An Investigation into the Behavior of Disposable Face Masks in Modified Bitumen for Sustainable Transportation Pathways

Since December 2019, COVID-19 infection rates have risen considerably, and the virus is currently widespread around the world. Following the COVID-19 outbreak, the production of medical waste has skyrocketed. Disposable face masks are considered medical waste. Alternative measures must be implemented to assist in reducing medical waste disposal, which can result in serious public health problems and have a negative influence on the environment. In this regard, this research was conducted to investigate the effect of disposable face mask (DFM) ash with varied rates ranging from 5% to 20% by weight on bitumen with a 5% increment to be utilised as an alternative material in asphalt pavement. A series of physical and rheological tests were conducted on the bitumen samples to study the behavior of the DFM ash in bituminous material. Overall, the physical and rheological test results revealed that introducing 20% DFM ash to the modified bitumen was unable to achieve the same properties as with the conventional SMA14 asphalt binder. However, the modified bitumen penetration grade PEN 60/70 has improved the properties and quality of the asphalt in the flexible pavement. In addition, utilising the DFM waste in road construction would be a sustainable technique for protecting the environment by minimising face mask waste caused by the COVID-19 epidemic while lowering the pavement's construction cost. These research findings may be commercialised to generate revenue in the construction industry for sustainable transportation pathways.

Methylprednisolone Versus Dexamethasone for Treatment of Severe or Critical Covid-19: A Quasi-Experimental Study (Md Treat)

Intro: Dexamethasone, a corticosteroid, was recently demonstrated to be the only medication capable of reducing mortality in severe COVID disease in the UK's Recovery Trial. There is a need to compare different steroids because it is well recognised that different corticosteroids have varied pharmacodynamic properties. The aim of our study was to compare outcomes in severe or critical COVID-19 when treated with Dexamethasone versus Methyl prednisolone. Method(s): We conducted a retrospective quasi-experimental, non-randomized study to determine whether intravenous or oral dexamethasone reduces mortality compared with intravenous methylprednisolone in patients with severe or critical COVID-19.The study was conducted on all patients aged 18 and over admitted at a 700-bedded academic medical center.The primary outcome was the mortality. The secondary outcome included length of stay. Finding(s): A total of 706 hospitalized patients with moderate to severe COVID- 19 were included in the study. There were n=217 patients in Dexamethasone group, n= 393 patients in Methylprednisolone group and n=96 patients who did not receive steroids.Among the baseline characteristics between the groups, there was no significant difference in median age (55 years in dexamethsone group vs 57 years in methyl prednisolone group p=0.09). There was male predominance in methylprednisolone group (74% versus 54% p<0.001) and a greater proportion of patients who required invasive mechanical ventilation (13.7% versus 3.2% p<0.001). Mortality was found to be significantly higher in methylprednisolone group compared to dexamethasone group on univariate logistic regression analysis (13.7% versus 3.2% p<0.001) and longer length of stay (7 days versus 4 days p<0.001). In multivariable model, dexamethsone was found to be associated with lower risk of mortality (aOR: 0.24;95% CI: (0.09- 0.62)(p=0.003) and lesser length of stay (aOR: 0.87;95% CI: (0.82-0.92) (p<0.001). Conclusion(s): Dexamethasone was associated with lower mortality and lesser length of stay when compared to Methyl prednisolone in moderate to critical COVID-19.Copyright © 2023

Steroids use in Severe/Life Threatening COVID-19 Pneumonia: Does the Type or Dose Matter?

