Identifying the source of an epidemic using particle swarm optimization

Identifying the primary case, denoted as the index case or commonly "patient zero", of an epidemic is a critical part of epidemiological investigation for understanding outbreak occurrence and how to prevent future outbreaks. In this paper, we devise a Particle Swarm Optimization algorithm to find solutions to the patient zero inverse problem, which aims to estimate the location and time origin of a disease from a single snapshot of the infection status of the post-outbreak population. We consider various compartmental models for disease spread on a regular lattice and also propose a new variant of the patient zero inverse problem where the disease is reintroduced into a population. Experimental results show that the proposed algorithm is effective at identifying the location and time of an epidemic's inception, and shows improvements over other algorithms in the literature. Specifically, the estimates for the location of an outbreak are 50% closer than similar algorithms along with statistically significant improvements in identifying the onset time of an outbreak. Moreover, the proposed algorithm is also able to consistently perform in partially observable environments and scales well when the search space is increased.

Mutation Pattern in the Receptor Binding Motif of SARS-Cov-2 Variants and the Effect on Molecular Interactions in Docked Ligand Complexes

The spike glycoprotein of SARS-Cov-2 is a therapeutic target for Covid-19 and mutations in the Receptor Binding Motif (RBM) may alter the binding properties of ligands proposed to inhibit viral entry. This study aimed to identify the existence of a mutation pattern in the RBMs of SARS-Cov-2 variants and study the effect on ligand binding interactions. RBM sequences were obtained using NCBI BLASTP and subjected to multiple and pairwise sequence alignment analysis. Hypothetical generations were drawn from the phylogenetic tree. The effect of mutation on ligand binding was studied by docking zafirlukast on selected RBMs. Molecular dynamics simulations were conducted to explain molecular interactions. The sequences at the same phylogenetic level showed higher similarity with the observed differences defined by the crystallized chain length. 6XDG_E, a leaf node sequence was 76% similar to 7NXA_E, a branch from the root, and had the highest mutation. Differences in sequence similarity across successive generations were based on mutations and crystallized chain length and the amino acid substitution is not predictable. Different bond types and binding affinities were observed as well as varying Root Mean Square Deviation (RMSD), Root Mean Square Fluctuation (RMSF), and Region of Gyration (RoG) values for the RBMs in different variants. The RMSD, RMSF, and RoG did not differ significantly in the bound and free states of RBM from specific variants suggesting that the observed differences are attributable to amino acid substitutions. This information is crucial for drug development intended to block SARS-Cov-2 entry.

Adapting a medical school cancer research education program to the virtual environment

Background: As the number of patients with a cancer diagnosis grows in the United States, there is an increasing need for physician scientists with oncology-related research training to develop new approaches to screening, diagnosis, therapy, and survivorship. A single US medical school developed the National Cancer Institute-funded Scholars in Oncology-Associated Research (SOAR) cancer research education program. Due to the COVID-19 pandemic, SOAR transitioned from fully in-person in 2019 to virtual in 2020 and hybrid in 2021. This study examines whether the in-person, virtual, or hybrid formats provide better educational experiences as rated by participants. Methods: SOAR includes a seminar series, an 11-week full-time cancer research experience, weekly research cluster group meetings, and tumor board and interprofessional shadowing experiences. In 2019 all program activities were in-person. In 2020 all activities were virtual with the shadowing suspended. In 2021, seminars and tumor boards were virtual, shadowing was in-person, and all other activities were hybrid. Pre- and post-surveys were collected from all participants to assess understanding of oncology and associated medical specialties. How participant understanding of oncology and related specialties changed within each year's program was analyzed with a Wilcoxon rank-sum test. The Kruskal-Wallis test was used to examine change in understanding between the cohorts. Results: 37 students participated in SOAR (2019 n = 11, 2020 n = 14, 2021 n = 12). Self-reported understanding of oncology as a clinical (p < 0.01 for all) and research discipline (p < 0.01 for all) improved within all three cohorts. There was no significant difference between each cohort's improvement in research understanding (p = 0.6158). However, there was a trend towards more of an improvement in the in-person cohort (p = 0.0796) for clinical understanding. There was no significant difference between each cohort's improvement in understanding of oncology-related disciplines such as medical oncology, radiation oncology, pediatric oncology, surgical oncology, and survivorship as both clinical and research disciplines (p > 0.1 for all). Conclusions: A virtual cancer research education program can be as effective as an in-person or hybrid program for research education although it may be suboptimal for learning about clinical oncology. Given the ongoing challenges presented by the COVID-19 pandemic, flexibility is needed in delivering cancer research education programs such as SOAR. With modern research methodology and communications technology, cancer research is becoming increasingly diverse and flexible in terms of research environment. If program leaders are steadfast in their adaptation of research education programs to a virtual or hybrid environment, participant understanding of oncology as a clinical and research discipline remains robust.

