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Background: The Brixia Chest X-ray (CXR) score, C-reactive protein (CRP), and the absolute neutrophil count (ANC) have been useful to predict outcomes in Coronavirus disease 2019 (COVID-19 patients). We studied the utility of the Brixia CXR score, CRP, and ANC in predicting the outcomes in terms of the need for invasive mechanical ventilation, length of stay, and mortality in moderate-severe COVID-19 patients. Material(s) and Method(s): This was a single-centre, retrospective, study on 122 COVID-19 patients. Brixia CXR score, CRP, and ANC on admission to the hospital and the fifth day of hospital stay were noted along with the need for invasive mechanical ventilation (IMV), prolonged length of stay (LOS) >= 14 days, and mortality. Result(s): 122 patients were included for analysis. The median and interquartile range (IQR) for baseline CRP was 81.50 (39-151) mg/L and 11.0 (4-30) mg/L (p < 0.001) on the fifth day. The median and IQR for baseline Brixia score was 10.0 (7-13), and on the fifth day was 7 (4-11) (p <0.001). The receiver operating characteristic curve (ROC) showed that the baseline CRP >= 52.5mg/L predicted both the need for IMV, with an area under the curve (AUC) of 0.628, and prolonged LOS with an AUC of 0.608. The ROC curve depicted that the baseline ANC >8500/muL predicted IMV requirement with an AUC of 0.657. The fifth day CRP >= 32 mg/L, ANC >= 11,000/ muL and Brixia CXR score >= 7 predicted a higher mortality in hospitalized patients. Conclusion(s): Baseline CRP (> 52.5mg/L) predicts the need for IMV and a prolonged LOS, but not mortality. Baseline ANC (> 8500/muL) predicted the need for IMV. CRP, Brixia CXR score, and ANC on the fifth day were not useful to predict LOS or mortality, though there was a significant reduction in CRP and Brixia CXR score on the fifth day compared to baseline after treatment. The fifth day CRP >= 32 mg/L, ANC >= 11,000/ muL and Brixia CXR score >= 7 predicted a higher mortality.Copyright © 2023, College of Anaesthesiologists of Sri Lanka. All rights reserved.
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In Delhi, the capital city of India, air pollution has been a perpetual menace to urban sustainability and public health. The present study uses a mixed-method approach to enumerate to the urban authorities: (a) the state of air pollution in the city;(b) systemic flaws in the current monitoring network;(c) potential means to bolster it;and (d) need of a participatory framework for monitoring. Information about Air Quality Index (AQI), obtained from 36 monitoring stations across Delhi is compared between 2021 (20 April–25 May;2nd year/phase of SARS-CoV-2 lockdown), and the corresponding time periods in 2020 (1st year/phase of lockdown), and 2019 (business-as-usual) using the Mann–Whitney U Test. AQI during the 2021 lockdown (a) appeared statistically more similar (p <.01) to that of 2019 and (b) exceeded the environmental health safety benchmark for 85% days during the study period (20 April–25 May). However, this only presented a partial glimpse into the air pollution status. It owes to numerous ‘holes’ in the AQI data record (no data and/or insufficient data). Moreover, certain areas in Delhi yet have no monitoring station, or only too few, to yield a ‘representative’ estimate (inadequate spatial coverage). Such shortcomings in the existing monitoring network may deter future research and targeted/informed decision-making for pollution control. To that end, the present research offers a summary view of Low-Cost Air Quality Sensors (LCAQS), to offer the urban sustainability authorities, ‘complementary’ technique to bolster and diversify the existing network. The main advantages and disadvantages of various LCAQS sensor technologies are highlighted while emphasizing on the challenges around various calibration techniques (linear and non-linear). The final section reflects on the integration of science and technology with social dimensions of air quality monitoring and highlights key requirements for (a) community mobilization and (b) stakeholder engagement to forge a participatory systems’ design for LCAQS deployment. © 2022 National Institute of Urban Affairs.
