An Ensemble Deep Learning Approach for COVID-19 Severity Prediction Using Chest CT Scans (preprint)

Chest X-rays have been widely used for COVID-19 screening; however, 3D computed tomography (CT) is a more effective modality. We present our findings on COVID-19 severity prediction from chest CT scans using the STOIC dataset. We developed an ensemble deep learning based model that incorporates multiple neural networks to improve predictions. To address data imbalance, we used slicing functions and data augmentation. We further improved performance using test time data augmentation. Our approach which employs a simple yet effective ensemble of deep learning-based models with strong test time augmentations, achieved results comparable to more complex methods and secured the fourth position in the STOIC2021 COVID-19 AI Challenge. Our code is available on online: at: https://github.com/aleemsidra/stoic2021- baseline-finalphase-main.

Ethnic differences in cellular and humoral immune responses to SARS-CoV-2 vaccination in UK healthcare workers: a cross-sectional analysis.

Background: Few studies have compared SARS-CoV-2 vaccine immunogenicity by ethnic group. We sought to establish whether cellular and humoral immune responses to SARS-CoV-2 vaccination differ according to ethnicity in UK Healthcare workers (HCWs). Methods: In this cross-sectional analysis, we used baseline data from two immunological cohort studies conducted in HCWs in Leicester, UK. Blood samples were collected between March 3, and September 16, 2021. We excluded HCW who had not received two doses of SARS-CoV-2 vaccine at the time of sampling and those who had serological evidence of previous SARS-CoV-2 infection. Outcome measures were SARS-CoV-2 spike-specific total antibody titre, neutralising antibody titre and ELISpot count. We compared our outcome measures by ethnic group using univariable (t tests and rank-sum tests depending on distribution) and multivariable (linear regression for antibody titres and negative binomial regression for ELISpot counts) tests. Multivariable analyses were adjusted for age, sex, vaccine type, length of interval between vaccine doses and time between vaccine administration and sample collection and expressed as adjusted geometric mean ratios (aGMRs) or adjusted incidence rate ratios (aIRRs). To assess differences in the early immune response to vaccination we also conducted analyses in a subcohort who provided samples between 14 and 50 days after their second dose of vaccine. Findings: The total number of HCWs in each analysis were 401 for anti-spike antibody titres, 345 for neutralising antibody titres and 191 for ELISpot. Overall, 25.4% (19.7% South Asian and 5.7% Black/Mixed/Other) were from ethnic minority groups. In analyses including the whole cohort, neutralising antibody titres were higher in South Asian HCWs than White HCWs (aGMR 1.47, 95% CI [1.06-2.06], P = 0.02) as were T cell responses to SARS-CoV-2 S1 peptides (aIRR 1.75, 95% CI [1.05-2.89], P = 0.03). In a subcohort sampled between 14 and 50 days after second vaccine dose, SARS-CoV-2 spike-specific antibody and neutralising antibody geometric mean titre (GMT) was higher in South Asian HCWs compared to White HCWs (9616 binding antibody units (BAU)/ml, 95% CI [7178-12,852] vs 5888 BAU/ml [5023-6902], P = 0.008 and 2851 95% CI [1811-4487] vs 1199 [984-1462], P < 0.001 respectively), increments which persisted after adjustment (aGMR 1.26, 95% CI [1.01-1.58], P = 0.04 and aGMR 2.01, 95% CI [1.34-3.01], P = 0.001). SARS-CoV-2 ELISpot responses to S1 and whole spike peptides (S1 + S2 response) were higher in HCWs from South Asian ethnic groups than those from White groups (S1: aIRR 2.33, 95% CI [1.09-4.94], P = 0.03; spike: aIRR, 2.04, 95% CI [1.02-4.08]). Interpretation: This study provides evidence that, in an infection naïve cohort, humoral and cellular immune responses to SARS-CoV-2 vaccination are stronger in South Asian HCWs than White HCWs. These differences are most clearly seen in the early period following vaccination. Further research is required to understand the underlying mechanisms, whether differences persist with further exposure to vaccine or virus, and the potential impact on vaccine effectiveness. Funding: DIRECT and BELIEVE have received funding from UK Research and Innovation (UKRI) through the COVID-19 National Core Studies Immunity (NCSi) programme (MC_PC_20060).