Objective: To compare the effect of different doses of methylprednisolone and dexamethasone on in-hospital mortality in severe COVID-19 pneumoniaMethods: This retrospective chart review was done by reviewing old medical reports of patients with severe disease admitted to COVID-19 Intensive Care and High Dependency Unit from October 2020 to September 2021. Those with suspected COVID-19 infection (suggestive radiological findings but negative PCR for SARS- CoV-2 on at least two occasions) were excluded. Patients requiring high flow oxygen (> 6 liters per minute) or higher levels of respiratory support were classified as having severe disease. We recorded the type of steroids used and the doses. Methylprednisolone in doses up to 40mg per day, or other steroids in equivalent doses, were considered low dose. Primary outcome of interest was in-hospital mortality.Results: There were 279 patients aged 52.53 +/- 11.31 years, including 216 (77.42%) males. Mean hospital stay was 10.18 +/- 3.13 days. During hospital stay, 96 (34.41%) patients died. Amongst patients receiving dexamethasone, 70 (44.87%) expired, whereas 26 (21.14%) out of 123 patients who received methylprednisolone expired (p < 0.001;hazard ratio 3.037). With high dose steroids, 52 (41.27%) out of 126 patients expired, whereas 44 (28.76%) out of 153 patients treated with low dose steroids expired (p=0.029;hazard ratio 1.741). In multivariate binary logistic regression, in-hospital mortality was related to the type of steroid but not the steroid dose.Conclusion: Methylprednisolone is superior to dexamethasone for treatment of severe COVID-19 pneumonia.

Tocilizumab in severe COVID-19 – A randomized, double-blind, placebo-controlled trial

Background: The therapeutic effectiveness of interleukin-6 receptor inhibitor in critically ill hospitalized patients with coronavirus disease 2019 (COVID-19) is uncertain. Methods: To evaluate the efficacy and safety of the outcome as recovery or death of tocilizumab for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, we conducted a randomized, double-blinded, placebo-controlled phase 2 trial in critically ill COVID-19 adult patients. The patients were randomly assigned in a 4:1 ratio to receive standard medical treatment plus the recommended dose of either tocilizumab or the placebo drug. Randomization was stratified. The primary outcome was the recovery or death after administration of tocilizumab or a placebo drug. The secondary outcomes were clinical recovery or worsening of the patients' symptoms and inflammatory markers and discharge from the hospital. Results: Of 190 patients included in this study, 152 received tocilizumab, and 38 received a placebo. The duration of hospital stay of the interventional group was 12.9 ± 9.2, while the placebo group had a more extended hospital stay (15.6 ± 8.8). The mortality ratio for the primary outcome, ie, mortality or recovery in the tocilizumab group was 17.8%;p = 0.58 by log-rank test). The mortality ratio in the placebo group was 76.3%;p = 0.32 by log-rank test). The inflammatory markers in the tocilizumab group significantly declined by day 16 compared to the placebo group. Conclusions: The use of tocilizumab was associated with decreased mortality, earlier improvement of inflammatory markers, and reduced hospital stay in patients with severe COVID-19. © 2022 The Author(s)

Assessment of post-COVID-19 clinical manifestations after recovery in healthcare professionals

Aim: In this study, we aimed to assess the COVID-19 clinical manifestations after recovery from illness among healthcare professionals. Material(s) and Method(s): After ethical approval, a structured questionnaire has been distributed among healthcare professionals who were willing to participate in the study. The questionnaire contained forty questions, which were divided into four sections. Result(s): A total of 126 participants completely filled the questionnaire, including 65 (51.6%) females and 61(48.4%) males. Fatigability is the most common (38.1%) post-COVID clinical manifestation in healthcare professionals. Other common post-COVID clinical manifestations are numbness in the face/ arms/ legs (34.2%), cough (23%), muscle pain (20.6%) and anxiety/depression (20.6%) in order of frequency. Discussion(s): The presence of fatigue, anxiety, cough and hair fall was observed in women healthcare workers up to 2 months even after recovery from mild to moderate disease.Copyright © 2022, Derman Medical Publishing. All rights reserved.

COVID-19 associated multisystemic mucormycosis from India: a multicentric retrospective study on clinical profile, predisposing factors, cumulative mortality and factors affecting outcome.

PURPOSE: The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis in these patients is very much concerning. COVID-19-associated mucormycosis was detected in huge numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucormycosis (CAM). METHODS: A multicenter retrospective study across three tertiary health care centers in Southern part of India was conducted during April-June 2021. RESULTS: Among the 217 cases of CAM, mucormycosis affecting the nasal sinuses was the commonest, affecting 95 (44%) of the patients, orbital extension seen in 84 (38%), pulmonary (n = 25, 12%), gastrointestinal (n = 6, 3%), isolated cerebral (n = 2) and disseminated mucormycosis (n = 2). Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAM patients. The mucormycosis-associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucormycosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucormycosis patients. CONCLUSION: Judicious and appropriate management of the predisposing factor and factors affecting mortality associated with CAM with multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.

