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Background: Coronavirus pandemic in 2019 led India to implement a complete lockdown except for essential services. Cancer patients faced hindrances in seeking medical help. This caused stress and worry, leading to reduced quality of life (QoL). This study evaluated QoL and pain management in palliative care cancer patients during the lockdown. Patients and Methods: This was a cross-sectional observational study at a tertiary cancer hospital, over one month period with convenience sampling. Participants included all who were unable to visit the palliative outpatient department during the lockdown during the COVID-19 pandemic. They were contacted telephonically and a valid QoL questionnaire was filled out. Disease, demographic details and pain were assessed. Result(s): A total of 51 were interviewed, 45% (n = 23) patients reported difficult access to medication during the lockdown;18 (35.3%) required morphine to alleviate pain and 6 (33.33%) faced difficulty in acquiring morphine tablets. QoL scores did not differ based on access to morphine (p = 0.648). Mean QoL scores were 12.7 +/- 3.76 and 15.0 +/- 3.60 amongst patients who did not have access to other medications and those who did have access, respectively (p = 0.03). Overall QoL FACT G7 mean score was 14 +/- 3.8. The variables NRS (pain intensity) and QoL scores were found to be negatively correlated (Pearson's Correlation Coefficient: r (49) = -0.69, p < 0.00001). Conclusion(s): Evaluation of QoL of palliative care cancer patients during global crises plays an important role in the assessment of patients' overall condition as well as to maintain a continuum of care.Copyright © Via Medica.
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Introduction This paper aims to provide an overview of the administrative and clinical preparations done in a tertiary care cancer hospital in continuing operation theatre (OT) services through the COVID pandemic.Methods Retrospective data collection, data for the past 1.5 years (COVID period) March 2020 to August 2021 were compared to surgical output for a similar duration of time before the COVID era (September 2018-February 2020).Results A total of 1,022 surgeries were done under anesthesia in the COVID period as against 1,710 surgeries done in a similar time frame in the pre-COVID era. Overall, we saw a 40%drop in the total number of cases. Thorax, abdominal, and miscellaneous surgeries (soft tissue sarcomas, urology, and gyneconcology) saw a maximum fall in numbers;however, head and neck cases saw an increase in numbers during the pandemic. Surgical morbidity and mortality were similar in the COVID and pre-COVID era. No cases of severe COVID infection were reported among the healthcare staff working in OT.Discussion We could successfully continue our anesthesia services with minimal risk to healthcare staff throughout the pandemic by adopting major guidelines in a pragmatic and practical approach with minor changes to suit our setup.
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In the present digital era, technology is being extensively used as an aid to teach different skills in a language teaching course. With the sudden outbreak of the COVID-19 pandemic, where technology that was being used for peripheral tasks and activities in education so far, has now become pervasive in the learning spaces. Tech aids such as audio, video, internet, educational tools, etc. are the popular ones among teachers at all levels. The present study aims to explore the use of one such tool - Digital Spinning Wheel that has been used as a tool for conducting Just-a- Minute sessions in the Effective Public Speaking course being offered at Birla Institute of Technology and Science, Pilani, one of the premier engineering institutes of India. The study also makes an attempt to understand students' perceptions about the appropriacy of the choice of the tool and the effectiveness of the instructional tool as used by the course instructors. For the study, a questionnaire was designed and circulated through Google Form among all the students of the course. The findings of the study suggest that the Digital Spinning Wheel makes the classroom activity interesting and dynamic and also ensures objectivity and fairness during the conduction of the evaluative component, Just-a-Minute. © 2022 IEEE.
