ABSTRACT
Background: COVID-19 pneumonia is newly recognized illness has spread rapidly around the world. It causes much morbidity and mortality. Diabetes in COVID-19 patients is individual risk factor and documented in worldwide studies to contribute to severity of the disease, increased length of stay and higher mortality. Aggressive management of blood sugars and acute diabetic complications reduce the length of stay and mortality. Method(s): The improvement project carried over for four months in King Fahd Armed Forces hospital. Randomly selected 200 patients admitted to the hospital with diabetes and COVID-19 studied. The unified treatment protocol applied for all patients and blood sugars monitored closely and optimized. Data collected on bimonthly basis and analyzed. The patient characteristics taken from data extraction tool (Oasis) of hospital. Median values for length of stay and post discharge FBS and RBS were calculated Microsoft Excel tool. Mortality rates calculated by percentages. Result(s): 200 patients studied in the 4 months study period. The median length of stay was 3 days. The mortality rate was 2.5%. The median FBS and RBS in the patient group monitored in the post discharge clinic was 130 mg/dl and 170 mg/dl respectively. The results compared with the standard international studies and improvements in primary and secondary outcomes documented. Discussion(s): The length of stay in the study population in the project was 3 days as compared to 13 days in a major international study helping rapid turnover of beds and financial savings. The mortality was 2.5% compared to 7.3% in a major published study, reflecting the implications of aggressive management of diabetes by teamwork. The median values of FBS 130 mg/dl and RBS of 170mg/dl achieved by regular follow-up and support to the patient by running postdischarged clinic definitely help reducing readmissions and acute complications of uncontrolled diabetes. Conclusion(s): COVID-19 patients with diabetes are more prone to have more severe disease, and tend to stay longer in hospital and have higher mortality compared to non-diabetics. An aggressive preemptive strategy with unified treatment protocols and readily available service of endocrinologist and effective control of diabetes and acute complications of diabetes significantly reduces the length of and mortality in COVID-19 patients with diabetes.
ABSTRACT
The Covid-19 outbreak has caused disruptions in the education sector, making remote education the dominant mode for lecture delivery. The lack of visual feedback and physical interaction makes it very hard for teachers to measure the engagement level of students during lectures. This paper proposes a time-bounded window operation to extract statistical features from raw gaze data, captured in a remote teaching experiment and link them with the student's attention level. Feature selection or dimensionality reduction is performed to reduce the convergence time and overcome the problem of over-fitting. Recursive feature elimination (RFE) and SelectFromModel (SFM) are used with different machine learning (ML) algorithms, and a subset of optimal feature space is obtained based on the feature scores. The model trained using the optimal feature subset showed significant improvement in accuracy and computational complexity. For instance, a support vector classifier (SVC) led 2.39% improvement in accuracy along with approximately 66% reduction in convergence time. © 2022 IEEE.
ABSTRACT
Introduction: - Myocarditis, cardiomyopathy, and heart failure;common cardiac manifestations of Coronavirus infectious disease (COVID-19).1-3 - Acute pericarditis is rare.4 - We report a case of a new-onset pericardial rub diagnosed as acute pericarditis due to COVID-19 in a patient with end-stage renal disease (ESRD) despite vaccination. Case Description: - A 61-year-old male with a history of chronic kidney disease stage 5 (CKD 5) approaching dialysis, status post renal transplant twice (first in 1997 and second in 2010) presented with dyspnea of a few days' duration. - Medications: amlodipine, atorvastatin, calcitriol, clonidine patch, hydralazine, sevelamer, tacrolimus, and tamsulosin. - Physical examination: 2+ pitting edema and rales over bilateral lung fields. - Laboratory tests: Blood urea nitrogen (BUN) and Creatinine (Cr) of 154/13.6, respectively. Initial COVID-19 serologies were negative. - Electrocardiogram (EKG) and echocardiogram (ECHO) at admission were unremarkable. - Received seven hemodialysis sessions that improved his symptoms. - Subsequently, he spiked a fever with a recurrence of dyspnea and pleuritic chest pain. - Auscultation: New onset pericardial rub. - Laboratory test: BUN/Cr of 54/5.3. Tested positive for COVID-19. - Repeat ECHO: Pericarditis and moderate-sized pericardial effusion with normal left ventricular systolic function and ejection fraction. - Treated with heparin-free intensive hemodialysis and colchicine. Discussion(s): - Acute pericarditis presentation;Two or more of the following symptoms: chest pain, friction rub, diffuse ST-elevations, PR depressions on EKG, and new or worsening pericardial effusion.5 - Can lead to cardiac tamponade if left untreated.6 - In ESRD, important to consider differential diagnoses of pericarditis;uremia, and fluid overload causing effusion. Due to the recent pandemic, COVID-19 must be taken into consideration irrespective of vaccination status.
