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Objectives: To describe and compare real-world outcomes for patients with mild-to-moderate COVID-19 at high risk for progression to severe COVID-19, treated with sotrovimab versus untreated. Method(s): Electronic health records from the National COVID Cohort Collaborative were used to identify US patients (aged >=12 years) diagnosed with COVID-19 (positive test or ICD-10: U07.1) in an ambulatory setting (26 May 2021-30 April 2022) who met Emergency Use Authorization high-risk criteria. Patients receiving the monoclonal antibody (mAb) sotrovimab within 10 days of diagnosis were assigned to the sotrovimab cohort with an index date on the day of infusion. Untreated patients (no evidence of early mAb treatment or prophylaxis mAb or oral antiviral treatment) were assigned to the untreated cohort with an imputed index date based on the time distribution between diagnosis and sotrovimab infusion for the sotrovimab cohort. The primary endpoint was hospitalization or death (both all-cause) within 29 days of index, reported as descriptive rates and adjusted (via inverse-probability-of-treatment weighting [IPTW]) odds ratios (OR) and 95% confidence intervals (CI). Result(s): Of nearly 2.9 million patients diagnosed with COVID-19 during the analysis time period, 4,992 met the criteria for the sotrovimab cohort and 541,325 were included in the untreated cohort. Patients in the sotrovimab cohort were older (60 versus 54 years), more likely to be male (40% versus 38%) and White (85% versus 75%), and met more EUA criteria (3 versus 2) versus the untreated cohort. The 29-day hospitalization or mortality rates were 3.5% (176/4,992) and 4.5% (24,163/541,325) in the sotrovimab and untreated cohorts respectively (unadjusted OR [95% CI]: 0.77 [0.67,0.90];p=0.001;IPTW-adjusted OR [95% CI]: 0.74 [0.61,0.91];p=0.004). Conclusion(s): Sotrovimab demonstrated clinical effectiveness in preventing severe outcomes (hospitalization, mortality) between 26 May 2021-30 April 2022, which included the Delta variant and early surge of Omicron BA.1/BA.2. Funding(s): GSK (Study 219020)Copyright © 2023
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Recently the education industry has moved at an increasing pace towards quality assurance programs. There is a high demand for efficient use of Information and Communication Technology (ICT) in education, especially to improve the quality of mathematics education. After COVID-19 lockdowns, ICT has become essential in the era of blended learning. Variations in pedagogy and assessments in mathematics are always challenging. Due to difficulties in learning mathematics, the need for innovative mathematical pedagogy is rising daily in online and blended learning environments. Through this paper, the authors attempt to provide more opportunities to mathematics teachers and students to learn through LMS. Through KJSCE-LMS (Moodle based LMS specially customized for students of K J Somaiya College of Engineering (KJSCE), Mumbai), the authors demonstrate the optimum use of innovative Teaching-Learning-Evaluation (TLE) techniques that can be easily practiced in online or blended mode of mathematics education. These technology-enhanced TLE methods were applied in the first year undergraduate engineering mathematics classroom in the urban part of India. To check the promethean ways to enhance pedagogical learning experiences by students, qualitative and quantitative surveys were conducted. Results of the survey reveal that teachers' systematic usage of KJSCE-LMS can make mathematics learning easy, effective and meaningful. 98% of the students agreed that the contents uploaded on LMS helped them to understand the concepts effectively. LMS can also help strengthen the learning process, motivate students, improve their learning outcomes, and positively impact their wholesome development. © 2022, Rajarambapu Institute Of Technology. All rights reserved.
