Syria. It has also included an analysis of vaccination and treatment options, as well as an exploration of cholera surveillance systems and clean water initiatives.

Key findings have indicated that prioritizing access to clean water through community water management plans and water purification technologies is essential for cholera prevention. Case studies, supported by epidemiological data up to September 2023, have underscored the importance of clean water in stopping cholera spread.

The study has highlighted the urgent need for a comprehensive strategy to protect millions in Syria through enhanced water, sanitation, and vaccination measures. It has advocated for improved cholera surveillance and response systems, along with continued efforts to ensure clean water access for all.

Global healthcare faces challenges in combating COVID-19, with rising cases despite widespread vaccination. Severe COVID-19 cases, marked by acute respiratory distress and cytokine release syndrome, highlight the importance of managing cytokine storms. Janus kinase (JAK) inhibitors, such as tofacitinib, show promise in this regard. While tofacitinib is recommended for severe cases, challenges include adverse effects, conflicting studies, and the need for further investigation of new virus strains. Overcoming these hurdles is crucial for developing an effective treatment protocol and reducing COVID-19 mortality.

This study conducted a comprehensive search across PubMed, Scopus, and ISI Web of Science for observational studies on tofacitinib treatment in human adults with COVID-19. The search covered a specified period up to 2024. Data extraction, including study characteristics and quality assessment, employed the Newcastle Ottawa Scale and a modified Cochrane tool. Statistical analysis, conducted with Comprehensive Meta-Analysis Software, assessed heterogeneity and significance levels.

The meta-analysis of the three studies showed a significant reduction in mortality (Risk Ratio: 0.372, 95% CI: 0.213–0.649, P-value = 0.001) with low heterogeneity (Cochrane P-value = 0.793), while no significant reduction in the need for mechanical ventilation was observed (Cochrane P-value = 0.194).

Tofacitinib administration shows a significant reduction in COVID-19 mortality. However, the limited studies on its efficacy highlight the need for cautious interpretation in clinical assessments.