The disruption of dental care delivery that occurred at a large scale during the first wave might have had great effects on dentists, other healthcare personnel, and the general public . Thus, assessing the extent of dental practice closure during the first wave and its determinants is important to help mitigate its impact and plan supportive measures. It also offers lessons to develop strategies during the third wave of the pandemic and help plan the future of the dental practice during the pandemic.
A cross-sectional, multi-country, electronic survey questionnaire was conducted from April to May 2020 during the first wave of the pandemic. The Ethics Review Committee of the Faculty of Dentistry, Alexandria University approved the study including how the consent was obtained (IRB No. 00010556-IORG 0008839). The study was carried out according to the principles of the Declaration of Helsinki.
COVID-19 had a considerable impact on dental practices around the world. During the first wave, most dentists reported practice closure because of COVID-19 with greater impact in the private sector than in the non-private sector. Personal, professional, and country-level factors were associated with practice closure. These findings help provide a profile of dentists with practices at greater risk of closure to plan appropriate support packages.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus in the coronavirus family causing the coronavirus disease 2019 (COVID-19) (Okan et al. 2020). COVID-19 was first reported in December 2019 and has since evolved into the sixth large-scale worldwide outbreak of the twenty-first century following the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002 (Felter 2020). Estimates suggest that COVID-19 is nearly twice as contagious as the seasonal flu and takes much longer to present symptoms, making transmission of the virus through asymptomatic carriers a substantial public health challenge (Tosta 2020). Given the lack of widespread use of a safe and effective vaccine against COVID-19, public compliance with measures, such as physical distancing, hand hygiene and wearing masks, is essential to intercepting transmission links (Cheng et al. 2020). Dissemination and consumption of clear, consistent and credible information about COVID-19 is a prerequisite to public compliance with these preventative measures (Van den Broucke 2020).
We screened all search outcomes through a two-step process: (i) title-abstract review, and (ii) full-text review (Fig. 1). As suggested in the common rapid review strategies (Tricco et al. 2015), only one reviewer of the research team screened the studies following the two-step process (the title-abstract screening and full-text screening. In the first screening step, the reviewer screened the papers based on the relevance of their titles and abstracts to our research question. After title-abstract screening, relevant abstracts and those from which the reviewer could not draw conclusions alone were included for further review. The full texts of the eligible abstracts were studied thoroughly for inclusion in the rapid review if found relevant to the research questions. Any indecision regarding an article to include or not were resolved by the team consensus.
All authors contributed to the study conception and design. Developing search strategy, conducting literature search, data preparation, and analysis were performed by Nashit Chowdhury, Ayisha Khalid, and Tanvir C. Turin. The first draft of the manuscript was prepared by Nashit Chowdhury and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
This study was the first initiative in Pakistan to develop an evidence-based treatment model of CBT with cancer patients during chemotherapy. This is recommended along with chemotherapy as an additional and supportive treatment to produce better outcomes. Further study should find its efficacy with cancer patients at all stages, focusing on other psychological problems except depression and anxiety. Patients were not familiar with psychological interventions; therefore, the termination rate was high, and some patients did not practice these interventions properly due to a lack of awareness about their efficacy.
What is beyond question is the fact that the world population is becoming more urban, and in Asia, this process of urbanization, driven by industrialization, has been especially dramatic due to the sheer size of the population and the rapid speed with which it has occurred. While not unlike the first wave of Western industrialization and urbanization, some of the consequences of these profound societal transformations are positive, such as increases in per capital income , however, Asian industrialization and resultant urbanization have also been linked to increases in the overall rate of psychopathology , including EDs, throughout the region. This is consistent with data from the Netherlands that indicated that the incidence of BN was correlated with degree of urbanization, with BN rates five times higher in urban centers as compared to rural areas. Anorexia nervosa (AN), however, was not associated with urbanization . Meanwhile, in China, data suggest that intensifying urbanization corresponds with increases in overall eating pathology, as characterized by decreasing BMIs, increasing weight and shape concerns and increasing dieting behaviors .