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The COVID-19 virus has been spreading at an alarming rate causing life-threatening conditions in many human beings. Since vaccines to prevent this disease have been allowed for public usage, it has become extremely important to quickly immunize people to prevent fatalities, which subsequently implies the necessity of an efficient vaccine supply system. In any supply system, technology can enable the transfer and processing of large amounts of data in a quick and secure manner, for all entities involved in the process. It is useful for planning, execution, and analysis. It is helpful for tracking and real-time updates so that the journey of a commodity to be supplied is known to all entities at any given time, and this can be useful to catch any faults or for improving the process. The vaccines often need to be supplied over long distances and thus, there is an evident need to have a database system to model the supply of these vaccines effectively. For this, relational databases have been used for a long time to create a structured and well-defined model. However, when it comes to efficiency and flexibility, modern technology like graph databases can be a better fit while still keeping the structure of data in mind. In this paper, we propose a graph database system for the supply of COVID-19 vaccines and describe its advantages when compared to a traditional relational database system. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Indian traditional system of medicine has a definite role in the treatment of Covid-19. This case report presents the outcome of Ayurvedic interventions along with modern medicines in a severe covid-19 infected patient with breathlessness. A patient with a history of cough, breathing difficulty and generalized weakness tested positive for the rapid antigen test and prescribed the standard treatment of care with 14 days of strict home quarantine. During follow-up, there was no clinical improvement and oxygen saturation was fluctuating and required oxygen support. Therefore, the patient sought ayurvedic intervention at the covid-19 healthcare center with supportive oxygen therapy. The patient was managed with ayurvedic intervention along with modern medicines. On the date of admission to the covid-19 care center, the patient's SpO2 72% on room air, HRCT 80-90%, and ESR, CRP, and LDH were 40(mm/hour), 11.47(mg/L), and 306(Units/L) respectively. By adhering to the integrated therapy patient's oxygen saturation and clinical profile were improved with time. On the 11th day of treatment patient, SpO2 was sustained at 95% and HRCT report was 70-80%, and clinical profile improved remarkably. The patient's HRCT after one month was50-60% compared to the previous report suggestive of remarkable improvement. The effect on inflammatory markers and oxygen saturation suggests that integration of modern medicines along with ayurvedic medicine in the patient was significant and deserves further studies. Integrating ayurvedic treatment along with modern medicine might be considered as an effective approach in the management of severe covid-19 patients. Copyright © RJPT All right reserved.
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Background: COVID-19 is an infectious disease caused by the newly discovered coronavirus (severe acute respiratory syndrome coronavirus 2). Efforts are being taken to control the spread of this disease, of which the development of vaccine against COVID-19 is a major landmark. However, doubts on the efficacy of the vaccine do exist among the population. Aim: The aim of this study was to know the reasons for, perceptions of, and knowledge about the COVID-19 vaccination among dental undergraduate students. Materials and Methods: The study was conducted using an online survey and distributed among undergraduate dental students throughout India. An online validated and piloted questionnaire was sent to dental colleges throughout India using the Google Forms platform. The responses were downloaded in MS Excel 2019. Descriptive analysis (SPSS IBM, USA version 25) was used. Results: The response rate of the study was 32%. Preventing the spread of COVID-19 infection was the primary reason for getting vaccinated and nonavailability of long-term safety data was the main reason for not getting vaccinated. Majority of the students agree that wearing masks, frequent handwashing, hand sanitation, and social distancing postvaccination are necessary. Conclusion: The study points to a rational wait-and-watch strategy adopted by majority of vaccine-hesitant dental students, though the flaws in reasons for getting vaccinated were observed in the present study. These flaws point to the need for a genuine, consolidated, up-to-date, unified easily available, and succinct source of information on all aspects of the present COVID-19 pandemic.