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Introduction: The COVID-19 pandemic led to the disruption of medical teaching nation-wide and pushed the institutions to explore the probable role of online teaching methods. The aim of this review is to identify the untested perspectives and help in strategizing based on evidence generation for the preparation for future. Methods: We followed the Preferred Reporting Items for Systematic and Meta-Analysis guidelines for reporting the present review. We searched PubMed, Scopus, and Embase databases for the articles published between April 2020 and October 2021 for studies on online medical education in India during the COVID-19 pandemic. Results: We initially screened a total number of 1412 articles and finally recruited 45 articles for the analysis. Majority of the articles were from single institution, and reported the experience of the students and teachers on online teaching. The common teaching platform used such as Zoom and Google Meet were enumerated. Internet connectivity was the most reported challenge of online teaching. None of the selected articles reported on ethical issues related to online teaching. Conclusion: Even though there were some strong points reported for the successful implementation of e-learning, a more sustainable and well-informed plan should be devised for the future on online teaching.
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Introduction: Charlson Co-morbidity Index (CCI) score has been shown to be an independent predictor of outcome in hospitalized COVID-19 patients. Patients with a score ≥3 have been shown to have increased chances of poor outcomes. Recent literature has shown a CCI score >4 as being a predictor for the need for mechanical ventilation and mortality. Regarding inflammatory markers, C-reactive protein (CRP) and ferritin have been shown to have significance in predicting morbidity and mortality in COVID-19 patients. However, most studies have analyzed an absolute cut-off value of these markers rather than the importance of a significant rise of these markers post ICU admission. Aim and objectives: The study aimed to determine the association between CCI score and a significant rise in CRP, ferritin, and lactate dehydrogenase (LDH) in the first 72 post ICU admission. Primary objective: Association of patients having high CCI score ≥3 with a significant rise in CRP, ferritin, and LDH in 72 hours post ICU admission. Secondary objective: Association of the significant rise of CRP (>10 mg/L), ferritin (>95 ng/mL) and LDH (>238 U/L) in the first 72 hours post ICU admission with outcome in terms of mortality. Materials and methods: Moderate-severe COVID-19 patients who were admitted to the ICU were recruited for the study. It was a singlecentre prospective observational study in which 62 patients were recruited from November 2020 to March 2021. Age, gender, CCI score, baseline CRP, ferritin, and LDH were recorded. The rise in inflammatory markers was noted after obtaining the levels of CRP, ferritin, and LDH after 72 hours. It was noted whether there was a significant rise in CRP, ferritin, and LDH as defined above. The mortality outcomes of the patients were noted. Results: 34/62 patients had low CCI <3 (55%) and 28/62 patients (45%) had a high CCI score ≥3. In patients with CCI ≥3, 35% of patients had a significant CRP rise in 72 hours post ICU admission, 30% had a significant rise in ferritin, and 20% had a significant rise in LDH. There was no significant association between patients with higher CCI scores and a significant rise in CRP, ferritin, and LDH in 72 hours of ICU admission (Mann-Whitney test, p > 0.05). Among those who expired (18/62) patients, there was a 25 times higher chance of a significant rise in ferritin by >95 ng/mL at 72 hours after ICU admission (multivariate logistic regression analysis). Conclusion: High Charlson comorbidity index score is not associated with a higher chance of a significant rise in inflammatory markers CRP, ferritin, and LDH in 72 hours post ICU admission in COVID-19 patients. Among those who expired, there was a 25 times higher likelihood of significant ferritin rise by >95 ng/mL in 72 hours of ICU admission, as compared to those who survived.