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Background. We sought to compareWWSARS-CoV-2 RNA detection across a range of sites and scales using RTqPCR and RTddPCR. Figure. Methods. Composite-24hWW was collected from aWWtreatment plant (WTP;n=18), a neighborhood (Nb1;n=12) and three hospitals;H-1, H-2, and H-3 (3-sites;A-C)(n=84). RNA was extracted using the 4S-silica column method. RTqPCR (QuantStudio5, Thermo Fisher) and RTddPCR (C1000 Thermal Cycler and QX200 Droplet Reader, BioRad) quantified SARS-CoV-2 RNA nucleocapsid (N2, US CDC) and envelope (E Sarbeco, Corman et al 2020) in triplicate. Fisher's exact test was used to compare assay sensitivity. Correlations between modalities and RNA - clinically-confirmed COVID-19 cases (defined by postal code of primary residence using 5-day rolling average) was assessed using Persons correlation. Results. 114 samples were tested (02/23/2021-04/22/2021). SARS-CoV-2-N2 was identified in 90/114 (79%) by RTqPCR and 89/114 (78%) by ddPCR (p=1). SARS-CoV-2 E was found in 72/114 (63%) by RTqPCR and 90/114 (79%) by ddPCR, p=0.01. Correlations between modalities were strongest for N2 relative to E across all sites (see Table). N2 correlated with clinically diagnosed cases for both modalities greater at the level of the WTP (RTqPCR;r=0.8972, p< 0.0001and ddPCR;0.933, p< 0.0001) relative to neighborhood (RTqPCR;r=0.6, p=0.04 and ddPCR;0.60, p=0.04). E correlated to a lesser degree with cases at WTP (RTqPCR;r=0.65, p=0.0035 and ddPCR;0.88, p=< 0.001) and neighborhoods (RTqPCR;r=0.40, p=0.20 and ddPCR;r=0.43, p=0.16). Conclusion. SARS-CoV-2 detection of N2 was similar between RTqPCR and RTddPCR across a range of sites and scales in the sewershed, and this correlated best with clinical cases whereas E detection was superior with ddPCR.
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Background. WW surveillance enables real time monitoring of SARS-CoV-2 burden in defined sewer catchment areas. Here, we assessed the occurrence of total, Delta and Omicron SARS-CoV-2 RNA in sewage from three tertiary-care hospitals in Calgary, Canada. Methods. Nucleic acid was extracted from hospital (H) WW using the 4S-silica column method. H-1 and H-2 were assessed via a single autosampler whereas H-3 required three separate monitoring devices (a-c). SARS-CoV-2 RNA was quantified using two RT-qPCR approaches targeting the nucleocapsid gene;N1 and N200 assays, and the R203K/G204R and R203M mutations. Assays were positive if Cq< 40. Cross-correlation function analyses (CCF) was performed to determine the timelagged relationships betweenWWsignal and clinical cases. SARS-CoV-2 RNA abundance was compared to total hospitalized cases, nosocomial-acquired cases, and outbreaks. Statistical analyses were conducted using R. Results. Ninety-six percent (188/196) of WW samples collected between Aug/ 21-Jan/22 were positive for SARS-CoV-2. Omicron rapidly supplanted Delta by mid-December and this correlated with lack of Delta-associated H-transmissions during a period of frequent outbreaks. The CCF analysis showed a positive autocorrelation between the RNA concentration and total cases, where the most dominant cross correlations occurred between -3 and 0 lags (weeks) (Cross-correlation values: 0.75, 0.579, 0.608, 0.528 and 0.746 for H-1, H-2, H-3a, H-3b and H-3c;respectively). VOC-specific assessments showed this positive association only to hold true for Omicron across all hospitals (cross-correlation occurred at lags -2 and 0, CFF value range between 0.648 -0.984). We observed a significant difference in median copies/ ml SARS-CoV-2 N-1 between outbreak-free periods vs outbreaks for H-1 (46 [IQR: 11-150] vs 742 [IQR: 162-1176], P< 0.0001), H-2 (24 [IQR: 6-167] vs 214 [IQR: 57-560], P=0.009) and H-3c (2.32 [IQR: 0-19] vs 129 [IQR: 14-274], P=0.001). Conclusion. WWsurveillance is a powerful tool for early detection andmonitoring of circulating SARS-CoV-2VOCs.Total SARS-CoV-2 andVOC-specificWWsignal correlated with hospitalized prevalent cases of COVID-19 and outbreak occurrence.