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The COVID-19 virus has been spreading at an alarming rate causing life-threatening conditions in many human beings. Since vaccines to prevent this disease have been allowed for public usage, it has become extremely important to quickly immunize people to prevent fatalities, which subsequently implies the necessity of an efficient vaccine supply system. In any supply system, technology can enable the transfer and processing of large amounts of data in a quick and secure manner, for all entities involved in the process. It is useful for planning, execution, and analysis. It is helpful for tracking and real-time updates so that the journey of a commodity to be supplied is known to all entities at any given time, and this can be useful to catch any faults or for improving the process. The vaccines often need to be supplied over long distances and thus, there is an evident need to have a database system to model the supply of these vaccines effectively. For this, relational databases have been used for a long time to create a structured and well-defined model. However, when it comes to efficiency and flexibility, modern technology like graph databases can be a better fit while still keeping the structure of data in mind. In this paper, we propose a graph database system for the supply of COVID-19 vaccines and describe its advantages when compared to a traditional relational database system. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Background & Aim: 'Aerosol generating procedures' (AGPs) can risk spread COVID-19 and other diseases. Suspension of routine dentistry due to COVID-19 pandemic led to increased use of antibiotics and dental extraction, reduced access to dental care, and compromised dental businesses' financial sustainability. The recommended additional personal protective equipment (PPE) for AGPs increases treatment cost, clinical waste and poses a risk to the environment. The transmission of COVID- 19 and other air-borne infections will be a risk for foreseeable future. We have developed a novel patient shield (NoPaS) to help prevent spread of COVID-19 and other air-borne viruses and bacteria during AGPs. NoPaS is a device with a hood, a suction and air curtains that prevents aerosol spread. Methods: We carried out extensive research to ensure acceptability and efficacy of NoPaS. This included: market research, computational simulations. in-vitro smoke visualization and particle image velocimetry (PIV). NoPaS was then tested using dental simulation units (DSUs) with artificial salivary enzyme. Dentists carried out three AGPs (examination using air spray;ultrasonic scaling;class I cavity repair) and a non-AGP (hand-scaling) with and without NoPaS. Dentists were randomized to perform procedures with or without NoPaS first. Aerosol generation and spread were measured by counting clearance zones on starch agar plates at three distances from the dentist's working field. Results: The data obtained from lab-based studies and market research informed the final product design. Over 90% of patients and dental practitioners felt safer when using NoPaS. The mean percentage of clearance zone for AGPs with and without NoPaS were 0.9% and 75%. The patent was filed following successful test results. Conclusions: NoPaS is an effective, low-cost, and environmentallyfriendly solution for performing AGPs with no risk of virus transmission. With modifications, it can be used for medical procedures on head and neck. Further work is currently underway to take NoPaS into mass production.
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Objectives: The world is experiencing unprecedented challenges from the coronavirus pandemic. There is a sparse data on Coronavirus disease-2019 (COVID-19) outcomes in pregnant women from India, especially during the second wave. We aimed to compare maternal clinical characteristics and prognostic markers during first and second waves of COVID-19 and to know the correlation of the laboratory markers with disease severity and to assess maternal and perinatal outcomes. Materials and Methods: This prospective study of COVID-19 positive pregnant women was conducted at a tertiary care hospital in India from the 1st of August 2020 to the 30th of June 2021. Data on epidemiological history, clinical presentation, laboratory results, and maternal-fetal outcome in the first and second waves of the COVID-19 pandemic were collected and analyzed. Results: One hundred eighteen patients participated in our study, with 64 belonging to the 1st wave and 54 in the 2nd wave. Fever and sore throat were common presenting symptoms, most women with bronchial asthma and cardiac disease progressed to severe/critical illness. C-reactive protein, lactate dehydrogenase (p < 0.05 in both waves), ferritin (p < 0.01 in 2nd wave), and procalcitonin (p < 0.05 in 1st wave) positively correlated with the severity of the disease. Conclusion: Our study showed that the clinical characteristics and severity of the disease did not differ significantly in both the waves. The adverse fetal outcome was significantly more in mothers with severe and critical disease. Laboratory markers correlated significantly with the severity of the maternal disease, hence can be used as prognostic indicators. © 2022 Royal Thai College of Obstetricians and Gynaecologists. All rights reserved.