Synergistic Detrimental Effects of Cigarette Smoke, Alcohol, and SARS-CoV-2 in COPD Bronchial Epithelial Cells.

Lung conditions such as COPD, as well as risk factors such as alcohol misuse and cigarette smoking, can exacerbate COVID-19 disease severity. Synergistically, these risk factors can have a significant impact on immunity against pathogens. Here, we studied the effect of a short exposure to alcohol and/or cigarette smoke extract (CSE) in vitro on acute SARS-CoV-2 infection of ciliated human bronchial epithelial cells (HBECs) collected from healthy and COPD donors. We observed an increase in viral titer in CSE- or alcohol-treated COPD HBECs compared to untreated COPD HBECs. Furthermore, we treated healthy HBECs accompanied by enhanced lactate dehydrogenase activity, indicating exacerbated injury. Finally, IL-8 secretion was elevated due to the synergistic damage mediated by alcohol, CSE, and SARS-CoV-2 in COPD HBECs. Together, our data suggest that, with pre-existing COPD, short exposure to alcohol or CSE is sufficient to exacerbate SARS-CoV-2 infection and associated injury, impairing lung defences.

SARS-CoV-2 Virus Infection-Related Arterial Thromboembolism Leading to Critical Limb Ischemia and Amputation

COVID-19 infection has been shown to increase risk for thromboembolism. With most studies reporting mainly venous thromboembolic events, there is a lack of literature regarding the incidence of arterial thromboses in patients with COVID-19 infection. We report a dramatic case of a 55-year-old male with confirmed COVID-19 infection who presented with acute left critical limb ischemia leading to amputation as a result of thromboembolism from a distal abdominal aortic thrombus. Our case report contributes to the limited body of literature on COVID-19-related arterial thromboembolism. The patient consented to publish this case.

Potential medicinal plants involved in inhibiting 3CLpro activity: A practical alternate approach to combating COVID-19.

At present, a variety of vaccines have been approved, and existing antiviral drugs are being tested to find an effective treatment for coronavirus disease 2019 (COVID-19). However, no standardized treatment has yet been approved by the World Health Organization. The virally encoded chymotrypsin-like protease (3CLpro) from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which facilitates the replication of SARS-CoV in the host cells, is one potential pharmacological target for the development of anti-SARS drugs. Online search engines, such as Web of Science, Google Scholar, Scopus and PubMed, were used to retrieve data on the traditional uses of medicinal plants and their inhibitory effects against the SARS-CoV 3CLpro. Various pure compounds, including polyphenols, terpenoids, chalcones, alkaloids, biflavonoids, flavanones, anthraquinones and glycosides, have shown potent inhibition of SARS-CoV-2 3CLpro activity with 50% inhibitory concentration (IC50) values ranging from 2-44 µg/mL. Interestingly, most of these active compounds, including xanthoangelol E (isolated from Angelica keiskei), dieckol 1 (isolated from Ecklonia cava), amentoflavone (isolated from Torreya nucifera), celastrol, pristimerin, tingenone and iguesterin (isolated from Tripterygium regelii), tannic acid (isolated from Camellia sinensis), and theaflavin-3,3'-digallate, 3-isotheaflav1in-3 gallate and dihydrotanshinone I (isolated from Salvia miltiorrhiza), had IC50 values of less than 15 µg/mL. Kinetic mechanistic studies of several active compounds revealed that their mode of inhibition was dose-dependent and competitive, with Ki values ranging from 2.4-43.8 µmol/L. Given the significance of plant-based compounds and the many promising results obtained, there is still need to explore the phytochemical and mechanistic potentials of plants and their products. These medicinal plants could serve as an effective inexpensive nutraceutical for the general public to help manage COVID-19.