DEVELOPMENT, UTILITY AND PATIENT SATISFACTION OF A VIRTUAL POST COVID RECOVERY CLINIC BASED IN PRIMARY CARE

STATEMENT OF PROBLEM/QUESTION: Post Acute Sequelae of SARS-CoV2 (PASC) became an new disease entity during the COVID-19 Pandemic, and in the midst of an evolving pandemic with social distancing and space contstraints, how could we create a platform to help evaluate and treat an emerging disease? DESCRIPTION OF PROGRAM/INTERVENTION: In October 2020, we created a Post-Covid Recovery Clinic that was a "hub and spoke" model. Primary Care Providers (n=4) served as the "hub" and conducted an initial appointment and the "spokes" were the speciality clinics. Each spoke created a referral algorithm with diagnostic testing requests. Eligible patients were those that did not have a PCP in our clinic. A PCP conducted an initial video visit, which accomodated for patient geographical constraints and space restrictions in our clinic. Initial appointments were 40 minutes in duration but were rapidly found to be inadequate. To address this challenge, we developed a detailed note template for documentation and pre-visit electronic health record questionnaires to facilitate elicitation of current symptoms, medications and medical history. To evaluate the clinic, a 21-question post-visit patient survey was emailed or administered by phone. The survey included questions about demographics and patient satisfaction (Likert scale, strongly disagree to strongly agree). All responses were anonymous and confidential. MEASURES OF SUCCESS: The metrics of success for the program were greater than 50% of patients 'agreeing' (defined as strongly agree and agree) with the following statements: 1) Without our clinic they would not have been able to seek care for their PASC symptoms 2) Telemedicine made it easier for them to be seen for their symptoms 3) They benefitted from seeking care from this clinic FINDINGS TO DATE: The survey was completed by 74 patients, who were predominantly women of non-Hispanic White ethnicity with a college education;age ranged from 16 to 79 and patients resided in 59 different Chicagoland zip codes. Overall, Likert results did not differ by gender, race, education, or employment status. The majority of respondents (74%) agreed that virtual visits made it easier to be seen for their PASC symptoms and that they benefitted from seeking care from the clinic. Slight under half of respondents (42%) agreed that without this clinic, they would not have received care for PASC with 37% disagreeing or strongly disagreeing with the statement. A majority respondents (86%) agreed that pre-visit questionnaires were not difficult to complete with a majority (73% and 84%) agreeing that telehealth is an acceptable way to receive healthcare services and that technology is not difficult for them to use. KEY LESSONS FOR DISSEMINATION: 1) A virtual clinic is an acceptable way of providing care for an emergent disease process and facilitates patients with geographical or time constraints to be seen by a specialized clinic. 2) Pre-visit questionnaires sent electronically were not burdensome to patients and helped streamline clinic visits, however there may be selection bias in our patient population.

