Handwriting and Drawing for Depression Detection: A Preliminary Study

The events of the past 2 years related to the pandemic have shown that it is increasingly important to find new tools to help mental health experts in diagnosing mood disorders. Leaving aside the long-covid cognitive (e.g., difficulty in concentration) and bodily (e.g., loss of smell) effects, the short-term covid effects on mental health were a significant increase in anxiety and depressive symptoms. The aim of this study is to use a new tool, the "online” handwriting and drawing analysis, to discriminate between healthy individuals and depressed patients. To this purpose, patients with clinical depression (n = 14), individuals with high sub-clinical (diagnosed by a test rather than a doctor) depressive traits (n = 15) and healthy individuals (n = 20) were recruited and asked to perform four online drawing/handwriting tasks using a digitizing tablet and a special writing device. From the raw collected online data, seventeen drawing/writing features (categorized into five categories) were extracted, and compared among the three groups of the involved participants, through ANOVA repeated measures analyses. The main results of this study show that Time features are more effective in discriminating between healthy and participants with sub-clinical depressive characteristics. On the other hand, Ductus and Pressure features are more effective in discriminating between clinical depressed and healthy participants. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

A PATIENT WITH COVID-19 PNEUMONIA, PULMONARY EMBOLISM, AND OSA

SESSION TITLE: Global Case Reports in Critical Care SESSION TYPE: Global Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Thrombotic complications in patients diagnosed with COVID-19 pneumonia are emerging as an important and significant morbidity and mortality burden, with overwhelming inflammation, hypoxia, immobilization, and diffuse intravascular coagulation among possible causes of a procoagulant state (1). Obstructive sleep apnea (OSA), with intermittent arterial oxygen desaturation, may in its turn contribute to a procoagulant state, causing hemodynamic alterations as polycythemia and sluggish blood flow (2). Here we report on a case of sudden and massive non-lethal pulmonary thromboembolism (PTE) in a patient with COVID-19 severe pneumonia, for whom OSA was suspected and documented as a possible concurrent mechanism of thromboembolic complication during follow-up. CASE PRESENTATION: A 55-year-old male non-smoker obese (BMI 33 Kg/m2) was admitted to our hospital after 9 days of fever. In the Emergency Room, a chest HRCT scan showed bilateral diffuse ground glass opacities. He was treated with subcutaneous Tocilizumab (324 mg) single shot, Remdesivir (200 mg/day for first day and 100/daily for further 4 days), methyl-prednisolone 40 mg/daily, Enoxaparin 6000 UI/twice daily, azithromycin 500 mg/daily, high flow nasal cannula oxygen (50 L/min, TC 34°C, FiO2 35%) for moderate acute respiratory failure due to COVID-19 pneumonia (pO2: 58 mmHg, PCO2 34 mmHg pH 7.50, P/F 275). After 10 days, patient's clinical conditions worsened, needing non-invasive respiratory support;D-dimer increased abruptly, rising to 10 ng/mL, with findings consistent with PTE at a computed tomographic angiography (CTA, Fig 1). The patient was successfully treated with 10 mg/daily subcutaneous fondaparinux for 12 days, while assisted in the Intensive Care Unit, being discharged home in room air shortly later with oral anticoagulants. At the 3-month follow-up visit, OSA was suspected due to reported excessive daytime sleepiness and weakness, snoring, disturbed night sleep, morning headache in the last 4 years. The patient underwent a home sleep apnea test (HSAT) overnight. Test results revealed an AHI of 50 events/h, with several prolonged episodes of obstructive sleep apnea (307 apnea and hypopnea (A+H) events, 70 obstructive apnea and 233 hypopnea events, with a mean duration of 10% and an average arterial saturation of 93% (Fig. 2). He was adapted to CPAP therapy, with benefit and good correction of polygraphic indexes. DISCUSSION: The pathogenetic mechanisms of COVID 19 and OSA could have played a synergistic effect on endothelial damage, thus increasing the risk of thromboembolism. CONCLUSIONS: The presence of underdiagnosed comorbidities may well worsen the clinical course and complication of COVID-19;an earlier diagnosis of OSA is a prerequisite for timely treatment and, potentially, improved long-term clinical outcomes. Reference #1: Suh YJ, et al. Pulmonary embolism and deep vein thrombosis in COVID 19: a systematic review and meta-analysis. Radiology 2021;298 (2): E70-E80. Reference #2: Alfonso-Fernandez A., Garcia Surquia A., de la Pena M. OSA is a risk factor for recurrent VTE Chest. 2016;150 (6): 1291-1301. DISCLOSURES: no disclosure on file for Antonietta Esposito;no disclosure on file for Antonella Frattari;no disclosure on file for Giustino Parruti;no disclosure on file for Giorgia Patrizio;no disclosure on file for Pierpaolo Prosperi;no disclosure on file for Giorgia Rapacchiale;No relevant relationships by ANTONELLA SPACONE no disclosure on file for Giacomo Zuccarini;