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Background: The COVID-19 pandemic has placed substantial strain on hospital resources and has been responsible for more than 733 000 deaths in the United States. The US Food and Drug Administration has granted emergency use authorization (EUA) for monoclonal antibody (mAb) therapy for patients with early-stage high-risk COVID-19. Methods: In this retrospective cohort study, we studied the emergency department (ED) during a massive COVID-19 surge in Orange County, California, from December 4, 2020, to January 29, 2021, as a potential setting for efficient mAb delivery by evaluating the impact of bamlanivimab use in high-risk COVID-19 patients. All patients included in this study had positive results on nucleic acid amplification detection from nasopharyngeal or throat swabs, presented with 1 or more mild or moderate symptoms, and met EUA criteria for mAb treatment. The primary outcome analyzed among this cohort of ED patients was overall improvement, which included subsequent ED/hospital visits, inpatient hospitalization, and death related to COVID-19. Results: We identified 1278 ED patients with COVID-19 not treated with bamlanivimab and 73 patients with COVID-19 treated with bamlanivimab during the treatment period. Of these patients, 239 control patients and 63 treatment patients met EUA criteria. Overall, 7.9% (5/63) of patients receiving bamlanivimab had a subsequent ED/hospital visit, hospitalization, or death compared with 19.2% (46/239) in the control group (P= .03). Conclusion: Targeting ED patients for mAb treatment may be an effective strategy to prevent progression to severe COVID-19 illness and substantially reduce the composite end point of repeat ED visits, hospitalizations, and deaths, especially for individuals of underserved populations who may not have access to ambulatory care.
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Clinical trial managers play a vital role in the design and conduct of clinical trials in the UK. There is a current recruitment and retention crisis for this specialist role due to a complex set of factors, most likely to have come to a head due to the COVID-19 pandemic. Academic clinical trial units and departments are struggling to recruit trial managers to vacant positions, and multiple influences are affecting the retention of this highly skilled workforce. Without tackling this issue, we face major challenges in the delivery on the Department of Health and Social Care's Future of UK Clinical Research Delivery implementation plan. This article, led by a leading network of and for UK Trial Managers, presents some of the issues and ways in which national stakeholders may be able to address this.
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Clinical Trials as Topic , Workforce , COVID-19 , Clinical Trials as Topic/organization & administration , Humans , Pandemics , Research DesignABSTRACT
Background: COVID-19, being a prothrombotic state, has been linked to ischemic infarcts. Pooled data on impact of COVID-related stroke on mortality are sparse. We conducted a meta-analysis to assess the risk of stroke-related inpatient mortality (SRIM) during the COVID pandemic vs. pre-pandemic. Methods: Pubmed/Medline, SCOPUS & EMBASE were searched for articles till August 2021 reporting stroke and SRIM during COVID-19 pandemic vs. pre-pandemic. Random-effects model for odds ratio (OR), I2 statistics for heterogeneity assessment and leave-one-out method for sensitivity analysis were employed. Results: A total of 31 studies with 455,073 stroke hospitalizations;365253 pre-pandemic and 89820 pandemics (mean age 72 vs 70 yrs) were analyzed. With a comparable distribution of males, AF, and thrombolysis, the meta-analysis showed a nearly 40% higher risk of mortality during pandemic vs. pre-pandemic admissions (OR 1.42, 95%CI:1.06-1.92, p=0.018, I2 =98.59). Further subgroup analysis showed a slightly higher risk of mortality in cohorts with mean age <70 years of age vs. ≥70 yrs [mean <70 years (n=11): OR:1.48, p=0.020 vs. ≥70 years (n=17): OR:1.27, p<0.001]. Cross-continental subgroup analysis revealed significantly higher mortality in Europe (n=14, OR:1.31, p<0.001) during pandemic vs. pre-pandemic, and non-significantly higher association in Asia (OR 1.13, p=0.57), USA (OR 1.59, p=0.23), Africa (OR 1.20, p=0.46) (Fig. 1). Subgroup analysis of 16 studies with n=100-1000 showed significantly higher OR (1.31) for SRIM during the pandemic vs. pre-pandemic, whereas studies with n<100 or >1000 did not show any significant difference. Sensitivity analysis showed overall and subgroup stability in OR. Conclusions: This largest meta-analysis to date on the subject found that hospitalized stroke patients, elderly or non-elderly, had nearly 40% higher risk of mortality during the COVID pandemic vs. pre-COVID era across the globe, more significantly in Europe. (Figure Presented).
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Acute kidney injury (AKI) is found to be common among COVID-19 patients. In this study, we performed extensive literature mining and used the BioGRID COVID-19 interaction data to bridge the mechanistic and molecular link between COVID-19 and AKI. DAVID GO enrichment analysis of the BioGRID data allowed for further filtration of COVID-19 related interactors by their relevance to untoward kidney manifestations. Key physiological processes involved in this pathway include Renin-Angiotensin system (RAS) activation, complement activation, and most importantly, systemic inflammation. Discovered interactors like CD147, CD209, CypA, and MASP2 were found to be heavily implicated in the mentioned processes. The Coronavirus Infectious Disease Ontology (CIDO) was used to represent our analyzed results, leading to further understanding of the COVID-19 associated AKI mechanisms. © 2021 Copyright for this paper by its authors.