EXAMINING THE RELATIONSHIP BETWEEN HEALTH LITERACY AND TECHNOLOGY ACCESS AND USAGE IN ADULT INPATIENTS DIAGNOSED WITH TYPE 2 DIABETES MELLITUS

BACKGROUND: Considering the increased reliance on health technology during the COVID-19 Pandemic, Electronic Health (eHealth) interventions have become important for DM self-management (e.g., glucose monitoring). We have previously shown low HL to be a barrier to technology usage in the general inpatient adult population. However, the role of lowHL specifically for DM self-management requires further evaluation. METHODS: This is a sub-analysis of the Hospitalist Study, an observational, ongoing, quality improvement study of adults (age ≥18 years) enrolled from June 2019-March 2021. Patients were eligible for our sub-study if they were English speaking, had a DM diagnosis, and completed the brief health literacy screen. Participants completed questionnaires assessing technology access/use and online capabilities. Descriptive statistics, bivariate chi-squared, and multivariate logistic regression analyses (adjusted for age, race, education, and gender) were performed using STATA version 15.1 (StataCorp). RESULTS: Among 110 participants, the mean age was 61±15 years, most identified as Black (76%) and/or female (51%) and had at least some college education (58%). There were no significant differences in device ownership between low (n=15) and adequate (n=95) HL groups (93% vs. 94%, p=0.96). Those with low vs. adequate HL were less-likely to have previously used the internet (47% vs. 83%, p=0.006) and less-likely to independently use several internet features: use search engine (33% vs. 76% p<0.001), open online attachment (33% vs. 68%, p =0.005), upload images/files to a website (20% vs 54%, p=0.005), print webpages/online information (27% vs. 49%, p=0.04), use a video (47% vs. 72%, p=0.02), and/or use an interactive video (27% vs. 52%, p=0.01). In the multivariate analysis, participants with low HL remained significantly associated with decreased ability to independently perform online tasks (all measures p<0.05). CONCLUSIONS: Our data suggest that low HL may be a barrier to internet access and usage among patients with DM, but not for technology ownership. Future studies are necessary to ensure that at-risk populations can effectively utilize novel eHealth technologies particularly in the rapidly changing landscape of technology use in the clinical setting.

THE ILLINOIS MEDICAL PROFESSIONALS ACTION COLLABORATIVE TEAM (IMPACT): REDEFINING CONNECTIVITY BY LEVERAGING SOCIAL MEDIA TO RAPIDLY IDENTIFY AND ADDRESS VACCINE ACCESS AND HESITANCY

BACKGROUND: The Illinois Medical Professionals Action Collaborative Team (IMPACT), a non-profit coalition of health professionals, used social media to improve COVID-19 vaccine access by 1) identifying vaccine access disparities for HCWs not affiliated with a large hospital systems and then creating vaccine clearinghouses/social media campaigns 2) identifying reasons for vaccine hesitancy and addressing them via infographics 3) connecting volunteers with local neighborhood/mobile events serving at-risk communities in the Chicagoland area. In January 2021, many large health systems were vaccinating employed HCWs (COVID-19 vaccine rollout Tier 1a). However, many HCWs not affiliated with large systems were unable to access the vaccine. Many of Chicago's hardest-hit communities were receiving vaccines at much lower rates than neighborhoods less burdened by COVID-19. METHODS: We created online clearinghouses with links to vaccine event sign-ups/waitlists and partnered directly with a local primary care organization to link HCWs to vaccines on Facebook. We partnered with health systems, community organizations, pharmacies and professional organizations to organize, promote, and staff community-based vaccine clinics/mobile vaccine units to a. To address vaccine hesitancy, we collected data on common myths using Facebook groups. We created 5 “debunking” infographics in both English and Spanish using climate science principles and also held 4 Facebook Live Q&As with Chicago-based Bump Club and Beyond. RESULTS: The HCW-specific vaccine information clearinghouse went live 1/4/2021 and had 7,829 views during the first 6 months. The general public vaccine clearinghousewent live on 1/25/2021 and had 21,279 views during the first 6 months. Facebook posts disseminating the HCW vaccination events reached >1650 HCWs within 7 days, and open/public Facebook group posts reached > 3.2K in 7 days. In the first 7 days of the campaign, >1800 HCWs were vaccinated. We registered >1700 volunteers to help staff 316 vaccination events in the Chicago-land area. Our COVID-19Myth Debunkers were shared over 200 times for >80K impressions. Our four vaccine-focused Facebook lives reached over 1000 people per session. CONCLUSIONS: Healthcare professionals can strategically leverage social media to identify public health challenges (vaccine hesitancy/vaccine access disparities) and address these challenges in real-time by disseminating tailored, high-quality information (ie. debunking infographics, Facebook Live Q&As, vaccine clearinghouses) and connecting community members and partner organizations with resources (ie. vaccination resources and volunteers).

