Journal of the Asian Medical Students Association
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Development of immunoinformatics program for amino acid sequence alignment and linear B-Cell epitope prediction based on spike proteins of SARS-CoV-2
Full text linkCorona Virus Disease 2029 (COVID-19), the current outbreak caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has been declared as a global pandemic. Insights into B-cell epitope profiles of SARS-CoV-2 will greatly contribute to a better design of a vaccine to combat COVID-19. With an advance in the immunoinformatics, B-cell epitope prediction combining multiple tools has been previously shown to be an effective and accurate method to identify potential B-cell epitopes from the SARS-CoV-2 S protein sequence. However, extracting the potential peptides from each prediction tool as well as finalizing the putative B-cell epitopes are still time-consuming and labor-intensive. In this work, we thus aim to develop a program and interface for a rapid and accurate prediction of B-cell epitopes by using SARS-CoV-2 S as a test sequence. To fill the gaps in B-cell epitope prediction combining multiple prediction tools, a new program was developed with a special feature that it can assemble the prediction results obtained from distinct tools and then generate potential B-cell epitopes. To run the program, a full-length sequence of the target protein in FASTA format is input together with CSV files of the prediction results obtained from B-cell epitope and coil structure prediction using BepiPred - 2.0 tool, and from predictions for accessibility, hydrophilicity and antigenicity using the methods of Emini, Parker, and Kolaskar & Tongaonkar, respectively. The program runs in 2 phases. In phase I, peptides are extracted from each tool based on the input thresholds and predicted peptides from all tools are next aligned. In phase II, the program creates the final putative B-cell epitopes depending on the users’ criteria. We provide a program with a solution addressing problems associated with B-cell epitope prediction using multiple tools and criteria for epitope identification, thus enabling a more rapid and accurate B-cell epitope prediction.
 
Respiratory Rate and Systolic Blood Pressure on Hospital Admission as Prognostic Factor in COVID-19: A Systematic Review and Meta-Analysis
Full text linkIntroduction: From December 2019 to September 10, 2021, More than 223 million people have been infected with COVID-19, resulting in more than 223 million 4.6 million deaths. The mortality rate is high in certain groups and particularly high in the absence of proven effective standard management measures. The use of a simple and accurate predictor for COVID-19 prognosis will be beneficial for the clinical management of patients. Therefore, we perform this systematic review and meta-analysis to reveal the association of specific clinical characteristics, that is respiratory rate (RR) and systolic blood pressure (SBP) on the first admission, with the COVID-19 severity.
Objective: To reveal the association of RR and SBP on first admission, with the COVID-19 severity.
Methods: We performed a systematic search in PubMed, ScienceDirect, and ProQuest for studies reporting clinical characteristics of mild and severe COVID-19 case. Included studies were evaluated for risk of bias based on Newcastle Ottawa Score. A meta-analysis was conducted using the data extracted from each study. Review Manager (RevMan) 5.4 was utilized to compute the summary of mean difference (MD) and 95% confidence intervals (CI) for the outcome.
Results: We included 6 studies involving 1,265 patients (severe cases=348 and mild cases=917), conducted in China, with several different outcomes. We found that increased RR (MD: 1.59; 95% CI: 0.31, 2.88; p<0.00001; I2= 86%) and increased SBP (MD: 5.27; 95% CI: 1.14, 9.40; p= 0.23; I2= 28%) and composite of both (MD: 2.09; 95% CI: 0.81, 3.38; p= 0.10; I2= 64.0%) were associated with severe COVID-19.
Conclusion: RR and SBP associated with the severity of COVID-19. Therefore, this clinical findings could be a prognostic factor of severe COVID-19 case among all the clinical manifestation. Longitudinal studies may reveal more long-term impacts of SARS-CoV-2 infection along the association of it's clinical manifestation.
Key Findings: COVID-19; Severity; Respiratory rate; Systolic blood pressur
Health utilization dynamics for the leading causes of inpatient and ambulatory care in Mongolia; COVID-19 indirect effects and beyond
Full text linkIntroduction
In 2020, Mongolia was one of the first countries in the world to implement a comprehensive policy response to the COVID-19 pandemic, early and timely manner. A detailed study of these transitions is of paramount importance in developing recommendations to reduce disease burden and reduce mortality.
Objective
We aimed to investigate the epidemiological shifts observed in Mongolia for the leading causes of hospitalization and outpatient visits during the pandemic year, as observed by the health system across the country.