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Introduction: A surge in incidence of out-of-hospital cardiac arrest (OHCA) has been reported during COVID-19 outbreak in certain countries. However, limited data exists on a comparison of outcomes among COVID-19 positive OHCA patients vs. non-COVID-19 OHCA patients. Therefore, we aimed to perform a meta-analysis comparing characteristics and outcome of COVID-19 OHCA vs COVID-19 negative OHCA patients. Methods: We reviewed PubMed/Medline, SCOPUS, and EMBASE until April 2021 using relevant keywords COVID-19, SARS-CoV-2, “out of hospital cardiac arrest” or OHCA to identify studies that included outcomes data on OHCA with COVID-19 positive and negative status. Random-effects models were obtained to perform a meta-analysis. I statistics was used for heterogeneity. Results: Of 5789 OHCA patients included from 6 studies, patients who were COVID-19 positive comprised of 61.46% males while COVID-19 negative patients included 63.37% of males (p=0.2). COVID-19 OHCA patients were younger (Mean±SD, 68.94±17.93 vs 70.23±17.93, p=0.03) compared to COVID-19 negative patients. Incidence of OHCA at home/private address was higher (OR=1.92, 95%CI:1.52-2.43), while shockable rhythm (OR=0.34, 95%-CI:0.24-0.46) and use of AED (OR=0.77, 95%CI 0.61-0.97) were less frequently noted in COVID-19 patients (p<0.0001). As shown in Fig. 1, return of spontaneous circulation did not differ significantly (OR=1.01, 95%CI:0.85-1.20, p<0.92);however, survival to admission (OR=0.64, 95%CI:0.48-0.86, p<0.01), and survival to discharge (OR=0.28, 95%CI:0.13-0.59, p<0.01) were significantly lower in COVID-19 OHCA admissions compared to non-COVID-19 OHCA admissions. Conclusions: This meta-analysis demonstrated that the SARS-CoV-2 infection in OHCA patients was associated with poorer outcomes as compared to COVID-19 negative OHCA admissions. Future studies are warranted to assess long-term residual effects of COVID-19 on OHCA risk and outcomes.
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Background: Intubation/extubation are aerosol/droplet-generating procedures. A combined paediatric facemask-face tent provided pre/apnoeic nasal oxygenation and reduced aerosol/droplet spread during RSI, intubation, and extubation in a COVID-19 positive patient.1-2 It was used to avoid severe desaturation and reduce aerosol/droplet spread during difficult intubation/extubation in a morbidly obese patient.1,3 We used it in a combative patient with SBO/perforation during RSI/intubation. Case Report: A lethargic 87-year-old female ex-smoker with HTN, CVA, CAD s/p MI, uterine cancer s/p TAH/BSO, hiatal hernia, recent URI, worsening abdominal pain, sinus tachycardia and respiratory distress, presented for emergency exploratory laparotomy for SBO. Following NGT suctioning 150 cc biliary fluid, she was transferred to OR table. She became agitated/combative, requiring 3 providers to hold her on the table. She was tachycardic, hypertensive, cold with undetectable SpO2. A nasal mask-face tent was secured over her nose and NGT for pre-oxygenation and reducing aerosol/ droplet spread (Fig.1). With cricoid pressure, RSI was induced with fentanyl/lidocaine/propofol/ etomidate/succinylcholine. Video-laryngoscopy assisted intubation was quickly accomplished under face tent while nasal mask delivered apnoeic oxygenation (Fig.2) with co-occurring NGT suction. Nasal oximetry revealed 99%SpO2 immediately post-intubation. Arterial and additional IV catheters were inserted to manage suspected septic shock. She tolerated ileocectomy with ileostomy well with 98-100%SpO2 throughout with stable yet critical hemodynamics. She remained intubated for managing septic shock which was resolved in one week. Discussion: This simple combined nasal mask-face tent provided CPAP pre- and continuous apnoeic oxygenation and reduced aerosol/droplet spread in an agitated/combative patient with SBO/perforation during RSI/intubation. It avoided desaturation and provided additional provider protection amid the ongoing COVID pandemic at no extra costs. (Figure Presented).
