Virtual Cardiac Point-of-Care Ultrasound Curriculum Among Residents: A Medical Education Project

INTRODUCTION: Point-of-care ultrasound (POCUS) is becoming increasingly important for rapid assessment and diagnosis in a variety of clinical situations. With the ongoing COVID-19 pandemic, the aim of this study is to determine whether a virtual POCUS session can improve learner competency in assessing left ventricular (LV) systolic function. METHOD(S): An hour long session, involving a short lecture and fourteen practice questions was created. The questions consisted of cardiac ultrasound clips from real patients, evaluated by three POCUS experts. For each clip, LV systolic function was classified as hyperdynamic, normal, reduced, or severely reduced. The session was given separately to a group of interns (n1=30) and a group of senior residents (n2=39) virtually via Zoom. Series of clips were shown as the lecture progressed and participants recorded their answers as either hyperdynamic, normal, reduced, or severely reduced using the polling feature within the Zoom platform. Effect size as the percent of correct responses was calculated. Data was analyzed using SPSS software with independent t-test and paired t-test analysis with a level of statistical significance as p <=0.05. Result(s): The intern group had a mean score of 69.9% [SD 21.8%] and the resident group had a mean score of 74.2% [SD 21.5%]. All participants achieved a mean score of 66.6% [SD 26.0%] during the first half of the lecture, which then improved to 77.6% [SD 14.2%] in the second half [p value 0.547]. Both groups showed similar overall trends, although these were not statistically significant. When combined, extremes of LV function (hyperdynamic and severely reduced) were better recognized than more subtle differences (reduced and normal) [81.4%+/-18.1 vs 55.2+/-15.9;p = 0.001] overall. Conclusion(s): Compared to the conventional in-person approach, this study highlights the potential for virtual didactic sessions in POCUS training with impressive results when recognizing extreme cardiac findings.

The Creation of a Rapid Psychiatric Stabilization Team for Psychiatric Surge Volumes

Background: The COVID-19 pandemic has impacted our community in many ways, with negative downstream effects on the mental health system. Greater limitations on community resources have resulted in increased emergency room visits for acute mental health treatment. The increase in patients, along with limited resources, has led to patients boarding for hours to days in emergency rooms and medical floors. Method(s): Given the need for acute psychiatric treatment in the ED and medical floor, a rapid psychiatric stabilization (RPS) team was created. This team consists of 2 complex case BH managers, ED BH case managers, advanced practice clinicians, and psychiatrists;they meet virtually each morning to deploy resources where needed. The goal is to start active psychiatric treatment at time of presentation. Result(s): Examples of cases treated by the RPS team: Example #1: J.R. is a 10 yr. old who presented to the ED for increasing aggressive behaviors. Initial recommendation was for inpatient psychiatric admission;however, no bed was able to be secured. A psychiatrist met with J.R. daily and started medication for his aggression. After 4 days in the ED, J.R was stable for discharge, with an aftercare plan arranged by the complex BH case manager. Additionally, the team collaborated with his pediatrician to obtain prior authorization for psychotropic medication until an outpatient psychiatric appointment was secured. Example #2: H.B. is a 28 yr. old who presented to the ED with SI, however, was medically admitted due to being COVID positive. She was treated psychiatrically on the medical floor. As a result, she was discharged prior to her 10-day quarantine was completed, due to her positive response to treatment, and with psychiatric follow up arranged by the complex BH case manager. Prior to establishing the RPS team, discharges from the medical floor would have been difficult due to the inability to set up aftercare. Discussion(s): The American Academy of Child and Adolescent Psychiatry and Children's Hospital Association have declared a national emergency in children's mental health (1). Data from Mental Health America showed that any mental illness has increased 5% nationally, with a 7.6% increase in Pennsylvania (2). Additionally, adults with serious thoughts of suicide have increased 6% nationally and 16% in Pennsylvania. At LVHN-Lehigh Valley, psychiatric emergency room presentations have increased 1,401 (20%) compared to last year and are projected at 8,398. Clearly, demand for psychiatric treatment has grown, creating strain on the limited recourses available. Conclusion(s): The increased need for psychiatric treatment, coupled with the reduction of community resources, will cause psychiatric providers to rethink and redesign care in the post-pandemic world. The deployment of a RPS team to actively treat patients in non-traditional psychiatric settings is just one attempt at dealing with the psychiatric crises. Copyright © 2022