To study changes to inpatient and outpatient care of diseases observed in Mongolia in 2020, for interrupted time-series analyses 2019 as a baseline
Assessing the community mobility and the incidence of other concomitant diseases, including injuries and poisoning in relevance to lockdown measures
Method
Data analysis was based on nationwide epidemiological data gathered to the H-Info system of the Center for Health Development of Mongolia. The epidemiological transition and shifts of diseases and injuries of total patients who visited the Mongolian health care services in 2020 were studied using the R(2020/2019) rate, compared to 2019 by the series of interrupted time-series analyses.
Result
We found healthcare utilization (R>1) has increased as the growing number of stroke, uterine prolapse, and acute upper gastrointestinal complications cases. However, pulmonary arterial hypertension, congenital disorders, peptic ulcer, non-ST-Elevation myocardial infarction did not show remarkable change (R=1). The majority of the diseases including decompensated cirrhosis and other chronic liver diseases, all types of myocardial infarction indicated a decline. Surprisingly, lower and upper respiratory tract infections showed a remarkable decrease, which has been the leading cause for hospitalization (R<1). Regarding the comparison of before and after pandemic mobility rates with injury epidemiology, total cases of injury and trauma seem to be reduced, but the burn injury cases have increased.
Conclusion
We observed some positive epidemiological shifts observed during the pandemic year. Based on these, we need to implement further interventions to reduce the prevalence of morbidity and mortality, as well as preventive and mitigation-based policies for lower respiratory infections and injuries. Injuries and both lower and upper respiratory tract infections have declined in Mongolia but the increase of burn injury cases in February to March of 2020 might be due to the kindergartens and schools’ closure
School Reopening during COVID-19 Pandemic: Is It Safe? A Systematic Review
Full text linkIntroduction: School closures around the world during the COVID-19 pandemic has brought adverse impacts to students’ learning processes. School reopening has been implemented in some regions, accompanied with health protocols. Strict implementation of health measures and policies are keys in preventing outbreaks in school settings. It is also necessary to identify precipitating factors in outbreaks to design the most effective health policies. Objective: To review the most effective health policies to prevent outbreaks and to identify precipitating factors in outbreaks during school reopening. Methods: Studies were collected from PubMed, ScienceDirect, Cochrane and ResearchGate from 2020-2021 and were selected based on the inclusion criteria. This systematic review was reported according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta Analyses) flow diagram. Quality of studies were assessed using the JBI (Joanna-Briggs Institute) checklist. Results: From 209 studies, 7 studies were eligible for qualitative analysis. Current health measures implemented during the school reopening are sufficient to maintain low attack rates. Student attack rates are lower compared to staff (0.03% vs 4.4%) and students in higher levels of education are more likely to have higher attack rates (kindergarten vs high school: 17.5% vs 33.5%). Some effective health measures are physical distancing, hand hygiene, use of masks, bubbles and a mandatory 14-day quarantine before entering schools. Young adults and staffs tend to have lower compliance to health measures, which results in higher attack rates. Precipitating factors identified are frequency of school attendance, parents’ occupation as healthcare workers, older age, certain ethnic groups, and positive COVID-19 cases in households. Conclusion: It is safe to reopen schools, if proper health protocols are actualized, such as wearing masks, maintaining hand hygiene, physical distancing, and early restriction to attend school for suspects, while main precipitating factors are frequency of attendance, age, and parents’ occupation
Addressing Factors Associated with Public Compliance Towards Quarantine Measurements as A Breakthrough Way Fighting Covid-19 Pandemic: A Meta-analysis
Full text linkINTRODUCTION: Quarantine strategy is implemented to prevent COVID-19 transmission and other infectious disease pandemic. Multiple concerns, such as economic, psychological, and social impacts have risen due to the policy which may lead to protocol violation, which is shown by low adherence to self-isolation.
OBJECTIVE: To assess factors related to quarantine compliance in COVID-19 pandemic.
MATERIALS AND METHODS: Systematic search through PubMed, Google Scholar, Cochrane, EBSCO, Medline, and Scopus, were done until November 11th 2021. Critical appraisal of included studies were performed using the JBI I (Joanna Briggs Institute) tools. We analyzed pooled Odds Ratio (OR) and its p-value using fixed effects models.