Systematic review and meta-analysis on coronary calcifications in COVID-19.

Chest CT is valuable to detect alternative diagnoses/complications of COVID-19, while its role for prognostication requires further investigation. Non-pulmonary radiological findings such as cardiovascular calcifications could increase the predictivity of clinical outcomes of COVID-19 patients beyond pulmonary involvement. Several observational studies have reported mixed results on the role of coronary calcifications in COVID-19 patients as a predictor of hospitalization, ventilatory support, and mortality. The purpose of the study is to systematically review the available evidence on the predictive role of cardiovascular calcifications in SARS-CoV2 disease. The meta-analysis confirms the prognostic significance of coronary calcifications on hospital mortality, and coronary calcifications (CAC ≠ 0) were associated with an OR for mortality of 2.19 (95% CI 1.36-3.52). CAC was neutral on respiratory outcomes, but it was associated with an increased trend of cardiovascular events. Coronary calcium appears as a promising biomarker imaging even in short-term outcomes (MACEs, hospital mortality) in a non-cardiovascular disease such as Sars-CoV2 infection. Further large studies are needed to confirm promising results of this imaging biomarker in non-cardiovascular disease.

A University-designed Middle School Remote Summer Engineering Academy

The K-12 education platform has drastically taken a different route since the onset of the COVID-19 global pandemic. With the classroom being transitioned to online, educators are presented with many challenges to keep their class engaged. The curriculum of Science, Technology, Engineering, and Mathematics (STEM) is possibly the toughest to adapt to remote instruction, given that participants may no longer have access to many school labs or school STEM resources. Moreover, science and engineering in-person outreach programs are no longer feasible due to the pandemic and one cannot help but question whether the adoption of the hands-on instructional strategies pioneered by the Next Generation Science Standards (NGSS) will be able to be maintained. Faculty and graduate assistants at Stony Brook University in New York developed a unique, remote, yet hands-on engineering opportunity for middle school participants over the course of five 90-minute sessions of synchronous learning. Asynchronous learning was also available through a website populated with detailed manuals and short videos demonstrating the activities and office hours helped participants to clarify questions and finish their designs and prototypes. Through this Engineering Academy experience, participants (N=90), from across Long Island, were exposed to real-world applications of 3D printing and electrical and materials/chemical engineering, as well as the engineering design process. Questionnaires were administered pre- and post-every session to learn about participants' engineering literacy while post Academy surveys were collected to analyze both participants' engineering self-efficacy and knowledge. Future science and engineering curricular efforts may utilize and replicate the learned best practices to ensure a sustainable implementation of the NGSS via online or hybrid (online and in-person) learning opportunities. © American Society for Engineering Education, 2021

