Impact of COVID-19 Pandemic on Health Care Professional due to Emergency Surgical Practice: A Hospital Based Observational Study

Background and Objectives: The effects of COVID-19 on surgical practice are extensive and include modifications to perioperative practice and ways of working, workforce and staffing difficulties, procedural prioritization, intraoperative viral transmission risk, and surgical training and education. There is a lack of information about the way this pandemic has impacted medical professionals because of surgical practice. Aims and Objectives: The current study's goal was to determine the dispersion of COVID 19 through patients to healthcare professionals utilising PPE during emergency surgeries. Material(s) and Method(s): The study was conducted as a hospital based retro prospective observational study at the Department of General Surgery, Government Medical College and hospital of central India. After receiving institutional ethical committee permission and the informed written consent, 36 patients receiving emergency surgeries during COVID-19 Era and 109 health care professionals involved in patient care were evaluated for the onset of any COVID 19 symptom for 5 days postoperatively. All the data collected were analyzed using SPSS statistical software version 26. Result(s): Among these 36 emergency surgeries patients, 86.1% (n=31) had COVID positive report during admission, mostly had complain of respiratory symptoms. Out of 16 COVID positive health workers, 81.25% (n=13) suffered from respiratory symptoms, 43.75% (n=7) had G.I symptoms and 12.50% (n=2) were asymptomatic. Analysis showed a positive relation between COVID positive status and depression in health care professionals (p=0.028). Out of 93 COVID negative health care workers involved in emergency surgeries, 90.32 % (n=84) were asymptomatic. Only 9.67% (n=9) health care workers had respiratory symptoms and 2.1% (n=2) had gastrointestinal symptoms. Conclusion(s): The current study may aid in the development of mitigation measures to enhance mental well-being, as well as the identification of factors of poor mental state and therapies to treat people suffering from a mental condition. Postoperative assessments in a digital environment on an individual basis allow team members to voice their worries and comments to the system as a mitigating technique. Evidence-based training and education for HCWs on pandemic preparation has been shown to be critical for improving hospital staff expertise, abilities, and mental well-being during a pandemic.Copyright © 2023, Dr. Yashwant Research Labs Pvt. Ltd.. All rights reserved.

Stem cells used in infectious diseases like pneumonia, respiratory infections and Covid-19: A study based on doctor's opinion

Worldwide, infectious diseases have contributed significantly to morbidity and mortality;among the leading causes of death are pneumonia, respiratory infections and Covid-19. Stem cell therapy will be used to treat virus-infected patients in an effective and safe manner. A cross-sectional questionnaire was used to collect data from doctors. Most doctors are aware of the applications of stem cells, but they do not confirm their usage because clinical trials are ongoing. Instead, they show support for using stem cells to treat patients. Stem cells have been hoping to help repair damaged tissues in the respiratory system to promote faster recovery. Stem Cells are being studied in current clinical trials for their efficacy and safety in virus severe pneumonia and respiratory infections. The doctors suggested that stem cells have been used in infectious diseases to improve their health.Copyright © 2023 Health Biotechnology And Biopharma. All rights reserved.

