A Rare Etiology for Ulcerative Colitis Flare

Introduction: Prior to colonoscopy, it is well understood that patients must undergo bowel cleansing. Based on the type of laxative, colonoscopy preparations fall into two categories - polymer-based formulas (PEG) and saline-based formulas (NaP). Both types of bowel preparations are deemed to be relatively safe and part of routine practice. However, we describe the rare case of an ulcerative colitis (UC) flare due to the bowel preparation formula. Case Description/Methods: A 29-year-old female with diagnosis of UC, presently in clinical and biochemical remission on oral mesalamine, contracted COVID-19 and had reactivation of UC symptoms. After being on budesonide tablets and rectal foam for two months, patient achieved clinical remission, and a surveillance colonoscopy was performed which revealed normal colon and terminal ileum except mild congestion in the cecum (Figure A). Pathology revealed unremarkable mucosa in the entire colon except for chronic active colitis in the cecum. Immediately following this colonoscopy, the patient started to experience another severe UC flare requiring hospitalization. The patient's laboratory work-up was normal except for an elevated fecal calprotectin (1710). Stool infectious work-up was negative and the patient denied any NSAID or antibiotic use. The patient underwent a repeat colonoscopy which revealed severe Mayo 3 pancolitis (Figure B) in comparison to a stable colonoscopy a few weeks prior. It was revealed that for her initial colonoscopy, she had used SUPREP bowel prep kit. On prior colonoscopies she had used MiraLAX bowel prep with no adverse effects. During hospitalization, the patient was started on biologic therapy with good effect. Discussion(s): There are no clear guidelines on appropriate bowel preparation formula for the inflammatory bowel disease (IBD) population. Sufficient literature exists to confirm that NaP can irritate the intestinal mucosal wall. Moreover, numerous animal experiments have employed dextran sodium sulfate for chemical induction of intestinal inflammation to mimic UC flares in humans [1]. Thus, it can be surmised that because SUPREP ingredients contain sodium sulfate, the potential for UC flare is higher. It is pertinent for practitioners to be aware of the possible rare adverse effects of saline-based formulas, especially when treating the IBD population.

A Survey of Deep Learning Techniques for the Analysis of COVID-19 and their usability for Detecting Omicron

The Coronavirus (COVID-19) outbreak in December 2019 has drastically affected humans worldwide, creating a health crisis that has infected millions of lives and devastated the global economy. COVID-19 is ongoing, with the emergence of many new strains. Deep learning (DL) techniques have proven helpful in efficiently analysing and delineating infectious regions in radiological images. This survey paper draws a taxonomy of deep learning techniques for detecting COVID-19 infection in radiographic imaging modalities Chest X-Ray, and Computer Tomography. DL techniques are broadly categorised into classification, segmentation, and multi-stage approaches for COVID-19 diagnosis at the image and region-level analysis. These techniques are further classified as pre-trained and custom-made Convolutional Neural Network architectures. Furthermore, a discussion is drawn on radiographic datasets, evaluation metrics, and commercial platforms provided for detection. In the end, a brief look is paid to emerging ideas, gaps in existing research, and challenges in developing diagnostic techniques. This survey provides insight into the promising areas of research in DL and is likely to guide the research community on the upcoming development of deep learning techniques for COVID-19. This will pave the way to accelerate the research in designing customised DL-based diagnostic tools for effectively dealing with new variants of COVID-19 and emerging challenges. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Dentist's Knowledge and Behavior on the Use of Smart Phones in Clinical Environment and their association with Cross Infections

Background: The use of smart phones inside hospitals especially in clinically sensitive areas is a subject of debate because it may improve the quality of healthcare but can also be a vehicle of hospital acquired infections. Aim: To determine dentist's knowledge and behavior related to the use of smart phones in clinical environment and to determine the presence of microbial growth on these devices. Methods: This is a cross-sectional study in which validated survey tool was used to collect data about knowledge and behavior of 397 dental graduates from 8 dental colleges of Pakistan, regarding their usage of smart phones in clinical environment. Bacterial isolates were collected from the smart phones of 45 participants from Fatima Memorial Dental Hospital, Lahore. Results: The SPTC Scale was used to divide the participants into 3 categories;low, moderate and high users. The behavior related to smart phone usage in clinical environment was significantly different among the participants. Moderate users had significantly higher average behavior score of 3.7 (p-value = 0.034). The growth of pathogenic bacterial flora was greater on high users of smart phones (95%,) whereas those participants who were low users the percentage was 37%. Conclusion: Hospital-acquired infections (HAIs) are increasing significantly in number of patients and these can be prevented by adhering to proper hand hygiene practices and if hand hygiene is improved the amount of bacterial load will be less and disinfection of smart phone devices will not be required.