Healing dialogue: Can the techniques and practices of Track Two diplomacy play a role in resolving public health conflicts?

Track Two Diplomacy, a form of facilitated informal and unofficial dialogues between conflicting parties, has become a well-established form of international conflict resolution. This paper seeks to explore whether the techniques and practices of Track Two could be applied in a new setting beyond international armed conflicts: public health. Global society continues to grapple with the devastating effects of the COVID-19 pandemic, systemic racism, and climate change, among other pressing public health issues that can not only exacerbate but also create new conflicts that negatively affect communities. Innovative and interdisciplinary approaches are needed more than ever. We synthesize literature from both Track Two and public health fields to present a conceptual framework that posits whether and how such concepts as the "problem-solving workshop," "transfer," "reflective practice" and others might support parties involved in divisive, intractable, visible, and invisible conflicts which currently mark the public health space.

Comparative Assessment of Trends of Social Anxiety and Social Avoidance during First and Second Wave of Covid-19 among Medical Students

Background: Corona virus disease 2019 (COVID-19) was first reported in China and became the global pandemic. This pandemic has proven fatal for the world and lasts drastic effects on the whole world. To combat with this hilarious pandemic, the whole world has adopted the strategy of social distancing and precautionary measures. Aim: To compare trends of social anxiety and avoidance during covid wave 1 and covid wave 2. Methodology: A cross-sectional study was conducted at Central Park Medical College from October 2020 and January 2021. To assess social avoidance and anxiety LIEBOWITZ Social Anxiety and avoidance Scale was employed. Paired sample t test and correlation was used to compare mean differences. A p value less than 0.05 were considered significant. Results: There was a reduction of score of social anxiety from covid wave 1 and wave 2 (26.73±4.65. 17.86±3.81) with p value of .001 and similarly there was a reduction of score of social avoidance (25.31±0.597 v/s 15.±0.3390) as well from wave 1 to wave 2 with p value of .001 Conclusion: There is a continuous decline in social avoidance and social anxiety which can cause an increase in covid 19 infection rate in order to combat that there's need of prompt vaccination along with the precautionary measures to combat covid pandemic.

