Long-COVID and its Physical and Neurological Symptoms in Adults: A Systematic Review

This review was carried out with the objective to study patterns of neurological, psychological and other physical consequences of COVID-19 in the long term. The guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalyses) had been followed;22 articles, published during January 2020 to September 2021, were selected. Original research, review articles, editorial and viewpoints were included. Google Scholar, Medline, and PubMed were searched through 2020 till 2021.Data collection in selected studies was performed mainly through the online survey, telephone survey, use of medical records, and patient interviews. This systematic review contains the studies conducted in the American, Asian and European countries. The major outcomes identified were the neurological, psychological, and other long-term chronic manifestations of COVID- 19. This review demonstrates that long-COVID has started to bring a huge wave of patients, the count of them being millions now, who can enter a phase of disability due to neurological damages if not treated during the early course of illness. Though more disabling than lethal, long-COVID patients with a neurological deficit is expected to overburden the healthcare system globally which is already been struggling to handle acute COVID-19 patients in this once-in-a-lifetime pandemic.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

COVID-19 intensity across U.S. states and the liquidity of U.S. equity markets

We study the effects of COVID-19 intensity on equity market liquidity across U.S. states. We exploit cross-sectional variation in cases and deaths to investigate any association with the deterioration of stock liquidity of firms whose headquarters or operations are in the corresponding state(s). Our motivation stems from several underlying economic channels such as order processing costs, inventory costs, and adverse selection costs. We find strong negative relations between pandemic intensity and various intra-day liquidity measures. Our results are more pronounced for firms operating in states with more stringent containment and health measures and within industries with greater risk exposure.

Classification of Post-COVID-19 Emotions with Residual-Based Separable Convolution Networks and EEG Signals

The COVID-19 epidemic has created highly unprocessed emotions that trigger stress, anxiety, or panic attacks. These attacks exhibit physical symptoms that may easily lead to misdiagnosis. Deep-learning (DL)-based classification approaches for emotion detection based on electroencephalography (EEG) signals are computationally costly. Nowadays, limiting memory potency, considerable training, and hyperparameter optimization are always needed for DL models. As a result, they are inappropriate for real-time applications, which require large computational resources to detect anxiety and stress through EEG signals. However, a two-dimensional residual separable convolution network (RCN) architecture can considerably enhance the efficiency of parameter use and calculation time. The primary aim of this study was to detect emotions in undergraduate students who had recently experienced COVID-19 by analyzing EEG signals. A novel separable convolution model that combines residual connection (RCN-L) and light gradient boosting machine (LightGBM) techniques was developed. To evaluate the performance, this paper used different statistical metrics. The RCN-L achieved an accuracy (ACC) of 0.9263, a sensitivity (SE) of 0.9246, a specificity (SP) of 0.9282, an F1-score of 0.9264, and an area under the curve (AUC) of 0.9263 when compared to other approaches. In the proposed RCN-L system, the network avoids the tedious detection and classification process for post-COVID-19 emotions while still achieving impressive network training performance and a significant reduction in learnable parameters. This paper also concludes that the emotions of students are highly impacted by COVID-19 scenarios.

Ve-Degree, Ev-Degree, and Degree-Based Topological Indices of Fenofibrate

The molecular topology of a graph is described by topological indices, which are numerical measures. In theoretical chemistry, topological indices are numerical quantities that are used to represent the molecular topology of networks. These topological indices can be used to calculate several physical and chemical properties of chemical compounds, such as boiling point, entropy, heat generation, and vaporization enthalpy. Graph theory comes in handy when looking at the link between certain topological indices of some derived graphs. In the ongoing research, we determine ve-degree, ev-degree, and degree-based (D-based) topological indices of fenofibrate’s chemical structure. These topological indices are the Zagreb index, general Randić index, modified Zagreb index, and forgotten topological index. These indices are very helpful to study the characterization of the given structure.