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The COVID-19 pandemic has adversely impacted the global economy by disrupting the market mechanism. The impact has been more severe than any other economic crisis in history. Post-pandemic economic recovery is the challenge presently faced by the world economies. The revival needs to address the prevailing challenges of climate change, environmental protection, and inclusive growth. Many national and international organizations have jointly undertaken various initiatives related to climate change mitigation, adaptation and reduction of carbon emissions. Developing renewable energy (RE) sector infrastructure and adopting energy-efficient technologies are the highest-yielding initiatives. The present study explores the role of green investment channelled towards RE projects for the cleaner revival of the Indian economy. It attempts to identify various challenges and drivers of green investment in renewable energy projects. The study proposes a theoretical framework by analyzing the factors and their prospects in reviving and ensuring the green recovery of the economy. The comprehensive literature review shows that the absence of a well-developed capital market, slow technological development, and policy uncertainty are significant barriers (Fuss et al., 2008;Halimanjaya, 2015;Bhatnagar & Sharma, 2021). Development of financial instruments, immediate liquidity infusion and low-cost green energy supply can attract investment in green projects. The study is an addition to the literature on GI in renewable energy projects. The factors identified in the study can be subject to the structural equation modelling for analyzing the impact within the variables. The results can support policy formulation that addresses GI’s challenges in renewable energy projects. © 2022 Management Development Institute.
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Background: Cancer patients are at increased risk of infection due to immunosuppression, poor nutrition, and other health problems. Various studies have shown that cancer patients have a higher risk of serious complications related to Coronavirus disease (COVID-19) than patients without cancer, however, the strength of associated varied significantly across the studies. We aim to analyze the differences in the clinical characteristics, laboratory parameters, and hospital outcomes of COVID-19 among patients with and without cancer. Method(s): This was a retrospective study of 1873 patients including 102 cancer patients who presented with SARS-CoV-2 infection at our hospital. Our primary outcome was the in-hospital mortality rate due to COVID-19 and the secondary outcome was a comparison of demographic, clinical, laboratory, and treatment parameters of cancer patients compared to non-cancer patients. Multivariate logistic regression models were fitted to identify factors predictive of disease progression in the hospital, including death. Result(s): Cancer patients had a higher in-hospital mortality rate than non-cancer patients (26.5 vs 21.2 %, P=0.211). The proportion of people with anemia, thrombocytopenia, and leukopenia was significantly higher in the cancer group. The median value of inflammatory markers (ferritin, D-dimer, and IL-6) in the cancer group is approximately two times than non-cancer group. The odds of worsening [1.73 (1.01-2.95)] and death [2.83 (1.46-5.47)] during hospital stay were significantly higher in cancer patients. Hematological malignancies had higher odds of developing critical illness [4.96 (1.57-15.7)] and receiving mechanical ventilation [4.35 (1.27-15.0)] compared to non-cancer cases. In cancer patients, breathlessness and hypoxia at presentation were significant predictors of mortality when adjusted for other clinical features. Conclusion(s): Cancer patients with COVID-19 infection have abnormally high inflammatory responses compared with non-cancer patients and the development of breathlessness and hypoxia are important predictors of mortality. Patients with hematological malignancies have a higher risk of developing serious disease. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest. Copyright © 2022
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Background: The COVID-19 pandemic hampered the palliative care services due to the policies of nationwide lockdown, social distancing and patient triaging. Telemedicine can be a possible solution to overcome the hurdles of providing holistic care to cancer patients by minimising the visit of patients to the healthcare facility. Aim: The objective of the study was to evaluate and assess the feasibility of telemedicine as a tool to provide palliative care during the COVID-19 pandemic in resource limited setting. Design/Participants: A retrospective study was conducted to analyse the telemedicine service from 25 March 2020 to 30 June 2020. Patients who availed the teleconsultation services during this period were recruited. A smartphone-based 24/7 model for conducting audio-visual consultations was created whereby patients could interact with a trained palliative medicine physician. The study explored the reason for teleconsultation, main barriers for hospital visit, and patient satisfaction. Results: Out of the 547 patients, 462 (84.46%) utilised voice calling service. The major reason for not visiting the hospital was issues with transportation (48.8%) followed by fear of contracting COVID-19 (37.3%). The majority of the calls (63.62%) were regarding uncontrolled symptoms related to primary disease. 402 (73.49%) patients were very satisfied, and 399 (72.94%) decided to use telemedicine in future as well. Conclusion: Telemedicine is a helpful tool to provide integrated palliative care to cancer patients who are unable to visit hospitals regularly. This was observed to be especially useful during the pandemic in a resource limited setting.