The role of cardiovascular calcifications in COVID-19

Background: Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated. Purpose: The principal aim was to evaluate the association of coronary artery calcium (CAC) and total thoracic calcium on in-hospital mortality in COVID-19 patients. Then, to evaluate the prognostic impact of clinical and subclinical coronary artery disease (CAD), as assessed by CAC. Methods: 1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included in the SCORE COVID-19 registry (calcium score for COVID-19 Risk Evaluation). At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Corelab blinded to patients' outcomes. A specific sub analysis on CAC was performed stratifying the patients in three groups: (a) “clinical CAD” (prior revascularization history), (b) “subclinical CAD” (CAC >0), (c) “No CAD” (CAC=0). In-hospital mortality was the primary endpoint, while a composite of myocardial infarction and cerebrovascular accident (MI/CVA) was the secondary one. Results: Non-survivors compared to survivors had higher coronary artery [(487.7±565.3 vs 207.7±406.8, p<0.001)], aortic valve [(322.4±390.9 vs 98.2±250.7 mm2, p<0.001)] and thoracic aorta [(3786.7±4225.5 vs 1487.6±2973.1 mm2, p<0.001)] calcium values. Coronary artery calcium (HR 1.308;95% CI, 1.046 - 1.637, p=0.019) and total thoracic calcium (HR 1.975;95% CI, 1.200 - 3.251, p=0.007) resulted to be independent predictors of in-hospital mortality. In the sub - analysis increasing rates of in-hospital mortality (11.3% vs. 27.3% vs. 39.8%, p<0.001) and MI/CVA events (2.3% vs. 3.8% vs. 11.9%, p<0.001) were observed from the No CAD to the clinical CAD groups. Among patients with subclinical CAD, increasing CAC burden was associated with higher rates of in-hospital mortality (20.5% vs. 27.9% vs. 38.7% for patients with CAC score thresholds ≤100, 101-400 and >400, respectively, p<0.001) Conclusion: Coronary, aortic valve and thoracic aortic calcium assessment on admission non-gated CT permits to stratify the COVID-19 patients in-hospital mortality risk. Cardiovascular calcifications may represent a bystander of an impaired vascular reserve, both microvascular and endothelial, but also a sign of vascular senescence. Therefore, it can be considered an index of biological frailty, likely more accurate than age and other risk factors. (Figure Presented).

COVID-19 related risk in patients enrolled in early-phase clinical trials

Background: Early phase clinical trials often represent a therapeutical opportunity for cancer patients (pts). However, high logistic commitment is demanded for participation. Here we explore the COVID-19 related risk during the pandemic for pts enrolled in clinical trials compared to pts receiving standard treatments. Methods: We retrospectively assessed the incidence of COVID-19 in pts treated in our Department from March 2020 to April 2021. Pts were divided into two groups;those enrolled in phase I/II clinical trials (A) and those being treated with standard therapies (B). Logistical (telemedicine and drug home-delivery), as well as clinical, characteristics of susceptibility to COVID-19 and number of events (SARS-CoV2 infections) were collected. The number of teleconsultations and COVID-19 events among the two groups were compared through Fisher’s exact test. Results: 115 pts were evaluated: 36 pts (31%) in A and 79 pts (69%) in B. Pts in A were younger, with a median age of 55 years (range 39-77) compared to 62 years (range 31-83) in B. Performance status (PS, ECOG) was similarly distributed: 0 (A 78%, B 83%), 1-2 (A 22%, B 17%). The median of previous treatment was 1 in A (range 0-9) and 2 (range 0-14) in B. The majority of the pts had at least one comorbidity in both groups (A: 72% and B: 83%). None of the pts had pulmonary comorbidity in A and 6% in B. Obesity was similarly distributed (A 11%, B 14%). The mean of monthly scheduled accesses was 1,5 in both groups. However, teleconsultation and delivery of oral cancer treatments at home were given, at least on one occasion, to only 6% of pts in A compared to 43% in B (p<0.01). A total of 15 COVID-19 cases were observed (13%): 8 (22%) in A and 7 (8%) in B. No statistically significant difference was observed (p = 0.068). Conclusions: Pts enrolled in early phase clinical trials had a significantly lower chance to perform teleconsultations compared to pts receiving standard therapy. Even if a trend was observed, they did not have a higher risk of contracting COVID-19. Future pts should then be encouraged to participate, if indicated. Considering the small numbers of pts in our cohorts, the foreseen trend toward a higher infection risk and the subsequent implications should be further explored in larger populations. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: G Curigliano: Financial Interests, Funding: Roche;Financial Interests, Funding: Novartis;Financial Interests, Funding: Lilly;Financial Interests, Funding: Pfizer;Financial Interests, Funding: Seattle Genetics. All other authors have declared no conflicts of interest.