EVALUATING VIRTUAL GROUP VISITS FOR DIABETES CARE DURING THE COVID-19 PANDEMIC

BACKGROUND: One strategy to aid patients in managing their diabetes is group visits (GVs) that include group education and individual medical visits with a provider. Though in-person GVs have been shown to benefit patients, few studies have evaluated virtual diabetes GVs. METHODS: In this single-arm trial, adult patients with A1c ≥ 8% from six community health centers were recruited to participate in monthly virtual GVs for 6 months. Patients completed surveys about diabetes self-care, support, distress, and the group visit concept before and after they participated in GVs. Health center staff trained to lead the GVs completed surveys pre and post virtual GVs. Linear mixed effects models were used to adjust cohort-based association and model the survey data over time for the time trend effect. RESULTS: Forty-five patients enrolled in the study and thirty-eight patients completed the baseline survey. The average age was 55 (range of 36-83) and 65% of enrollees were female. 63% were black/African American, 32% were white/Caucasian, and 8% were Hispanic/Latino. Thirty-four patients attended one or more GVs and twenty-one patients completed the post GV survey. Overall satisfaction with the virtual GVs was high with 18/20 (90%) of participants being very satisfied and 20/21 (95%) saying they would attend GVs in the future. Most participants agreed that GVs helped improve diabetes self-management skills (78%), motivated them to achieve health goals (89%), and introduced them to others living with diabetes (78%). Barriers to participation were the timing of the GVs and access to a computer, tablet, phone, and internet. Patients had an increase in their diabetes knowledge (mean (SD): 3.2/ 5 (0.9) to 3.6/5 (0.7), p= 0.02) and diabetes support (3.5/5 (0.64) to 4.1/5 (0.7), p <0.001) as well as decreased diabetes distress (2.9/6 (1.5) to 1.2/6 (0.5), p=0.03) from baseline to 6 months. Thirty-five staff enrolled in the study and seventeen completed a post GV survey. Most staff agreed that GVs provided patients with social support and more frequent contact with medical providers. Staff largely agreed that virtual GVs increased opportunity for teamwork and collaboration (94%), care coordination (82%), and understanding of patients (94%). However, only 5/17 (29%) and 3/17 (18%) staff members agreed that virtual GVs increased provider productivity or led to higher reimbursement, respectively. Staff cited other priorities at the health center, difficulty recruiting patients, and concerns about access to technology as the biggest barriers to implementing virtual GVs. CONCLUSIONS: Virtual GVs show promise as evidenced by high patient satisfaction and improvements in support, distress, and diabetes knowledge in patients. Staff also perceived virtual GV benefits to patients, staff, and health centers despite concerns about logistics such as productivity, reimbursement, and the health center's ability to continue visits virtually.

IMPACT OF VIRTUAL DIABETES GROUP VISITS ON PATIENT OUTCOMES DURING THE COVID-19 PANDEMIC IN MIDWESTERN HEALTH CENTERS

BACKGROUND: Diabetes group visits (GVs) or shared medical appointments have been shown to improve clinical outcomes, but few have reported results from virtual diabetes GVs. No studies have evaluated virtual GVs among community health center patients across a region of the U.S. METHODS: Six health center sites across five states conducted six monthly virtual GVs with up to 12 adult patients with type 2 diabetes and suboptimal glycemic control (glycosylated hemoglobin (A1C) ≥8%). Virtual group visits consisted of six monthly 60 to 90 minute-long diabetes education sessions led by health center staff via a videoconferencing platform. GV patients enrolled at the site also had an appointment with their primary care physician within two weeks of each monthly virtual group visit. Primary outcome was change in patients' A1C from baseline to 6- months. Secondary outcomes were changes in patients' blood pressure, low density lipoproteins (LDL) and weight. Patients also completed surveys at baseline and 6-months describing their diabetes self-care behaviors and satisfaction with the virtual GVs. Generalized linear mixed models and linear mixed models were used to test the effects of GVs, time points and their interaction. RESULTS: Forty eight patients were enrolled (mean age 55 ± 12 years, 67% female, 63% black/African American, 32% white/Caucasian, and 8% Hispanic/Latino, 88% had public health insurance, mean baseline A1C of 9.84% ± 1.78%, 35% with A1c <9%). 34 patients completed one or more virtual GVs;14 patients attended no virtual group visits. At 6-months, average A1C was 8.96 ±1.82;A1C decreased by -0.56% ± 0.31 compared to baseline which was borderline significant (p=0.08). At 6-months, 58% of patients had an A1C < 9% which was borderline significantly decreased (p=0.055) compared to baseline. For patients with an A1C at baseline >9%, there was a significant decrease in A1C at 6 months (-1.06 ±0.45, p=0.03). There was no significant difference in blood pressure, LDL or weight from baseline to 6- months or association of number of visits attended and change in A1C. There were no significant changes in foot self-exams, blood sugar testing, nor exercise, but patients did report more days of healthy eating in the past week at 6-months compared to baseline (4.5 ±2.3 vs. 3.2 +2.7 days, p=0.02). Overall satisfaction with the virtual GVs was high with 90%of participants being very satisfied and 95% saying they would attend GVs in the future. CONCLUSIONS: Virtual GVs show high patient satisfaction and promise for improving A1C among patients with poor glycemic control who receive care in community health centers. Future studies are needed with a larger patient sample size and a control comparison group to determine which patients and health centers are best suited for virtual GVs.

Medical teaching in the covid era: The rise of the webinar

Background: Since the emergence of COVID-19, virtually the whole world has been forced to into lockdown and adapt to a way of life not seen in living memory. Although pandemics are not new, nor will this likely be the last, the modern era has one major advantage that our ancestors did not have: the internet. Through the usage of modern technology and the internet, we have been able to continue our professional lives through a virtual medium through programs like Zoom. As part of this virtual shift, medical teaching is also mainly online. A QI study was conducted on webinars. Aim: To determine whether medical students and junior doctors find online teaching to be an effective medium of learning, as well as to determine the advantages and disadvantages, including mental health impact. Method: A webinar series was created, entitled back2basics (B2B) surgery, which was run for around 2 months with weekly, 1-hour long webinars on a surgical topic. Feedback was collected following each session specific to that week's webinar as a general opinion of our participants on webinars. Results: Both qualitative and quantitative data was collected. The majority (83%) of participants agreed by the 8th week that webinars were an effective mode of medical teaching compared to 48% in the 1st week. Participants pointed out that webinars are 'low pressure' and 'less competitive' than in person lectures, so good for mental health. Conclusions: Participants agree that the webinars are effective for medical teaching and that there are mental health benefits.