Syphilis: "The Great Imitator" Presenting as Acute Hepatitis

Introduction: Syphilis is a multi-systemic disease caused by spirochete Treponema pallidum. Very rarely, it can affect the liver and cause hepatitis. Since most cases of hepatitis are caused by viral illnesses, syphilitic hepatitis can be missed. Here, we present a case of syphilitic hepatitis in a 35-year-old male. Case Description/Methods: Patient was a 35-year-old male who presented to the hospital for jaundice and mild intermittent right upper quadrant abdominal pain. His medical history was only significant for alcohol abuse. His last drink was 4 weeks ago. He was sexually active with men. On exam, hepatomegaly, mild tenderness in the right upper quadrant, jaundice, and fine macular rash on both hands and feet were noted. Lab tests revealed an ALT of 965 U/L, AST of 404 U/L, ALP of 1056 U/L, total bilirubin of 9.5 mg/dL, direct bilirubin of 6.5 mg/dL, INR of 0.96, and albumin of 2.0 g/dL. Right upper quadrant ultrasound showed an enlarged liver but was negative for gallstones and hepatic vein thrombosis. MRI of the abdomen showed periportal edema consistent with hepatitis without any gallstones, masses, or common bile duct dilation. HIV viral load and Hepatitis C viral RNA were undetectable. Hepatitis A & B serologies were indicative of prior immunization. Hepatitis E serology and SARS-CoV-2 PCR were negative. Ferritin level was 177 ng/mL. Alpha-1-antitrypsin levels and ceruloplasmin levels were normal. Anti-Smooth muscle antibody titers were slightly elevated at 1:80 (Normal < 1:20). Anti-Mitochondrial antibody levels were also slightly elevated at 47.9 units (Normal < 25 units). RPR titer was 1:32 and fluorescent treponemal antibody test was reactive which confirmed the diagnosis of syphilis. Liver biopsy was then performed which showed presence of mixed inflammatory cells without any granulomas which is consistent with other cases of syphilitic hepatitis. Immunohistochemical stain was negative for treponemes. Patient was treated with penicillin and did have Jarisch-Herxheimer reaction. ALT, AST, ALP, and total bilirubin down trended after treatment. Repeat tests drawn exactly 1 month post treatment showed normal levels of ALT, AST, ALP, and total bilirubin (Figure). Discussion(s): Liver damage can occur in syphilis and can easily be missed because of the non-specific nature of presenting symptoms. In our patient, the fine macular rash on both hands and feet along with history of sexual activity with men prompted us to test for syphilis which ultimately led to diagnosis and treatment in a timely manner. (Figure Presented).

EBUS audit: assessing the diagnostic performance of the service at UHL

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an important diagnostic procedure in the lung cancer pathway. False-negative or inadequate sampling can lead to inaccurate staging or delay in diagnosis. This study was conducted to assess the performance of the Cancer EBUS service at a tertiary hospital. Method(s): We conducted a retrospective analysis of patients who underwent EBUS-TBNA for suspected cancer between 1st June 2021 to 31st May 2022. Request forms, CT reports, EBUS reports and pathology reports were reviewed for analysis. Result(s): 205 EBUS-TBNA procedures were performed. All patients had an appropriate staging CT prior to procedure. The mean time to test was 10.5 days (7.4). 77 (38%) had tests within 7 days of request. 293 lymph nodes and 10 mass lesions were sampled. The mean time to pathological results being received was 2.9 days (1.8). Final histology showed 39 (19%) cases of lung adenocarcinomas, 3 (1%) lung non-small cell carcinomas, 25 (12%) lung squamous cell carcinomas, 25 (12%) small cell cancers, 4 (2%) lung NOS, 3 (1%) pulmonary carcinoid, 2 (1%) lymphoma, 12 (6%) other cancers, 12 granulomata and 1 thyroid tissue (6%). 43 (21%) cases showed lymphoid tissue and 28 (14%) were reported as inadequate. No samples were taken in 8 cases (4%). Adequate tissue for predictive marker testing was available in 93% (66) of cases of non-small cell lung cancer (NSCLC). Complications were encountered in 9 cases (4%). Only 3 cases (1.5%) required any form of intervention. [Figure presented] Conclusion(s): Our data provides assurance of safety while also highlighting specific areas for attention regarding performance and time to test that can be addressed and our sensitivity was comparable to national standards. The increased waiting times may be partly related to COVID-19 precautions and will require reauditing at a later date. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Redefining Industry 5.0 in Ophthalmology and Digital Metrology: A Global Perspective

The demand for ophthalmic diagnosis and monitoring equipment is high due to day-by-day increasing eye-related diseases. These diseases are growing very fast due to changes in lifestyle, the aging crowd, and chronic diseases. During COVID-19, old ophthalmic diagnostic devices failed to fulfill the patients' needs due to social distancing and took more diagnosis time, making patients uncomfortable and unsatisfied to visit the clinic. Seeing all these problems during the COVID-19 time, patients are demanding personalized healthcare services and clinical home services to protect themselves from the COVID-19 virus attack. To fulfill the mass personalized needs and easily accesses clinical services from the patient's home, there is a requirement to embrace Industry 5.0 with its emerging digital technologies. The current work is based on the theoretical view of Industry 5.0 in ophthalmology and its supporting digital technology, various models and challenges faced by the healthcare system in ophthalmology during the COVID-19 pandemic time, limitations of the study, and its future scope, digital metrology, and strength, limitation, opportunities, and threat analysis in brief. © 2023, Metrology Society of India.