COVID-19-ASSOCIATED PULMONARY MUCORMYCOSIS PRESENTING AS SPONTANEOUS PNEUMOTHORAX: A RARE PRESENTATION

SESSION TITLE: COVID-19 Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Mucormycosis is an angio-invasive fungal infection with substantial morbidity and mortality. While diabetes and immune suppression remain well-known risk factors for mucormycosis, COVID-19 is now emerging as its independent predictor. CASE PRESENTATION: A 43-year-old male, with a history of hyperlipidemia and alcoholism, presented to the hospital with complaints of progressive dyspnea on exertion, productive cough, intermittent fever, anorexia, and chest pain over the course of 2 weeks. About 5 weeks prior to the current presentation, he was tested positive for COVID-19 by a polymerase chain reaction (PCR) based test and remained in quarantine at home. He was not vaccinated against COVID-19. He had no known immunosuppressive disease. On initial examination, he was ill-appearing and had a temperature of 101 F, blood pressure 138/83 mmHg, respiratory rate 22/minute, pulse 102/minute, and saturation of 91% on 2 L nasal cannula oxygen. A computerized tomography (CT) scan of the chest revealed small bilateral pneumothorax (2 cm and 5mm) along with extensive ground-glass opacifications in all lobes. In the next 24 hours, the right-sided pneumothorax progressed to tension pneumothorax requiring pigtail pleural drainage catheter placement. The drained pleural fluid had more than 100,000/uL total nucleated cells (91% neutrophils, 2% lymphocytes, and 1% eosinophils) and ultimately cultures grew Rhizopus spp. He was started on intravenous liposomal amphotericin-B infusion (5 mg/kg daily). On hospital discharge, he was switched to oral posaconazole (started with loading 300 mg delayed-release tablet twice a day, followed by 300 mg dosing of delayed-release posaconazole tablets daily) to complete the long term treatment course. DISCUSSION: Most of the reported cases of mucormycosis in COVID-19 were in patients with either diabetes or receiving steroids. This is a rare presentation of COVID-19–associated pulmonary mucormycosis (CAPM) as spontaneous pneumothorax, in the absence of known immunosuppression history. COVID-19 results in a considerable increase in cytokines, particularly interleukin-6 (IL-6), which increase free iron by increasing ferritin levels due to increased synthesis and decreased iron transport. Also, concomitant acidosis increases free iron by reducing the ability of transferrin to chelate iron and this available iron becomes a considerable resource for mucormycosis. [1] Also, Mucorales adheres to and invades endothelial cells by specific recognition of the host receptor glucose-regulator protein 78 (GRP-78). Acidosis associated with severe COVID-19 triggers GRP-78 and fungal ligand spore coating homolog (CotH) protein expression on endothelial cells, both contributing to angioinvasion, hematogenous dissemination, and tissue necrosis. [2] CONCLUSIONS: Mucormycosis can present as spontaneous pneumothorax after recent COVID-19 and clinicians should be aware of rare clinical presentation. Reference #1: Singh AK, Singh R, Joshi SR, et al. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr Clin Res Rev 2021;15:102146. doi:10.1016/j.dsx.2021.05.019 Reference #2: Baldin C, Ibrahim AS. Molecular mechanisms of mucormycosis—The bitter and the sweet. PLOS Pathog 2017;13:e1006408. doi:10.1371/journal.ppat.1006408 DISCLOSURES: No relevant relationships by Faran Ahmad No relevant relationships by AYESHA BATOOL No relevant relationships by Zachary DePew No relevant relationships by Neil Mendoza

Do fear and perceived knowledge of Covid-19 drive sustainable consumption behaviour in Muslims? The mediating role of religiosity

Purpose This research aims to investigate the impact of fear and perceived knowledge (PK) of Covid-19 on the sustainable consumption behaviour (SCB) of Muslim consumers and to test the mediating role of (intrinsic) religiosity. Design/methodology/approach A total of 417 responses were collected during Covid-19 lockdown through an online structured survey using the snowball technique. A two-step research approach was adopted. In Study 1, an exploratory factor analysis was performed on the SCB measurement scale through SPSS. In Study 2, hypothesised associations were analysed using SmartPLS-SEM. Findings PK of Covid-19 pandemic directly motivates SCB in Muslim consumers, whereas fear has no direct effect on any factor of SCB. Religiosity is found to be a significant driver of SCB. Indirect effects also depict that religiosity positively mediates the association between fear and SCB as well as PK and SCB. Practical implications The study may guide policymakers and marketers in using the current pandemic as a tool to inspire sustainable consumption. Religious values, teachings and knowledge about the pandemics can be publicised to create awareness and induce desired behaviour to cope with adverse events and adopt sustainable consumption patterns and lifestyles among Muslim consumers. Originality/value The article is the pioneer of its kind to present survey research about Covid-19 fear and PK's impact on SCB through religiosity. It adds to the Islamic marketing literature about religiosity, coping theory, PK and fear of pandemics and their role in transitioning Muslim consumers towards SCB. Moreover, the use of partial least squares structural equation modelling in the context of Covid-19 research was extended.