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Comprehensibility is the most crucial factor for the design and evaluation of a sign. Evaluation of sign’s comprehensibility through appropriate method is of utmost necessity before its implementation to avoid the wrong interpretation and thereby devastating impact. Hence, a comprehensibility evaluation of a sign was attempted using the triangulation method to overcome intrinsic biases from a single method study. One important COVID-19 warning sign was shown to 50 volunteers (43 male 7 females, graduates, and non-OSH experts) who were employees of India’s leading manufacturing organization. Two different methods were used for the comprehensibility assessment of the given sign. One was in the form of a score, and the other was in the form of a short descriptive answer. Two OHS experts evaluated both types of responses. The threshold was tuned between 30 and 100%, and comprehensibility results were recorded accordingly. The given sign was found comprehensible to 40% of the volunteers in Method-1 and 48% in Method-2 when comprehensibility was judged based on the gold standard, i.e., 60% (score = 0.6). The findings of both methods were found to be almost similar and effective in evaluating comprehensibility. The triangulation using two different methods produced consistent findings and revealed high positive correlation of data between two methods (Pearson r = 0.86). Both collected data and methods were thus validated and qualified for the generalization of the observed result. Hence, researchers became confident about the results of the sign’s comprehensibility, although the sign was found less comprehensible, needing further research and redesign. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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BACKGROUND AND AIMS: Since the beginning of the COVID-19 pandemic in early 2020, >290 million people were infected by SARS-CoV-2 and >5.4 million have died from or with COVID-19 (https://coronavirus.jhu.edu/). Patients with chronic health conditions such as end-stage kidney disease (ESKD) experience particularly high morbidity and mortality because of COVID-19. ESKD patients on hemodialysis are widely vaccinated for hepatitis B (HBV) and seroconversion is routinely measured. This practice presents a rare opportunity to study immune function on a wide scale. It can be reasonably assumed that patients who are able to produce a vaccinal or post-HBV antibodies titers have a better immune function than those who are unable to mount such a serological response. We aim to jointly analyze results of SARS-CoV-2 RT-PCR and hepatitis B serology to determine if presence of vaccinal or post-HBV antibodies is associated with likelihood of developing COVID-19 infection. METHOD: Patients who were tested for COVID-19 at Fresenius Medical Care North America dialysis clinics from May 2020 to September 2020 were included in this analysis. HBV infection/vaccination status, demographic parameters and clinical parameters were obtained from the medical record. Nasopharyngeal swab specimen was tested via RT-PCR to detect presence of SARS-CoV-2. Patients were categorized as having good immune function or poor immune function based on vaccinal and post-HBV sero-status. Patients who were vaccinated against HBV but did not seroconvert were considered to have poor immune function. On the other hand, patients who mounted vaccinal or post-HBV antibodies were considered to have good immune function. Univariate and multivariate logistic regression were utilized to study the association between immune function and other demographic, anthropometric and clinical parameters on the likelihood of not being diagnosed with COVID-19. Four models were constructed: Model 1: unadjusted;Model 2: adjusted for age. Model 3: adjusted for age, gender, race, ethnicity, body mass index (BMI). Model 4: adjusted for parameters in model 3 and dialysis vintage (in years), diabetes and congestive heart failure (CHF). RESULTS: 11 870 patients were included in this analysis. 54% patients were male, 33% were Black, 24% of the patients were Hispanic, 69% had diabetes and 22% had CHF. Patients were 61.2 ± 14.4 years old with dialysis vintage of 3.9 ± 3.9 years, BMI of 29.6 ± 9.7 kg/m2 and eKt/V 1.5 ± 0.3. Of these patients, 21% had poor immune function and 79% had good immune function. Results of the logistic regression models are shown in Table 1. In the unadjusted model, poor immune function was associated with an increased likelihood of being diagnosed with COVID-19. In models, 2, 3 and 4 age, vintage and presence of diabetes were all significantly associated with a higher likelihood of being diagnosed with COVID-19. However, poor immune function was not a significant predictor of COVID-19 diagnosis in the adjusted models. CONCLUSION: Patients who have vaccinal or post-HBV antibodies did not have a lower likelihood of COVID-19 compared with patients who were unable to mount an adequate vaccinal or post-HBV antibody response. Response to HBV vaccination or infection may not be adequate to characterize a patient as having good immune response. Other factors that are routinely measured in hemodialysis patients, which may allow us to make inferences about a patient's immune function should be explored.
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Superspreading events and overdispersion are hallmarks of the COVID-19 pandemic. However, the specific roles and influence of established viral and physical factors related to the mechanisms of transmission, on overdispersion, remain unresolved. We, therefore, conducted mechanistic modeling of SARS-CoV-2 point-source transmission by infectious aerosols using real-world occupancy data from more than 100 000 social contact settings in ten US metropolises. We found that 80% of secondary infections are predicted to arise from approximately 4% of index cases, which show up as a stretched tail in the probability density function of secondary infections per infectious case. Individual-level variability in viral load emerges as the dominant driver of overdispersion, followed by occupancy. We then derived an analytical function, which replicates the simulated overdispersion, and with which we demonstrate the effectiveness of potential mitigation strategies. Our analysis, connecting the mechanistic understanding of SARS-CoV-2 transmission by aerosols with observed large-scale epidemiological characteristics of COVID-19 outbreaks, adds an important dimension to the mounting body of evidence with regard to airborne transmission of SARS-CoV-2 and thereby emerges as a powerful tool toward assessing the probability of outbreaks and the potential impact of mitigation strategies on large scale disease dynamics. © 2022 Author(s).