Survival prediction of COVID-19 patients using multi-modal dataset

COVID-19 has proved to be a global emergency that has fractured the healthcare systems to the extent that its impact is too challenging to encompass. Though many Computer-Aided Diagnoses (CAD) systems have been developed for automatic detection of COVID-19 from Chest X-rays and chest CT images, very few works have been done on detecting COVID-19 from a clinical dataset. Resources needed for obtaining Clinical data like blood pressure, liver disease, past traveling history, etc., are inexpensive compared to collecting Chest CT images for COVID-19 infected patients. We propose a novel multi-model dataset for the survival prediction of patients infected with COVID-19. The dataset proposed is collected and created at Mahatma Gandhi Memorial Medical College, Indore. The dataset contains clinical data and chest X-ray images obtained from the same patient infected with COVID-19. For proper prognosis of the COVID19 positive patients from the clinical dataset, we have proposed a Bi-Stream Gated Attention-based CNN (BSGA-CNN) model. The BSGA-CNN model achieved an accuracy of 96.90% (± 3.05%). A CNN based on pre-trained VGG-Net is used to classify the corresponding Chest X-Ray images. It gave an accuracy of 87.76% (± 8.78%)%. © 2022 IEEE.

S6 Timing of pneumothorax post-CT-guided thoracic biopsy in a tertiary referral centre: implications for the ambulatory pneumothorax pathway

S6 Table 1Study population characteristicsn % Total number of procedures 641 - Male 371 57.9% Female 270 42.1% Median age (years) 71.0 - Lesion site RUL 177 27.61% RML 22 3.43% RLL 109 17.00% LUL 151 23.56% LLL 104 16.22% Anterior mediastinal 29 4.52% Pleural 40 6.24% Chest wall 9 1.40% Median lesion size (mm) 41 - Total pneumothorax incidence 223 34.8% Timing of pneumothorax T = 0 hours 186 83.41% T = 0-2 hours 37 16.59% T = 2 hours - 7 days 0 0.00% Pneumothorax management(% of n=223) Conservative 144 64.57% Aspiration 47 21.08% Chest drain 31 13.90% Pleural vent 1 0.45% Total pneumothorax needing intervention (% of n=223) 79 35.43% Immediate pneumothorax management (% of n=186) Conservative 111 59.68% Aspiration 46 24.73% Chest drain 28 15.05% Pleural vent 1 0.54% Immediate pneumothorax needing intervention (% of n=186) 75 33.63% Delayed pneumothorax management (% of n=37) Conservative 33 89.19% Aspiration 1 2.70% Chest drain 3 8.11% Pleural vent 0 0.00% Delayed pneumothorax needing intervention (% of n=37) 4 10.81% ConclusionsThis study demonstrates that the incidence of delayed-onset pneumothorax requiring intervention is low in a tertiary centre setting. The optimal time for patient observation post-CTGB remains unknown. The authors acknowledge a high incidence of pneumothorax in the study cohort, which they postulate may be due to a higher volume of complex procedures in a tertiary setting, higher sensitivity of CT for reporting trivial post-biopsy pneumothorax, and the diversion of more complex lung cancer patients to the CTGB route during the COVID pandemic to avoid aerosol-generating procedures.ReferenceHeerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol 2017;Jan;27(1):138–148.

Adoption of digital technologies amidst COVID-19 and privacy breach in India and Bangladesh

This article problematizes the institutional void caused by the lack of accountable digital regulation in India and Bangladesh regarding the adoption of public health-related digital technologies during the COVID-19 pandemic. Findings from literature review and preliminary interviews illustrate an emerged pattern in these countries that intersect governmentality and materiality with an absence of oversight. The findings further indicate an absence of privacy laws that leave citizens vulnerable to privacy breach. As surveillance becomes a social norm, authorities appear to turn a blind eye toward human rights while public remain unaware and uninformed. The article recommends that consumer-centric governmentality is needed to ensure the privacy and protection of consumers and citizens in India and Bangladesh.

