Remote Pulse Estimation in the Presence of Face Masks

Remote photoplethysmography (rPPG), a family of techniques for monitoring blood volume changes, may be especially useful for contactless health monitoring via face videos from consumer-grade cameras. The COVID-19 pandemic caused widespread use of protective face masks, which results in a domain shift from the typical region of interest. In this paper we show that augmenting unmasked face videos by adding patterned synthetic face masks forces the deep learning-based rPPG model to attend to the periocular and forehead regions, improving performance and closing the gap between masked and unmasked pulse estimation. This paper offers several novel contributions: (a) deep learning-based method designed for remote photoplethysmography in a presence of face masks, (b) new dataset acquired from 54 masked subjects with recordings of their face and ground-truth pulse waveforms, (c) data augmentation method to add a synthetic mask to a face video, and (d) evaluations of handcrafted algorithms and two 3D convolutional neural network-based architectures trained on videos of unmasked faces and with masks synthetically added. © 2022 IEEE.

Coronary Artery Dilation in Pediatric Patients with Asymptomatic or Mild COVID-19 Infection

Background: COVID-19 infection and Multisystem Inflammatory Syndrome in Children (MIS-C) in hospitalized pediatric patients have been associated with cardiac manifestations . Generally, children have asymptomatic or mild COVID-19 infection and MISC is rare. We examined the cardiac implications of asymptomatic or mild COVID-19 infection in non-hospitalized children to better define this outcome. Methods: We queried the electronic medical record for patients ≤18 years-old referred for outpatient pediatric cardiology evaluation following COVID-19 infection from 5/1/2020 - 4/30/2021. We excluded patients without a confirmatory COVID test (PCR or serology), who had been hospitalized for any condition related to COVID-19 (including MIS-C), or with history of cardiac disease that could affect coronary artery dimension. We recorded electrocardiogram (EKG) and echocardiogram (ECHO) findings, and laboratory studies performed during a preceding emergency department or most recent cardiology clinic visit. Results: Of 277 records reviewed, 134 met inclusion criteria (Figure 1);mean age 9.6 +/- 5.4 years, 53% male. 131 patients had a normal or minor variant on EKG and ECHO (Table 1). Three patients had coronary artery (CA) abnormalities on ECHO: 1) 7-year-old male with history of mild COVID-19 infection;borderline left main CA dilation (Z-score +2.1 on largest measurement). Plan for close follow-up and repeat ECHO. 2) 16-year-old male with positive COVID serology;dilated right CA (Z-score +2.3);started on aspirin. Plan for close follow-up, repeat ECHO, and possible CT angiography. 3) 8-yearold male with history of mild COVID-19 infection;dilated left main CA (Z-score +2.6);started on aspirin;CT angiography confirmed enlarged left main CA. Plan for close follow-up and repeat ECHO. Prior to COVID-19 this patient had an ECHO with normal CA dimensions (Z-score -0.4). Conclusion: While cardiac disease in children with COVID-19 infection is uncommon, we report three pediatric patients who may have developed CA dilation following confirmed mild or asymptomatic COVID-19 infection. Current return to play guidelines recommend cardiology evaluation after moderate to severe COVID-19 infection, as studies have reported myocarditis in young healthy athletes. Our study adds to the body of literature on COVIDrelated cardiac disease and may have important implications for post-COVID surveillance in young healthy children following minimal illness. Data collection is ongoing.

Change in Food Purchasing Patterns and Increased Reliance on Support Programs During the COVID-19 Pandemic in Inner-City Dialysis Patients

We investigated how food purchasing behavior changed in a cohort of inner-city dialysis patients during the COVID-19 pandemic. 33 dialysis patients were surveyed face-to-face about use of grocery stores, restaurants, take-out, and use of SNAP or other benefits over the past year. The survey also assessed patient attitudes and fear relating to COVID-19. Mean age was 57.1±17.9 yrs, 20 (61%) men, 91% identified as Black. 9/20 pts (27%) reported yearly income under $20,000 with 70% less than $40,000. The number of pts using SNAP, WIC, or Greenmarket Bucks to buy groceries increased from 21% before the pandemic to 33% after (p=0.019). Age correlated negatively with feeling safe eating at a restaurant indoors (r=-0.47, p=0.008), or outdoors (r=-0.58, p=<0.001) and increased use of take-out since the start of the pandemic (r=-0.39, p=0.032). There was a significant difference in pts who purchased breakfast (45.9±4.0 vs 65.3±3.6, p<.001), lunch (49.7±4.1 vs 65.3±4.0, p=.006), and dinner compared to those who didn’t (48.5±4.9 vs 60.9±3.9, p=0.031). There was a positive correlation between income and the frequency that pts purchased breakfast (r=0.45, p=0.048) and lunch (r=0.45, p=0.046). There was a negative correlation between age and the statement “I wish I could cook more meals at home” (r=-0.497, p=0.004) and a positive correlation with income (r=0.06, p=0.006). There was no association between age and income. Only 6% (2) pts were employed and both were <60 yrs old. In our population of inner-city dialysis pts: 1. Use of food assistance programs increased since the start of the pandemic. 2. Older pts felt less safe eating at restaurants regardless of whether it was indoors or outdoors and were more likely to make meals at home. 4. Younger patients were more likely to eat take-out food and reported they wished they could cook more meals at home. 5. Increased use of food programs and association of younger age or lower income with eating out suggests that careful nutritional guidance should be emphasized as dietary habits have changed since the pandemic and eating out has been associated with worse adherence to sodium and other restrictions in pts on dialysis.