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Background: The COVID-19 pandemic has had significant impacts on the healthcare system, including HIV outpatient care. Lockdowns, infection concerns, and staffing and resource shortages had the potential to affect patient care and viral suppression. Methods: We conducted a retrospective analysis of patients at six HIV primary care clinics in New York City in the Mount Sinai Health system. We compared outcomes in a pre-COVID period [PC], Mar 2019-Feb 2020, to a COVID period [CP] of Mar 2020-Feb 2021. Demographics of interest included age, sex, race/ethnicity, and HIV risk factor. In the two time periods we compared viral load suppression (VLS;HIV RNA <200 copies/mL), primary care encounters, antiretroviral (ART) prescribing, and hospitalizations. We then evaluated predictors of loss of VLS or loss to follow-up in a logistic regression model. Results: Our cohort was comprised of 9,740 HIV primary care patients with ≥1 viral load measurement PC. Median age was 53 years and 79% were male;20% were white, 37% Black, and 30% Hispanic. 42% had an HIV risk factor of MSM, 22% heterosexual sex, and 4% injection drug use (IDU). 87.9% (8559/9740) of the PWH during PC had VLS. While 90.7% (7268/8013) of the population assessed during CP had VLS, 18% of the initial cohort had no VL testing during this period and 15% had neither testing nor a clinical visit during CP. In CP, 13% had at least one measured detectable HIV VL (≥200 copies/mL). Primary care encounters decreased from 93% to 79%. ART prescription rates were unchanged: 88% had active prescriptions for >80% of the year both PC and in CP. All-cause hospitalizations decreased from 766 (7.9%) to 633 (6.5%;p<.001). Male sex (OR 1.32,CI 1.17-1.49), identification as a transgender woman (OR 1.81,CI 1.22-2.69), age <35 years (OR 1.74,CI 1.53-1.97), Black race (OR 1.4,CI 1.23-1.59), and HIV risk factor of heterosexual sex (OR 1.54,CI 1.34-1.77) and IDU (OR 1.73,CI 1.35-2.22) were associated with loss of VLS or loss to follow-up. Conclusion: In this large cohort of PWH in a NYC medical system, viral suppression of those who remained in care remained stable-yet a substantial portion of patients were not engaged in care and monitored for VLS during the CP. Strategies to retain patients in care and ensure suppression (eg, with televisits and care coordination) may have helped mitigate effects of the pandemic. Clinics must continue targeted efforts to re-engage patients, facilitate access to testing, and prevent longstanding loss to follow-up in at-risk groups.
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Recent outbreaks of infectious pathogens such as Zika, Ebola, and COVID-19 have underscored the need for the dependable availability of vaccines against emerging infectious diseases (EIDs). Prior to the COVID-19 pandemic, the cost and risk of R&D programs and uniquely unpredictable demand for EID vaccines discouraged many potential vaccine developers, and government and nonprofit agencies have struggled to provide timely or sufficient incentives for their development and sustained supply. However, the economic climate has changed significantly post-pandemic. To explore this contrast, we analyze the pre pandemic economic returns of a portfolio of EID vaccine assets, and find that, under realistic financing assumptions, the expected returns are significantly negative, implying that the private sector is unlikely to address this need without public-sector intervention. However, in a post-pandemic policy landscape, the financing deficit for this portfolio can be closed, and we analyze several potential solutions, including enhanced public-private partnerships and subscription models in which governments would pay annual fees to obtain access to a portfolio of stockpiled vaccines in the event of an outbreak.