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Objective: Rhinocereberal mucormycosis is an acute, fulminant, and often lethal opportunistic infection typically affecting diabetic or immunocompromised patients. Early diagnosis is vital in these infections because delay in initiation of the treatment can be life-threatening. Computed tomography (CT) with axial and coronal sections is a highly accurate and non-invasive modality to accurately image sinonasal mycosis. The aim of the study was to describe the imaging findings in suspected cases of mucormycosis on CT. Methods: This study was conducted in Radiodiagnosis Department of Rajindra Hospital, Patiala. The data of 22 patients who were referred for CT with a clinical suspicion of mucormycosis were collected and all these patients were followed up to know about the prognosis of the disease. Results: In our study, there were 54.60% females and 45.40% males. Maximum number of patients (45.45%) belonged to 40-49 year age group. Diabetes mellitus was found to be the most commonly (90.90%) found comorbidity followed by hypertension (36.36%). In our study, involvement of unilateral nasal cavity was observed in 36.36% cases. Among the paranasal sinuses, maxillary and ethmoid sinuses were the most commonly involved in 95.45% and 77.27% cases. Conclusion: Prompt diagnosis and treatment of rhino-orbital mucormycosis are the sine qua non as antifungal drugs and surgical debridement can successfully control the infection and thus reduce the high mortality and morbidity associated with mucormycosis.
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Introduction: COVID-19 pandemic has placed the health systemworldwide in unprecedented stress, therefore, prompt identification and management of patients having severe disease is essential fortriaging of patients at the time of admission.Aims &Objectives: To identify hematological biomarkers ofCOVID-19 disease severity in patients admitted in a tertiary carehospital.Materials &Methods: A retrospective study was conducted over aperiod of 17 months (20th March 2020-19 August 2021) on 7416COVID-19 patients. Patients with cancers, pregnancy and chronichematological diseases were excluded from the study. Patients wereclassified clinically as per severity of disease as non-severe (asymptomatic, mild, moderate) or severe and their hematological parameterswere analyzed.Mann-Whitney test was used to compare between the groups. Optimal predictive cut off points for the variables were defined by receiveroperating characteristic (AUC) curve to dichotomize the variables.Univariate analysis was performed to screen out independent variables to be used in the binary logistic regression (BLR). A p valueof< = 0.05 was considered as statistically significant.Result: Age, duration of hospital stay, RBC count, WBC, Plateletcount, RDW, Neutrophils %, Absolute neutrophil count (ANC),Absolute monocyte count (AMC), NLR, PLR, NMR were statisticallyhigher whereas hemoglobin, hematocrit, MCHC, lymphocyte %,Absolute lymphocyte count (ALC), Eosinophils %, Absolute eosinophil count (AEC), Monocytes %, Basophils %, Absolute Basophilcount (ABC) and Lymphocyte Monocyte ratio (LMR) were lower insevere group. MCV and MCHC were not significant, so wereexcluded from the logistic regression model. All variables were significant in univariate analysis. Age (>42 yrs), duration of hospitalstay (>10 days), RBC count (B 4.33 106/lL),WBC count (> 7.73103/lL), RDW (>14.8%), Neutrophils (>71.7%), Eosinophils(B 0.3%), Monocytes (B 5%), ALC (B 1.01 103/lL), LMR(B 3.125) with adjusted odd ratio of 1.8, 1.5, 1.3,1.3, 1.4, 2.0, 2.1, 1.5,2.0 and 1.3 respectively were found to be significant predictors ofseverity.Conclusions: Age, duration of hospital stay, RBC count, WBC,RDW, Neutrophils %, Eosinophils %, Monocytes %, ALC, LMRshould be assessed and monitor at the earliest to halt unfavorableoutcome of mortality or morbidity.