IMPACT OF INHALED CORTICOSTEROID USE ON OUTCOMES IN HOSPITALIZED PATIENTS WITH COVID-19 AND OBSTRUCTIVE LUNG DISEASES

SESSION TITLE: COPD Medications and Treatment Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Conclusive data on whether inhaled corticosteroids (ICS) have a protective effect on COVID-19 hospitalization rates or outcomes are lacking. The main objective of our study was to assess the impact of pre-hospitalization ICS use on the clinical course of hospitalized COVID-19 patients with underlying obstructive lung diseases - asthma and chronic obstructive pulmonary disease (COPD). METHODS: We conducted a retrospective chart review study of all COVID-19 patients hospitalized at our institution between March 1st - June 3th, 2020. Diagnosis of asthma and COPD was determined using ICD-10 codes. Demographics, information about pre-hospitalization ICS use and clinical data were recorded through chart review. Outcomes of interest were all-cause 28-day mortality and need for intubation. Chi-square or Fischer’s exact test was used to assess univariate associations. Linear and logistic regression models were constructed to adjust for potential confounders. RESULTS: Data was analyzed from 356 hospitalized COVID-19 patients with prior diagnosis of obstructive lung disease;219/356 (62%) had asthma, 137/356 (38%) had COPD. Hospitalized COVID-19 patients with asthma were younger (mean age 61 [range: 51-71] vs 74 [range:67-81] years, p<0.01), more likely to be female (69% vs 48%, p<0.01), Hispanic (43% vs 25%, p<0.01) and never smokers (52% vs 20%, p<0.01) compared to those with COPD. There was no difference in the use of pre-hospitalization ICS between the two groups (35.2% in Asthma vs 38% in COPD, p=0.59). Overall, COVID-19 patients with COPD were more likely to die compared to those with asthma (47% vs 25%, p<0.01). Pre-hospitalization ICS use was not significantly associated with all-cause 28-day mortality (asthma: OR 0.9 [95%CI 0.4-2.0], p=0.85;COPD: OR 0.7 [95%CI 0.3-1.5], p=0.3) or need for intubation (asthma: OR 1.0 [95%CI 0.5-2.0], p=0.94;COPD: OR 0.7 [95%CI 0.3-1.7],p=041) after adjusting for potential confounders. CONCLUSIONS: Mortality among hospitalized COVID-19 patients with COPD was higher compared to those with asthma. While the pre-hospitalization use of ICS was similar between the two groups, it did not protect hospitalized COVID-19 patients in either group from intubation or mortality. High mortality rates among COVID-19 patients with COPD is likely due to concomitant risk factors such as older age, and comorbidities such as diabetes and chronic kidney disease. Being a retrospective study, the quality of our data was limited and dependent on documentation accuracy. CLINICAL IMPLICATIONS: Pre-hospitalization ICS use did not improve outcomes in hospitalized COVID-19 patients with asthma or COPD. Further studies are required to investigate the role of ICS in preventing COVID-19 related hospitalizations, morbidity and mortality in randomized control settings. DISCLOSURES: No relevant relationships by Hammad Aleem No relevant relationships by Denisa Ferastraoaru No relevant relationships by Manuel Hache Marliere No relevant relationships by Gabriel Hernández Romero No relevant relationships by Christa McPhee No relevant relationships by Francine Palmares No relevant relationships by Divya Reddy No relevant relationships by Felix Reyes No relevant relationships by Deborah Schwartz

Life Orientation, Life Satisfaction and Well-being among School Teachers during COVID Pandemic

Previous researches have positioned well-being as an integral variable of mental health correlated with other factors like satisfaction with life and life orientation. The present research examines well-being, life satisfaction, and orientation towards life among teachers during COVID-19. During the initial phases of COVID-19, the Government imposed lockdown in the month of May-June (2020). This led to the closure of all the schools and colleges, offices, public places, etc. Although the schools were closed, staff and teachers of the schools were asked to perform tasks which included the distribution of ration, home surveys, shift- work at hospitals, airports, shelter homes, etc. With an increasing rate of infections and mortality, the teachers were hesitant to volunteer for any COVID duty and were generally apprehensive about being called up for such duties. In this research, 364 school teachers (both male & female of 27-60 years) were included as an inclusive sample of those performing and not performing any such duty from Delhi, India. The present research aims to understand the dynamics of well-being among teachers during COVID. It utilizes measures of the Life Orientation Test-revised (LOT-R), Satisfaction towards Life Scale (SWLS), and Warwick-Edinburg Mental Well-being Scale (WEMWBS). Correlation and multiple regression are used as statistical measures to find out the relationship and predictability among the variables. Results show a significant relationship among Life orientation, life satisfaction and well-being and wellbeing is significantly predicted by life satisfaction and orientation towards life. Discussion suggests that similar results are being observed among variables under consideration amid COVID and future implications are drawn out from the present study.

Remote work and the COVID-19 pandemic: An artificial intelligence-based topic modeling and a future agenda.

As remote work has become more common than ever throughout the COVID-19 pandemic, it has drawn special attention from scholars. However, the outcome has been significantly sporadic and fragmented. In our systematic review, we use artificial intelligence-based machine learning tools to examine the relevant extant literature in terms of its dominant topics, diversity, and dynamics. Our results identify-eight research themes: (1) Effect on employees at a personal level, (2) Effect on employees' careers, (3) Family life and gender roles, (4) Health, well-being, and safety, (5) Labor market dynamics, (6) Economic implications, (7) Remote work management, (8) Organizational remote work strategies. With further content analysis, we structure the sporadic research into three overarching categories. Finally, for each category, we offer a detailed agenda for further research.

