Unique vascular complication following extended VV-ECMO support

Objectives: To present an unusual complication related to prolonged ECMO support in a patient with COVID19 induced acute respiratory syndrome (ARDS). Method(s): Clinical chart review of the care process after obtaining the informed consent from the patient. Result(s): A 48-year-old female with COVID-19 infection during second wave of pandemic in August 2021 progressed to severe ARDS. She was put on VV-ECMO support after failing conventional therapy for refractory hypoxemia. Her cannulation configuration included a 25 F venous drainage cannula in the right femoral vein and a 21 F venous return cannula in the right Internal Jugular (IJ) vein. Cannulations were performed using the ;Seldinger technique;under USG guidance, and no difficulties or complications were reported. Her hospital course was notable for delirium, and intermittent bleeding from the cannula sites. After 80 days of support, she showed adequate respiratory improvement which allowed ECMO decannulation. She continued to show improvement, and was eventually discharged after 102 days of total hospital stay. During her 6 weeks follow-up clinic visit a palpable thrill was noted at the jugular ECMO cannula site. A CT angiogram of the neck demonstrated a large venous varix connecting the right IJ and the left common carotid artery with filling from the left common carotid artery. ECMO cannulation site complications such as aneurysm, clots, infections and stenosis are well known. What was unusual in this case is the nature of the aneurysm given that there were no arterial procedures performed on the left side of the neck. She was managed by an ;Amplatzer plug;to the carotid artery at the level of the connection to the varix without any complications. Conclusion(s): Longer duration of ECMO support needs careful follow-up for timely recognition and management of vascular complications. (Figure Presented).

Clinical characteristics, complications, and outcomes of severe COVID-19 ARDS patients supported by ECMO and triaged for lung transplantations

Objectives: More than 200 patients have benefited from lung transplantation who failed to recover from COVID-19-induced acute respiratory distress (ARDS) with conventional ventilatory support and/ or extracorporeal membrane oxygenation support (ECMO) in USA. We aim to share our experience and lessons learned at our institute through this case series. Method(s): After IRB approval, we performed a retrospective chart review and identified 37 patients who received ECMO for COVID-19 induced ARDS between May 2020 through January 2022. Out of these, 12 received a formal consultation from the transplant team. We studied patient characteristics, interventions during ECMO support, and evaluation outcomes. Result(s): Most of our patients had single organ failure i.e., lung, except for two who required dialysis after ECMO initiation. Six out of the 12 patients received bilateral lung transplant. One patient received the transplant before ECMO initiation. However, the patient required two runs of ECMO after the transplant due to postop complications from suspected COVID19 reinfection and deceased on postoperative day 101. All the patients after transplant had an expedited recovery except one who required prolonged hospitalization before starting physical therapy. The median length of hospital stay for the transplant group was 148 (89- 194) days and for the non-transplant group was 114 (58-178) days. The 30-day survival rate was 100% for the transplant group. At a median follow-up of 207 (0- 456) days after discharge, 5(83.3%) patients in the transplant group and 3(50%) patients in the nontransplant group were alive. In the non-transplant group, 4 patients received ECMO support for more than 75 days and at last follow-up 2 were alive and functioning well without needing new lungs. This asks for an objective prospective study to define the timeline of irreversibility of the lung injury. Conclusion(s): Lung transplantation is a viable salvage option in patients with COVI-19 induced irreversible lung injury. However, the irreversibility of the lung injury and the timing of lung transplant remains to be determined case-by-case. (Figure Presented).

Are Parents Willing to Vaccinate Their 6 to 11 Year Old Children Against COVID-19? A Community Based Study in Murshidabad, India