Stress and Adherence During the COVID-19 Pandemic in an Inner-City Population of Dialysis Patients: Relationship to Age

It has been reported that older pts adapt better to dialysis than younger pts. We investigated in response by age to various stressors encountered during the COVID-19 pandemic in a population of inner-city dialysis patients. A survey was conducted in a random sample of 32 dialysis patients. Patients were asked about their fluid intake, general attitudes towards medical recommendations, and changes in their wellbeing due to COVID19. The PSS (Perceived Stress Scale) and KAS-R (Kim Alliance Scale Revised) were also used. Mean age was 56.8 ± 18.2 years. 15 pts (46.9%) were <60 yrs (younger) and 17 (53.1%) were ≥60 yrs (older). Mean dialysis time was 88.0 ± 104.0 months. There were 20 (62.5%) male, 29 (90.6%) identified as black, 18 (56%) had a high school diploma or less, and 14 (44%) completed some college or more. 7% (1) of older and 46% (6) of younger pts reported “some of the time” or “never” rather than "most of the time" when asked how often they followed the fluid restriction recommendations (p=0.034). 29% (4) of younger pts reported fluid restrictions were difficult to follow, vs. none of the older pts (p=0.037). 33% (5) of younger pts reported “poor” or “average” when asked about wellbeing prior to the pandemic and 100% (15) of older patients reported “good” (p=0.05). When asked to rate their stress level over the last year, 64% (9) of younger pts reported being somewhat or very stressed and 79% (11) of older pts reported not at all or a little stressed (p=0.015). 29% (4) of younger pts stated they sometimes work well with their provider and 100% (15) of older patients stated always (p=0.026). There were no statistically significant differences between the groups for sex, race, or education. In our population during the pandemic: 1. Younger pts were less adherent to fluid restriction and found them more difficult to follow. 2. Older pts were more likely to report feeling good prior to the pandemic and were less stressed following it. 3. Older pts were more likely to report a good relationship with their provider. 4. Younger pts may need more support through the pandemic as they appear to be coping less well, feel less connected, and are less able to follow important dietary restrictions. (Table Presented) This case highlights the uncommon sequelae of untreated primary hyperparathyroidism which is rare since the introduction of automated chemistry analyzers [2]. Pancreatitis is reported in < 3% of patients with hyperparathyroidism and is seldom seen in current practice. Nephrocalcinosis and pancreatitis are rare complications of untreated hyperparathyroidism and could have been averted with the definitive treatment of parathyroidectomy.

Managing outpatients on vitamin k antagonists (VKAS) during the COVID-19 pandemic in a tertiary referral hospital

Background: While the use of vitamin K antagonists (VKAs) has markedly reduced since the introduction of direct oral anticoagulants (DOACs), they are still the anticoagulant of choice for certain patients. The COVID-19 pandemic has resulted in anticoagulation clinics having to adapt services to ensure that anticoagulation is safely monitored, while minimising viral transmission to patients and staff. Contingency planning for staff absences also needed to be considered. Aims: To review the success of the strategies adapted for outpatient management of VKAs during the Covid-19 pandemic. Methods: Patients attending the anticoagulation clinic were managed as per the algorithm in Figure 1. Performance of the clinic was monitored using time in therapeutic range (TTR) and extreme INR values <1.5 and >4.5 during this time period using DAWN® anticoagulation software. Results: 504 patients required INR monitoring during the pandemic (See Figure 2). A total of 8588 INR tests were carried out with an overall TTR of 74% and 6% of extreme INR values. The percentage time in range of the Covid-19 pathway patients was 39% (15/39) of which 17% (7/39) had extreme INR values. There were a total of 314 days of Covid-19 leave due to contact isolation and vulnerable staff in the department. Conclusions: Under normal circumstances, patients on VKAs require regular monitoring to ensure safe and efficacious anticoagulation. Covid-19 patients require more frequent monitoring when ill due to changes in their oral intake and commencement of interacting medications. The global Covid-19 pandemic has made regular monitoring of these patients more difficult due to the potential for spread of the virus between patients and staff. However, following a global review of the service, proper monitoring and patient care has been safely achieved by the careful triage of patients, the use of personal protective equipment and the use of virtual consultations.