Random Data Augmentation based Enhancement: A Generalized Enhancement Approach for Medical Datasets (preprint)

Over the years, the paradigm of medical image analysis has shifted from manual expertise to automated systems, often using deep learning (DL) systems. The performance of deep learning algorithms is highly dependent on data quality. Particularly for the medical domain, it is an important aspect as medical data is very sensitive to quality and poor quality can lead to misdiagnosis. To improve the diagnostic performance, research has been done both in complex DL architectures and in improving data quality using dataset dependent static hyperparameters. However, the performance is still constrained due to data quality and overfitting of hyperparameters to a specific dataset. To overcome these issues, this paper proposes random data augmentation based enhancement. The main objective is to develop a generalized, data-independent and computationally efficient enhancement approach to improve medical data quality for DL. The quality is enhanced by improving the brightness and contrast of images. In contrast to the existing methods, our method generates enhancement hyperparameters randomly within a defined range, which makes it robust and prevents overfitting to a specific dataset. To evaluate the generalization of the proposed method, we use four medical datasets and compare its performance with state-of-the-art methods for both classification and segmentation tasks. For grayscale imagery, experiments have been performed with: COVID-19 chest X-ray, KiTS19, and for RGB imagery with: LC25000 datasets. Experimental results demonstrate that with the proposed enhancement methodology, DL architectures outperform other existing methods. Our code is publicly available at: https://github.com/aleemsidra/Augmentation-Based-Generalized-Enhancement

Snapshot of Research Issues in Service Robots

A service (social) robot is defined as the Internet of Things (IoT) consisting of a physical robot body that connects to one or more Cloud services to facilitate human-machine interaction activities to enhance the functionality of a traditional robot. Many studies found that anthropomorphic designs in robots resulted in greater user engagement. Humanoid service robots usually behave like natural social interaction partners for human users, with emotional features such as speech, gestures, and eye-gaze, referring to the users’ cultural and social background. During the COVID-19 pandemic, service robots play a much more critical role in helping to safeguard people in many countries nowadays. This paper gives an overview of the research issues from technical and social-technical perspectives, especially in Human-Robot Interaction (HRI), emotional expression, and cybersecurity issues, with a case study of gamification and service robots. © 2022, Springer Nature Switzerland AG.

Level of Patient’s satisfaction with Online Psychiatric Outdoor services (preprint)

Purpose: During the ongoing COVID-19 global pandemic, there have been treatment gaps for common physical and mental disorders due to vast reasons like lockdowns, poor convenience, fear of getting COVID infection, and economic restraints. Hence, to reduce the treatment gap and, also to limit exposure to COVID-19 infections, telemedicine in the form of telephonic and internet consultations has been increasingly adopted worldwide. Our centre also started telepsychiatry to cater for the needs of patients with pre-existing mental health disorders to ensure regular follow-up and compliance with prescriptions. The study aimed to assess the level of patient satisfaction through online psychiatric services (Telepsychiatry). Methods: Ethical clearance for the present study was granted by the research cell of the study centre. The sample consisted of 100 patients with pre-existing mental health disorders. This was a single-point cross-sectional study for 6 months. Hospital Information system (HIS) software, which is used to manage the patient's appointment schedule, relevant clinical and lab details along with follow-up prescriptions was used to follow the selected patients for study purposes. This software also provides a digital platform for video calls for online consultation. Client Satisfaction Questionnaires-8 (CSQ-8) were applied to collect patient data for analysis.  Result: The mean total CSQ-8 score of the study sample was 21.01±5.80 (8-32), which indicates a low to moderate level of satisfaction with online psychiatric services. Most patients (45%) reported low satisfaction levels followed by 37% of the patients who reported moderate levels of satisfaction. Only 18% of the patients reported higher satisfaction with online psychiatric services.  Conclusion: Despite the psychiatrist's ability to deliver adequate professional advice and psychoeducation through online psychiatric services, the patient’s level of satisfaction was moderate to low. This suggests a need to design standard protocols and guidelines for consultation through online psychiatric services to enhance the patient’s level of satisfaction.