ASSESSMENT OF INPATIENTS' FAMILY TECHNOLOGY OWNERSHIP, USAGE, AND AVAILABILITY OF ASSISTANCE WITH TELEHEALTH TECHNOLOGY

BACKGROUND: As COVID-19 shifted healthcare delivery online, family assistance in accessing care using technology was highlighted, particularly in vaccine appointments and telehealth. While previous literature has characterized factors associated with patients' technology ownership and use, the role of families in assisting with technology access and use is less characterized. METHODS: This is a cross-sectional observational sub-study of a larger study of adult general medicine inpatients at the University of Chicago between 5/2019-8/2021. Patient reported family technology access, use, and assistance were evaluated. Multivariable logistic regressions were conducted to evaluate for association(s) with patient demographics, education level, and health literacy. Health literacy was measured using the Brief Health Literacy Screening Tool. STATA 15.1 was used for analysis, and significance was measured at p<0.05. RESULTS: Of 383 participants, the median age was 57 years, 65%(248/383) were Black, and 53% (204/383) were female. A third were college graduates (32%, 123/383) and had low health literacy (34%, 130/383). Most participants reported that their families owned technology devices (88%, 336/383) and regularly used the internet (once or more per day;72%, 274/383). Cell phones were the most commonly reported way that their families accessed the internet, with 29% (108/369) mostly using a cell phone, and 10% (38/369) using a cell phone and another device equally. 22% (84/383) of participants reported using the internet at a family or friend's house. In the multivariable logistic regression, family technology ownership was negatively correlated with increasing age (p=0.04) and self-identifying as Black (p=0.03). Increasing age (p <0.001) and low health literacy (p= 0.03) had a negative association with family daily internet use. Most participants (89%;233/263) reported having a family member or caretaker who could help them use technology to access telehealth. Increasing age (p= 0.01) and low health literacy (p= 0.03) were negatively associated with having family assistance, while female gender had a positive correlation (p= 0.04). CONCLUSIONS: Although family ownership and usage of technology devices are generally high, family ownership was reported less often among older and Black participants. Lower usage was also reported among those with lower health literacy. While most do have someone to help with telehealth technology, this was less common in older patients and those with low health literacy. Considering the importance of family technology use and assistance in ensuring healthcare, leveraging family networks to access technology-based care can help bridge the technology divide for patients.

A New Antiviral Regimen Against SARS-CoV-2 Based on Nanoviricide’s Biopolymer (NV-CoV-2)

NV-CoV-2, a nanoviricide composed of covalently attached polyethylene glycol and alkyl pendants that are designed to bind free virion particles of multiple strains of coronaviruses in a broad-spectrum manner at multiple points. The binding interaction is like a nano-velcro-tape and may cause a lipid–lipid fusion between nanoviricide micelle and the lipid envelope of the virus. A nanoviricide can encapsulate the virus and dismantle it without any involvement of the host immune system, ultimately disabling the infectibility of the host cells. Thus, it may be expected to count a stronger and synergistic antiviral effect by combining NV-CoV-2 with other anti-coronavirus regimens like remdesivir. Furthermore, some ligands similar to the SARS-CoV S-protein are designed by molecular modeling and attached to the nanoviricide at the same site as where the cognate cellular receptor, ACE2, binds. As a result, a competitive binding inhibition may occur. A nanoviricide can encapsulate other antiviral compounds and protect them from serum-mediated degradation in vivo. This makes the antiviral compounds available for a longer period of time to interact with RNA polymerase and inhibit it. Altogether, a multipoint antiviral efficacy can be achieved with our nanoviricide, NV-CoV-2. Copyright © 2022 Chakraborty, Diwan, Barton, Arora, Thakur, Chiniga, Tatake, Pandey, Holkar, Holkar and Pond.