Context/Background: The future of Corona virus disease is still uncertain due to viral mutations. Immunization against COVID-19 has not yet been introduced for children aged 6-11 years. Parents are instrumental for the success of any immunization programme, being the chief decision makers for their wards. The study aims to assess the perceptions of parents regarding COVID 19 vaccination among children aged 6-11 years in an urban slum of Murshidabad and identify the factors influencing such perceptions among them. Methodology: A cross sectional study was conducted among 106 parents in a slum area of Murshidabad, West Bengal. Participants were interviewed using a validated WHO Vaccine Hesitancy Scale (VHS). Bivariate and multivariable analysis were done using Chi square test and binary logistic regression respectively. Results: Majority of the study subjects instead of parents were unlikely to vaccinate their children against COVID-19. The major concern centered around the safety (73.5%) of the vaccine. Higher level of education (p=0.003), previous history of COVID-19 infection in the family (p=0.004) and having a children aged between 6-8 years (p=0.006), influenced such perceptions, with the latter being the single most important predictor (AOR 4.126, P=0.007). Conclusions: The likelihood of parents to vaccinate their child was found to be low. This underscores the importance of an effective communication strategy when such programme will be rolled out. © 2023 National Journal of Community Medicine.

"Cardioxy" - A Novel and Portable Instrumentation Amplifier based and IoT enabled ECG device

During the COVID-19 pandemic the healthcare facilities all over world collapsed due to shortage of essential biomedical devices. ECG devices are one of those crucial instruments required for tracing electrical activities of heart. Due to the high cost of gold standard ECG devices used in the medical industries, the availability of on-demand ECG devices was not accessible to everyone. Thus, the need of portable, low cost, on-demand ECG device was needful at the earliest. In this paper we propose a novel, versatile, 3-lead, IoT enabled, LM324/LM741 operational amplifiers in instrumentation amplifier configuration Electrocardiogram machine that is aimed towards providing accurate information about the electrical activity of our heart in real time. In this attempt, we have come up with an analogue circuit design consisting of multiple operational amplifier IC based fundamental circuit blocks. The prototype is designed in such a way that the output of ECG can be visualised worldwide using IoT. © 2023 IEEE.

Mucormycosis an Emerging Fungal Infection Associated with COVID-19- A Case Report

Introduction: Mucormycosis is an exceptional but rising fungal infection correlated with the COVID-19 disease. COVID-19 positive patients exhibiting severe symptoms admitted in the ICU have an increased susceptibility to develop bacterial and fungal infection. We hereby report a case of oral mucormycosis that is seen in a patient in post COVID-19 infection. Case Presentation: A 65-year-old woman presented to our institution, with the chief complaint of ulceration in her right palate region for the past 7 days along with pyrexia and generalised malaise. The patient reported to have recovered from COVID-19 infection recently. She presented with medical history of diabetes and hypertension for past 8 years. Post recovery from COVID-19 infection the patient developed an ulcer in the hard palate. Treatment: Surgery was done under General anesthesia. Maxillectomy was done with aggressive debridement of necrotic tissue. Bilaterally periosteal flap was approximated and suture was placed. Conclusion: The extensive use of steroids and broad-spectrum antibiotics in COVID-19 treatment may raise the risk of fungal infections. Medical practitioners should be aware of the possibility of invasive secondary fungal infections in patients with COVID-19 infection.

Psychosocial and behavioural impact of COVID-19 pandemic in children and adolescents with autism spectrum disorder

Background: The children and adolescents with ASD around the world have experienced a major disruption of their everyday lives due to the COVID-19 pandemic. Social isolation has inflicted a negative impact on the psychological well-being of these children and adolescents. Aim(s): To investigate the impact of COVID-19 pandemic in children and adolescents with ASD in terms of comprehension and adherence to implemented measures and changes in their behavioural problem. Methodology: A retrospective cross-sectional (descriptive) study was done involving 16 ASD children and adolescents attending OPD of a tertiary care institute within a time period of 12 months for various behavioural problems using ISAA scale and Nisonger CBRF. Each subject was assessed on a single occasion for 3 different timelines-Pre-COVID (before March 2020), during full Lockdown (March-May 2020) and Post-Lockdown (January 2021-January 2022). Result(s): The ISAA scoring revealed significant increase in ASDrelated behaviours (i.e. inappropriate emotional response, difficulty in communication etc.) from before pandemic to during pandemic and Post-Lockdown (p value<0.05).The Nisonger Child Behaviour Rating Form revealed deterioration in Positive Social behaviour (p value<0.05).Significant increase in problem behaviour was seen in all the six domains (Conduct problem, Insecure/Anxious, Hyperactive, Self-injury/Stereotype, Self-isolated/Ritualistic and Overtly Sensitive) (p value<0.05). Conclusion(s): Disruption of daily routine and social distancing have led to increase in problem behaviours of the children and adolescents with ASD as well as an increase in deficits of positive behaviours.