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Background: Intubation is a highly aerosol generating procedure. Recent airway management guidelines advocate the use of appropriate personal protective equipment, a video laryngoscope and 'intubation box' while intubating a suspected or an infected COVID patient.1 We undertook a study to compare CMAC Videolaryngoscope with Mc Grath Videolaryngoscope for tracheal intubation using an intubation box along with PPE. Methods: The patients were randomly allocated to two groups by computer-generated random numbers, depending upon the Video laryngoscope used: Group C (n=30) where C-MAC VL was used and Group M (n=30) where Mc Grath VL was used. The primary outcome was total time required for successful intubation. The secondary outcomes included number of attempts required, CL grade, POGO score, difficulty faced while using the device and user's preference. Results: The time to intubation was 57.17± 19.98 seconds with C-MAC laryngoscope as compared to 57.93 ± 14.92 seconds with McGrath laryngoscope (p=0.134). The POGO score and CL grade were comparable. Both the devices had a good POGO score. Twelve patients in each group were found to have a CL grade of 1. The time to glottis visualization was more with Mc Grath than with C-MAC although not significant (23.8±14.03 vs 20.10±10.78). Both the devices were easy to use. Conclusions: Both C-MAC and McGrath video laryngoscopes, are equally effective devices for intubation by a donned anaesthesiologist using an intubation box but McGrath with a disposable blade is better suited in these conditions.
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Rationale: Thoracic computed tomography (CT) is an integral part of diagnosis and classification of interstitial lung diseases (ILD). However, recommended interpretative guidelines for ILD are often difficult to follow and radiological diagnosis of ILD frequently relies on subjective interpretation (gestalt) by the thoracic radiologist. Moreover distinguishing ILD from numerous other diagnoses that mimic the radiological appearance of ILD can at times be extremely challenging to non-specialized radiologists. Here we applied an image analysis technique of CT scans to explore automated discrimination between different forms of clinico-radiologically diagnosed ILD, various ILD mimickers and normal controls. This technique is based on the concept of mean curvature of isophotes (MCI), a computer vision technique recently shown to perform well at detecting COPD on CT scans. Here, we apply it for the first time to detection and classification of ILD. Methods: Our convenience sample of patients was divided in four categories: 25 ILD patients with definite or probable usual interstitial pneumonia (UIP), 26 ILD patients indeterminate for UIP or with an ILD diagnosis other than UIP, 31 normal controls, and 36 ILD mimickers. The latter category included CTs featuring pulmonary edema, lymphangitic carcinomatosis, multifocal pneumonia, multifocal minimally invasive adenocarcinoma, pulmonary alveolar proteinosis, atelectasis, pulmonary sarcoidosis, pneumocystis jiroveci pneumonia, Kaposi sarcoma, and COVID19. From each patient's CT scan we computed MCI at a fine (1mm) and coarse (4mm) scale over a segmentation of the lungs performed with open-source software [http://chestimagingplatform.org]. We then quantified both MCI results with a probability density estimate (PDE). We subsequently performed a functional principal component analysis (FPCA) on the PDEs for each subject to capture the largest modes of variation. A multinomial logistic regression with the top 5 principal components from each scale as predictors was used to classify patient status. Results: Our method had excellent discriminative ability with a multi-class area under the operating characteristic curve of 0.976. The sensitivities and specificities ranged from 0.81-0.97 and 0.94-0.99, respectively (Table 1). Conclusion: The MCI technique showed good ability in differentiating definite and probable UIP from other categories of ILD, normal controls and various ILD mimickers. While the unsupervised nature of our predictors makes our method less susceptible to overfitting, external validation will be needed to provide an unbiased estimate of performance. The proposed method could ultimately be a valuable screening algorithm for incidental findings and/or decision support mechanism in contexts where specialized radiology expertise may not be readily available.