A Study on Secondary Infections in Patients with COVID-19 Admitted to ICU

Introduction: COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has resulted in 119.2 million infections and 2.64 million deaths by 14 March 2021, globally. As of March 14, 2021, India has seen 11.35 million infections and 0.15 million deaths. Critically ill COVID-19 patients need hospitalization, which increases their risk of acquiring secondary bacterial and fungal infections and would lead to a significant increase in morbidity and mortality. The prevalence of secondary infections in ICU patients infected with COVID-19 is not well understood. Objectives: The aim of our study was to know the prevalence and impact of secondary infections on patients with COVID-19 infection admitted to ICU. Materials and methods: This was an observational prospective study conducted in Apollo hospital, for a period of 6 months (December 2020 to June 2021). We considered patients who develop secondary infections (bacterial/ fungal) developed 48 hours after ICU admission until death or discharge. Results: Among 50 patients, males were 68% and females were 32%. The mean age at presentation was 55 years. Secondary infections were detected in 29 patients (58%) with a median of 9 days after intensive care unit (ICU) admission (Fig. 1). Among which 79.3% was bacterial and 20.7% was fungal infections. Most of which were isolated from blood-16/29 patients (55.2%), respiratory-9/29 patients (31.03%), and urine-4/29 patients (13.8%). Gram-negative organisms were predominant [Klebsiella (39.1%), Acinetobacter (26.1%), E. coli (17.4%), Pseudomonas (13.0%)] over grampositive organisms-enterococci (4.4%). Among fungal infections, Aspergillosis in 3/6 patients (50%), Mucor in 1/6 patients (16.7%), and Candida in 2/6 patients (33.3%) were noted. The average length of ICU stay in patients with secondary infections was significantly high when compared to patients without secondary infections. Out of 50 patients, 10 patients were on high oxygen support, 24 required BIPAP support, 16 were ventilated. Patients who developed secondary infections received a high dose of steroids (mean dose of steroids received was 1996 mg). Patients receiving invasive mechanical ventilation or longer ICU (>9 days) stay had a higher rate of secondary infections (p < 0.001). Similarly, a 28-day mortality rate was also more in patients with secondary infections (17/29 patients;58.62%) when compared to patients without infections (5/21 patients;23.8%). Conclusion: For critically ill COVID patients, the secondary infection rates were found to be high. Although antibiotics likely provide minimal benefit as empirical treatment in COVID-19 patients and may be associated with unintended consequences including adverse events, toxicity, resistance, and C. difficile infections, it is always prudent for clinicians to prescribe them judiciously to ICU patients to reduce the length of ICU stay and mortality. We must have a high suspicion for fungal infections in patients who have long ICU stays and not improving with empirical antibiotics, as early detection and timely treatment may reduce mortality (Figs 2-4).

Implementation of a Non-Invasive Helmet Ventilation Solution for the Management of Severe COVID-19 Respiratory Disease in Nigeria: The CircumVent Project (preprint)