Indian Guidelines on Nebulization Therapy.

Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.

Long Term Health Consequences of COVID-19 in Hospitalized Patients from North India: A follow up study of upto 12 months

Background: Long-COVID syndrome is now a real and pressing public health concern. We cannot reliably predict who will recover quickly or suffer with mild debilitating long COVID-19 symptoms or battle life-threatening complications. In order to address some of these questions, we studied the presence of (post covid) symptoms and various correlates in COVID-19 patients who were discharged from hospital, 3 months and up to 12 months after acute COVID-19 illness. Methods: This is an observational follow-up study of RT-PCR confirmed COVID-19 patients admitted at 3 hospitals in north India between April – August 2020. Patients were interviewed telephonically using a questionnaire regarding the post-COVID symptoms. The first tele-calling was done in the month of September 2020, which corresponded to 4- 16 weeks after disease onset. All those who reported presence of long COVID symptoms, were followed-up with a second call, in the month of March 2021, corresponding to around 9-12 months after the onset of disease. Results: Of 990 patients who responded to the first call, 615 (62.2%) had mild illness, 227 (22.9%) had moderate and 148 (15.0%) had severe COVID-19 illness at the time of admission. Nearly 40% (399) of these 990 patients reported at least one symptom at that time. Of these 399 long-COVID patients, 311 (almost 78%) responded to the second follow-up. Nearly 8% reported ongoing symptomatic COVID, lasting 1-3 months and 32% patients having post-COVID phase with symptoms lasting 3-12 months. Nearly 11% patients continued to have at least one symptom even at the time of the second interview (9-12 months after the disease onset). Overall, we observed Long-COVID in almost 40% of our study group. Incidence of the symptoms in both the follow-ups remained almost same across age-groups, gender, severity of illness at admission and presence of comorbidity, with no significant association with any of them. Most common symptoms experienced in long COVID phase in our cohort were fatigue, myalgia, neuro-psychiatric symptoms like depression, anxiety, “brain fog” and sleep disorder, and breathlessness. Fatigue was found to be significantly more often reported in the elderly population and in those patients who had a severe COVID-19 illness at the time of admission. Persistence of breathlessness was also reported significantly more often in those who had severe disease at the onset. The overall median duration of long COVID symptoms was 16.9 weeks with inter-quartile range of 12.4 to 35.6 weeks. The duration of symptom resolution was not associated with age, gender or comorbidity but was significantly associated with severity of illness at the time of admission (P=0.006). Conclusions: Long-COVID was seen in almost 40% of our study group with no correlation to age, gender, comorbidities or to the disease severity. The duration of symptom resolution was significantly associated with severity of illness at the time of admission (P = 0.006). In our study, all patients reported minor symptoms such as fatigue, myalgia, neuro-psychiatric symptoms like depression, anxiety, “brain fog” and sleep disorder and persistence of breathlessness.

Effect of first sixty-eight days of lockdown due to COVID-19 on autopsy cases in a tertiary care teaching hospital situated in a rural area of Himachal Pradesh

COVID-19 virus and disease were unknown before the outbreak began in Wuhan, China, and now it is a pandemic affecting many countries globally including India. On 30th of January, 2020 India reported its first case of COVID-19 in Kerala and on 24th of March 2020;the Government of India ordered a nationwide first phase of lockdown for 21 days. Our study is to compare the number and type of cases brought for medico legal autopsies in our institution during the complete lockdown period of first 68 days i.e., 25th of March to 31st of May, 2020 versus the cases brought to the same mortuary during the same period of the years 2018 and 2019. In total, 55 cases (42 were of males and 13 were of females) were brought to the mortuary in this lockdown period constituting 19% of total case of 2020 as compared to 91(21%) cases and 99 cases (21%) in the years 2019 and 2018 respectively. Present study shows drastic fall in motor vehicle accidents and shows increase in natural causes of deaths but the suicidal tendencies in the form of hanging and poisoning remained almost same as compared to previous two years and did not increase © 2021, Journal of Indian Academy of Forensic Medicine.All Rights Reserved.