Health Care Worker's Perception Survey and Psychological Distress during the Covid-19 Pandemic: An Indian Context

Objective: Health professionals struggled with additional stress as compared to the rest of the population during the time of COVID19 Pandemic. Previous reports and current data suggest that tremendous burden led to many stress disorders among the health care workers and their long-term effects on their state of mind need to be studied to take necessary measures. This study has been designed to assess the level of stress and other psychiatric disorders among HCWs and the role of administration to overcome it. Method: This survey based retrospective study was conducted across multiple Centres and data from health care workers who were in direct contact with confirmed or suspected cases were collected and analyzed. Result: Data were compared on the basis of different parameters, i.e., category, gender, age, marital status, years of work experience per se with the degree of stress. Our study shows significant degree of stress among the healthcare workers during and post pandemic. Nursing staffs and doctors were affected significantly with higher degree of stress. Overall higher stress was observed among females as compared to the males;and among youngers and HCWs with lesser years of work experience. Conclusion: This study is the first of its kind assessing stress levels in the health care workers on every aspect in great details. Our study also observed that instead of using Headington scale to classify the degree of stress, if we can compare stress scores using different statistical tools, obtained results are more reliable and it can accurately assess the degree of stress.

Nasal Irrigation to Prevent and Treat Viral Upper Respiratory Tract Infections During the COVID-19 Pandemic

Introduction: Nasal irrigation is a common treatment used for symptomatic relief during a viral upper raspatory tract infection. It is currently unknown if the regular use of nasal rinses contributes to a reduction in viral load and transmissibility in patients with upper respiratory tract infections, including COVID-19. Method(s): A systematic review was completed in April 2022 with predefined search criteria using keywords related to nasal irrigation and viral illnesses. Common nasal solutions used for irrigation, including saline, corticosteroid and providineiodine were included. Databases included MEDLINE, Embase, Web of Science, Cochrane, ClinicalTrials.gov. Data related to the type of nasal rinse, virus studied, effects on symptoms, viral load, and transmission were gathered in a standardized data extraction tool. Result(s): Title and screening was performed for 1267 unique results, where 65 studies received full-text review and 12 were included in data extraction. Eight of these 12 studies looked specifically at COVID-19. Six out of 10 randomized controlled trials (RCTs) used saline, 3 used providine- iodine, and 1 used an intranasal corticosteroid. Eight out of 10 RCTs showed that nasal irrigation reduced upper respiratory tract symptoms. Three trials showed a reduction in viral load. Four studies demonstrated a reduction of viral load in the nasopharynx. Four studies reported data on side effects. The most common was mild nasal irritation. Study methods were heterogeneous. Data on transmission were reported in only 1 study. Conclusion(s): Nasal irrigation is well tolerated in patients with viral upper respiratory tract infections with minimal risk. The data for nasal rinses for the prevention and treatment of viral infection are limited, and there are conflicting results. Saline and providine-iodine rinses may have some efficacy in reducing viral titres. While nasal rinses appear to be beneficial in reducing nasal symptoms of an upper respiratory tract infection, a larger scale study is needed to identify if these rinses impact the viral load, illness severity, and transmissibility in patients with COVID-19.

