A Retrospective Study of Microbiological Profile and Resistance Pattern in Early- and Late-onset Ventilator-associated Pneumonia Among COVID-19 Patients of a Tertiary Care ICU

Aim and objectives: To compare the microbiological profile, resistance pattern, and outcome in early- and late-onset ventilatorassociated pneumonia (VAP) among severe COVID-19 patients in a tertiary care ICU. Materials and methods: It is a retrospective study conducted in the Department of Critical Care Medicine, Fortis Hospitals Pvt ltd, Bangalore over a period of 15 months (April 2020 to June 2021). It included all patients who had a first episode of VAP confirmed by positive tracheal aspirate culture. Patients on mechanical ventilation for <4 days (48-96 hours) were included in the early-onset VAP group and 5 days or more were included in the late-onset VAP group. Data collected from case records including demographic and clinical characteristics of the patients at ICU admission, data related to the disease course, ICU treatments (prior antibiotic exposure and immunomodulatory therapy), mortality and, finally, data related to each VAP episode (date of sampling, implicated germs and their detailed biochemical testing identified any significant growth, and antibiotic sensitivity testing report). Results: We analysed a total of 404 patients, out of which 149 patients had VAP. The incidence of VAP was found to be 36.8%, out of which 59 (39.5%) had early-onset VAP and 90 (60.5%) had late-onset VAP. The most common organisms isolated from early- and late-onset VAP was Klebsiella pneumoniae. Among earlyonset VAP, 42% of Klebsiella pneumoniae were extended-spectrum beta-lactamase (ESBL) with carbapenemase-producing strains and in late-onset VAP 85% of Klebsiella pneumoniae strains were ESBL with carbapenemase-producing strains. The overall mortality in our study was 65.7%. Conclusion: VAP is one of the most common complications in critically ill mechanically ventilated COVID-19 patients. The underlying immune nature of the virus and the various immunomodulating therapies used for the same has contributed towards a high incidence of VAP in COVID-19 pneumonia patients. Knowledge of your local microbial flora can help in initiating the appropriate therapy at the correct time and hence improve clinical outcomes.

INCIDENCE AND OUTCOMES OF COVID-19 IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD): A SYSTEMATIC REVIEW AND META-ANALYSIS

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causativeagent of COVID-19 pandemic, is affecting the health care system globally. Patients withinflammatory bowel disease (IBD), such as those with Ulcerative Colitis (UC) and Crohn’sDisease (CD), may be prone to have more severe COVID-19 infection, as compared tohealthy individuals. As a result, widespread concern exists among gastroenterologists andIBD patients, especially those on immunosuppressive therapy, regarding risks of COVID-19 and it's complications. In this study we aim to consolidate the current evidence on therisk and clinical outcomes of COVID-19 in IBD patients by meta-analysis methods.METHODS: We searched multiple databases from inception through June 2020 to identifystudies that reported on outcomes of COVID-19 in patients with IBD. Outcomes from theincluded studies were pooled to estimate the risk of COVID-19 infection and its clinical outcomes.RESULTS: A total 1773 IBD patients with COVID-19 were analyzed from eight studies.Average age was 46.6 (7-86) years. 54% were males. While 53% patients had UC and 43%patients had active disease. 10.5% patients were on combination therapy, 20.7% on salicylicacid derivatives, 11.2% on steroids, 9% on immunomodulators and 54.7% on biologics.Most common presenting symptoms were fever, cough and dyspnea. Five studies provideddata that enabled the calculation of COVID-19 incidence in IBD patients. The pooledincidence of COVID-19 was 1.1% (95% CI 0.1-8.5;I2=98%). Variation to the pooled ratewas observed when sensitivity analysis was performed by removing one study at a time.The pooled values ranged from 0.5% to 1.6%. Four studies provided information on thecumulative COVID-19 incidence in the general population at the time the studies wereconducted. Incidence of COVID-19 in IBD patients was similar to the general population,and the pooled odds ratio (OR) was 1.3 (95% CI 0.5-3.7;I2=69%),p=0.6.The pooled rate of IBD patients admitted to hospital due to COVID-19 was 27.3% (95%CI 20.5-35.3;I2=60%), while rate of ICU admission was 5.7% (95% CI 4.7-6.9;I2=3%).The pooled rate of death in IBD patients due to COVID-19 was 5% (95% CI 2.5-9.5;I2=46%), whereas fatality among IBD patients admitted to ICU was 61.1% (95% CI 51.1-70.3;I2=0%). Meta-regression analysis based on IBD type, disease activity and immunosuppressanttherapy did not demonstrate significant effect on the pooled rates of clinical outcomes.CONCLUSION: Risk of COVID-19 in IBD patients is not increased when compared to thecumulative COVID-19 incidence in the general population. Rates of hospitalization, ICUadmission and death due to COVID-19 seem favorable compared to the general population.Meta-regression analysis seems to suggest that IBD patients need not change their immunosuppressanttherapy due to the ongoing COVID-19 pandemic.(Image Presented)(Image Presented)

REDUCED ENDOSCOPY UTILIZATION FOR UPPER GASTROINTESTINAL BLEEDING DURING COVID-19 PANDEMIC: A MULTICENTER RESEARCH NETWORK STUDY