It had been more than 5 years since the first case of Middle East Respiratory Syndrome coronavirus infection (MERS-CoV) was recorded, but no specific treatment has been investigated in randomized clinical trials. Results from in vitro and animal studies suggest that a combination of lopinavir/ritonavir and interferon-β1b (IFN-β1b) may be effective against MERS-CoV. The aim of this study is to investigate the efficacy of treatment with a combination of lopinavir/ritonavir and recombinant IFN-β1b provided with standard supportive care, compared to treatment with placebo provided with standard supportive care in patients with laboratory-confirmed MERS requiring hospital admission.
The protocol is prepared in accordance with the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. Hospitalized adult patients with laboratory-confirmed MERS will be enrolled in this recursive, two-stage, group sequential, multicenter, placebo-controlled, double-blind randomized controlled trial. The trial is initially designed to include 2 two-stage components. The first two-stage component is designed to adjust sample size and determine futility stopping, but not efficacy stopping. The second two-stage component is designed to determine efficacy stopping and possibly readjustment of sample size. The primary outcome is 90-day mortality.
This will be the first randomized controlled trial of a potential treatment for MERS. The study is sponsored by King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Enrollment for this study began in November 2016, and has enrolled thirteen patients as of Jan 24-2018.
Since the first report of infection with the Middle East Respiratory Syndrome coronavirus (MERS-CoV) was published in 2012, the World Health Organization has been notified of 2123 laboratory-confirmed infections with MERS-CoV from 27 countries and at least 740 reported deaths (case fatality 35%) . There is no specific therapy of proven efficacy available and no potential treatment has been tested in a randomized clinical trial (RCT) for evaluation [2,3,4]. Based on results from in vitro and animal studies of MERS-CoV infection, the guanosine analog ribavirin, in combination with interferon alpha (IFN-α), has been used to treat patients with MERS [5,6,7,8]. However, the concentration of ribavirin required to inhibit MERS-CoV in vitro exceeds peak levels in the blood after therapeutic doses in humans [9,10,11]. Furthermore, retrospective studies with IFN-α2a, IFN-α2b or IFN-β1a in combination with ribavirin have not shown a clear benefit in patients with MERS [6,7,8, 12].
The study is a recursive, two-stage, group sequential, multicenter, randomized, placebo-controlled, double-blind trial . The trial is initially designed with 2 two-stage components with two interim analyses and one final analysis. The first two-stage component is designed to adjust sample size and determine futility stopping, but not efficacy stopping. The second two-stage component is designed to determine efficacy stopping and possibly readjustment of sample size to maintain conditional power at the final analysis.
Patients will be followed daily until discharge from hospital or day 28, whichever comes first (Fig. 1). After day 28, the patients will be followed only to document their ICU, hospital, 90-day mortality and length of stay. Collection of this information may require telephone interviews with patients or next of kin. Figure 1 shows the schedule of enrollment, intervention and assessment for the MIRACLE trial according to the SPIRIT template. The SPIRIT Checklist is given in Additional file 1.
Because of the uncertainty surrounding the recruitment rate and the efficacy level of the treatment, the trial is designed as recursive, two-stage, group sequential randomized trial . The trial is designed initially to have 2 two-stage components with two interim analyses and one final analysis (Fig. 2). The first two-stage component is designed to determine futility stopping and adjust sample size, but not efficacy stopping. The second two-stage component is designed to determine efficacy stopping and possibly readjustment of sample size to maintain conditional power at the final analysis. A classic two-group design requires a total of 194 subjects (97 subjects per group) to have a 80% power at a significant level of 2.5% (one-sided test) to detect 20% absolute risk reduction in 90-day mortality among subjects receiving treatment (20%) compared to the control group (40%). The trial will start the first two-stage design with 136 subjects (68 subjects per group). We will conduct the first interim analysis when the total subject with 90 days of follow-up reaches 34 subjects (17 per group), which is about 17.5% of the total sample size needed for classical design. We use the method of summing of stage-wise p value to determine the one-sided stopping boundaries in the first two-stage design listed in Table 2. At the first interim analysis we will use the stage-wise p values obtained from the chi-square test for difference in proportion to determine whether the trial will be stopped for futility or not. Should the trial continue, sample size re-estimation based on the observed effect size will be determined using the following formula assuming a conditional power of 80%: 1e1e36bf2d