A Rare Cause of Angioedema - A Novel Case Report

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is well described as an etiology to severe acute respiratory distress syndrome (ARDS). However, rare immunologic and allergic manifestations may also occur from this infection. We report a novel case of angioedema occurring in the setting of COVID-19 infection in a fully vaccinated patient. Case Report: A 61-yearold COVID-19 vaccinated female with hypertension presented to the emergency department with tongue and lip swelling, odynophagia, dysphonia, and difficulty breathing. She denied personal or family history of allergies, anaphylaxis, or angioedema. Her home medications included Aspirin, methadone, Seroquel, and Klonopin, with no recent changes reported. Physical exam was notable for significant lip and tongue edema, audible dysphonia, and bilateral end-inspiratory wheezing. She was hypoxemic and placed on nasal cannula. Laboratory findings revealed lymphopenia, elevated inflammatory proteins, including C-reactive protein (57), Lactate dehydrogenase (LDH) (238), and D-dimer (11.52). Functional C1 esterase inhibitor levels (>91) were normal. Nasal PCR swab returned positive for SARS-CoV-2. Ear, nose, and throat specialist was consulted given concern for angioedema, and flexible nasolaryngoscopy was performed revealing uvular, epiglottic, and bilateral arytenoid edema concerning for impending airway compromise. The patient was initiated on intravenous methylprednisolone, epinephrine, antihistamines, tranexamic acid and admitted to the medical intensive care unit (ICU). She was monitored closely in the ICU with subsequent improvement of the angioedema and resolution of the hypoxemia. She was discharged with an oral steroid regimen and scheduled for a follow-up appointment with an allergist. Discussion: There exists only a handful of case reports describing angioedema in patients with COVID-19 infection. In those reports, patients also had normal C1 esterase inhibitor levels and no personal or family history of inherited angioedema. Interestingly, our patient was vaccinated six months prior to her presentation. The association between SARS-CoV-2 and angiotensinconverting enzyme 2 (ACE-2), the primary receptor for viral entry into the epithelial cells of the lungs, could be a potential explanation for the occurrence of angioedema. ACE-2 plays a pivotal role in inhibiting a potent ligand of bradykinin receptor 1, Arginine bradykinin. It has been postulated that SARS-CoV-2 downregulation of ACE-2 leads to elevated angiotensin II levels and subsequent activation of the bradykinin pathway. Excessive bradykinin production generates high levels of nitric oxide and prostaglandins, resulting in vasodilation, increased vascular permeability, and angioedema. This case highlights the importance of recognizing atypical and rare presentations of COVID-19 infection, especially angioedema, given its sudden onset and life-threatening complications.

Electric Vehicles Load Forecasting Considering the Effect of COVID-19 Pandemic

This study addresses the problem of the electric vehicles load forecasting through the application of a modified Kalman filter method. The electric vehicles charging demand for the years 2019 to 2020 are used to predict the electric vehicles load demand for the year 2021, which incorporate the effect of COVID-19 pandemic. Such effect on the electric vehicles load and the forecasting method are discussed and the conclusion are drawn.

Clinical profile and outcome of coronavirus disease-2019 in kidney transplant recipients admitted to a tertiary care center: A retrospective study

Background: The mortality of kidney transplant recipients (KTR) affected with coronavirus disease-2019 (COVID-19) is reported to be higher than the general population. There is a scarcity of data on the pattern and outcome of COVID-19 in KTRs in developing country like India. Materials and Methods: It was a retrospective study conducted in a tertiary care center in North India. The detailed data on the Covid-19 affected KTR admitted to our center from March 2020 to March 2021 was obtained from computerized records. Clinical and biochemical characteristics of the survivors and nonsurvivors were studied. The factors affecting the mortality in this cohort were analyzed. Results: Of the 35 participants, 25 (71.4%) were males. The mean age was 53.06 & PLUSMN;11.84 years. Overall, mortality was 17.1% (Six out of 35). There was a significant difference in the oxygen saturation at presentation, computed tomography severity scores, level of inflammatory markers, level of serum albumin, and the absolute lymphocyte count (ALC) between the survivors and nonsurvivors (P < 0.05). On univariate regression analysis, serum C-reactive protein, ferritin, albumin, and ALC were found to be significantly predicting mortality in COVID-19 affected KTR. Conclusions: Mortality rate in COVID-19 affected KTR is higher than in the general population. Clinical, biochemical, and radiological parameters can be helpful in predicting the adverse outcome.