RESULTS AND DISCUSSION: Nine studies of 13,282 subjects were included in this review. Better compliance was significantly associated with unmodifiable factors, namely female sex (OR=1.26[95%CI:1.15-1.37],p<0.00001), single marital status (OR=0.79[95%CI:0.69-0.90],p=0.0006), elderly (OR=1.01[95%CI:1.01-1.02],p=0.002), and city residents (OR=1.19[95%CI:1.03-1.37],p=0.02), and modifiable factors including existing emergency regulations (OR=1.80[95%CI:1.49-2.17],p<0.00001), perception to protect own families (OR=1.67[95% CI:1.25-2.22,p=0.0004]), higher education degree (OR=1.29[95%CI:1.10-1.52],p=0.002), trust in government (OR=1.44[95%CI:1.33-1.55],p<0.00001), and worry or distress over COVID-19 (OR=1.44[95%CI:1.34-1.56],p<0.00001). We recommend widening broadcast of quarantine regulations, ensuring consistent and trustworthy government policies with disease containment along with socioeconomic considerations, providing better education in efforts to reduce disease spread. Therefore, decreasing overloaded healthcare burdens and prepare the public not only during COVID-19 but also for future outbreaks.
CONCLUSION: Compliance toward quarantine orders are influenced by several modifiable and nonmodifiable factors. We hope that strategies to further increase people compliance toward quarantine may be formulated based on this comprehensive assessment
Sentiment and Data Analysis of Mental Health Hotline in Thailand Based on Social Media by Machine Learning
No full textIntroduction
The Thai Mental Health Hotline has been utilized to help people with their mental health issues, bridging the gap in mental health access. However, no previous article has identified its drawbacks. Thus, this evidence on social media response might reflect real world feedback and show substantial impediments to providing mental health care via telepsychiatry in Thailand.
Objective
Our research aims to describe and analyze feedback on social media about receiving mental health services from the Thai Mental Health Hotline by using sentiment analysis, machine learning, visualization of data, and text analytics.
Method
Thai Mental Health Hotline comments were gathered manually from Facebook and Pantip, and automatically from Twitter by using related keywords. Data preparation and sentimental analysis were applied to interpret all comments by using WangchanBERTa, the latest and largest Thai language NLP model. Exploratory Data Analysis was performed through Python and Excel to clean and investigate trends of feedback by time. The negative opinion was focused to identify causes of adverse outcomes. The overall data was visualized to discuss and conclude the outcome.
Result
From 555 comments gathered from 2013-2020, 52.40% of the comments are neutral, followed by negative at 35.05%, and positive at 12.55%. The number of comments from social media were low from 2013 - 2019, and then rose extremely to climax (213 comments) during 2020. Focused on the complaints, most of them are about absent response issues (79.47% out of all negative response), service quality (13.16% out of all negative response) and others.
Conclusion
The peak of comment in 2020 may be influenced by Covid-19. Moreover, aside from neutral reactions, data suggest that there are more negative than positive responses. To deal with negative feedback, including absent response and poor service quality, more psychologists should be provided, and more expenditure should be spent on training consultants.
 
The Efficacy of Telemedicine Interventions in Promoting Drug Adherence among Solid Organ Transplant Recipients Compared with Usual Care: a Network Meta-Analysis
Full text linkIntroduction
Medication adherence plays an essential role in organ transplant recipients, where clinical outcomes rely highly on post-transplant care to prevent risks of graft rejection. Telemedicine has long been used to facilitate interactions and promote clinical adherence. However, only a few studies have examined these interventions in terms of their efficacy in raising patients’ adherence compared to standard care, especially in organ transplantation; therefore, we have conducted this research aiming to meet the aforementioned gap of knowledge.
Objectives
To compare the medication adherence-enhancing efficacy (1) amongst telemedicine interventions and (2) between telemedicine interventions and usual care
Method
This network meta-analysis was conducted using papers from PubMed and Embase published between 2012 to April 2022. Randomized controlled trials that applied telemedicine intervention in solid organ transplant recipients with immunosuppressant administrations were included. The analyses of adherence-promoting efficacy were done with direct comparisons of interventions within the RCTs and indirect comparisons across trials based on a common comparator measured 6 months after the operation. The primary outcome was medication adherence using BAASIS, TAQ, and HHS as parameters.
Result
A total of six RCTs consisting of 604 patients were eligible. The analysis showed that education via telemedicine appears to be the most effective comparing to other interventions (i.e. reminder & education and reminder & monitoring - OR 2.56 [95%CI: 1.26-5.19] and OR 2.47 [95%CI: 1.42-4.27, respectively). Contrarily, the difference between all interventions and usual care is insignificant (OR 0.94 [95%CI: 0.57-1.54], p = 0.800).