Is STEM a better adaptor than non-STEM groups with online education: an Indian peri-urban experience

Purpose: The existing literature contains few references on the better adaptors of online distance education amongst STEM (read as science, technology, engineering and mathematics) and non-STEM (composed of humanities, social science and commerce) study groups in an Indian peri-urban context. The study's objective is to determine the better adaptor amongst these two study groups in online distance learning in higher education systems in an Indian peri-urban context. Design/methodology/approach: The investigation was carried out prior to COVID-19 and during the pandemic. The inquiry is triangulated in nature with a disproportionate stratified random sampling approach used to pick 312 post-graduate students (STEM = 135 and non-STEM = 177) from a peri-urban higher education institute in West Bengal, India, using the "Raosoft” scale. Given the prevailing social distance norms, 235 samples of respondents from 312 students were evaluated via telephonic/online interviews during the COVID-19 period. The data were analysed using SPSS 22. Findings: This study's investigations reveal that the STEM respondents have better digital profiles, better basic computing and Internet knowledge and greater digital usage for academic purposes before the pandemic times than the non-STEM group. This prior digital exposure has enabled the STEM group to cope with regular online distance education during the pandemic more quickly than the non-STEM group, as evidenced by their regular attendance in online classes and their greater awareness of its utilitarian role than the other group. Originality/value: The study offers a way forward direction to evolve with more inclusive online distance learning in peri-urban Indian regions. © 2023, Aakash Ranjan Das and Asmita Bhattacharyya.

IOT-Based Telemedicine Network Design Implementation of a Smart Health Monitoring System in COVID-19

The role of telemedicine and big data analysis in the COVID-19 pandemic is highlighted in this chapter along with some real-life applications. The IoT and modern healthcare background exhibit the improvement of technology in the health sector with continuous research and innovation. The primary objectives of this discussion are to portray the impacts of telemedicine in the continuation of advanced healthcare approaches and help individuals to become familiar with modern healthcare. Along with expanding new research opportunities and extending telemedicine principles throughout the future medical sector, health services will become stronger and more easily accessible to everyone. © 2023 selection and editorial matter, Ben Othman Soufene, Chinmay Chakraborty, Faris. A. Almalki. All rights reserved.

Impact Analysis of Covid-19 Pandemic on Construction Employment in the United States

Construction industry is one of the major contributing sectors of the U.S. economy. Due to COVID-19 pandemic construction industry has witnessed halt and cancellation of ongoing and planned projects. As projects got halted and cancelled many construction companies furloughed or terminated employment contracts of their workers. This sudden termination has been reflected in the monthly employment numbers. This paper presents the employment change in three constituting subsectors of construction industry: building, heavy and civil, and specialty trade due to COVID-19 pandemic. The paper has utilized historical data from the U.S. Bureau of Labor Statistics to forecast the expected employment numbers in absence of the pandemic. It has been found that due to pandemic the construction employment went down by 5.5 million between March 2020 and December 2020. Additionally, it has been found that the variation of the extent of impact of the COVID-19 pandemic in terms of employment on the three subsectors is insignificant. This means that the three subsectors suffered the consequences equally. The outcomes of the paper can be utilized by the policy makers in exploring the broader implications of the construction employment change. It can also be used in subsector specific policy planning purpose. © 2023, Canadian Society for Civil Engineering.

Theta Autoregressive Neural Network: A Hybrid Time Series Model for Pandemic Forecasting

Forecasting time series present a perpetual topic of research in statistical machine learning for the last five decades. Due to the unprecedented outbreak of the novel coronavirus (COVID-19), forecasting the COVID-19 pandemic became a key research interest for both epidemiologists and statisticians. These future predictions are useful for the effective allocation of health care resources, stockpiling, and help in strategic planning for clinicians, government authorities, and public-health policymakers. This paper develops an effective forecasting model that can generate real-time short-term (ten days) and long-term (fifty days) out-of-sample forecasts of COVID-19 outbreaks for eight profoundly affected countries, namely the United States of America, Brazil, India, Russia, South Africa, Mexico, Spain, and Iran. A novel hybrid approach based on the Theta method and Autoregressive neural network (ARNN) model, named Theta-ARNN (TARNN) model, is proposed. The proposed method outperforms previously available single and hybrid forecasting models for COVID-19 predictions in most data sets. The ergodicity and asymptotic stationarity of the TARNN model are also studied.