LEGIONELLA INFECTION IN THE MIDST OF COVID-19 PANDEMIC

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: With the COVID-19 pandemic, when 90% of ICU has COVID-19 patients, it's common to overlook other rare causes of acute hypoxic respiratory failure. Our case highlights the importance of maintaining a broad differential for pneumonia and importance of early urine legionella antigen testing. CASE PRESENTATION: 55 year-old male with no significant medical history presented with 8 day history of fever, chills and dry cough. Exam was unremarkable except bilateral rales. Labs were significant for elevated inflammatory markers done as part of a COVID panel with C-reactive protein >190, troponin 0.063, d-dimer >20, ferritin 15k, lactate dehydrogenase 682, Creatinine kinase 553 and WBC 31.1, absolute lymphocyte 0.7, AST 179, ALT 91, ALP 164, Total Bilirubin 6.0, Sodium 123, BUN 130, Creatinine 12.4. Chest X-ray significant for bilateral ground glass opacity, He was admitted to ICU for acute hypoxic respiratory failure. Despite high suspicion, COVID-19 test was negative thrice, including lower respiratory sampling. However, his urine legionella antigen testing was positive. ICU course was complicated by septic shock, renal failure requiring renal replacement therapy, acute liver failure and acute respiratory failure requiring mechanical ventilation and later tracheostomy. He was treated with 14 day course of antibiotics and later weaned off the ventilator. DISCUSSION: Severe legionnaires' disease, though uncommon, has a very similar presentation as COVID-19 pneumonia. Fever, dry cough, shortness of breath, diarrhea being the most common clinical presentation, whereas laboratory findings significant for elevated inflammatory markers including CRP, CK and LDH are noted in both the diseases (1). Liver and renal failure are also equally involved in both the disease. However, severe hyponatremia and elevated WBC count should raise higher suspicion for Legionella than COVID-19. Our patient presented as a diagnostic challenge with many clinical features that resemble both diseases. The early detection of Legionella pneumonia was imperative to our patient's recovery with prompt treatment with empiric antibiotics. First-line diagnostic testing typically occurs by looking for urine antigens, which tests for the most virulent legionella species, L. pneumophila serogroup 1 (2). Although culture diagnosis remains the gold standard and the most specific diagnostic testing, urine antigen testing allows for early diagnosis and earlier tailoring of antibiotics (3). Thus, for all patients with increased suspicion for COVID-19, we recommend co-testing for urine legionella antigen to rule out Legionnaires' pneumonia. CONCLUSIONS: In conclusion, our case report suggests that we should not overlook typical presentations of known diseases even in the midst of a pandemic. It serves as a reminder to continue early testing for treatable diseases, like Legionella, so as to not miss an opportunity to save a life. REFERENCE #1: Huang C Wang Y Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;(published online Jan 24). https://doi.org/10.1016/S0140-6736(20)30183-5 REFERENCE #2: Cunha BA, Burillo A, Bouza E. Legionnaires' disease. Lancet. 2016;387(10016):376-385. doi:10.1016/S0140-6736(15)60078-2 REFERENCE #3: Fields BS, Benson RF, Besser RE. Legionella and Legionnaires' disease: 25 years of investigation. Clin Microbiol Rev. 2002;15(3):506-526. doi:10.1128/cmr.15.3.506-526.2002 DISCLOSURES: No relevant relationships by trisha arno, source=Web Response No relevant relationships by Brian Cuneo, source=Web Response No relevant relationships by Kejal Gandhi, source=Web Response

Impact of COVID 19 pandemic on thesis by anaesthesia trainees in a tertiary care institute of north India