Cushioning the economy from COVID-19: A commentary on the approaches adopted by major nations

The COVID-19 pandemic has left the world in complete disarray. Different economies around the world have tackled the COVID-19 pandemic differently, with several monetary and fiscal policies being introduced to combat the devastating effects the pandemic has had on the economy. This chapter focuses on some of the most economically powerful countries and their policies to overcome pandemic-related adversities. More importantly, it gives insights on how COVID-19 is different from earlier crises in terms of its characteristics and also in terms of the uniqueness of the initiatives taken by the major economies in mitigating its impact. The chapter also discusses how the new-age technologies can help manage this crisis better. The study also discusses the implications for the policymakers, the governments, the executioners, and the think tanks or consultants to the decision makers. © 2021, IGI Global.

EXCIMER LASER CORONARY ATHERECTOMY: USED IN A STAGED APPROACH TO REDUCING THROMBUS BURDEN IN A 34 YEAR OLD WITH ACS

Background: Excimer Laser Coronary Atherectomy (ELCA) is a well-established adjunctive treatment modality that can be effectively used to reduce thrombus burden during percutaneous coronary intervention of coronary thrombosis. Case: A 34-year-old male with history of COVID-19 pneumonia one month prior, presented with non-ST elevation myocardial infarction. Coronary angiography revealed large thrombus burden involving the distal left main (LM) and ostial left anterior descending artery (LAD), as well as a distal LAD thrombotic occlusion (Figure 1A). Intravascular ultrasound showed distal LM plaque rupture with overlying thrombus (Figure 1C). Decision-making: Given the large thrombus burden and elevated risk of distal embolization, we proceeded with lesion passivation using adjunctive antiplatelet and antithrombotic treatment for 48 hours. ELCA was then used for thrombus debulking with a 1.7-mm catheter under distal embolic protection placed in mid LAD (Figure 1B). This was followed by aspiration thrombectomy, balloon dilation, and placement of a drug eluting stent in the distal LM and ostial LAD (Figure 1D). Conclusion: A strategy of using ELCA followed by stent implantation can be useful in selected patients with high intracoronary thrombus burden. ELCA can achieve effective thrombus removal, promotion of fibrinolysis, and platelet-stunning effects allowing plaque debulking and reduction of distal embolization. This case combines traditional tools to achieve the best possible outcome. [Formula presented]

Assessing the Confidence, Knowledge and Preferences of Hospital Staff with Regards to Personal Protective Equipment (PPE) Practices during the COVID-19 Pandemic

Background. Effective use of personal protective equipment (PPE) by hospital staff is critical to prevent transmission of COVID-19. This study examines hospital staff confidence in and knowledge of effective PPE use, and their preferences for learning about PPE practices. Methods. Three isolation precautions signs were created for use in the care of those with or under investigation for COVID-19 infection: first, a special respiratory precautions sign designed by infection control;and next, two signs outlining proper donning and doffing practices - one created internally with the support of health literacy, and another developed with a design firm (IDEO) using principles of human-centered design (Figure 1). All signs were used for ≥ 10 weeks prior to distribution of a questionnaire (REDCap) to clinical and non-clinical hospital staff. Those who had not worked on hospital units during the pandemic (after March 15, 2020) were excluded. The 38-item survey was sent by supervisors over email between July 14-31, 2020, and examined demographics, confidence in and knowledge of PPE best practices, and preferences for each precaution sign with regards to trustworthiness, ease of following, informative content, and clarity of image/layout. Responses were reported using descriptive statistics. A non-parametric test of trends compared staff preferences across signs. Logistic regression examined the association between answering all knowledge-based questions correctly and staff role and confidence in PPE practices (Stata). Results. Of the 531 respondents, 461 were eligible for inclusion. The majority were female, white, and not high risk for COVID-19 (Table 1). Most were confident about PPE use, correctly answered questions examining knowledge of PPE best practices, and found PPE signage helpful (Table 2). Staff preferred the professionally designed sign for informative content (p< 0.01) and clear imagery/layout (p=0.01) (Table 3). Confidence in PPE practices and physician or nurse roles were associated with answering all knowledge-based questions correctly (p< 0.001 and p=0.04, respectively). Conclusion. In a convenience sample of hospital staff, most were confident and knowledgeable about PPE use, found PPE signage helpful, and preferred professionally designed signs.