ABSTRACT
Introduction: Magic (Psilocybin) mushrooms are used as hallucinogens, renal dysfunction as a rare side effect has been reported in literature. We chronicle a rare case of acute kidney injury and hypertensive emergency precipitated by psilocybin ingestion in a young female. Case Description: A 31-year-old female with good overall health and medical history of well controlled Hypertension (HTN) and metabolic syndrome presented with AKI in the setting of hypertensive emergency. Initial blood pressure (BP) on presentation was 210/140, with transient visual loss and elevated troponin >6000. Her other past medical history was significant for nephrolithiasis and COVID-19 few months ago. Physical examination was significant for HTN;no significant edema was present. Remaining physical examination was unremarkable. Laboratory evaluation demonstrated serum creatinine 4.6 mg/dL (baseline creatinine 0.9 mg/dL), 24-hr urine protein 920 mg/g, and serum albumin 3.0 g/dl. A blood film revealed occasional schistocytes. Urinalysis showed proteinuria and microscopic hematuria. Urine toxicology screen was negative. Routine blood and urine cultures showed no growth. Her serology, infectious disease workup and workup for paraproteinemia were inconclusive. Workup for secondary hypertension was negative. Computed tomography of the brain in the setting of transient visual loss, and ultrasound of the kidneys and bladder were unremarkable. Her transthoracic echo (TTE) showed severe concentric left ventricular hypertrophy, with grade II diastolic dysfunction. Renal biopsy showed features suggestive of vascular-predominant acute thrombotic microangiopathy. Patient was managed conservatively and did not require renal replacement therapy. Her serial follow up labs from last several months revealed the new baseline creatinine of 2.2-2.4 mg/dl, resulting in CKD as a sequel of partial recovery from AKI in the setting of psilocybin poisoning. Discussion(s): Psilocybin use can be associated with AKI leading to CKD and secondary hypertension. Mechanisms of renal injury are thought to be secondary to vasoconstricting effects and endothelial reaction, which needs to be further investigated. Nephrologists and primary providers should be vigilant to identify this rare cause of AKI.
ABSTRACT
Introduction: & Background: Diabetes in COVID-19 patients is individual risk factor and documented in worldwide studies to contribute to disease severity, increased length of stay and higher mortality (fig-1). Aggressive management of blood sugars and acute diabetic complications reduce the length of stay and mortality. Methods: Randomly selected 200 patients admitted with diabetes and COVID-19 studied. The unified treatment protocol (fig-2) applied for all patients and blood sugars monitored closely and optimized. Data collected on bimonthly basis and analyzed. Patients’ characteristics taken from data extraction tool (Oasis) of hospital. Median values for length of stay and post discharge FBS and RBS were calculated Microsoft Excel tool. Mortality rates calculated by percentages. Results: 200 patients studied in the 4 months study period. The median length of stay was 3 days. The mortality rate was 2.5% (fig-3,4). The median FBS and RBS in the patient group monitored in the post discharge clinic was 130 mg/dl and 170 mg/dl respectively. The results compared with the standard international studies. Discussion: Diabetes in COVID-19 patients posed great challenge as increased severity and mortalities reported compared to non-diabetic. Taking a pre-emptive strategy to combat this problem by aggressively manage diabetes help in reducing length of stay and morbidity. The length of stay in studded population was 3 days as compared to 13 days in a major international study(Ref: 1) . Financial saving come from rapid turnover of beds. The mortality was 2.5% compared to reported 7.3% in a major study (Ref: 2), reflecting the implications of aggressive management of diabetes. Regular follow-up and support by running post-discharge clinic definitely help reducing readmissions and acute complications of uncontrolled diabetes. Conclusion: Aggressive management of diabetes in COVID-19 patients by tailored treatment protocols and dedicated teams will help to decrease the morbidity and mortality.Presentation: No date and time listed
ABSTRACT
Cocaine is one of the most used illicit drugs. Cocaine induced toxicity can result in hepatotoxicity, pulmonary toxicity, and renal dysfunction. Acute kidney injury (AKI) is an emergent complication in cocaine abusers. Rhabdomyolysis and vasoconstrictions mechanism are well known cause of AKI, cocaine induce thrombotic microangiopathy (TMA) is rarely reported. Cocaine is widely used in the United States, we report a case of Cocaine induced TMA in a cocaine abuser. We chronicle a case of a 42-Year-old male cocaine abuser, who presented to ED with complaints of Dyspnea, cough, anorexia and chest tightness for two days. He attributed to inhaling ammonia from cat urine along with cocaine abuse. No prior history of kidney disease or any other chronic illness. On examination, the patient appeared malnourished and cachectic. He was normotensive, lethargic and oriented. There were crackles at the lung bases. Blood tests revealed serum creatinine 18.0 mg/dL, blood urea nitrogen 150 mg/dL, hemoglobin 8.2 g/dL, platelets 173000/mm3, Retics count 8 %, LDH 1120 (84–246 IU/L) and haptoglobin < 8 (30–200mg/dL). A blood film revealed occasional schistocytes. Urinalysis showed proteinuria and microscopic hematuria. Urine toxicology revealed cocaine. Routine blood and urine cultures showed no growth. Serologic tests showed reduced complement C3 level of 40 (82-185 mg/dL) and normal C4 level of 32 (10–53mg/dL). There were no antibodies against HIV 1/2 and Covid 19. His ADAMTS-13 results showed 0.61 and 0.63 (0.68 to 1.63). Renal Ultrasound was unremarkable. Patient was intubated and ventilated in ICU;he was initiated on hemodialysis. He was provided four sessions of plasma exchanges till his ADAMTS-13 result came back near normal that was indicative of Cocaine induce TMA. Cocaine abuse is a global issue with increasing number of cases in the USA. It can cause AKI due to well-known etiologies like Rhabdomyolysis, Vasculitis, Acute interstitial Nephritis and Renal Infarction. However, Clinicians and nephrologists should also consider rare causes like TMA as a possible differential cause of AKI in the setting of cocaine abuse.