A Quality Improvement Initiative on sustaining Kangaroo Mother Care Practices During COVID Pandemic

Introduction: COVID-19 pandemic has affected the KMC practices in our SNCU. Lack of clear guidelines and training about continuing KMC in COVID-19 times has further lead to decrease in KMC practices. Method(s): This is a prospective single centered quality improvement study conducted in the inborn unit of a tertiary care hospital. Intervention phase was done in August and September 2020. Preterm mother-infant dyads who were admitted in the inborn Level 2 Neonatal care unit with birth weight less than 2000 grams were enrolled in this study. A QI team comprising of resident doctors, nurses and supporting staff and a lactation counsellor was formed. The potential barriers for prolonged KMC were evaluated using fish bone analysis. A variety of measures were introduced and subsequently tested by seven plan-do-study-act (PDSA) cycles. Data on percentage of initiation of KMC was measured by bedside nurses on daily basis and the data was plotted on run chart every week during implementation phase. Result(s): 116 eligible mother-infant dyads were studied during implementation period (50 days). We achieved our goal by step-wise implementation of changes through multiple PDSA cycles. The percentage of initiation of KMC among eligible preterm infants has increased from baseline of 43.4% to 83.3% and duration of KMC from 1.5 mean hours to 4.5 hours over a period of eight weeks. Conclusion(s): Ongoing quality improvement measures increased the percentage of initiation and duration of KMC among eligible preterm infants without addition of extra man power.Copyright © 2022 by author(s). This is an Open Access article distributed under Creative Commons Attribution License (CC BY NC ).

Fungal osteomylitus in diabetic patients and COVID-19

Background: COVID-19 pandemic has become a big medical problem worldwide. In this era, COVID-19 along with diabetes mellitus are at an increased risk of developing opportunistic infections. This study demonstrate association of COVID-19 infection in patients having uncontrolled diabetes with the fungal osteomyelitis. Subjects and methods: This prospective cross-sectional study was done at a Nishter Institute of Dentistry, Multan. Patients diagnosed with fungal osteomyelitis of jaw bones presented during April to December 2021 were included in this study. Data was collected from the patients regarding history of the disease, clinical diagnosis, imaging findings by plain radiographs and CT scans, histopathology. Association of disease process with diabetes and COVID-19 was analyzed in SPSS. Results: Between the period April 2021 to December 2021, 23 cases presented in Nishter Institute of Dentistry Multan with fungal osteomylitus were diagnosed clinically and fungal organism was identified by immunohistochemical studies by PAS and GMA stains. 22/23 (95.6%) patients were with uncontrolled diabetes mellitus and 18/23(78.2%) gave the history of Covid 19 infection 2 to 3 months before with moderate to severe symptoms.11/23 (47.8%) gave the history of treatment with systemic steroid. Age range was 38-72 years of age with mean age 53.26. 12/23(52.1%) were males and 11/23 (47.8%) were females. 17/23 (73.9%) patients presented with pain in jaws with exposed bone and 6/23(23%) complained of pain and loose teeth in arch. In 22/23 (95.6%) involved jaw was maxilla. In one patient associated medical condition was hepatitis C virus infection also with diabetes. 2 patients were cardiac and 3 were hypertensive along with diabetes. One patient was previously treated with radiotherapy of mandible due to alveolar cancer. Only one (0.04%) patient was non diabetic. She was on chemotherapy for renal cancer. Conclusion: There is increased incidence of fungal osteomyelitis of jaws mostly maxilla in diabetic and COVID-19 infected patients. © 2022 Authors.

COVID-19, SME training support by ASEAN governments and analysis of digital investments in Brunei

Digital adoption and related investments among SMEs can be challenging during COVID-19 smart business adjustments due to their small size and limited capabilities especially in ASEAN region where contribution of SMEs is over 99%. In order to overcome this barrier, it is necessary for every country's government to provide SMEs with the right support that can help them in their digital transformation journey. The negative impact of the pandemic phenomenon has been huge on adaption and employability of human resources and SME's technological innovation globally. The support of ASEAN governments in the context of human resources development dimension in digital space is reviewed in this article. Besides, digitalization of Brunei's SMEs has been lukewarm although the public of the country has been an active user of social media where the subscription rate of mobile usage is around 136% and internet usage around 94%. Therefore, in order to provide the evidence of explanatory theory on the digital technologies' adoption among SMEs in Brunei, this study has used both qualitative and quantities approaches, has collected data from 101 Brunei SMEs through survey questionnaire and analyzed it using partial least square with the help ADANCO. The study has found that the internal capacity of organization in the form of digital skills and external capacity in the form of digital infrastructure in the economy are statistically significant in explaining the importance of digital educational support provided by the government towards the adoption of digital technologies. The challenges faced by SMEs due to pandemic related restrictions in the form of decrease in sales, access to finance, budget constraints for employee salaries and wages, procurement and order delivery related difficulties, however, have not statistically necessitated the adoption of digital technologies because of policy incentives for digital technology related education and training facilitations. © 2022 Author(s).