Limited usage of prednisolone: Severe alcoholic hepatitis beyond steroids, a path to be explored!

Background: Steroids are mainstay of treatment in severe alcoholic hepatitis and steroid ineligibility is major cause of mortality, specially in the absence of transplant option. There is paucity of data on the proportion and causes of steroid ineligibility, and the natural history and outcome in such patients.This data would help in planning alternative therapeutic strategies.We aimed to study the factors responsible for steroid ineligibility and clinical course of these patients. Methods: Consecutive patients of SAH admitted to the Institute of Liver and Biliary Sciences, between April 2017 to February 2021 were screened for steroid eligibility. All patients who left against medical advice or had likelihood of death within 24 hours of admission, were excluded. The criteria for ineligibility were MDF >90,Acute kidney injury, sepsis, extrahepatic organ failures or severe comorbidities. The patients who developed an event in the hospital or were discharged were followed for 90days survival. Results: Altogether,522 patients were admitted with SAH,138(26.4%) were steroid eligible and 384(73.6%) were ineligible(figure 1).The main reasons for steroid ineligibility were: one or more organ failures in 179(46.7%) patient, with 37(9.6%), 71(18.4%), 28(7.2%) and 43(11.1%) patients having 4,3,2 and 1 organ failures respectively. Specifically, 28.3%(109) patients had AKI, 31.8% (122) had respiratory failure, 33.5% (129) had circulatory failure, 39.3%(159) had grade 3 or more encephalopathy. In addition, 32(8.3%) patients had a DF of >90, 27(7.0%) patients had recent upper GI bleed,25/384(6.5%) had superadded acute viral hepatitis ,20(5.2%) patients had severe alcohol withdrawal and 7(1.8%) had SBP. 15(4%) patients were not given steroid due to spontaneous reduction in mDF to <32 after admission. Further, 42(10.9%) patients were either found to spontaneously improve during the period of evaluation and hence were not taken up for steroid therapy. 37(9.6%) patients were not given steroids due urinary infection, continuous fever, cellulitis, mild COVID and active tuberculosis. The overall survival in the steroid ineligible cohort at day 90 was 54.4%, while the 28 day survival was 58.5%. On multivariate Analysis the presence of any organ failure, Age, albumin, AARC score, Presence of variceal bleed increase the risk of mortality (table1). 42 patients had spontaneously resolving jaundice were not given steroids, out of them 6 patients were readmitted and required the therapy. None of them died on follow up at day 90. Twenty patients had alcohol withdrawal at presentation;6 of them subsequently received steroids. Conclusion: Almost two-third patients with SAH are not eligible to receive steroids and carry a high 90 days mortality. The age, albumin, AARC score, variceal bleed and presence of organ failure predict mortality in steroid non exposed SAH patients. RCT's are needed for comparing various therapies used in such patients. .

Creation and translation of IMPACT (illinois medical professional action collaborative team) to amplify and address disparities in COVID-19: The case of vaccine