The Impact of the COVID-19 Pandemic on Medical Student Residency Specialty Selection

Background: The COVID-19 pandemic has had an unprecedented impact on the medical community, including in the way that medical students are educated. While media outlets have portrayed health care workers actively battling this disease, there has been little to no discussion of how the pandemic has affected medical students. Currently practicing physicians chose their specialties long before the threat of this novel coronavirus was known. It is unclear how the pandemic may change the mindset of current medical students and their decisions regarding their choice of residency specialty following graduation. Study Objectives: The purpose of this study was to determine if the COVID19 pandemic has affected future residency specialty choices for current M.D. candidate students. Methods: In September 2020, a brief (approximately 3 minute) anonymous survey of first through fourth-year medical students was created utilizing Qualtrics software and emailed via medical school listservs. Survey questions included basic demographics, what residency specialty they plan to pursue, and what residency specialty they planned to pursue prior to the COVID19 pandemic. The electronic survey was disseminated to current M.D. candidate students (first year [MS-1] through fourth year [MS-4]) at a large, suburban medical school in New Jersey with over 600 students over four clinical and pre-clinical years. A 14 day period was provided for medical students to complete the survey, with a reminder sent to students at the 7 day mark. Results: A total of 87 medical students responded to the survey. Of those that responded, 21% were MS-1, 18% were MS-2, 29% were MS-3, and 29% were MS-4. Eighty-six participants chose to report a sex. Of those, 60% identified as female. Seventy percent of those who responded knew someone personally who was negatively affected by the COVID-19 pandemic. Eleven respondents intended to go into emergency medicine. Five medical students planned on selecting a different residency specialty based on the pandemic. Of those, two had initially planned to pursue emergency medicine and changed specialties based on the pandemic (to radiology and ophthalmology). Of the remaining students, they made the following changes in specialty: psychiatry to anesthesiology, orthopedic to general surgery, and obstetrics/gynecology to undecided. Of these five students who switched specialties, 4 (80%) knew someone negatively affected by COVID-19. Conclusions: Despite the COVID-19 pandemic and the effect it has had on medical student education, the majority of current medical students who responded to this survey have not let it affect their decision regarding which residency specialty to pursue. Of the small sample of students in this survey that did change their decision regarding residency specialty, two students made the decision to switch from emergency medicine to radiology and ophthalmology.

Is pleural effusion in COVID-19 interstitial pneumonia related to in-hospital mortality?

The recent severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) pandemic has highlighted the importance of pulmonary computed tomography (CT) for diagnosis and prognostic stratification of this new viral pneumonia. 1370 lung CT scans (performed at the time of admission) of consecutive patients hospitalized for SARS-CoV-2 in Northern Italy during the first epidemic wave were analyzed by a radiological CoreLab. The presence of pleural effusion on pulmonary CT scan was present in 188 patients (13.3% of the population) and identified a population with more comorbidities. Patients with pleural effusion had more cardio-respiratory complications with higher mortality. Pleural effusion was an independent predictor of death on multivariate analysis with an HR of 1.4 (95% confidence interval 1-1.9). Pulmonary CT pleural effusion was an independent predictor of mortality.

Self-perception of psychological distress duringthe lock-down period of COVID-19 pandemic crisis

Background and Aim: We evaluated the psychological distress(PD) associated with self-perception of personal and family resources, loneliness, and aging during a lock-down period at home.Materials and Methods: 697 subjects answered a questionnaire.We registered age, gender, family status, working status and measured several items associating various validated tests. We measured the self-perception: a) of stress factors such as occupationalrisk and fear about own health;b) of one's personal and familyresources, related with emotion regulation, behavioral, and socialcoping strategies;c) of loneliness and psychological distress;d)toward own aging. Analysis was performed by measuring a scorecalculated for groups of subjects subdivided by gender, agegroups, family status and working position. Student's T-test for acomparison between means and Chi-square test for a comparisonbetween percentages were used. A p value <0.05 was consideredsignificant.Results: Women perceive PD more than men (p<0.004);youngerpeople more than older people (p<0.02);those who live with morethan 2 family members perceive PD more than those who livealone or with one family member (p<0.001);among the categories that remained at home (students, housewives and retirees)students perceive greater PD (p<0.01);those who have to go towork perceive PD more than those did smart working (p<0.003). Conclusions: In the event of a lock-down it is necessary to paymore attention and offer psychological support to the women, theyoung subjects, in those who work outside, and in those who livein numerous families.