Cardiac Amyloid Reaching for Extended Survival (CARES): Study Design of Two Placebo-Controlled, Double-Blind, Randomized, International Phase 3 Trials Assessing Cael-101 in Patients with Mayo Stage Iiia or Stage IIIb AL Amyloidosis

Background: Light-chain amyloidosis (AL-A) is a rare, severe, progressive, systemic disorder with high mortality caused by immunoglobulin (Ig) light chains that misfold and aggregate into amyloid fibrils that deposit in multiple organs, leading to progressive organ dysfunction/damage and death. Prognosis is poor for patients with cardiac involvement (characterized by high levels of cardiac troponin T and N-terminal brain natriuretic peptide). Median survival is 24 and 4 months for Mayo Stage IIIa and IIIb AL-A, respectively, based on the 2013 European Modification of the 2004 Mayo Staging system. For most patients, standard of care (SOC) is anti-plasma cell dyscrasia (PCD) therapy to suppress plasma cell proliferation, halt generation of amyloidogenic free light chains, and stop deposition of new amyloid fibrils and further organ decline. However, a critical need exists for therapies that accelerate the removal of deposited fibrils. CAEL-101 is a monoclonal antibody that binds to misfolded Ig light chains in amyloid fibrils. In Phase 1 and 2, CAEL-101 (with and without concurrent PCD SOC) was well tolerated up to 1000 mg/m 2. Preliminary Phase 2 data (NCT04304144) suggest improvements in cardiac and renal biomarkers in some patients. Objective: To evaluate the efficacy and safety of CAEL-101 versus placebo when administered concurrently with SOC anti-PCD therapy in treatment-naïve patients with cardiac AL-A, Mayo Stages IIIb (NCT04504825;Study 1) or IIIa (NCT04512235;Study 2). Methods: These international, multicenter, double-blind, randomized, phase 3 trials, initiated in 2020, are enrolling patients at over 70 sites in 14 countries. Newly diagnosed adults with AL-A stage IIIb or IIIa based on the 2013 European Modification of 2004 Mayo Staging (Wechalekar AD et al. Blood 2013;121:3420. Dispenzieri A, et al. J Clin Oncol. 2004;22:3751), measurable hematologic disease, and histopathological diagnosis of amyloidosis with cardiac involvement are eligible. Patients cannot have any other form of amyloidosis, symptomatic orthostatic hypotension, or supine systolic blood pressure <90 mmHg. Patients in Mayo Stages IIIb (N=111) and IIIa (N=267) are randomized 2:1 to receive once-weekly intravenous infusions of CAEL-101 (1000 mg/m 2) or placebo for 4 weeks, followed by maintenance dosing every 2 weeks. In these event-driven studies, treatment will continue to a minimum of 54 deaths for Study 1 and 77 deaths for Study 2 (a minimum treatment duration of 12 months is expected). Patients will receive concurrent anti-PCD therapy per the institutional protocol for SOC and will be followed to death from any cause or until end of study (Figure). The primary endpoint is overall survival (defined as the time from first dose of study drug to date of death, with censoring at last known living date), and will be analyzed via time-to-event log-rank statistics. Functional, quality of life, and echocardiography measures are targeted secondary endpoints. Results: Patient baseline characteristics and demographics are presented (Table). As of July 17, 2021, 9/13 (69.2%) patients in Study 1 and 23/39 (59%) patients in Study 2 have received at least 4 doses of CAEL-101 concurrently with anti-PCD therapy. Discussion: These ongoing trials will evaluate the efficacy and safety of CAEL-101 as first-in-class treatment to reduce amyloid burden in patients with cardiac AL-A. Notably, Study 1 (Mayo Stage IIIb) is the first randomized, placebo-controlled efficacy clinical trial to formally assess the effects of a pharmacological in this severely ill population. Because the median expected survival for Mayo Stage IIIb patients is far shorter than for Mayo Stage IIIa patients, the resulting sample size required for the Mayo Stage IIIB study is less (111 patients) than for the Mayo Stage IIIA study (267 patients). Importantly, these studies include patients identified as Stage III and IV based on the 2012 Mayo staging system (Kumar S. et al. J Clin Oncol. 2012;30:989). These trials are ongoing in a challenging environment. The approval of daratumumab i 2021 changed the landscape and modified the SOC, requiring appropriate protocol amendments. While the COVID pandemic affected all people, it had a greater impact on patients with AL amyloidosis, a rare disease that can only be treated effectively by a coordinated team of experts at centers of excellence. [Formula presented] Disclosures: Wechalekar: Alexion, AstraZeneca Rare Disease: Consultancy;Caelum Biosciences: Other: Clinical Trial Funding;Janssen: Consultancy;Celgene: Honoraria;Takeda: Honoraria;Amgen: Research Funding. Silowsky: Caelum Biosciences: Current Employment. Daniel: Caelum Biosciences: Current Employment. Harnett: Caelum Biosciences: Current Employment. Spector: Caelum Biosciences: Current Employment. Sobolov: Caelum Biosciences: Current Employment. Quarta: Alexion, AstraZeneca Rare Disease: Current Employment. Kurman: Caelum Biosciences: Other: Medical Monitor. Tulchinskiy: Caelum Biosciences: Consultancy. Bhattacharyya: Alexion, AstraZeneca Rare Disease: Current Employment. Liedtke: Karyopharm: Membership on an entity's Board of Directors or advisory committees;Kite: Membership on an entity's Board of Directors or advisory committees;Celgene: Membership on an entity's Board of Directors or advisory committees;Sanofi: Membership on an entity's Board of Directors or advisory committees;Takeda: Membership on an entity's Board of Directors or advisory committees;GlaxoSmithKline: Membership on an entity's Board of Directors or advisory committees;Pfizer: Honoraria;Oncopeptides: Membership on an entity's Board of Directors or advisory committees;Kura Oncology: Membership on an entity's Board of Directors or advisory committees;Janssen Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees;Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees;Alnylam: Membership on an entity's Board of Directors or advisory committees;Caelum: Membership on an entity's Board of Directors or advisory committees, Other: Clinical Trial Funding.