Mental Health Consequences of Covid-19 among Health Care Workers in Abbottabad

Objective: To compare the mental health impact and Post Traumatic Stress Disorder between medical and paramedical staff using DASS-21 and IES scale respectively and to find association of mental impact of COVID-19 with socio-demographic variables. Study Design: Analytical cross sectional study Place and Duration of Study: This study was conducted at the Department of Medicine, Ayub Teaching Hospital Abbottabad for 16 months from June, 2020 to October, 2021. Materials and Methods: Carried out on 150 health care workers of Ayub Teaching Hospital. Data was collected by using two validated questionnaires DASS and IES scales. Analysis was conducted by SPSS version 20. Independent sample t test was used for comparison of scores between medical and paramedical staff while chi square test of association was used to find association of mental impact with socio-demographic variables. P value of ≤0.05 was considered significant. Results: The mean age of the health care workers was 30.01±6.62 years. Out of 150 participants, 105 (70%) were doctors, 45 (30%) were paramedics. Male to female ratio was 1:1. Overall mean depression score accounted for 8.81±8.26;anxiety score was 7.94±7.86;stress score was 12.60±9.02 and mean PTSD score was 24.76±16.40. A statistically significant difference was observed between medical and paramedical staff for stress (p=0.002) and PTSD (p=0.05). Stress was found to be significantly associated with category of health workers (p<0.001) while anxiety with gender (p=0.04). Conclusion: Substantial impact of COVID-19 on mental health of healthcare workers was found during Covid-19. © 2022 Medical Forum Monthly. All rights reserved.

Impact of COVID-19 on Peripheral Nervous System Disorders

Objective: The objective of this study was to determine the frequency of peripheral nervous system disorders among COVID-19 survivors. Study Design: Cross-sectional Survey Place and Duration of Study: This study was conducted at the Department of Rehabilitation and Allied Health Sciences, Riphah International University Lahore Campus from December, 2020 to June, 2021 for a period of 06 months. Materials and Methods: 144 patients recovered from Covid-19 through non probability convenience sampling were recruited for study. Patients were assessed for pain, smell, taste, balance and two-point discrimination and the ability to identify familiar objects. The data was collected according to the responses after patients approved to provide information. Data was coded in SPSS data sheet which was later analyzed for statistical frequencies and percentages. Results: Mean age of patients was reported to be 34.5 ± 6.9 years. The mean score patients marked on the VAS scale for their pain was reported to be 4.96 with a standard deviation of 1.77. 42.4% of the 144 patients had complaints of symptoms associated to peripheral nerve involvements thus making a prevalence of 42.4%. Out of 144 patients in total, 39 i.e. 27.1% reported to have a total loss of smell i.e. Anosmia, 42 patients i.e. 29.2% sensed the smell accurately, 45 i.e. 31.3% had a reduced sense of smell whereas 18 patients i.e. 12.5% had an increased sensitivity to the different smells they were asked to sense. 47 patients i.e. 32.6% had ageusia i.e. a total loss of taste they were offered. 36 i.e. 25% had normal taste and accurately comprehended the different flavors they were offered, 41 i.e. 28.5% had reduced taste sense i.e. hypoeusia and responded that they could taste but the intensity was lesser than normal. Conclusion: Majority of the patients had peripheral nerve symptoms, a loss of smell, taste and impaired balance after recovery. © 2021 Medical Forum Monthly. All rights reserved.

Association of abo and rh blood groups with covid-19 pcr positive status: A case control study

Objective: To determine association of ABO and Rh blood groups with COVID-19 RT-PCR positive status. Study Design: Case control study. Place and Duration of the Study: Department of Pathology, Margalla Hospital Taxila, from Apr 2020 to Dec 2020. Methodology: The sample comprised of 436 cases and 500 controls. Out of 3936 RT-PCR done during the study duration, 436 RT-PCR positives were enrolled in study as cases. 500 age and gender matched controls were selected from same population. Study variables (age, gender, blood groups, RT-PCR result) were obtained from Hospital data (HIMS). Data was analyzed using SPSS version 25. Mean and SD was calculated for age. Frequencies were calculated for categorical variables. p-value calculated applying chi square test. Odds ratios calculated to determine association. Results: The mean age of cases was 37.3 ± 16.3. Statistically significant association was observed between age, gender and COVID-19 RT-PCR positive status. B+ blood group was most frequent both among cases (35.4%) and controls (36.2%), followed by O+ and A+. However, no significant association was observed between blood groups and COVID-19 RT-PCR positivity. Odds ratios calculated for blood group O and non-O (OR=0.95), A antigen (OR=0.97) and Rh factor (OR 0.93) among cases and controls showed week negative association. Whereas a weak positive association of B antigen + and B antigen-with PCR positivity (1.07) was observed between cases and controls. Conclusion: Susceptibility to acquire COVID-19 infection is not associated with ABO and Rh blood groups according to this study. © 2021, Army Medical College. All rights reserved.