Clinical Spectrum of COVID-19 Patients after Vaccination

Objective: To examine the clinical severity and magnitude of COVID-19 patients after the second dose of the COVID-19 vaccine. Study Design: Cross-sectional study. Place and Duration of Study: Tertiary Care Hospital, Islamabad Pakistan, from Feb to Jun 2021. Methodology: The individuals who had two doses of the vaccine (dead inactivated-Vero Cell) and got COVID-19 at least two weeks after vaccination were included in the study. These patients were divided into Mild, Moderate and Severe categories based on their symptoms and Investigations. Results: Out of 5000 individuals vaccinated, 225(4.5%) got infected with COVID-19 later. Among these 225, 172(76.4%) had mild symptoms and recovered, with only 1(0.4%) death was reported. Conclusion: COVID-19 vaccination does not infer 100% immunity, but if someone gets infected with COVID after vaccination, there are remarkable chances of recovery. © 2022, Army Medical College. All rights reserved.

Continuing fast-track (Expedited) pancreaticoduodenectomy service during the COVID-19 pandemic: Experience from an established pancreatic surgical centre

Aim: Avoiding preoperative Biliary drainage (PBD) can facilitate early curative Surgery for patients with periampullary tumours. However, The evidence over PBD is conflicting. This prospective re-audit aimed to assess compliance to NICE guidelines (NG85) and surgical outcomes at a well-established HpB Surgery unit after achieving additional theatre sessions following prior audit. Method(s): Prospective data collection and analysis for all patients undergoing pancreaticoduodenectomy with curative intent was performed as re-audit at a tertiary pancreatic centre between September 2020 to August 2021. Result(s): 64 or 71 patients received curative pancreaticoduodenectomy (43 Kausch-Whipple & 23 pylorus-preserving pancreaticoduodenectomy, 7 inoperable). of 29 patients without PBD, 10 were jaundiced with median bilirubin levels of 138 Micromole/L (range 27-357 Mmol/L). Median time (range) from diagnostic imaging to Surgery with curative intent was 21 days (3-42) for patients without PBD compared to 62 days (22-305) for those with PBD (p=0.00028). No statistically significant difference in median HDU/ITU stay (4 Vs 3 days, p=0.849), postoperative complications (C-D>2) (30% Vs 27.8%, p=0.755), RO resection rates (42.8% Vs 75%, p=0.364), and median hospital stay (17 Vs 10 days, p=0.076) was observed for patients without or with PBD respectively. Interestingly, inoperable patients had shorter time delay from diagnostic imaging to Surgery (29 Vs 49 days, p=0.010) Conclusion(s): Fast-track (expedited) pancreaticoduodenectomy is feasible and safe for selected group of jaundiced patients without PBD. The constraints and challenges posed by COVID-19 pandemic are likely reflected in higher number of patients receiving PBD (42/71) despite clear referral pathway established following prior work at our institute.

Facial nerve palsy as a presentation of COVID-19 in a child: A case report

The COVID-19 pandemic has affected millions of people with a wide range of presentations from asymptomatic to multiorgan failure, including neurological presentations. Facial nerve palsy is a commonly encountered presentation, however a rare presentation of COVID-19. Decio, et al has reported facial nerve palsy in a 15 month old with positive serological testing for COVID-19. We report a rare case of facial nerve palsy as a clinical presentation of COVID-19 infection. A 9 years old boy was admitted in March 2022 to Hospital Sungai Buloh;designated National COVID-19 centre, was referred to the Otorhinolaryngology team for a sudden onset of right sided facial nerve palsy as the main symptom on day 8 of illness of COVID-19 infection. He was treated with standard treatment of tapering dose of oral prednisolone, eye lubricant, eye patch and physiotherapy. The child was followed up in the outpatient clinic in 3 weeks interval revealing partial recovery of the palsy. As seen in this case, facial nerve palsy can be the main presentation of COVID-19 in children making its worthwhile to add this symptom into the spectrum of neurological presentation of COVID-19 and to screen children presenting with facial nerve palsy for COVID-19 in the current epidemiology context.