Background and aims: The COVID19 pandemic prioritises care for COVID patients and working practices in hospitals have been radically adjusted accordingly. It has deeply impacted structured anaesthesia training in medical institutes. Conduct of thesis by trainees (mandatory research work as a partial fulfilment for requirement of degree) especially with non-COVID19 related topics has also been affected. Aim of this cross-sectional, observational trial is to assess the impact of COVID19 pandemic on thesis by anaesthesia trainees in a tertiary care institute of north India. Methodology: After obtaining institute ethical committee approval, the study protocol was prospectively registered with Clinical Trial Registry of India (CTRI/2020/12/029724). Eligible anaesthesia trainees (MD as well as DM super-specialty courses) of Department of Anaesthesia and Intensive Care at our institute were asked to fill the self-administered questionnaire using Google forms. Submission of Google forms was considered as consent for participation. Duration of the survey was limited to 1 week. The primary objective was to assess number of thesis affected by ongoing pandemic. The secondary objective was to find factors affecting the conduct of thesis during pandemic. Results: Out of 92 eligible anaesthesia trainees, 85 responded to the questionnaire. 71 (83.52%) perceived some delays in the conduct of thesis. During thesis planning phase, the most common cause was inability to meet statistician, followed by delay in topic selection, and inability to meet the mentors. During study execution phase, travel restriction for patients, curtailment of elective surgeries as well as investigators' COVID duties/ quarantine leaves were more commonly associated with delay. During study completion phase, inability to have frequent meetings with mentors as well as to get statistical analysis done resulted in delay. Conclusion: Conduct of non-COVID19 related thesis by anaesthesia trainees have been significantly affected during the COVID19 pandemic.

Characteristics of mild to moderate COVID-19 infection from an urban ambulatory COVID-19 clinic-a guide to triage patients in the clinic

Introduction:Since the start of the pandemic, COVID-19 has spread rapidly. It presents with flu-like symptoms and can cause serious complications in high-risk individuals. Here, we discuss the presentation of COVID-19 infection in an ambulatory setting. Method:Data was collected from all patients who visited the COVID-19 clinic from 03/11/2020- 06/14/2020. Testing was done based on the CDC guidelines at the time using a PCR method. Medical records were reviewed and captured on a RedCap database. Statistical analysis was performed using both univariate and bivariate analysis using Fischer's exact test with 2-sided p values. All analyses were done in person with a high predictive valve per CDC guidelines for testing, and not in general population. Results:Of the 2471 total evaluated patients, 846 (34.2%) were positive for COVID-19. The mean age was 43.4 years (SD+/-15.4), 60.1% were female and 48.4% were Black. There was known exposure to COVID-19 in 58.7% of all people tested, and amongst those with exposure, 33.3% were positive. Hospitalization occurred in 101 patients (11.1%), with a median number of days from testing to hospitalization of 2 (range 0-25) and the median length of stay of 6 days (range 1-51). A total of 22 patients (23.4% of hospitalized patients) required ICU admission and 10 patients died. The overall death rate of patients presenting to COVID clinic was 0.4%, or 1.2% amongst those who tested positive. When compared to patients without COVID-19 infection, the symptoms significantly associated with COVID-19 positivity included anosmia, subjective fever, change in taste, anorexia, objective fever, myalgias, cough, chills and fatigue (Figure 1). No significant differences were noted in other presenting symptoms and vital signs. An increased risk for COVID-19 infection was seen in diabetics [OR 1.39, CI1.09-1.77]. Whereas, individuals with lung disease, asthma and malignancy were not associated with increased risk of COVID-19 infection. No statistically significant association with COVID-19 infection was found in individuals with hypertension, heart failure, COPD, HIV, CKD, ESRD and immunocompromised state. Discussion:Blacks and females had the highest infection rates. Most patients with mild to moderate disease did not require hospitalization. The hospitalization rate was 11.1%, while the death rate for patients who visited COVID-19 clinic was <1%. This suggests there is a broad gap in mortality of those who are very ill and require hospitalization to those who remain ambulatory. The above data could assist health care professionals perform a targeted review of systems and co-morbidities, allowing for appropriate patient triage.