Mucormycosis, Covid -19 & Diabetes "THE TROUBLESOME THREESOME"

Background: Covid-19 infection time and again has been causing major morbidities and mortalities. Increased vulnerability of Covid-19 recovered patients was seen towards mucormycosis infection. Mucormycosisis is an aggressive, angioinvasive fungal disease caued by fungi of order Mucorales. This increase in cases may be attributed to a weakened immune system, pre-existing comorbidities such as diabetes, overzealous use of steroids. We conducted a study on 25 cases admitted in mucor ward in a tertiary care setting to highlight this association and focusing on possible causes so that we can be prepared to handle any such catastrophe in future in a better way. Methods and Results: We did a retrospective study on 25 cases admitted in a tertiary care center catering to large population of Covid -19 patients with varying severity.Covid-19 associated mucormycosis(CAM) was found to be more common in males(76%).Diabetes mellitus was the most common underlying condition(72%).68% patients had received steroids and antibiotics, 28% patients had history of receiving Oxygen. In CAM predominant presentation was rhino-orbital mucormycosis. Unilateral orbit involvement was seen in (88%) cases. Conclusion(s): As severe acute respiratory syndrome coronavirus-2 is highly susceptible to mutations and is causingseries of waves, its association with opportunistic fungal infection is a serious concern. Incidences of mucormycosis were increased in Covid-19 patients due to immune modulation and coexistence of immunosuppressive conditions such as diabetes. Concurrent glucocorticoid therapy further heightens the risk. Early diagnosis and prompt intervention can help improve outcome. Copyright © 2023 Ubiquity Press. All rights reserved.

Mucormycosis, Covid -19 & Diabetes "THE TROUBLESOME THREESOME"

Background: Covid-19 infection time and again has been causing major morbidities and mortalities. Increased vulnerability of Covid-19 recovered patients was seen towards mucormycosis infection. Mucormycosisis is an aggressive, angioinvasive fungal disease caued by fungi of order Mucorales. This increase in cases may be attributed to a weakened immune system, pre-existing comorbidities such as diabetes, overzealous use of steroids. We conducted a study on 25 cases admitted in mucor ward in a tertiary care setting to highlight this association and focusing on possible causes so that we can be prepared to handle any such catastrophe in future in a better way. Methods and Results: We did a retrospective study on 25 cases admitted in a tertiary care center catering to large population of Covid -19 patients with varying severity.Covid-19 associated mucormycosis(CAM) was found to be more common in males(76%).Diabetes mellitus was the most common underlying condition(72%).68% patients had received steroids and antibiotics, 28% patients had history of receiving Oxygen. In CAM predominant presentation was rhino-orbital mucormycosis. Unilateral orbit involvement was seen in (88%) cases. Conclusion(s): As severe acute respiratory syndrome coronavirus-2 is highly susceptible to mutations and is causingseries of waves, its association with opportunistic fungal infection is a serious concern. Incidences of mucormycosis were increased in Covid-19 patients due to immune modulation and coexistence of immunosuppressive conditions such as diabetes. Concurrent glucocorticoid therapy further heightens the risk. Early diagnosis and prompt intervention can help improve outcome. Copyright © 2023 Ubiquity Press. All rights reserved.

Effect of Covid-19 Vaccination Status on Adverse Events and Outcomes in Advanced Non-Small Cell Lung Cancer (Ansclc) Patients Treated with Immunotherapies

Background Immunotherapy is one of the most prominent therapies for NSCLC patients. While there is a lot of promise, adverse events (AEs) due to immunotherapies are a concern. Entering the era of COVID-19, the interaction of COVID-19 vaccination status with immunotherapy is not fully understood. 1-2 As most newly diagnosed NSCLC patients will be vaccinated, understanding this interaction is important for managing their treatment. This study aims at determining whether COVID-19 vaccination status has any significant effect on AEs and outcomes of aNSCLC patients treated with immunotherapies in 1st line. Methods This retrospective study leverages ConcertAI's NSCLC Patient360TM dataset, a deeply curated real-world oncology dataset with patients from across the United States. aNSCLC patients who started 1st line treatment containing an immunotherapy at least 30 days after their last COVID-19 vaccine were included in the vaccine-primed cohort (N= 138). 1st line treatment in these patients started between January 2021 - April 2022. Similarly, a cohort of vaccine-naive patients was created by including all patients in the dataset who received their 1st line immunotherapy treatment between January 2019 - April 2020 (N=1537) to ensure none of them received COVID-19 vaccine prior to immunotherapy treatment. Descriptive analysis on these cohorts showed no significant differences in terms of age, race, gender and treatment patterns. AEs for each patient during the course of 1st line immunotherapy treatment were identified. These AEs were categorised into 5 levels (table 1). To normalise the effect of length of treatment, AE/time on immunotherapy was calculated. Progression-Free Survival (PFS) and Overall Survival (OS) from start of L1 was also compared between the two cohorts. Results 56% vaccine-naive and 54% vaccine-primed patients had an AE while on immunotherapy. The distribution of severity of AEs between the two cohorts was also quite similar (table 2). Although the AE/time was higher in the vaccinenaive cohort (p-value=0.03) (figure 1), this effect was mostly driven by 41 (2.6%) outlier patients who had many AEs in a very short span of time after starting immunotherapy. We believe such outliers were not seen in the vaccine-primed cohort primarily due to its smaller sample size. OS and PFS were similar between the two cohorts (figures 2 and 3). Conclusions COVID-19 vaccination status does not affect frequency or severity of immunotherapy related AEs or have a significant impact on patients' outcomes. As more data becomes available on the vaccine-primed cohort the impact on rarer patient sub-populations can be evaluated. (Figure Presented).