UTILITY OF RISK CALCULATORS AND INFLAMMATORY MARKERS IN THE ASSESSMENT OF OUTCOMES FOR PATIENTS WITH COVID-19 ON EXTRACORPOREAL MEMBRANE OXYGENATION

SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Before the Coronavirus disease 2019 (COVID-19) pandemic, the use of extracorporeal membrane oxygenation (ECMO) specific scoring systems have been shown to predict survival better compared to general risk scores used in the intensive care unit (ICU). However, data is lacking on the utility of these scores in predicting mortality in COVID-19 patients managed with ECMO. Also, inflammatory markers have been reported to be predictors of mortality in patients with COVID-19 but have not been studied well in ECMO patients. Our study aims to assess the utility of standard ICU [Acute Physiology And Chronic Health Evaluation (APACHE-IV)] and ECMO specific [Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP)] risk calculators along with inflammatory markers in COVID-19 patients treated with ECMO. METHODS: This study is a retrospective analysis of all adult patients with COVID-related acute respiratory distress syndrome (ARDS) admitted to the ICUs of a quaternary care hospital between 03/01/2020 and 03/31/2022 who were managed with ECMO. Demographic and clinical characteristics, inflammatory markers at the time of hospital admission, and respiratory parameters at the time of ECMO cannulation of the patients who survived were compared and analyzed with patients who did not survive. RESULTS: Of the 36 COVID-19 patients managed with ECMO during the study period, 12 (33%) patients survived. Both groups were similar in terms of age, gender, and comorbidity burden (measured by Charlson Comorbidity Index). The severity of illness at the time of ICU admission (assessed by APACHE IV score) was not significantly different between two groups [Median (IQR) = 58 (50-67) vs. 60 (52-71), p= 0.627]. D-dimers at the time of ICU admission were significantly lower in the survivor group as compared to their counterpart [Median (IQR) ng/ml = 1238 (1021-1830) vs. 2990 (1298-16583), p= 0.031]. RESP score at the time of ECMO cannulation was significantly higher among the survivors as compared to non-survivors (Mean ± SD = 3.7 ± 2.2 vs. 1.3 ± 3.5, p= 0.042). CONCLUSIONS: Our study showed that higher D-dimers at the time of hospital admission and lower RESP score at the time of ECMO cannulation are associated with increased morality in patients with COVID-19 related ARDS placed on ECMO. Knowledge of these factors may assist with determining appropriate candidates for this limited resource as well as may enhance outcome predictions. Our study is limited by a relatively small sample size and therefore larger studies will be needed to validate our findings. CLINICAL IMPLICATIONS: This study shows that similar to pre-COVID studies, RESP score be useful in risk stratification of COVID-19 patients treated with ECMO. DISCLOSURES: No relevant relationships by ALEENA ARSHAD No relevant relationships by Dipak Chandy No relevant relationships by Oleg Epelbaum No relevant relationships by Daniel Greenberg No relevant relationships by Theresa Henson No relevant relationships by Areen Pitaktong No relevant relationships by Hamid Yaqoob