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Background: Vaccination against COVID-19 among people living with HIV (PLWH) infection is crucial. At present, evidence lacks to strategize vaccinating the hesitant PLWH. This study has estimated the proportion of PLWH vaccinated till October 2021, enumerated the various adverse events following vaccination, and identified the enabling and constraining factors associated with vaccination. Methods: A cross-sectional survey was conducted among PLWH by the snowball sampling in the Chittoor district of Andhra Pradesh, India. Data were analyzed using the descriptive statistics and qualitative analyses. Results: Two-hundred and forty-seven PLWH responded, out of which 52 (20.7%) were yet to be vaccinated. Seventy-five (30%) participants reported having adverse events, out of which five (7%) had pain at the injection site, and 72 (96%) had systemic reactions. Fever (n = 51, 68%), dizziness (n = 23, 31%), and joint pain (n = 23, 31%) were the major systemic reactions. Among the vaccinated, motivation by the health-care workers and village volunteers were the major enabling factors. On the contrary, uncertainty about the vaccine effects, negative feedback from the health-care workers, and lack of self-motivation were the important constraining factors in taking the vaccines. Conclusion: Some PLWH are still hesitant to take the vaccine. Evidence generation, coupled with community mobilization, is required to upthrust the vaccination campaign in achieving the herd immunity against COVID-19.
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Machine vision techniques particularly convolutional neural networks (CNNs) have attained major breakthrough in medical image analysis and classification because of their ability to learn representative features from the input in a hierarchical manner. A couple of years back performing an effective and accurate CNN based classification was a tremendous challenge due to non-availability of large and good quality chest X-ray image (CXR) database. In this paper, we have presented the experiment based on state of the art deep CNN architectures like AlexNet, Res Net and VGG16. These experiments were conducted based on two types of study, one containing dataset with chest Xray images of subjects who contracted Covid-19, viral pneumonia and no respiratory disorder(normal) mentioned as study II and the other dataset containing only Covid-19 and healthy subjects mentioned as study I. A comparison has been drawn with the proposed architecture and classification results based on standard metrics have been carried out on test dataset. The raw chest Xray (CXR) images were passed to the CNN during the training phase without any prior image processing techniques applied on them. Also, we have proposed a new CNN architecture which incorporates the use of an adaptive activation function and it classified the above mentioned studies(I and II) with an accuracy of 96.89 % and 96.75 % and proved to be better than some of the very deep and much more advanced CNN architectures in terms of number of parameters, training time and the amount of space it occupied. © 2021 IEEE.
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Hyperchloremia leads to adverse effects like increase in pro-inflammatory mediators, anaemia and renal dysfunction. Aim of this study is to determine the association of hyperchloremia with rise in C-reactive protein (CRP), serum ferritin, lactate dehydrogenase (LDH), serum creatinine and anaemia in COVID-19 patients in intensive care unit (ICU). It was a single-centre study, 62 COVID-19 patients participated. Change in CRP, serum ferritin, LDH, serum creatinine, haemoglobin between day one and day three of ICU admission were noted. Outcome in terms of in-hospital mortality was noted. Hyperchloremia (>106mmol/L) or rise in chloride by > 5mmol/L was seen in 13/62 (20.96%) patients. It was not associated with a rise in CRP, ferritin, LDH, creatinine, drop in hemoglobin within 72 hours or in-hospital mortality. 44/62 (71%) patients survived and were discharged from hospital. Multivariate logistic regression showed that if age and gender are also considered, there is a 25 times higher chance of having had a significant ferritin rise (> 95 ng/mL) in 72 hours of ICU admission among those who died. (p=0.01). Hyperchloremia (>106mmol/L) or a rise in chloride by > 5mmol/L in 72 hours of ICU admission was not associated with a significant increase in CRP, LDH, ferritin, serum creatinine within 72 hours of ICU admission or mortality in moderate-severe COVID-19 patients. If age and gender are taken into consideration, there is a 25 times higher chance of having had a significant ferritin rise (> 95 ng/mL) in 72 hours of ICU admission among those who died.