Correlation between Oxygen Saturation of patient and Severity Index of Covid 19 Pneumonia on CT

Aim: To investigate the correlation between capillary blood oxygen saturation and Computerized tomography (CT) severity index in patients with Covid-19 pneumonia. Study design: A cross sectional study design Setting & duration: Ibne-sina hospital Multan Medical & Dental College Multan, from 1stJune 2020 to 1stJune 2021 Methods: A cross-sectional analytical study was conducted at the COVID-19 ward of Ibne-sina hospital Multan Medical & Dental College Multan for 1 year. At the time of admission, all capillary oxygen saturation of all the included patients was measured. Pulmonary CT scans were then performed on these patients and CT severity index was calculated. SPSS was used for data analysis. Results: A total of 170 Covid-19 infected patients were included in the study. At the time of admission, the mean oxygen saturation was found to be 88.9%±6.53%. Whereas, the mean severity index was 15.01±7.79. 22 patients had hypoxia when presented in hospital and a significantly high iCT severity index was found in these patients (p=0.001). Chronic obstructive pulmonary disease (COPD), hypertension, and diabetes were significantly related to reduced blood oxygen saturation (p<0.05). A significant inverse correlation was found between capillary oxygen saturation and CT severity index (r= -0.41, p< 0.01). Conclusions: The study revealed a significant inverse correlation between capillary oxygen saturation and CT severity index. Moreover, it was found that underlying commodities (i.e., past medical history) can also affect the CT severity index.

Evaluation of Noise Pollution in Bengaluru City, India During COVID-19 Pandemic

Most of the Indian cities and towns have been facing serious traffic noise pollution due to urbanization, substantial growth of new vehicles, inadequate road network, etc. Automotive traffic, railroads, and air traffic are the most common sources of noise pollution in cities, with vehicular traffic accounting for around 55% of overall metropolitan noise. Prolonged exposure to such loud noise causes anger, stress, mental diseases, discomfort, hypertension, concentration problems, and sleeplessness. This study aims to investigate the effects of COVID-19 societal lockdown on changes in the noise pollution levels before, during, and after the lockdown period in various industrial, commercial, residential, and silence zones in Bengaluru, India, in light of the recent imposition of COVID-19 societal lockdown. According to data acquired from the KSPCB (Karnataka State Pollution Control Board) online portal, the average noise levels before and during lockdown were determined to be in the range of 59.4 dB to 70.9 dB and 58.2 dB to 62.7 dB for different zones. During the lockdown, all commercial, industrial and educational activities were closed to limit the spread of infection, resulting in usage of private and commercial transportation declining dramatically. Reduction in the noise level was observed during the lockdown in all monitoring stations of Bengaluru, except for Indira Gandhi Institute of Child Health, where the noise level didn???t decline because of a COVID emergency. Maximum reduction was observed in the commercial area (11.56%) followed by industrial areas (8.34%). The result further indicated that only the industrial area experienced an increase of 8.41% in noise level, while other areas experienced a reduction in a noise level during the early post-lockdown. During the mid and late post-lockdown periods, most locations experienced a rapid spike in the noise intensity.

A Deep Learning-based Predication of Fall Portents for Lone Construction Worker

As construction projects resume worldwide and workers return to the job site, the possibility of transmitting the Covid-19 could be added to the extensive list of risks confronting workers in the construction sites;thus, the workers need to work alone in an assigned activity. Many workers are already working alone in the construction sites, such as utility workers, repair technicians, teleworkers, operators, and drivers. Lone workers in construction are subjected to greater safety risks compared with those working alongside others. Considering the accidents faced by lone workers, it’s less likely that another person would be there to aid them - and if they don’t get treatment quickly enough, serious injuries might prove deadly. Currently, the construction sites depend on physical inspections to the construction sites and manual observation of video streams generated through close circuit television (CCTV). To solve this issue, this research work presents an automated deep learning-based fall detection system of a lone worker to provide information of severe situations and help the workers in their golden time. A diverse dataset of multiple scenarios having workers with the excavator, forklift, ladder, and mobile scaffold is established, and a deep learning algorithm has been trained to validate the concept. The developed system is expected to reduce the efforts being made in manual inspection, enhance the timely access of the due aid from co-workers and supervisors, which is more easily obtainable in non-lone working situations. © 2021 Proceedings of the International Symposium on Automation and Robotics in Construction. All rights reserved.