Impact of COVID-19 on the US Construction Industry as Revealed in the Purdue Index for Construction

The coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented impacts (e.g., labor shortage, suspension and cancellation of projects, and disrupted supply and logistics) on the US construction industry. To address challenges caused by the pandemic, it is critical for the construction industry to develop a clear understanding of how the pandemic has affected the industry and how it will change in the future. However, assessing the impacts of COVID-19 on the construction industry is challenging due to the broad influence of the pandemic and the dynamic nature of the industry. The Purdue Index for Construction (Pi-C), which was developed as an indicator based on five dimensions and corresponding metrics to measure the health status of the construction industry, offers an opportunity to understand the impact of the pandemic. In this context, this paper presents a study to reveal the relationship between COVID-19 and the health status of the industry as measured through Pi-C and predict the future trend of the construction industry. This study achieves the objective via the three steps. First, the relationship between the pandemic and Pi-C metrics is identified using the Granger causality test and structural equation modeling (SEM) analysis. Second, multivariable prediction models are developed based on a long short-term memory (LSTM) network - a deep learning algorithm - to predict Pi-C metrics in the future. Third, forecasted Pi-C metrics are integrated into the existing Pi-C structure to analyze the impacts of the COVID-19 pandemic and predict its trends in 2021-2022. The results revealed that the impacts of the pandemic were conspicuous in two Pi-C dimensions (economy and stability), whereas no significant impacts were observed in the remaining Pi-C dimension (social). In addition, the Pi-C forecasted that there would be no significant adverse impacts on the US construction industry caused by the pandemic until the end of 2022. © 2021 American Society of Civil Engineers.