Conclusion
Education was suggested to be the most effective telemedicine intervention in promoting medication adherence, however, the difference between standard care and every intervention altogether is insignificant. With further studies, we believe that telemedicine could be potentiated in becoming an ideal adherent tool
Advancement of telemedicine due to wearable device
Full text linkA.introduction
Telemedicine was applied to medicine to overcome barrier of distance limit, but medical information that could be obtained only through a simple phone call or video call was limited. However, with the development of IT technology, and semiconductors, medical devices have been miniaturized. Therefore, medical devices appeared in the form of wearables. So, we would like to investigate how the development of these medical devices has affected telemedicine.
B.objective
How wearable devices developed telemedicine was divided into three major contents. First, the EKG and PPG used in cardiology was investigated. Second, the measurement and monitoring of vital signs were investigated. Lastly, we investigated artificial intelligence.
C.Method
A Research direction was set to “Advancement of telemedicine due to wearable device" and nine people conducted literature survey. The inclusion criteria were set as telemedicine, wearable device, IOT, advancement, outcome.
D.Result
First, wearable devices are used to determine the presence or absence of cardiovascular disease by measuring continuous data. Second, Wearable devices aim to predict and evaluate underlying health conditions, enabling continuous and ambulatory measurement of vital signs including blood pressure, heart rate, respiratory rate, body temperature, and blood oxygen saturation, which are valuable clues to be monitored in order to identify clinical deterioration. Finally, as telemedicine is developed, a flood of data was applied in medical area. Artificial intelligence medical devices using medical data can significantly reduce misdiagnosis and the problem due to lack of supply of specialists.
E.Conclusion
Wearable devices made physicians to receive objective data and continuous measurements. Patients also receive quality care without going hospital and are not affected by external factors such as whitegown syndrome. However, it is necessary to consider who should be responsible for the misdiagnosis, and more research should be done to minimize the error
Efficacy and Safety of COVID-19 Vaccines for Patients with Solid Cancer: A Systematic Review and Meta-Analysis
Full text linkThis systematic review and meta-analysis compared the efficacy and safety of COVID-19 vaccines between solid cancer patients and general people. We searched five electronic databases on July 18, 2021. The inclusion criteria for a study were: i) solid cancer patients; ii) receiving at least one dose of COVID-19 vaccine; iii) reporting of anti-spike(S) IgG seropositivity rates (primary outcome) and other efficacy and safety outcomes; and iv) comparing the outcomes between solid cancer patients and general people or within solid cancer patients. We assessed the study quality and pooled the outcomes using relative risks (RRs) and 95% confidence intervals (95% CIs). This review included ten studies, seven for meta-analyses. Almost all participants received the BNT162b2 vaccine. In comparison to the controls’ anti-S IgG seropositivity rates, those of solid cancer patients were significantly lower after the first vaccination (RR = 0.46, 95% CI 0.37 to 0.57) and slightly lower (RR = 0.94, 95% CI 0.91 to 0.96) after the second vaccination. In conclusion, the BNT162b2 vaccine is relatively safe for solid cancer patients. These patients may have a lower seropositivity rate after the first vaccination. However, the seropositivity rate increases considerably and is comparable to general people after the second vaccination
Self Medication Practices For The Prevention And Treatment Of Covid-19 Among Undergraduate Medical Students
Full text linkINTRODUCTION: As the COVID-19 pandemic continues, health care workers are still at an increased risk for infection. Medical students, attending classes in person, as well as interacting with probable infective patients may have led to an increase in preventive measures such as Self Medication. This study was conducted to assess the knowledge, attitude, and practices of Medical Students in a tertiary care hospital of South India, regarding Self Medication Practices
OBJECTIVES:
To assess knowledge and practices towards self-medication in regards to COVID-19 pandemic in undergraduate medical students
To assess protective measures followed for prevention of the spread of COVID-19 in medical students
METHODOLOGY:
An online survey-based cross-sectional study was conducted in the undergraduate medical student population of a tertiary care hospital in South India. Data from students from 1st year to Internship of the medical college was collected through Google Forms. Statistical Analysis was done using Google Sheets
RESULTS: A total of 326 students (209 female, 117 male). 29.8% of individuals stated that they had self medicated for prevention or treatment of COVID-19, the most common drugs being taken were 'over the counter' supplementary medicines such as Vitamin C and Zinc tablets. 21.3% of individuals being treated for COVID-19 admitted to self medicating, the commonest reason for self medicating being easy access to medication.
CONCLUSION
Though Medical Students have knowledge and are aware of the risks associated with Self Medication, the practice is prevalent for the prevention and treatment of COVID-19.
Based on the results, it can be noted that apart from self medication, many measures are being implemented for prevention of infection