Impact of covid-19 pandemic on routine immunization of children

Objective: To find the impact of Covid-19 pandemic on routine immunization of children. Methodology: This cross sectional study was done at the New City Teaching Hospitaland Divisional Head Quarter Teaching Hospital, Mirpur, Azad Kashmir from March to September 2021. Data about routine immunization of children from parents was collected by using predesigned questionnaire. All data were analysed using SPSS version 20. Results: The study included 1200 parents. We found that 80% parents had scheduled vaccination for their children, 18% had delayed vaccination while 2% missed vaccination during Covid – 19 pandemic. Major reason for delayed vaccination was fear of contracting Covid – 19 in 65% respondents. We found that 80% parents feared that their children have chance to get Covid – 19 infection, 78% responded that their children might transmit this infection while 74% reported that their children have chance to get hospitalized due to Covid-19. Majority of the respondent had positive attitude towards vaccination. Conclusion: Covid-19 pandemic had major impact on the timing of routine immunization of children in Pakistan. © 2022, Pakistan Medical Association. All rights reserved.

Major Update 2: Remdesivir for Adults With COVID-19: A Living Systematic Review and Meta-analysis for the American College of Physicians Practice Points.

BACKGROUND: Remdesivir is approved for the treatment of adults hospitalized with COVID-19. PURPOSE: To update a living review of remdesivir for adults with COVID-19. DATA SOURCES: Several electronic U.S. Food and Drug Administration, company, and journal websites from 1 January 2020 through 19 October 2021. STUDY SELECTION: English-language, randomized controlled trials (RCTs) of remdesivir for COVID-19. DATA EXTRACTION: One reviewer abstracted, and a second reviewer verified data. The Cochrane Risk of Bias Tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) method were used. DATA SYNTHESIS: Since the last update (search date 9 August 2021), 1 new RCT and 1 new subtrial comparing a 10-day course of remdesivir with control (placebo or standard care) were identified. This review summarizes and updates the evidence on the cumulative 5 RCTs and 2 subtrials for this comparison. Our updated results confirm a 10-day course of remdesivir, compared with control, probably results in little to no mortality reduction (5 RCTs). Updated results also confirm that remdesivir probably results in a moderate increase in the proportion of patients recovered by day 29 (4 RCTs) and may reduce time to clinical improvement (2 RCTs) and hospital length of stay (4 RCTs). New RCTs, by increasing the strength of evidence, lead to an updated conclusion that remdesivir probably results in a small reduction in the proportion of patients receiving ventilation or extracorporeal membrane oxygenation at specific follow-up times (4 RCTs). New RCTs also alter the conclusions for harms-remdesivir, compared with control, may lead to a small reduction in serious adverse events but may lead to a small increase in any adverse event. LIMITATION: The RCTs differed in definitions of COVID-19 severity and outcomes reported. CONCLUSION: In hospitalized adults with COVID-19, the findings confirm that remdesivir probably results in little to no difference in mortality and increases the proportion of patients recovered. Remdesivir may reduce time to clinical improvement and may lead to small reductions in serious adverse events but may result in a small increase in any adverse event. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs.

Telehealth Appointments Increase the Likelihood that Patients with Diabetes and Diabetic Retinopathy Return for Recommended In-person Care