Research Objective: During the COVID-19 pandemic, novel infrastructure is needed to 1) assess disparities in care delivery 2) address these needs through rapid dissemination of rapidly-evolving, evidenced-based information 3) connecting people to resources and 4) advocating for policy change. Study Design: An interdisciplinary coalition of health care professionals on social media created the organization IMPACT. IMPACT (www.impact4hc.com) leverages social media and novel non-profit/for-profit partnerships to 1) identify and amplify public health needs and disparities in care delivery 2) address needs and gaps by rapidly disseminating evidence-based information, 3) connecting groups to resources, and 4) advocating for science-based policy. IMPACT and Oak Street Health (OSH) [a value based primary care system for low income seniors and medicare enrollees] identified a critical gap in Phase 1a vaccinations in Illinois: limited access to COVID-19 vaccination for health care workers not affiliated with health systems. IMPACT worked with OSH to 1) identify the gap 2) leverage the partnership to vaccinate 3) amplify the messaging to disseminate resources for vaccine sign ups and 4) approach city leadership for policy change. Population Studied: A case study of healthcare workers in Illinois awaiting vaccination in 01/2021. Principal Findings: Disparities in vaccination needs were rapidly identified through multiple sources (twitter, Chicago facebook groups for healthcare workers, emails and messages to IMPACT) for health care workers (HCWs1a) not affiliated with health systems. An IMPACT clearinghouse for vaccine information (registration, interest surveys) was created procuring information rapidly through social media and professional networks. Given high levels of interest (1342 views/10 days, avg 127/daily), IMPACT-OSH partnered to highlight need (twitter, facebook, policy statement), while OSH created a vaccination clinic with web-based vaccine registration for non-system affiliated HCWs. Targeted posts on facebook (2 closed HCW groups [2.2 K members/each], 1 closed general group [15.1 K]) were used to disseminate clearinghouse and OSH vaccine clinic information. Facebook posts alone reached 1650 HCWs, general member group posts reached >3.2 K in 7 days. In the first 7 days of the campaign, 5800 HCWs signed up for the OSH vaccine clinic, with >1800 vaccinated. In the first 48 hours of the social media campaign (over weekend) approx. 2000 HCWs signed up. Of a subgroup of OSH vaccinated HCWs (N = 1500), 50% reported receiving information through social media or web-based link. In response to these concerns, the local health departments encouraged all health care entities to vaccinate non-system affiliated HCWs, and the work was highlighted in the mayor's weekly press conference. Conclusions: By leveraging novel methods of communication and dissemination (social media, partnerships), IMPACT and Oak Street Health were able to assess and address the gap in care delivery of vaccinations to HCWs in a rapid time frame. Implications for Policy or Practice: Novel partnerships and utilization of social media made it possible to identify and then rapidly address a critical gap in HCW vaccination in the short term while laying groundwork for longer-term policy solutions. These findings have future implications for further vaccine rollout.

Impact of coronavirus disease 2019 on ENT clinical practice and training: the resident's perspective.

BACKGROUND: The arrival of the coronavirus disease 2019 pandemic disrupted life suddenly and forcefully, and healthcare systems around the world are still struggling to come to terms with it. This paper reviews the impact of the pandemic on ENT practice and training. METHODS: The present manuscript was developed as a narrative review to examine the role of otorhinolaryngologists in the management of the pandemic, and assess its impact on practice and training in the specialty. RESULTS: Otorhinolaryngologists handle secretions of organs implicated in disease transmission, leaving them particularly vulnerable even while performing simple procedures. Although the pandemic increased skill expectations, it simultaneously reduced learning opportunities for trainees. In addition, attention to emergencies has been delayed. Further, the suspension of elective procedures has affected patients with malignancies. CONCLUSION: While planning service resumption, provisions need to be made for protective equipment and training; improving teleconsultation services will help provide sustainable care during further waves.

Effect of SARS-CoV-2 on management of paediatric blood malignancy: A regional cancer centre study

Background: COVID-19 has emerged as a global pandemic. The purpose of this study to assess the effects of SARS-CoV-2 on management of Paediatric blood malignancies. Methods: Patients (Age <14years) of blood malignancies during the period of 3 months (March, April and May) of year 2019 and 2020 was compared for remissions rates and regular follow up. Results: Remission rates in 2020 were 56% (14 out of 25) showed remission whereas in 2019 it was 83% (24 out of 29). A striking decrease in remission rate by 26 % in 2020. The number of patients of Rajasthan (study state) also increased to 7%. Loss of follow up cases in 2019 was 4% (1in 25) in comparison to 24% (6 in 29) in 2020(a rise by 20 %). Conclusions: There has been a negative impact in remission rate of blood malignancies admist the pandemic of COVID-19. Editorial acknowledgement: The author would like to thank the doctors and support staff of the Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India. Legal entity responsible for the study: Medical Oncology Department, ATRCTRI, S.P. Medical College, Bikaner, Rajasthan, India. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.