ACE2 and TMPRSS2 co-localization in proximal tubules from human kidneys obtained at autopsy from COVID-19 patients

Background: Studies at the single cell level have revealed that the localization of TMPRSS2 is in the distal nephron whereas ACE2 is in the proximal tubule. Since TMPRSS2 is a serine protease necessary for activation of the SARS-CoV-2 S spike protein after it binds to ACE2, this spatial separation would make it difficult to explain how SARS-CoV-2 can infect the kidney. The purpose of this study was to examine the localization of these proteins by immunofluorescence in the kidneys of patients who died from COVID-19. Methods: Human kidney slides from a Northwestern COVID-19 repository were used after IRB approval. Slides from paraffin-embedded blocks were probed with different antibodies (ACE2, TMPRSS2, ACE, NBC-1, Aquaporin 2) for immunofluorescence studies. Mouse kidneys were also examined as additional controls. Results: In mouse kidneys, TMPRSS2 was found in the brush border of proximal tubules and co-localized strongly with ACE2. Similarly, in human kidneys from patients who died from COVID-19, with or without AKI and from non-COVID-19 subjects, ACE2 and TMPRSS2 co-localized in the proximal tubule. TMPRSS2 and ACE2 also co-localized with ACE, a marker of the apical proximal tubule and to a lesser extent with NBC-1, a marker of the basolateral proximal tubule membrane. By contrast, TMPRSS2 and ACE2 did not co-localize with Aquaporin 2, a marker of principal cells in the collecting tubule. Conclusions: In both mouse and human kidneys, ACE2 and TMPRSS2 co-localize in the proximal tubule. In kidneys from patients with COVID-19 with or without AKI obtained at autopsy, both proteins co-localized in the proximal tubule but not in the collecting tubule. Contrary to what was suggested from single-cell mRNA analysis?, the co-localization of both proteins in the proximal tubule would make it possible for the SARS-CoV-2-ACE2 complex to be activated when coronavirus reaches the kidney.

The effects of COVID-19 on access to telemedicine visits in a tertiary headache clinic

Objective: Determine the effect of COVID-19 on telemedicine access for racial minorities prior to, during and following the COVID-19 surge at the Cleveland Clinic Headache Section. Background: Racial, ethnic and socioeconomic minority patients face significant barriers to receiving equal access to health care. Telemedicine has the potential to increase access to specialty medical care among the urban underserved. We seek to understand the effects of rapid implementation of telehealth across different racial subgroups during the COVID-19 pandemic. Design/Methods: We conducted a retrospective data review of patient visits at Cleveland Clinic Headache Section during the following time points: January 1 - March 13, 2020 (control - prior to COVID-19 pandemic surge), March 16, 2020 - May 22, 2020 (COVID-19 surge) and May 26, 2020 - August 20, 2020 (post COVID-19 surge) in 2020. We compared demographic data (age, sex, race, and marital status). Results: Pre COVID-19 pandemic surge included 380 virtual visits of which, 339 (89%) were white and 18 (4.7%) were identified as BIPOC (black, indigenous people of color). In-person visit group included 1890 patients with 1426 white (75%) and 365 (19%) identified as BIPOC. During the COVID surge, there were 1797 virtual visits with 1423 (79% white) and 303 (17%) BIPOC. The post COVID-19 surge had 1801 virtual patients with 1472 (82% white) and 256 (14%) BIPOC. In person group had 805 patients with 582 white (72%) white and 187 (23%) BIPOC. Conclusions: Pre-COVID-19 pandemic there was proportionally less usage of virtual visits by minorities compared to whites. It was unclear if such groups would have the same access to virtual care. However, during COVID-19 surge we saw a slight increase in virtual visits by minority groups which continued post COVID-19 surge when in person visits began. We also saw an overall slight increase in healthcare utilization by this minority group.

Psychological sequelae of covid 19 calamity on medical personnel in pakistan

Aim: To gauge the physiological sequelae of covid-19 pandemic on medical personnel in Pakistan. Place & duration: An online cross sectional study was conducted from May, 2020 to August, 2020 in Lahore. Methodology: 17 score PTSD check list civilian version was used to assess the symptoms of post-Traumatic stress disorder in medical personnel. Results: Mean post-Traumatic stress score (PTSS) was 39±15 with a range of 18-89. 66% (n=240) of the participants experienced moderate to extreme stress level. Chi Square test was used to determine an association between higher stress level and age, gender and staff category. Higher stress scores were associated with females (p<0.01). Conclusion: Rewarding the health personnel with gratitude, acknowledgement, financial compensations and provision of personal protective equipments (PPEs) can halt the psychological sequelae and is a promise to win this battle.