Purpose : The aim of this study is to determine whether telehealth (TH) appointments improve the rate of return for in-person diabetic eye exams. Methods : A retrospective chart review was conducted to determine the rate of return for in-person diabetic eye examinations for patients with diabetes who had been seen in the Department of Ophthalmology at the Lahey Hospital & Medical Center in 2019. Since TH appointments were not initiated at the Lahey Hospital & Medical Center until March 16, 2020 in response to the COVID-19 pandemic, this study looked at only patients who were seen after this date. The main outcome was the number of in-person diabetic eye exams completed by patients who had a prior TH encounter compared with those that did not have a TH encounter. Patient demographic (age, gender, ethnicity, and race) and clinical characteristics (A1c, type of diabetes, and severity of retinopathy) were abstracted from the medical record. Results : Of the 7,796 patients with a diagnosis of diabetes who were seen in 2019, 1,723 (22.1%) completed TH appointments in 2020. The rate of return for in-person diabetic eye examinations was significantly greater for the cohort of patients who completed a TH appointment compared with those who did not (44.6% compared with 36.5%, OR: 1.71 95% CI: 1.54 - 1.90, p<0.0001). Patients with diabetic retinopathy were more likely to complete a TH visit. Of the 1,202 patients with diabetic retinopathy, 365 patients (30.4%) competed a TH appointment. In contrast, only 1,294 of the 5,999 patients (21.6%) without a history of retinopathy competed a TH appointment (χ =43.693, p <0.0001). For both groups the likelihood that a patient would subsequently complete an in-person diabetic eye exam increased after the completion of a TH encounter: 74% of patients with diabetic retinopathy completed an in-person visit after a TH appointment, compared with 49.6% of patients who returned for in-person care without a prior TH appointment (OR: 2.89;95% CI: 2.20 - 3.79, p<0.0001). Similarly, 44.6% of patients without retinopathy who completed a TH visit returned for in-person care, compared with only 36.5% who did not complete a TH visit (OR: 1.40;95% CI: 1.24 - 1.59, p<0.0001). Conclusions : TH appointments are an effective method to improve the likelihood that patients with diabetes and diabetic retinopathy will return for recommended in-person care.

Remdesivir for Adults With COVID-19 : A Living Systematic Review for American College of Physicians Practice Points.

BACKGROUND: Few treatments exist for coronavirus disease 2019 (COVID-19). PURPOSE: To evaluate the effectiveness and harms of remdesivir for COVID-19. DATA SOURCES: Several databases, tables of contents of journals, and U.S. Food and Drug Administration and company websites were searched from 1 January through 31 August 2020. STUDY SELECTION: English-language, randomized trials of remdesivir treatments for adults with suspected or confirmed COVID-19. New evidence will be incorporated using living review methods. DATA EXTRACTION: Single-reviewer abstraction and risk-of-bias assessment verified by a second reviewer; GRADE (Grading of Recommendations Assessment, Development and Evaluation) methods used for certainty-of-evidence assessments. DATA SYNTHESIS: Four randomized trials were included. In adults with severe COVID-19, remdesivir compared with placebo probably improves recovery by a large amount (absolute risk difference [ARD] range, 7% to 10%) and may result in a small reduction in mortality (ARD range, -4% to 1%) and a shorter time to recovery or clinical improvement. Remdesivir may have little to no effect on hospital length of stay. Remdesivir probably reduces serious adverse events by a moderate amount (ARD range, -6% to -8%). Compared with a 10-day remdesivir course, a 5-day course may reduce mortality, increase recovery or clinical improvement by small to moderate amounts, reduce time to recovery, and reduce serious adverse events among hospitalized patients not requiring mechanical ventilation. Recovery due to remdesivir may not vary by age, sex, symptom duration, or disease severity. LIMITATIONS: Low-certainty evidence with few published trials, including 1 preliminary report and 2 open-label trials. Trials excluded pregnant women and adults with severe kidney or liver disease. CONCLUSION: In hospitalized adults with COVID-19, remdesivir probably improves recovery and reduces serious adverse events and may reduce mortality and time to clinical improvement. For adults not receiving mechanical ventilation or extracorporeal membrane oxygenation, a 5-day course of remdesivir may provide similar benefits to and fewer harms than a 10-day course. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs, Veterans Health Administration Office of Research and Development, Health Services Research and Development Service, and Evidence Synthesis Program.

Major Update: Remdesivir for Adults With COVID-19 : A Living Systematic Review and Meta-analysis for the American College of Physicians Practice Points.