ASSOCIATION BETWEEN ETHNICITY AND COVID-19 PATIENTS TREATED WITH EXTRACORPOREAL MEMBRANE OXYGENATION

SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: As of March 25, 2022, age-standardized data reported by the Centers for Disease Control and Prevention showed that Hispanic, Black and American Indian or Alaska Native are about twice as likely to die from coronavirus disease 2019 (COVID-19) as their White and Asian counterparts. However, there is paucity of data regarding the effect of race on outcomes in COVID-19 related acute respiratory distress syndrome (ARDS) patients managed with extracorporeal membrane oxygenation (ECMO). Our study aims to understand the differences in the outcome between White/Asian and other ethnically minority COVID-19 patients treated with ECMO in our intensive care unit (ICU). METHODS: Retrospective analysis of adult patients with COVID-19 related ARDS treated with ECMO in the ICUs of a quaternary care hospital between 03/01/2020 and 03/31/2022. Patients were divided into two groups: White/Asian (WA) and Other Minorities (OM). Demographics, clinical characteristics, and outcomes of the two groups were compared. RESULTS: Of the 36 COVID-19 patients managed with ECMO during the study period, 18 (50%) patients belonged to the WA group while 18 (50%) patients belonged to the OM group. In the WA group, 16 (89%) were white and 2 (11%) were Asians whereas in the OM group, 16 (89%) patients were Hispanics and 2 (11%) patients were African-American. Both groups were similar in terms of age, gender, comorbidity burden (measured by Charlson Comorbidity Index), and severity of illness at the time of ICU admission (assessed by APACHE-IV score). Mean RESP score was lower in the OM group but was not statistically significant (1.3 ± 3.9 vs 2.9 ± 2.3, p= 0.157). This was reflected in the higher hospital mortality in the OM group compared to the WA group [n= 9 (50%) vs. 15 (83%), p=0.075]. There was no significant difference between the groups in the rate of ECMO-related complications, including major bleeding requiring transfusion, transaminitis (alanine transaminase greater than 5 times of upper normal limit), stroke, myocardial dysfunction (defined as an ejection fraction < 30%), acute kidney injury requiring dialysis and positive sterile fluid cultures. CONCLUSIONS: Our study showed higher mortality in ethnically minority patients compared to the white and Asian population but the difference was not statistically significant. It is possible that the relatively small number of patients in our study led to a beta error. Higher mortality rates among people of color have been attributed to low socio-economic status, structural inequities in health care and differences in vaccination rates. CLINICAL IMPLICATIONS: Larger studies are needed to further explore differences in clinical characteristics and outcomes of COVID-19 patients of different races and ethnicities treated with ECMO. DISCLOSURES: No relevant relationships by ALEENA ARSHAD No relevant relationships by Dipak Chandy No relevant relationships by Subo Dey No relevant relationships by Oleg Epelbaum No relevant relationships by Daniel Greenberg No relevant relationships by Theresa Henson No relevant relationships by Lawrence Huang No relevant relationships by Daniel Peneyra No relevant relationships by Areen Pitaktong No relevant relationships by Hamid Yaqoob

EXTRACORPOREAL MEMBRANE OXYGENATION: A HOPE FOR THE SICKEST PATIENTS WITH COVID-19

SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The role of extracorporeal membrane oxygenation (ECMO) for patients with coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS) is evolving. Data from different waves of the pandemic has shown that mortality of COVID-19 patients treated with ECMO ranges from 40-94%. Pre-COVID studies have shown that ECMO is associated with bleeding in 30-50% of patients, thrombotic complications in about 10% and secondary infections in 40% of patients. However, there is a paucity of data regarding complications with the use of ECMO in COVID-19 patients. In this study, we describe the hospital course and complications seen in the COVID-19 patients admitted to our Intensive Care Unit (ICU) treated with ECMO. METHODS: Retrospective cohort analysis of adult patients with COVID-19 related ARDS admitted to the ICUs of a quaternary care hospital between 03/01/2020 and 03/31/2022 who were managed with ECMO. RESULTS: Of the 36 COVID-19 patients treated with ECMO, 23 (64%) patients were male. Median age was 48 years (IQR 36-59). Patients had a mean BMI of 36 ± 12. Median Charlson Comorbidity Index (assesses comorbidities) was 1 (0-2) and median APACHE-IV score (assesses severity of illness at the time of ICU admission) was 60 (51-72). Prior to initiation of ECMO, 14 (39%) patients were proned and 29 (81%) patients received a trial of neuromuscular blockade. Patients had high plateau pressures (mean 31 ± 8 cm H20) with pO2/FiO2 ratios consistent with severe ARDS (mean 63 ± 17) at the time of ECMO cannulation. Mean Respiratory ECMO Survival Prediction (RESP) score was 2.1 ± 3.3. The most common complications were bleeding requiring transfusion seen in 94% of patients and positive sterile fluid cultures (53% patients). Hemorrhagic stroke was seen in 3 patients (8%). None of the patients had limb ischemia or clotting of the cannula requiring catheter exchange. Withdrawal of care occurred in 3 patients (8%). 13 (35%) patients were successfully decannulated from ECMO;however only 12 (33%) patients were discharged alive. CONCLUSIONS: Our study shows a survival rate in COVID-19 patients treated with ECMO that is comparable to previously reported studies. High bleeding and infection rates can possibly be explained by steroid use and COVID-19 disease specific characteristics. CLINICAL IMPLICATIONS: Our study describes the hospital course of the COVID-19 patients treated with ECMO and can be used to evaluate it's role in the management of severe COVID-19 patients refractory to conventional ventilatory management. DISCLOSURES: No relevant relationships by ALEENA ARSHAD No relevant relationships by Dipak Chandy No relevant relationships by Oleg Epelbaum No relevant relationships by Daniel Greenberg No relevant relationships by Theresa Henson No relevant relationships by Lawrence Huang No relevant relationships by Daniel Peneyra No relevant relationships by Areen Pitaktong No relevant relationships by Hamid Yaqoob