The prognostic significance of neutrophil-lymphocyte ratio (NLR) in patients with COVID-19

INTRODUCTION: Neutrophil lymphocyte ratio (NLR) is elevated in response to stressful stimuli and has been shown to be associated with poor prognosis in both benign & malignant disorders. Literature regarding NLR as a prognostic marker in COVID19 are limited. Our study was aimed to investigate the relationship between NLR & survival outcomes in patients hospitalized with Coronavirus disease 2019 (COVID19). METHODS: Ours was a single center, retrospective observational study, which included 472 nasopharyngeal swab SARS-CoV-2 RT-PCR positive patients. NLR was derived from the admission complete blood count & was divided into 5 sub-groups as (0-0.99, 1-2.99, 3-9.99, 10-19.99, >20). Demographics, comorbid conditions, and outcomes such as need for mechanical ventilation, length of stay and inpatient mortality were assessed. Statistics were performed using STATA. Significance was assigned at p<0.05. RESULTS: The mean age was 71.16 years in NLR >10 group as compared to 60.3 years in patients with normal NLR 1-2.99. Male patients were found to have much higher NLR than females (65.12% vs 34.88% in NLR 10-19.99, 64.86% vs 35.14% in NLR>20;p-value: 0.05). Among comorbidities, COPD patients were found to have higher NLR (18.92% of NLR>20 vs 10.71% of NLR 1-2.99;p-value:0.02). Rate of endotracheal intubation and need for mechanical ventilation was significantly higher with increasing NLR (0% vs 7% vs 14% vs 17% vs 32%;p-value: 0.03). Inpatient mortality was significantly higher in patients who had NLR>20 (70.27% of NLR>20 vs 16.07% of NLR 1-3 p-value <0.0001). On multivariate regression, patients with NLR>20 had 4 times higher odds of mortality;however, the p-value was not significant (4.07±2.78 p-value: 0.175). CONCLUSIONS: Increasing NLR in COVID19 patients is associated with increased ICU admission, intubation & inpatient mortality. Further studies are warranted to establish NLR, which is readily available & inexpensive, as a potential prognostic indicator in COIVD19 patients.

The prognostic significance of absolute lymphocyte count in patients with COVID-19

INTRODUCTION: The host immune responses try to confront Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with all the potential cells and cytokines. Eventually, natural killer cells and T cells become exhausted, decreasing their counts, leading to lymphopenia. This study aims to assess the clinical utility of the absolute lymphocyte count (ALC) at admission in predicting outcome in patients with COVID-19. METHODS: Ours was a single-center, retrospective observational study, which included 463 nasopharyngeal swabs SARS-CoV-2 RT-PCR positive patients. Absolute lymphocyte count was retrieved from the admission complete blood count & was divided into 3 sub-groups (<500, <1000, and >1000 cells/μL). Demographics, comorbid conditions, and outcomes such as the need for mechanical ventilation, length of stay, and inpatient mortality were assessed. Statistics were performed using STATA. Significance was assigned at p<0.05. RESULTS: 13.82% of patients had ALC count<500, 44.71% had <1000 and 41.25% had more than 1000. Mean age in ALC group<500 was higher (71±1 years vs 65± 1.1 years in ALC group <1000 and 59.9+/-1.3 in ALC group >1000). Profound lymphopenia (<500 cells/μL) was more common in males compared to females (71.88 % vs 28% p value 0.01). ALC count <500, was associated with higher rate of non-invasive (45.31% vs 26.56% for ALC <1000, p-value: 0.01) as well as invasive ventilation (26.5% with ALC <500 vs 19% with ALC <1000 vs 10.4% with ALC with >1000;p-value: 0.01). Inpatient mortality was significantly higher in cohort with ALC <500 (51.56% with ALC <500 vs 33.3% with ALC <1000 vs 24.08% with ALC >1000;p-value 0.05). On multivariate regression, ALC was not a independent predictor of mortality (ALC<500, OR: 1.56±0.75, p-value: 0.44). CONCLUSIONS: Lymphopenia at admission in COVID19 patients is associated with an increased need for non-invasive & invasive ventilation & inpatient mortality. Currently, clinical trials assessing GM-CSF as a possible therapeutic option is underway.