A Systematic Survey on COVID 19 Detection and Diagnosis by Utilizing Deep Learning Techniques and Modalities of Radiology

One of the most difficult aspects of the present COVID19 pandemic is early identification and diagnosis of COVID19, as well as exact segregation of non-COVID19 individuals at low cost and the sickness is in its early stages. Despite their widespread use in diagnostic centres, diagnostic approaches based solely on radiological imaging have flaws given the disease's novelty. As a result, to evaluate radiological pictures, healthcare practitioners and computer scientists frequently use machine learning and deep learning models. Based on a search strategy, from November 2019 to July 2020, researchers scanned the three different databases of Scopus, PubMed, and Web of Science for this study. Machine learning and deep learning are well-established artificial intelligence domains for data mining, analysis, and pattern recognition. Deep learning in which data is passed through many layers and automatically learning the composition of each layer from large dataset and it enables a new way that evaluates the complete image without human guidance to discern which insights are valuable, with applications ranging from object detection to medical image. Deep learning with CNN may have a significant effect on the automatic recognition and extraction of crucial features from X-ray and CT Scan images related to Covid19 analysis. According to the results, models based on deep learning possess amazing abilities to offer a precise and systematic system for detecting and diagnosing COVID19. In the field of COVID19 radiological imaging, deep learning software decreases false positive and false negative errors in the identification and diagnosis of the disease. It is providing a once-in-a-lifetime opportunity to provide patients with quick, inexpensive, and safe diagnostic services while also reducing the epidemic's impact on nursing and medical staff. © 2022 ACM.

SPATIAL MAPPING AND CLUSTER ANALYSIS OF COVID-19: A CASE STUDY OF UTTAR PRADESH, INDIA

In public health, the representation and analysis of the incidence of the disease play an important role in assessing the regional disparity and health infrastructure. The geographic information system is one of the best methods to do so. This paper aims to visualise the spread of COVID-19 and perform cluster analysis. The prospective Poisson space-time scan statistic was utilised to detect clusters of COVID-19 at the district level in the Uttar Pradesh state of India. The spatial mapping was performed to assess the situation of COVID-19 and related factors. The log-likelihood ratio and relative risk were calculated monthly from May to December 2020. As per the results, the size and location of clusters kept changing with being more concentrated in Lucknow, Kanpur, Gautam Buddha Nagar districts and NCR regions. The significance of these clusters was less than 0.001. The detection of these clusters helped understand the overall dynamics of the disease spread. The number of confirmed cases declined in most districts, with only a few being at higher risk and needing more attention and resources. It was concluded based on the analysis that the areas of higher economic activities and population density with higher access to hospitals and testing had a larger number of cases and were the regions of hotspots. The findings can help to create health awareness, monitor situations in real-time and evaluate the steps taken to assess their efficacy.