Assessment of post-COVID-19 clinical manifestations after recovery in healthcare professionals Post COVID-19 clinical manifestations

Aim: In this study, we aimed to assess the COVID-19 clinical manifestations after recovery from illness among healthcare professionals. Material and Methods: After ethical approval, a structured questionnaire has been distributed among healthcare professionals who were willing to participate in the study. The questionnaire contained forty questions, which were divided into four sections. Results: A total of 126 participants completely filled the questionnaire, including 65 (51.6%) females and 61(48.4%) males. Fatigability is the most common (38.1%) post-COVID clinical manifestation in healthcare professionals. Other common post- COVID clinical manifestations are numbness in the face/arms/legs (34.2%), cough (23%), muscle pain (20.6%) and anxiety/depression (20.6%) in order of frequency. Discussion: The presence of fatigue, anxiety, cough and hair fall was observed in women healthcare workers up to 2 months even after recovery from mild to moderate disease.

VMS - Visitation Management System

Under the growing uncertainties prevailing around the world, one of the most debated topics that have brought worldwide medical facilities to the test would be the ongoing Covid-19 pandemic devastating people from all walks of life. The constant intake of chronically ill or possible Covid19 infected patients into the hospital along with the high influx of visitors is harming the safety and wellbeing of both the front liners and patients especially when hospitals are one of the most important facilities to combat the spread of Covid-19 into the community. Concerning this, the researcher proposes a Visitation Management System (VMS) that solves certain key problems arising due to the high influx of hospital's visitors that causes a significant risk of Covid-19 infection, additional hospital staff to cope with the high influx of visitors at the entrance of the hospital, the difficulty of identifying high-risk Covid-19 infection locations in the hospital, as well as risk of shutting down hospitals if there are Covid-19 clusters found while losing profits or income. Apart from that, this research uses Rapid Application Development as the system development methodology for the development of VMS. Both requirement gathering methods via interview and questionnaire have been applied among various users. This research has included the findings of the collected analytical data to highlight the user requirements of VMS and a system providing proof of concept to underline the implementation of VMS to help curb the spread of Covid-19 in hospitals. © 2021 IEEE.

Classification of Pulmonary Viruses X-ray and Detection of COVID-19 Based on Invariant of Inception-V 3 Deep Learning Model

Coronavirus (COVID-19) is a catastrophic illness that has already infected several million individuals and caused thousands of fatalities globally. Any technical technique that enables quick testing of the COVID-19 with high accuracy might be essential for healthcare providers. X-ray imaging is an easily available technique that might be a great option for its quick detection. This research was conducted to examine the usefulness of artificial intelligence (AI) to detect COVID-19 quickly and accurately from chest X-ray scans. The objective of this study is to provide a solid technical method for the automatic identification of COVID-19, Pneumonia, Lung opacity, and Normal digital X-ray scans using pretrained, deep learning algorithms while optimizing detection accuracy. Inception v3 with an additional added dense layer is used with image augmentation to train and validate the selected dataset. The obtained accuracy of 99.72% promises speedy detection of COVID-19. © 2021 IEEE.