Can age alone be used as a guide for decision-making in COVID-19 patients? a retrospective study

INTRODUCTION: Coronavirus disease 2019 (COVID- 19) caused by the SARS-CoV-2 virus has emerged as one of the greatest challenges to humanity in recent history. Older people have shown to have poor outcomes in recent studies. Our study looks at the characters and outcomes in patients of different age groups admitted to our center. METHODS: Our study is a single-center, retrospective, observational study of 471 COVID-19 patients (confirmed with a positive nasopharyngeal swab for SARS-CoV2 RT PCR) admitted to our hospital. Patients were divided into 3 groups based on Age (0-45 years, 46-65 years, and >65 years). Demographic characteristics and in-hospital outcomes were compared between these groups. STATA was used to perform statistics. Statistical significance was assigned at p=<0.05. RESULTS: 471 patients were included in the study of which 79 (16.77%), 159 (33.76%), and 233 (49.47%) belonged to the age group of 0-45 years (Group A), 46- 65 years (Group B) and >65 years (Group C) respectively. On comparison of pre-existing comorbidities, patients in group B and group C had a higher incidence of baseline comorbidities (Diabetes, Hypertension, Heart failure, COPD rates were 33.96% vs 43.1%, 55.35% vs 81.12%, 9.01% vs 20.59%, 2.5% vs 11.21% respectively). On comparing in-hospital outcomes, the mean time to mechanical ventilation from admission was 3.25 (±1.31) days, 2.42 (±0.68) days and 2.75 (±0.53) days for group A, B and C respectively. 74 (15.71%) patients required intubation during hospitalization of which 7.5%, 32.5%, and 60% belonged to groups A, B, and C respectively. The overall mortality rate among intubated patients was 90.54% among which 8.15%, 31.08%, and 60.81% belonged to groups A, B, and C respectively. The inhospital mortality rate was 32.48% of which 3.27%, 17.65%, and 79.08% belonged to groups A, B, and C respectively. In-hospital mortality rate for group A, B and C were 6.33%, 16.98% and 51.93% respectively (p <0.0001). However, on multivariate regression analysis, age was not an independent predictor of in-hospital mortality for any age group. CONCLUSIONS: Patients >65 years of age have higher co-morbidities and worse in-hospital outcomes. However, age is not an independent predictor of mortality and each patient should be evaluated individually while making an important treatment decision.

The prognostic significance of lymphocyte-to-crp ratio (Lcr) in patients with COVID-19