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Purpose : After the Illinois shelter-in-place COVID-19 mandate was instituted on March 16, 2020, outpatient ophthalmology care was limited to patients with vision-threatening conditions. In order to better understand the impact of the mandate on patients receiving intravitreal injections (IVIs), we compared key demographic and clinical features of patients seen before and after quarantine measures. Methods : Retina patients receiving IVIs at Northwestern Medicine sites between 12/1/19 and 6/30/20 were identified and divided into pre-COVID (PC) and Strict-Quarantine (SQ) groups (12/1/19-3/15/20 and 3/16/20-6/30/20, respectively). A subset of patients lost to follow-up (LTFU), defined as having been seen at least once in the PC period but not at all during the SQ period, were also identified. Comparison of primary diagnoses and selfreported demographic data was performed between these three sub-groups. Primary diagnoses necessitating IVIs were identified as age-related macular degeneration (AMD), diabetic retinopathy (DR), retinal vein occlusion (RVO), and other causes of neovascularization (other). Results : 1426 injections were administered to 716 patients during the PC period compared to 1121 injections to 637 patients during the SQ period. More injections per patient were performed in the PC period compared to the SQ period (1.99 ± 1.00 vs 1.76 ± 0.87, p = 5.87E-06). There were no significant differences in primary diagnosis or demographic characteristics between these two groups (p = 0.852, 0.974, respectively). 24.2% of PC patients (173 patients) were identified as LTFU. Of the LTFU patients, a lower percentage identified as White and higher percentages identified as Black, Asian and Other in comparison to the PC (p = 0.0413) and SQ (p = 0.00853) groups. LFTU patients proportionally had a higher percentage of DR (35.88%) and RVO (20.59%) primary diagnoses and a lower proportion of AMD (33.53%) primary diagnoses than patients in the PC (p=0.0011) and SQ (p=0.0014) groups. Conclusions : The COVID-19 pandemic resulted in disruption of normal ophthalmic clinic operations. Because Black and other non-white patients and patients with diabetic retinopathy made up higher percentages of the LTFU group, efforts should be made to understand and address any barriers to medically necessary follow-up during this unprecedented public health crisis.
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BACKGROUND: The Corona Virus 19 (COVID-19) infection is associated with worse outcomes in blacks, although the mechanisms are unclear. We sought to determine the significance of black race, pre-existing cardiovascular disease (pCVD), and acute kidney injury (AKI) on cardiopulmonary outcomes and in-hospital mortality of COVID-19 patients. METHODS: We conducted a retrospective cohort study of blacks with/without pCVD and with/without in-hospital AKI, hospitalized within Grady Memorial Hospital in Georgia between February and July 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on qualitative polymerase-chain-reaction assay. The primary outcome was a composite of in-hospital cardiac events. RESULTS: Of the 293 patients hospitalized with COVID-19 in this study, 71 were excluded from the primary analysis (for race/ethnicity other than black non-Hispanic). Of the 222 hospitalized COVID-19 patients included in our analyses, 41.4% were female, 78.8% had pCVD, and 30.6% developed AKI during the admission. In multivariable analyses, pCVD (OR 4.7, 95% CI 1.5-14.8, P=0.008) and AKI (OR 2.7, 95% CI 1.3-5.5, P=0.006) were associated with increased odds of in-hospital cardiac events. AKI was associated with increased odds of in-hospital mortality (OR 8.9, 95% CI 3.3-23.9, P<0.0001). The presence of AKI was associated with increased odds of ICU stay, mechanical ventilation, and acute respiratory distress syndrome (ARDS). CONCLUSION: pCVD and AKI were associated with higher risk of in-hospital cardiac events, and AKI was associated with a higher risk of in-hospital mortality in blacks.