PREDICTORS AND OUTCOMES OF BACTERIAL AND FUNGAL SUPERINFECTIONS IN CRITICALLY ILL PATIENTS WITH COVID-19

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Secondary infections are well-described complications in patients with viral pneumonia and are associated with increased mortality and morbidity (1). A recent meta-analysis reported that secondary infections in critically ill Coronavirus Disease 19 (COVID-19) patients in intensive care unit (ICU) are around 14% (2). Most of the studies are limited by false-positive cultures in non-sterile body fluids (2). Our study aims to assess the burden of secondary infections by focusing on the positive rate of sterile body fluid cultures in ICU patients, to examine associated risk factors and to assess their impact on outcome. METHODS: Retrospective analysis of all adult patients with COVID-related acute respiratory distress syndrome (ARDS) admitted to the ICUs of a quaternary care hospital between 03/01/2020 and 05/31/2020. Patients who had positive sterile body fluid (blood, peritoneal, pleural or cerebrospinal fluid) cultures for bacteria or fungi, were compared with those without positive cultures. RESULTS: Of the 210 patients admitted to our ICU with COVID-19 related ARDS, 55 patients (26%) had positive sterile body fluid cultures, of which 37 grew bacteria, 7 fungi and 11 both. Patients with positive cultures were similar in terms of baseline demographics, comorbidities and severity of illness at ICU admission to those patients without positive cultures. Peak inflammatory markers were significantly higher in the positive culture group. In the positive culture group, the rates of receipt of steroids (78% vs. 61%, p=0.02) and convalescent plasma (64% vs. 45%, p=0.03) were significantly higher. The prevalence of acute kidney injury (AKI) requiring dialysis was significantly greater in the positive culture group (55% vs. 28%, p<0.001). There was no difference in terms of mortality between the two groups. However, mechanical ventilation (MV) free days at day 28 were significantly lower in the positive culture group (Mean ± S.D: 2.7 ± 5.7 vs. 6 ± 9.9, p=0.004). CONCLUSIONS: Our study shows that the incidence of superinfections in COVID-19 patients admitted to ICUs is higher than previously reported. The higher incidence is comparable to the rate of superinfections in the H1N1 influenza pandemic of 2009 (2). However, the high rates of steroid and plasma administration in our positive culture group may also have contributed to the high incidence of secondary infections. Our results have also shown that these infections may prolong ventilatory support as well as increase the likelihood of developing AKI requiring dialysis. Therefore, intensivists need to be vigilant about not missing superinfections in patients with COVID-19 which can negatively impact patient outcomes. CLINICAL IMPLICATIONS: This study will help to identify the risk factors associated with higher incidence of secondary infections in patients with COVID-19, and will assist physicians to identify and treat them early in the course of disease. 1. I. Martín-Loeches, A. Sanchez-Corral, E. Diaz, R.M. Granada, et al., H1N1 SEMICYUC Working Group Community-acquired respiratory coinfection in critically ill patients with pandemic 2009 influenza A(H1N1) virus. Chest, 139 (2011), pp. 555-562. 2. Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020;81(2):266-275. DISCLOSURES: No relevant relationships by ALEENA ARSHAD, source=Web Response No relevant relationships by Dipak Chandy, source=Web Response No relevant relationships by Oleg Epelbaum, source=Web Response No relevant relationships by Daniel Greenberg, source=Web Response No relevant relationships by Muhammad Rizwan, source=Web Response No relevant relationships by Hamid Yaqoob, source=Web Response

Lung Cancer Services and the COVID-19 Pandemic

The first outbreak of COVID-19 was reported in December 2019 in Wuhan, China and it was declared as a global pandemic on March 11, 2020. To cope with the high infectivity and increasing number of deaths associated with this disease, the healthcare resources of nearly all countries were directed to put measures in place to manage this disease. As a result, many other services including lung cancer care have been adversely affected as treatments have been delayed. The widespread lockdowns and advice to stay at home especially with common symptoms of cough has resulted in late presentations and possible upstaging of lung cancer. Owing to this similarity of symptoms and pressures faced by respiratory community to manage COVID-19 pandemic, the lung cancer patients will encounter delays in their management leading to untoward effects on their survival and quality of lives. According to an estimate, the impact of COVID-19 could lead to an additional 1372 deaths due to lung cancer in the United Kingdom alone. There has also been reluctance among the oncology community to treat patients with systemic anticancer agents due to fear of patients catching COVID-19 infection. There should be a balance between the risks and benefits of providing cancer services during this pandemic and every step should be taken to minimize delays faced by patients with lung cancer.