Effect of Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on COVID-19 outcome: A Record Based Observational Study in West Bengal

BACKGROUND: Since its first identification in December 2019, in WUHAN (CHINA), SARS-COV-2, causative agent of Corona virus pandemic, has affected millions of people worldwide, causing thousands of death. There is much speculation about the interplay between ACEI/ARB and Corona virus infection, as for internalization into host cell SARS-COV-2 binds through S spike protein to ACE-2, aided TMPRSS2. METHODS: A record based observational study has been conducted (data obtained from the clinics of fourteen physicians) in two worst affected districts of West Bengal, to find out the association of ACEI/ARB on patients, suffering from Corona virus infection. The study-protocol has already been approved by Clinical Research Ethics Committee of Calcutta School of Tropical Medicine. (IEC Ref. No: CREC-STM/2020-AS-37) Results: Increasing age, male sex and presence of co-morbidities (viz. Diabetes, COPD) are significantly associated with the occurrence of moderate and severe disease. Drugs (viz. ACEI/ARB), though are associated with less severe disease, have not achieved statistical significance, in the present study. CONCLUSION: Drugs, like ACEI/ARB, should be continued in patients suffering from COVID-19 infection, (if they are already on these drugs). © Journal of the Association of Physicians of India 2011.

Effect of angiotensin converting enzyme inhibitors/angiotensin receptor blockers on COVID-19 outcome: A record based observational study in West Bengal

Background: Since its first identification in December 2019, in WUHAN (CHINA), SARS-COV-2, causative agent of Corona virus pandemic, has affected millions of people worldwide, causing thousands of death. There is much speculation about the interplay between ACEI/ARB and Corona virus infection, as for internalization into host cell SARS-COV-2 binds through S spike protein to ACE-2, aided TMPRSS2. Methods: A record based observational study has been conducted (data obtained from the clinics of fourteen physicians) in two worst affected districts of West Bengal, to find out the association of ACEI/ARB on patients, suffering from Corona virus infection. The study-protocol has already been approved by Clinical Research Ethics Committee of Calcutta School of Tropical Medicine. (IEC Ref. No: CREC-STM/2020-AS-37) Results: Increasing age, male sex and presence of co-morbidities (viz. Diabetes, COPD) are significantly associated with the occurrence of moderate and severe disease. Drugs (viz. ACEI/ARB), though are associated with less severe disease, have not achieved statistical significance, in the present study. Conclusion: Drugs, like ACEI/ARB, should be continued in patients suffering from COVID-19 infection, (if they are already on these drugs). © 2021 Journal of Association of Physicians of India. All rights reserved.

Saving the savior in COVID19 pandemic: Face masks

Using masks for self-protection has a long history. There are records of the use of masks ranging as far back as the Roman era to Medieval Europe, where masks were used as protective devices. During many festivities, masks were used as a fashion statement. Gas masks were commonly used during the world wars. As pollution started growing, people started using pollution masks. 2020 might be the only era when the entire human population has been forced to wear masks to protect themselves and to protect others. As expected, the healthcare workers, who are leading the fight against the COVID19, are the ones who are most at the need of these devices. Unfortunately, there is a shortage of personal protection equipment all over the world. Hence, we must understand their properties and strengths, and hence that we can achieve maximum benefits from the limited resources.

Biomarker profile in pediatric inflammatory multisystem syndrome temporarily associated with SARS-CoV-2 (PIMS-TS)/multisystem inflammatory syndrome in children (MIS-C)

Pediatric Inflammatory Multisystem Syndrome temporarily associated with SARS-CoV-2 (P1MS-TS) or Multisystem Inflammatory Syndrome in Children (MIS-C) is a post COVID-19 multisystem inflammatory syndrome in children and adolescents <21 years of age. It is slowly emerging in India with clinical features overlapping with Kawasaki Disease (KD) and Toxic Shock Syndrome (TSS). Ten P1MS-TS cases admitted in a pediatric hospital between July and Sept 2020 were compared with 19 Kawasaki Disease (KD) patients' data. The median age of PIMS-TS was 6 years (older to KD), 80% were males. PMS-TS cases had high inflammatory markers: CRP, ferritin, interleukin (IL)-6. Other distinct features were lymphopenia, hypoalbuminemia, and hyponatremia. Serial measurements of CRP showed high baseline values with subsequent decrease. NT-Pro BNP level was extremely elevated;suggestive of cardiac injury. All patients recovered. Laboratory features of P1MS-TS present a unique pattern of intense inflammation, and cardiac involvement that is different from features of pre COVID-19 KD. CRP remains a useful, inexpensive marker for P1MS-TS diagnosis and clinical progression.