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The coronavirus disease of 2019 (COVID-19) is an ongoing pandemic which is known to predominantly affect the respiratory system. Oxygen (O2) therapy has a profound role in the treatment of COVID-19 patients. The pandemic has drawn special attention to ensure uninterrupted O2 supply to all hospitals, especially those catering to COVID-19 patients. During the pandemic, a rational use of O2 therapy is essential. This includes optimal supplemental O2 therapy, careful monitoring of patients, and escalation as well as de-escalation of O2 therapy when indicated. We summarize the various sources of O2 to health-care establishments and various O2 delivery devices which are of paramount importance to ensure seamless O2 supply in the pandemic scenario.
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The COVID-19 pandemic has affected the lives of billions of people worldwide. Individuals and groups were compelled to construct theories of common sense about the disease to communicate and guide practices. The theory of social representations provides powerful concepts to analyse the psychosocial construction of COVID-19. This study aimed to understand the social representations of COVID-19 constructed by middle-class Brazilian adults and their ideological implications, providing a social-psychological analysis of these phenomena while the pandemic is still ongoing. We adopted a qualitative approach based on semi-structured in-depth interviews conducted online in April-May 2020. Participants were 13 middle-class Brazilians living in urban areas. We analysed the interviews with thematic analysis and a phenomenological approach. The social representations were organised around three themes: 1) a virus originated in human actions and with anthropocentric meanings (e.g., a punishment for the human-led destruction of the environment);2) a dramatic disease that attacks the lungs and kills people perceived to have "low immunity";and 3) a disturbing pandemic that was also conceived as a correction event with positive consequences. The social representations included beliefs about the individualistic determination of immunity, the attribution of divine causes to the pandemic, and the need for the moral reformation of humankind. The discussion highlights the ideological implications of these theories of common sense. Socially underprivileged groups are at greater COVID-19-related risk, which the investigated social representations may contribute to conceal and naturalise.
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Introduction: We would like to report a rare case of cryoglobulinemic vasculitis precipitated by COVID-19. Cryoglobulinemic vasculitis is a small vessel vasculitis affecting the skin, joints, peripheral nerves, and kidneys. It is usually associated with hepatitis C virus infection, B-cell lymphoproliferative disorders, and autoimmune disorders. Materials and methods: Written informed consent obtained from the patient and patients relative to present the details pertaining to the clinical course of illness with pictures and radiological images while maintaining the confidentiality of patient and identification. Results: 48 year old male patient seropositive for hepatitis C with known end stage kidney disease on maintenance dialysis with history of recent severe COVID-19 disease treated with remdesivir, steroids and anticoagulant;presented with shortness of breath, recent onset skin lesions. Purpural lesions on extremities and trunk could not be attributed to any isolated dermatologic disorder. Tzanck smear and gram staining were inconclusive. Covid-19 RTPCR was negative. HRCT chest was done to rule out re-infection. HRCT showed diffuse alveolar haemorrhage. In view of multi system involvement, vasculitis was suspected and diagnosed to have hepatitis C infection associated cryoglobulinaemic vasculitis. Patient underwent dialysis along with plasmapheresis for 3 days and discharged from the intensive care unit. Discussions: The onset of symptoms and disease progression of cryoglobulinemic vasculitis was probably altered by COVID-19 infection. The patient developed pulmonary complications earlier in the course of illness. To our best of our knowledge, it is the first case of COVID-19 precipitating and hastening disease progression in cryoglobulinemic vasculitis. Conclusion: In a patient with COVID-19 with hepatitis C infection, the possibility of alveolar hemorrhage due to cryoglobulinemic vasculitis should be kept in mind while ruling out re-infection. Utmost sagacity is required by the treating physician, as the treatment approach is different.
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Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2, novel enveloped RNA beta-coronavirus. The clinical manifestations vary from no symptoms to fever, cough, respiratory distress, pneumonia, and adult respiratory distress syndrome (ARDS) or uncommonly diarrhea. Typically, the disease has viremic phase, pulmonary phase, and severe host inflammatory phase. Prompt interventions in the first two phases such as awake prone positioning and administration of low-dose corticosteroids can prevent the onset of the third phase of the deadly disease. Awake prone positioning and systemic corticosteroids are simple interventions, which can prevent the requirement of mechanical ventilation and also lead to reduction in the inflammatory response and disease severity. We report a case series of six patients who diagnosed with COVID-19 ARDS and were benefitted by awake prone positioning sessions and low-dose systemic corticosteroid therapy.