Introduction-The Coronavirus Disease-2019 (COVID-19) caused by the novel severe acuterespiratory syndrome coronavirus-2 (SARS-CoV-2) led to significant strain on healthcaresystems worldwide. The decline in UGIB-related hospitalizations is thought to be related tothe fear of contracting the virus and failure of the patients to seek medical care. It is unclearif UGIB-related hospitalizations have been reduced in the US during the pandemic.Methods-We utilized a federated cloud-based network (TriNetX), which provides accessto electronic medical records from 92 healthcare organizations (HCOs) from the US. TheUGIB patients hospitalized from January 1, 2020, to December 1, 2020, were compared toa similar timeline in 2019 from the TriNetX database. Outcomes of the study includemortality rate, utilization rates of esophagogastroduodenoscopy (EGD), colonoscopy, andsigmoidoscopy. The outcomes were measured before and after 1:1 propensity matching ofthe groups based on the baseline demographics and comorbidities.Results-Prevalence of UGIB hospitalizations in 2020 was 27.84% (28,518 UGIB hospitalizationsamong 102,437 total hospitalizations), compared to 34.22% (110,327 UGIB hospitalizationsamong 322,405 total hospitalizations) in 2019. There was a significant decrease (6.4%) in the number of UGIB hospitalizations from pre-pandemic compared to pandemic times(P<0.001). However, the proportion of variceal bleeding and non-variceal bleeding amongthe UGIB population did not change in 2020 compared to 2019 (Table 1). Patients in the2020-group had lower mortality rate (RR 0.45, 95% CI: 0.42–0.47), decreased utilizationof EGD (RR 0.76, 95% CI: 0.74–0.78), colonoscopy (RR 0.71, 95% CI: 0.69–0.74) andsigmoidoscopy (RR 0.67, 95% CI, 0.59 – 0.76) (Table 2).Conclusion-A significant reduction (6.4%) of UGIB hospitalizations with no change in theproportion of variceal and non-variceal bleeding was seen in 2020 compared to 2019.Despite these changes, EGD utilization declined by 25% in 2020 compared to 2019 duringthe same months.AGA s(Figure Presented)Figure 1: Patient's characteristics an comorbidities before and after matching(Figure Presented)Figure 2: Laboratory values and outcomes of the patient admitted with upper gastrointestinal bleed

The pancreas and COVID-19: A clinical conundrum

With the progression of the COVID-19 pandemic, the classic manifestations of COVID-19 (e.g., persistent fever, dry cough, pneumonia, and acute respiratory distress syndrome in the severe disease) have expanded to include less common complications of the extrapulmonary organs. Recent evidence has shown that COVID-19 patients with concomitant presence of GI symptoms are at higher risk of developing severe disease and have poor clinical outcomes. Recently, multiple SARS-CoV-2-induced acute pancreatitis (AP) cases have been reported. This literature review aims to provide an insight into SARS-CoV-2-directed invasion of the pancreas. We will also review the currently available literature on the clinical effects of SARS-CoV-2, including AP and mild elevation of lipase levels in patients with COVID-19. In addition, we will discuss plausible mechanisms that underly SARS-CoV-2-induced pancreatitis.

Debunking Health Fake News with Domain Specific Pre-Trained Model

During this covid pandemic it is clearer than ever how much health misinformation effects. It is much easier now to publish health related articles online without validation, these articles are shared across social media contributing to the spread of health fake news. This Health fake news are spread with intent to damage image of person or product, to increase sells of a product or to promote a product. In recent research papers, many useful health misinformation detection models use BERT (Bidirectional Encoder Representations from Transformers) which is pretrained on unlabeled data extracted from English Wikipedia and book corpus and are mostly dealt with health misinformation on social media. Therefore, a self - ensemble SCIBERT (Scientific BERT) based model that makes use of domain specific word embeddings is proposed for detection of health misinformation specifically in news which is less explored and a dataset combining existing FakeHealth dataset and custom dataset that contains health articles scraped from news fact checking website Snopes.com. Classification results exhibits that the proposed model provides weighted F1 score of 0.715.

Prevention of SARS-CoV-2 Spread in Dental Clinic: The Future Challenge in Resuming Clinical Practice

In the present scenario, the pandemic of coronavirus disease 2019 (COVID-19), which is responsible for simple upper respiratory infection to fatal pneumonia and multi-organ failure has become a major public health challenge and a public health emergency of international concern. Apart from secondary and tertiary care, it is very much essential to provide primary care, prevention, and early detection. To prevent the virus from the human-human transmission and to control the situation, the protocols vary at various setups. Due to the uniqueness of dental settings and practice, the risk of cross-infection can be high between patients and dental practitioners. Establishment of strict and effective infection control protocol is necessary owing to the varying sustainability of the virus on different surfaces. The area of concern for a dental professional is the oral cavity and upper respiratory region where the host recipient cell receptor, angiotensin-converting enzyme receptor 2, is present abundantly acts as the host cell entry route for the coronavirus. Dental professionals play an important role in preventing the transmission of SARS-CoV-2;we aim to review the infection control measures in dental practice. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.