Impacts of reduced deposition of atmospheric nitrogen on coastal marine eco-system during substantial shift in human activities in the twenty-first century

The novel infectious disease (COVID-19) took only a few weeks from its official inception in December 2019 to become a global pandemic in early 2020. Countries across the world went to lockdown, and various strict measures were implemented to reduce the further spread of the infection. Although, the strict lockdown measures were aimed at stopping the spread of COVID-19, however, Its positive implications were also observed for the environmental conditions across the global regions. The present study attempted to explore the eco-restoration of coastal marine system in response to reduced deposition of atmospheric nitrogen (NO2) emission during the substantial shift in human activities across the global metropolitan cities. Remotely data of NO2 emission were taken from Ozone Monitoring Instrument and the coastal water quality along the marine system was estimated from MODIS-Aqua Level-3 using Semi-Analytic Sediment Model (SASM). The changes in tropospheric NO2 in 2020s were also compared with the long-term average changes over the baseline period 2015 - 2019. A significant reduction in anthropogenic mobility (85 - 90%) has been observed in almost all countries over different places, especially grocery, parks, workplaces, and transit stations. A massive reduction in tropospheric NO2 was detected in Wuhan (53%), Berlin (42%), London (41%), Karachi (40%), Paris (38%), Santiago (35%), and Chennai (34%) during the strict lockdown period of the early 2020 as compared to the last five years. However, after the partial lockdown was lifted, tropospheric NO2 values bounced back and slightly increased over Karachi (6%) and Bremen (12%). For water turbidity, the rate of reduction was found to be the highest along the different coastal regions of the Mediterranean Sea and Black Sea (51%), West Atlantic Ocean (32%), East Atlantic Ocean (29%), and Indian Ocean (21%) from Apr to Jun 2020. The monthly comparison of overland-runoff in 2020 compared to 2019 across the different costal watersheds indicates that the observed decline in turbidity might have been due to the reduced deposition of atmospheric nitrogen. The findings of this study suggest that the recent decline in tropospheric NO2 and water turbidity might be associated with reduced emissions from fossil fuels and road transports followed by COVID-19 forced restrictions in the twenty-first century. The inferences made here highlight the hope of improving the global environmental quality by reducing greenhouse gas emissions using innovative periodic confinement measures on heavy transport and industries while securing public health and socioeconomics.

Characteristics, Outcomes, and Trends of Patients With COVID-19-Related Critical Illness at a Learning Health System in the United States.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally. OBJECTIVE: To describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery. DESIGN: Single-health system, multihospital retrospective cohort study. SETTING: 5 hospitals within the University of Pennsylvania Health System. PATIENTS: Adults with COVID-19-related critical illness who were admitted to an intensive care unit (ICU) with acute respiratory failure or shock during the initial surge of the pandemic. MEASUREMENTS: The primary exposure for outcomes and care delivery trend analyses was longitudinal time during the pandemic. The primary outcome was all-cause 28-day in-hospital mortality. Secondary outcomes were all-cause death at any time, receipt of mechanical ventilation (MV), and readmissions. RESULTS: Among 468 patients with COVID-19-related critical illness, 319 (68.2%) were treated with MV and 121 (25.9%) with vasopressors. Outcomes were notable for an all-cause 28-day in-hospital mortality rate of 29.9%, a median ICU stay of 8 days (interquartile range [IQR], 3 to 17 days), a median hospital stay of 13 days (IQR, 7 to 25 days), and an all-cause 30-day readmission rate (among nonhospice survivors) of 10.8%. Mortality decreased over time, from 43.5% (95% CI, 31.3% to 53.8%) to 19.2% (CI, 11.6% to 26.7%) between the first and last 15-day periods in the core adjusted model, whereas patient acuity and other factors did not change. LIMITATIONS: Single-health system study; use of, or highly dynamic trends in, other clinical interventions were not evaluated, nor were complications. CONCLUSION: Among patients with COVID-19-related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Further studies are necessary to confirm this result and to investigate causal mechanisms. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.