Ethnic Variation in Adult and Pediatric Liver Transplantation

Purpose: Despite several policy reforms over the years, disparities in the access to solid organ transplantation continues to exist remains a significant barrier to liver transplant. The MELD Allocation system and subsequently the Share-35 policy (adopted June 2013) were implemented to address the inequitable access to liver transplantation (LT). The implication of these changes on adult and pediatric LT among ethnic groups is uncertain. Therefore the aim of this study, is to explore the factors associated with access to LT across ethnic groups of all age groups. Method(s): The study period (2014 -2019) included the period after Share-35 policy (June 2013) implementation and prior to implantation of Acuity Circle and COVID pandemic (Feb/March 2020). Using the UNOS database, we identified all candidates (Pediatrics and Adults), who received liver Transplant during the study period. Data extracted included type of transplant, liver diagnosis, age, MELD/PELD score, gender and race/ethnicity. Chi square test and anova were used for comparative analysis. Result(s): During the study period, 46,926 candidates received liver transplant of which 96% were Adults, living donor LT (5%) and ethnic distribution (White 69%, Hispanic 15%, Black 9%, Asian 4% and others 3%). In contrast to the Adult recipients in which there is a gender variation with male predominance (65%), among pediatric group there was similar distribution (Male 51% and Female 49%). There was significant ethnic variation in type of insurance payor (Figure 1) and proportion of LT (Figure 2) across age groups. Among pediatric recipients, no significant difference in LT trends across ethnic groups. In contrary, among the adult recipients, though there was no change among White (71% in 2014 and 71% in 2019) and Asian (4% in 2014 and 4% in 2019), there was slight increase among Hispanic ( 13 % in 2014 and 16% in 2019) and a steady decline among Blacks ( 10% in 2014 and 7.3% in 2019). Conclusion(s): Ethnic Variation in Access to Liver Transplantation exists in both Adult and Pediatric Candidates. Future studies to explore the observed difference in Insurance payors, gender gaps among ethnic groups will provide useful insights to the non-medical factors contributing to inequitable LT access irrespective of age. Identification and understanding the key social determinants that impact LT access will be key in developing strategies to reduce and eliminate these barriers across age groups.

Factors influencing perceived learning of students during online classes: A case study from Taiwan

Online learning has modified the ways in which competencies are taught in recent years, where the focus has majorly been on maximizing learning effectiveness. Due to the recent surge in the COVID-19 pandemic, most universities in Taiwan switched to online learning as control measures not to interrupt students' learning. Based on the Technology Acceptance Model (TAM), the main purpose of the current study is to explore the critical factors that influence the students' learning effectiveness while undergoing the sudden shift from physical classroom learning to online learning. Data was collected from 428 students studying at a private university in Taiwan. Results show that high levels of attitude towards technology are associated with higher levels of perceived learning when moderated by higher levels of perceived usefulness of technology and higher levels of intention to use technology. This study aims to contribute to the TAM literature, particularly on how different factors affect perceived learning in students within the context of Taiwan. These findings can encourage university policymakers, educators, and course instructors to integrate technology into teaching pedagogies and thereby enhance learning performance in students. © 2022 ACM.

Diagnostic conundrum in a patient with small cell lung cancer (SCLC)

Introduction: It is rare for pulmonary SCLC to present as a cavitating lesion unlike non-small-cell-cancer (NSCLC). Hence, if a cavitating lesion is found with histo-pathology showing SCLC, it is important to rule out alternate diagnosis e.g., infection [1]. Case: We present the case of a 41-year-old-male of Bangladeshorigin. He was referred on 2ww-pathway to UHL Glenfield hospital lung cancer team for haemoptysis. Clinical assessment (05/12/2019) revealed that he had 4kg weight loss/haemoptysis/anorexia/fatigue. He was a current smoker (10 pack-years) with no significant past/ family history. He worked in a restaurant. Clinical examination was unremarkable. Chest x-ray showed left-hilar-mass. CT scan revealed 3.2cm mass with peripheral cavitation and mild focal enhancement without calcification/mediastinal-lymphadenopathy. Differentials included cancer/rheumatoid arthritis/infection. Bloods including ANCA/ANA/rheumatoid factor and bronchial-washings microbiology/cytology were unremarkable. He was given antibiotics. He did not attend subsequent 2 out-patient-appointments. Repeat CT scan (March 2020) showed growing lesion with focally dilated vessel. CT-guided biopsy was advised but he declined it due to COVID19 pandemic. In May 2020, he agreed to undergo CT-guided biopsy. However, pre-procedure CT scan showed possible pseudoaneurysm. CT-guided biopsy was deemed high-risk and not attempted. Lung cancer MDT advised lobectomy given diagnostic dilemma. Patient declined surgery. CT in November 2020 showed progressive lesion. Patient still was not keen for surgery. He was admitted in June 2021 with haemoptysis. CT scan showed progressive cavitating disease with necrotic left hilar/mediastinal lymph nodes. He underwent EBUS-TBNA that confirmed SCLC. Given cavitating lesion and long history, left lower lobe lesion was deemed unlikely to be due to SCLC. He was referred to infectious disease (ID) clinic. Blood parasitology screen revealed positive Hydatid ELISA. He did not attend subsequent outpatient appointments in Oncology/ID clinics and has been discharged. Learning points: There were two pathologies: hydatid cyst (Fig. 1a);SCLC developed between November 2020 and June 2021 (Fig. 1b). 1) To look for cause of a cavitating lesion even if SCLC is diagnosed. 2) To consider hydatidcyst in lung-cavity differentials.(Figure Presented) Fig. 1