ABSTRACT Affordable novel strategies are needed to treat COVID-19 cases complicated by respiratory compromise in resource limited settings. We report a mixed-methods pre-post assessment of 1) the useability of CPAP/O2 helmet non-invasive ventilation (NIV) to treat COVID-19, at ∼ 1% the cost of mechanical ventilation; 2) the effectiveness of a train-the-trainer practice facilitation intervention; and 3) whether use of CPAP/O2 helmet NIV was associated with increased COVID-19 infection among healthcare workers. At baseline, eight COVID-19 treatment centers in Nigeria (CircumVent network) received CPAP/O2 helmet systems, and were instructed on its use. After five months, clinicians within the CircumVent netwok participated in a 2-day train-the-trainers educational intervention. The physicians completed i) standardized forms on patient demographics, clinical course, and outcomes for patients seen in the treatment centers; ii) standardized surveys of feasibility and acceptability of use of CPAP/O2 helmet systems; and iii) in-depth-interviews to explore facilitators and barriers to implementation of CPAP/O2 helmet NIV. Physicians described the CPAP/O2 helmet ventilator as easy to use and they felt comfortable training their staff on its use. They rated CPAP/O2 helmet NIV as feasible, acceptable, and appropriate (mean score of 4.0, 3.8, and 3.9 out of 5, respectively, on standardized scales). Case report forms for 546 patients with suspected and/or confirmed COVID-19 infection were obtained between May 2020 and November 2021. Of these, 69% (n=376) were treated before the training; and 29.7% (n=162) were treated with CPAP/O2 helmet ventilation. CPAP/O2 helmet NIV was well-tolerated by patients, with 12% reporting claustrophobia, and 2% reporting loose- or tight-fitting helmets. Although patient outcomes improved among CPAP/O2 helmet users overall, this was not associated with training (P=0.2). This finding persisted after adjustment for disease severity at presentation. Serosurvey of 282 health workers across treatment centers revealed that 40% (n=112) were seropositive for SARS-CoV-2. Seropositivity was significantly associated with direct contact with COVID-19 patients and limited access to PPE and hand hygiene during aerosol generating procedures (P = 0.02), but not use of CPAP/O2 helmet (P’s ≥ 0.2). In conclusion, physicians effectively used CPAP/O2 helmet NIV systems to treat COVID-19 patients in Nigeria without need for practice facilliation of their training and without increased risk of infection among healthcare workers. The use of CPAP/O2 helmet NIV could be an important strategy for treating individuals with COVID-19 infection and other disease conditions complicated by respiratory distress, particularly in settings were resources such mechanical ventilation are limited.

To Determine the Effect of Diabetes Mellitus on the Clinical Course and Outcome of COVID-19 at Jinnah Hospital, Lahore, Pakistan

Background: Diabetes is a common disease known to cause morbidity and mortality. Individuals with diabetes are at greater risk of complications from coronavirus and have recently gains attention of researchers and practitioners. Aim: To assess the effect of diabetes mellitus on clinical course and outcome of coronavirus infection. Study design: Prospective cohort study Place and duration of study: Coronavirus Disease High Dependency Unit Jinnah Hospital, Lahore from 01-01-2021 to03-04-2021. Methodology: Three hundred and seventy six patients of either genders and age range of 15-75 years were enrolled. They were divided into diabetic or non-diabetic groups. The various attributes such as demographic data, medical history, COVID-19 exposure history, symptoms and signs, laboratory findings, chest radiograph findings, the treatment measures and complications of diabetes and in hospital outcome were compared for both the groups. Result: Statistically different from each other in terms of oxygen requirement, lymphocyte %, neutrophil to lymphocyte ratio (P=0.026), alanine aminotransferase (P=0.038), C-reactive protein (P=0.048), ferritin (P=0.031), lactic acid dehydrogenase (LDH) (P=0.011), Ddimer (P=0.024), Quick sequential organ failure assessment score (qSOFA score) (P=0.001) and Chest X-ray (P=0.049), blood sugar random (P=0.000), treatment during hospital stay (P=0.000), insulin dose increase (P=0.000), complications during hospital stay (P=0.042) and shifting to the intensive care unit (P=0.002). Conclusion: Diabetic coronavirus patients have poorer prognosis due to higher risk of severe pneumonia and related complications including mortality than their non-diabetic counterparts.