Effectiveness of natural antioxidants against SARS-CoV-2? Insights from the in-silico world

The SARS CoV-2 pandemic has affected millions of people around the globe. Despite many efforts to find some effective medicines against SARS CoV-2, no established therapeutics are available yet. The use of phytochemicals as antiviral agents provides hope against the proliferation of SARS-CoV-2. Several natural compounds were analyzed by virtual screening against six SARS CoV-2 protein targets using molecular docking simulations in the present study. More than a hundred plant-derived secondary metabolites have been docked, including alkaloids, flavonoids, coumarins, and steroids. SARS CoV-2 protein targets include Main protease (MPro), Papain-like protease (PLpro), RNA-dependent RNA polymerase (RdRp), Spike glycoprotein (S), Helicase (Nsp13), and E-Channel protein. Phytochemicals were evaluated by molecular docking, and MD simulations were performed using the YASARA structure using a modified genetic algorithm and AMBER03 force field. Binding energies and dissociation constants allowed the identification of potentially active compounds. Ligand-protein interactions provide an insight into the mechanism and potential of identified compounds. Glycyrrhizin and its metabolite 18-beta-glycyrrhetinic acid have shown a strong binding affinity for MPro, helicase, RdRp, spike, and E-channel proteins, while a flavonoid Baicalin also strongly binds against PLpro and RdRp. The use of identified phytochemicals may help to speed up the drug development and provide natural protection against SARS-CoV-2.

Impact of covid19 lockdown on sleep quality and acute psychiatric morbidity in medical students in Sudan. (preprint)

Introduction: The severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) is an emerging infection causing a widely spread pandemic of Coronavirus disease 2019 (COVID-19). The current COVID-19 pandemic is promoting fear of falling sick, dying, helplessness, and stigma. Urgent and timely understanding of sleep quality and mental health status is needed to help the community. Our investigation designed to assess the degree of sleep disturbance and psychological impact of the lockdown among medical students at university of Khartoum.Objectives: this study conducted to assess the impact of covid-19 lockdown on sleep quality and acute psychiatric morbidities among medical students at university of Khartoum.Method: Institutional based cross sectional study was conducted among 326 participants from Khartoum university, faculty of medicine. Study participants were determined by two steps, stratified sampling followed by systematic sampling techniques. Data was collected using standardized questionnaire, entered and analyzed using Statistical Package for Social Science (SPSS) software version 25.Results: out of the total 326 participants 211(64.7%0 were females, and 115(35.35) were males. 92 (28.2%) form the participants were good sleepers and 234 (71.8%) were poor sleepers, the prevalence of moderate to severe anxiety and depression in the participants was found 19.4%, 35.9% respectively. There was correlation between having poor sleep quality and depression among the participants.Conclusion: This study found that there is negative impact of the covid-19 lockdown on medical students, which we found that two thirds of the participants are poor sleepers with a predominance of the female gender among them, One third of the participants had moderate to severe depression which also affects the female more than the males and the junior students more than the seniors, Fifth of the participants had moderate to severe anxiety which affect both gender equally but it did affect the junior students more than the seniors.

Kuwait University faculty’s use of electronic resources during the COVID-19 pandemic

PurposeThis paper aims to examine the extent of benefits Kuwait University faculty received from the electronic resources offered by Kuwait University Libraries Administration, specifically during the COVID-19 pandemic in 2020.Design/methodology/approachAn online survey was distributed using Google Forms via different social media platforms and official emails. The sample was Kuwait University faculty from all 16 colleges.FindingsThe results showed humble use of electronic resources during this critical time. The faculty mostly used the electronic resources for writing research papers, and databases and e-journals were their most preferred resources. The majority of nonusers indicated that they did not need these resources, and the rest referred to their unawareness of these resources. The results also showed that the majority of nonusers were willing to learn more about the electronic resources and how to use them.Originality/valueThe results and recommendations of this study are expected to be beneficial to Kuwait University and Kuwait University Libraries Administration, specifically, in terms of knowing what the faculty members use and prefer and the problems they face when searching electronic resources.