MULTISYSTEM INFLAMMATORY INFLAMMATORY SYNDROME IN ADULTS (MIS-A) IN THE RETURNING TRAVELER

CASE: A 27-year-old man presented with a one-day history of meningismus and fever six days after returning from Belize in the setting of COVID-19 infection 6 weeks prior to admission. On hospital day 3, he had persistent cyclical fevers and developed a non-pruritic erythematous maculopapular rash as well as conjunctival injection and diarrhea. Overnight (day 3-4), he developed chest pain and tachycardia;labs were remarkable for myocardial injury and elevated inflammatory markers. Emergent cardiac echo identified myopericarditis with LV ejection fraction of 20%. These constellation of symptoms in the setting of a recent COVID-19 infection were consistent with a diagnosis of multisystem inflammatory syndrome of adults (MIS-A). Pulse dose steroids and heart failure therapy were initiated;he had a rapid response to the treatment with cardiac MRI documenting partial recovery of his LVEF to 48% and resolved myocarditis after 4 days of therapy. IMPACT/DISCUSSION: MIS-A is a rare complication of the post-acute phase of COVID-19. As of June 2021, less than 150 cases had been published. The CDC criteria for MIS-A include age >21 hospitalized for >24 hours with a fever for >24 hours and with at least 1 primary criteria (severe cardiac illness OR rash and conjunctivitis) and 2+ secondary criteria (new neurological signs, unexplained shock, abdominal symptoms or thrombocytopenia). Lab criteria include A) a positive SARS CoV-2 test for current or recent infection and B) elevated levels of at least 2 inflammatory markers. A systematic review by Patel et al. highlighted key trends amongst MIS-A patients, including a median age of 21, male preference (70%), and lack of co-morbidities (58%) A majority presented with fever (96%), hypotension (60%), cardiac dysfunction (54%), and diarrhea (52%) In adults, conjunctivitis, rash, and cervical adenopathy were noted but less common. Although 97% of patients had positive serologic or RT-PCR tests, only 32% were positive for both during the hospitalization. Our patient possessed key demographic and clinical features associated with MIS-A. However, we initially prioritized the differential of fever in a returning traveler over empiric management of MIS-A. Nevertheless, early recognition of decompensation from MIS-A allowed for quick initiation of steroids and transfer to the ICU. The fulminant nature of this disease makes it an important diagnosis to include on the differential of acutely febrile young individuals with a history of COVID. CONCLUSION: MIS-A is a rare disease that can easily be confounded with other causes of inflammation;as a diagnosis of exclusion, delays in diagnosis can be expected. However, it's potential severity makes it a critical one to consider early in key patient populations. Increased awareness of cardinal symptoms and population trends can help clinicians consider MIS-A early in their clinical reasoning and facilitate early treatment. This is especially important in a world with an increasing incidence of COVID-19.

Machine Learning based COVID-19 Mortality Prediction using Common Patient Data

COVID-19 was declared a pandemic in 2020, and it caused havoc worldwide. The fact that it is unpredictable adds to its lethality. The world has already seen various COVID-19 infection waves, subsequent waves being even more deadly. Many patients are asymptomatic initially but suddenly develop breathing problems. More than four million people have died due to COVID-19. It is necessary to forecast a patient's likelihood of dying so that appropriate precautions can be implemented. In this study, a COVID-19 mortality prediction model which uses machine learning is proposed. Most of the current research work requires several patient features and lab test results to predict mortality. However, we suggest a simpler and more efficient technique that relies solely on X-rays and basic patient information such as age and gender. Several ensemble-based models were evaluated and compared using a variety of metrics, and the best method was able to achieve a classification accuracy of 92.6% and AUPRC of 0.95. © 2022 IEEE.