BACKGROUND: Remdesivir is being studied and used for treatment of coronavirus disease 2019 (COVID-19). PURPOSE: To update a previous review of remdesivir for adults with COVID-19, including new meta-analyses of patients with COVID-19 of any severity compared with control. DATA SOURCES: Several sources from 1 January 2020 through 7 December 2020. STUDY SELECTION: English-language, randomized controlled trials (RCTs) of remdesivir for COVID-19. New evidence is incorporated by using living review methods. DATA EXTRACTION: 1 reviewer abstracted data; a second reviewer verified the data. The Cochrane Risk of Bias Tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) method were used. DATA SYNTHESIS: The update includes 5 RCTs, incorporating data from a new large RCT and the final results of a previous RCT. Compared with control, a 10-day course of remdesivir probably results in little to no reduction in mortality (risk ratio [RR], 0.93 [95% CI, 0.82 to 1.06]; 4 RCTs) but may result in a small reduction in the proportion of patients receiving mechanical ventilation (RR, 0.71 [CI, 0.56 to 0.90]; 3 RCTs). Remdesivir probably results in a moderate increase in the percentage of patients who recovered and a moderate decrease in serious adverse events and may result in a large reduction in time to recovery. Effect on hospital length of stay or percentage remaining hospitalized is mixed. Compared with a 10-day course for those not requiring ventilation at baseline, a 5-day course may reduce mortality, the need for ventilation, and serious adverse events while increasing the percentage of patients who recovered or clinically improved. LIMITATION: Summarizing findings was challenging because of varying disease severity definitions and outcomes. CONCLUSION: In hospitalized adults with COVID-19, remdesivir probably results in little to no mortality difference but probably improves the percentage recovered and reduces serious harms and may result in a small reduction in the proportion receiving ventilation. For patients not receiving ventilation, a 5-day course may provide greater benefits and fewer harms with lower drug costs than a 10-day course. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs.

Examine the association between severe Vitamin D deficiency and mortality in patients with Covid-19

Aim: To determine the association between severe vitamin D deficiency and mortality in patients presented with covid-19. Study Design: Prospective/Observational Place and Duration: Shaikh Zayed Hospital, Lahore during from March 2020 to June 2020. Materials & Methods: Total 140 patients of both genders diagnosed to have covid-19 were enrolled in this study. Patients ages were ranging from 15 years to 75 years. Detailed demographics including age, sex, and body mass index (BMI) were recorded after taking written consent. 5 ml blood sample was taken from all the patients to examine the vitamin D level. Severe Vitamin D deficiency was defined as 25(OH)D < 25 nmol/L (10 ng/dL). Association between mortality and severe vitamin D deficiency was examined. Data was analyzed by SPSS 24.0. Results: Out of 140 patients, 82 (58.57%) were males while 58 (41.43%) were females with mean age 42.46±14.73 years. Severe vitamin D deficiency was observed in 60 (42.86%) patients. Mortality found in 22 (15.71%) patients. Patients with severe vitamin D deficiency had high rate of mortality 16 (26.67%) as compared to patients with no vitamin D deficiency 6 (7.5%), a significant association was observed between severe vitamin D deficiency and mortality in patients with covid-19 disease with p-value <0.05. Conclusion: It is concluded that there was strong relationship between severe vitamin-D deficiency and mortality in patients with covid-19 disease. © 2020 Lahore Medical And Dental College. All rights reserved.

Exploring dependence of COVID-19 on environmental factors and spread prediction in India

COVID-19 has taken the world by storm, with the majority of nations still being challenged by the novel coronavirus. The present work attempts to evaluate the spread of COVID-19 in India using the Susceptible-Exposed-Infectious-Removed (SEIR) model to establish the impact of socio-behavioural aspects, especially social distancing. The impact of environmental factors like temperature and relative humidity (RH) using statistical methods, including Response Surface Methodology (RSM) and Pearson’s correlation, is also studied on numbers of COVID-19 cases per day. Here we report the resultant changes of lockdowns-unlocks initiated by the Government of India for COVID-19, as against the scenario of total lockdown. The phased unlocks and crowded gatherings result in an increase in the number of cases and stretch the mitigation timeline of COVID-19 spread, delaying the flattening of the curve. The SEIR model predictions have been fairly validated against the actual cases. The daily spread of COVID-19 cases is also fairly correlated with temperature in Indian cities, as supported by well-established causation of the role of higher temperatures in disrupting the lipid layer of coronavirus, but is greatly undermined by the key factor of social distancing and gets confounded with other multiple unknown co-varying environmental factors. However, the analysis couldn’t clearly establish the role of RH in affecting daily COVID-19 cases. Hence, it becomes essential to include environmental parameters into epidemiological models like SEIR and to systematically plan controlled laboratory experiments and modeling studies to draw conclusive inferences, assisting policymakers and stakeholders in formulating comprehensive action plans to alleviate the COVID-19 spread. © 2020, The Author(s).