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INTRO: Hemophagocytic lymphohistiocytosis (HLH) is an uncommon type of hemophagocytic syndrome characterized by systemic inflammation and overactivation of the immune system leading to multisystem failure.1 Most common in pediatrics1, it's a rare, challenging diagnosis often missed in older adults. CASE: A 67 year-old male with a PMH of COPD, CKD3a, and lung nodules presented to his PCP for dyspnea and cough. COVID19 test was negative, CXR showed irregular opacities but no consolidation, so he was treated for COPD exacerbation. One month prior, he saw Pulmonology and completed a 10 day course of Augmentin. After 3 days, family noted the patient was jaundiced with dark urine. Labs showed normocytic anemia, acute on chronic kidney injury, and elevated LFTs. His PCP had him admitted for further workup and treated for community-acquired pneumonia;dyspnea improved. But, the patient's acute kidney injury worsened, so he was transferred from an outside facility to U of M Hospital. Nephrology was consulted and urine studies were consistent with ATN. Liver function worsened and drug-induced liver injury with cholestasis was suspected, given recent Augmentin. Acute hepatitis panel, infectious and autoimmune workups were negative. The patient's hgb declined, requiring multiple transfusions despite no source for an active bleed. Abdominal ultrasound showed an enlarged liver with diffusely coarse echogenicity. Liver biopsy showed diffuse granulomatous hepatitis with necrosis and cholestasis. Finally, soluble IL-2R was ordered and was quite elevated at 35,150 U/mL (normal 137-838 U/mL). Lab findings and clinical presentation led to a diagnosis of HLH. At the end, the patient decompensated requiring transfer to ICU for multi-organ failure. Following goals of care discussions with family, he was transitioned to comfort care and passed away soon afterward. DISCUSSION: This case shows the importance of considering HLH as a diagnosis in older adults with characteristic findings. Early diagnosis is often hard due to low suspicion, limitations of diagnostic criteria in adults, and inaccessibility to specialized lab tests (like soluble IL-2 assay). Adult HLH is usually fatal with median survival of about 2 months.
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Aims & Objectives: The present study was undertaken to evaluate prognostic relevance of hematological parameters in COVID-19 infected patients for early identification of critical patients for early management. Patients/Materials & Methods: A retrospective study was conducted over a period of 2 months (01st July 2020 to 1st September 2020) on 912 admitted COVID-19 positive patients. 2 ml venous blood was aseptically collected in EDTA vaccutainer and processed in automated hematology analyser (ADVIA 2120i). Patients with hematological malignancy were excluded from the study. Patients were assigned into three groups according to the severity of disease (mild/asymptomatic, moderate and severe) as well as on the basis of clinical outcome (discharged ordeath). Results: To talleucocyte count, absolute neutrophil count, neutrophillymphocyte ratio, plateletlymphocyte ratio, reddistribution width were significantly higher (p<0.05) is the decreased patients and in severe disease group where as hemoglobin and hematocr it was significant lower in these patients. Lymphopenia was recorded in decreased patient but was not statically significant. Discussion & Conclusion: COVID-19 patients with severe disease and poor outcome showed significant difference in ther outine hematological parameter such as total leucocyte count, absolute neutrophil count, absolute monocyte count, neutrophillymphocyte ratio, plateletlymphocyte ratio, reddistribution width and hematocrit which are readily available and can be helpful in the prediction of COVID-19 patien toutcome.
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Introduction: In this paper, we consider a fundamental problem of testing faced by the health staff on testing COVID 19 patients. In general, the number of testing kits or testing capabilities is limited, and the number of COVID 19 patients is much larger than that. This paper tries to answer this fundamental question that how to perform COVID 19 testing to reduce the death rate. Materials and Methods: We consider that the survival rate of patients is dependent over two parameters: their age and severity of symptoms at a time. Based on these observations, we propose a survival rate function. Using the survival rates, the death rate for an individual is obtained. MATLAB was used for plotting the graphs. Results: It is shown by numerical results that by using the proposed mechanism, the average death rate can be significantly reduced. Conclusion: It is proposed to conduct the testing for those patients who lie in the high death rate regimen.