Burnout among doctors working at a tertiary care hospital during pandemic of COVID-19 in Kashmir Valley, India

Introduction: Burnout syndrome (BO) has negative consequences for the doctors, their family members, coworkers, and also the patients. We conducted this study to estimate the prevalence of BO among doctors working in a tertiary care hospital in Kashmir valley just after the peak of the second COVID-19 wave. Methods: This cross-sectional study was conducted among doctors working at one tertiary care hospital in Kashmir Valley. Participants included interns, residents (junior and senior residents) and faculty members. An online questionnaire containing Oldenburg Burnout Inventory to estimate burnout was used for data collection from 1st to 10th July 2021. In addition, the questionnaire captured demographic information, job profile and work-related information. Mean scores of ≥ 2.25 on exhaustion and ≥ 2.1 in the disengagement domain were used to define burnout. Binary logistic regression was used to evaluate associations. Results: Of the 322 participants in the study, 119 (36.9%) had completed their post-graduate degree. Of the participants, 150 (46.6%) had to perform 6 or more-night shifts per month and, 61 (18.9%) had previously been diagnosed with COVID-19. Of the participants, 257 (79.8%) had BO, 24 (7.5%) were exhausted and 17 (5.3%) were disengaged. BO was associated with female gender, younger age, number of night duties and emergency room duties per month, being a resident doctor and history of COVID-19 infection on binary logistic regression. Conclusion: This survey reported a very high prevalence of burnout among doctors. Addressing BO among healthcare workers should be a key priority for improving quality of life among doctors and to improve quality of care. This journal is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License.

Psychiatric co morbidity in patients being treated for COVID-19: A cross-sectional study in India

Background: COVID-19 pandemic has become one of the central health crises of a generation and has affected people of all nations, continents, races, and socioeconomic groups. No matter how much resources are put aside, the patient are vulnerable to develop psychological and sleep problems due to covid as there is no specific management for covid 19 infection. There could be multiple causes of mental health issues in COVID-19 , ranging from stigma, hospitalization, uncertainty about prognosis, media created fear, lack of social/family support, loneliness, and even feeling of not having last right/rituals after death. AIM: To determine mental health issues among patients being treated for COVID-19 infection. Methods : A random sample of COVID 19 in Era medical college was examined using a cross-sectional design(n=200).Depression was measured using the Patient Health Questionnaire(PHQ-9).Anxiety was assessed using the Beck Anxiety Inventory(BAI).Sleep was evaluated using the Insomnia Severity Index(ISI). Results: 31% of patients were having moderate anxiety symptoms.20% reported of mild depression whereas 62.5% had subthreshold insomnia. Conclusion: COVID-19 has devastating effects within the short time and cause increase in mental health problems in Covid 19 patients. We should learn from this experience that in future, in such exigencies, the mental health services should be geared up to adapt to the emerging situation.

Phenomology of delirium in patients with COVID 19 infection

Background: In patients with COVID-19, delirium may be presented as direct central nervous system invasion, activation of CNS inflammatory mediators, a secondary effect of other organ system failure, prolonged mechanical ventilation time, or environmental factors, including social isolation. AIM: To study the phenomenology of delirium in patients of COVID infection admitted in Intensive care unit of level 3 COVID hospital. Methods: Forty five patients were included in this study all of whom were diagnosed COVID 19 infection and were admitted in ICU. They had been referred to the psychiatry department for assessment of delirium, and those who screened positive for the same were evaluated by applying delirium assessment instruments, such as the Confusion Assessment Method for the ICU (CAM-ICU), delirium rating scale-R-98 (DRS-R-98) and Richmond agitation sedation scale(RASS). Results: The disturbance in sleep wake cycle(93.3%) was the most frequent and most severely affected symptoms of delirium and delusion(11.1%) was least common symptom of delirium. Conclusion: Delirium appears to be a sequele of events in patients with COVID 19.Although these constellation of symptoms do raise a question about whether the delirium seen in COVID-19 indicates simply a severe systemic illness or whether COVID 19 uniquely target subcortical structures.