INTRODUCTION: Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19). This study aims to assess the clinical utility of the lymphocyte-to-C-reactive protein (CRP) ratio (LCR), typically used for gastric & colorectal cancer prognostication. METHODS: Ours was a single center, retrospective observational study, which included 321 nasopharyngeal swab SARS-CoV-2 RT-PCR positive patients. LCR was derived from the admission complete blood count & was divided into 2 sub-groups (<99.99 vs >100). Demographics, comorbid conditions, and outcomes such as need for mechanical ventilation, length of stay and inpatient mortality were assessed. Statistics were performed using STATA. Significance was assigned at p<0.05. RESULTS: LCR <99.99 group had more elderly patients as compared to LCR >100 group (67.74% vs 54.01% of patients >60 years of age). Male patients were found to have lower LCR than females (60.75% vs 39.25% with LCR <99.99;p-value: 0.03). Among comorbidities, patients with history of cancer were found to have higher LCR (7.53% of LCR <99.99 vs 13.24% of LCR >100;p-value:0.03). Lower LCR was associated with higher rate of non-invasive (36.56% with LCR <99.99 vs 19.12% with LCR >100;p-value: 0.01) as well as invasive ventilation (17.74% with LCR <99.99 vs 11.76 with LCR >100;p-value: 0.01). Inpatient mortality was significantly higher in patients who had LCR <99.99 (39.25% with LCR <99.99 vs 22.63% with LCR >100;p-value <0.03). On multivariate regression, patients with LCR <99.99 had 2 times higher odds of mortality;however, this finding did not reach statistical significance. (2.27± 0.81 p-value: 0.15). CONCLUSIONS: Decreasing LCR in COVID19 patients is associated with increased need for non-invasive & invasive ventilation & inpatient mortality. Further studies are warranted to establish LCR, which is readily available & inexpensive, as a potential prognostic indicator in COIVD19 patients.

Outcomes of novel coronavirus disease in patients with diabetes mellitus: A retrospective analysis

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a multisystem infection caused by SARS-CoV-2 Virus. Recent studies have demonstrated poor outcomes in patients with diabetes mellitus (DM). We sought to assess the in-hospital outcomes of COVID19 patients with DM at our centre. METHODS: Ours was a single centre, retrospective, observational study of 470 COVID-19 patients admitted to our hospital. We divided these patients into 2 groups;those with DM and those without. We compared demographic characteristics, comorbid conditions, and in-hospital outcomes between the two groups. Statistics were performed using STATA. Statistical significance was assigned at p<0.05. RESULTS: Out of the 470 patients included in the study, 35.53% of patients had DM. Mean age of patients with and without DM was 68.35years±1.08 vs 61.71±1.05years respectively. 8.72% of patients were on pharmacological therapy. The diabetic cohort had a higher prevalence of hypertension, heart failure compared to the non-diabetic cohort (88.02 vs49.5% p-value:0.004, 22.9% vs 9.31% p-value: 0.04). Other comorbidities such as OSA, CKD, COPD, Asthma were comparable between both groups. The DM group had a higher level of inflammatory markers during the course of hospitalisation (D-dimer 3802.68± 1499 vs 3448.13 ±1139, CRP: 12.60±0.76 vs 11.85±0.60, ESR: 73.66±10.41 vs 58.04±7.10). The DM group had a significantly higher need for mechanical ventilation (18.56% vs 13.29%, p<0.03), and subsequent in-hospital mortality (43.35% vs 25.74% p<0.05). On multivariate regression, diabetics had 2.64 higher odds of in-hospital mortality, however, the p-value was not significant (Write ODDS Ratio and Confidence interval p-value: 0.116). CONCLUSIONS: Overall inpatient mortality was higher in patients with DM, likely driven by an increased need for mechanical ventilation. Our study positively adds to the existing literature that DM is a significant risk factor for higher morbidity and mortality in COVID-19 patients.

Healthcare workers with COVID-19 infection: Experience from a designated COVID-19 clinic

Background: Healthcare workers (HCW) are at the frontline of the COVID- 19 pandemic, risking infection through hospital contacts. Data regarding predisposing factors in the healthcare field is limited. In this study, we characterized presenting symptoms, occupation and hospitalizations for HCW who tested COVID-19 positive. Methods: This is a retrospective study of HCW who presented for screening to a designated COVID-19 clinic at the largest hospital in Washington, DC between 3/13/20 - 5/28/20. Variables extracted included profession, exposure, presenting symptoms, past medical history and outcomes. Univariate analysis was performed using Fischer's exact tests, with significance defined as p < 0.05. IRB approval was obtained. Results: There were a total of 881 HCW who presented for COVID-19 testing: 316 (35.8%) tested positive;216 (68.4%) were female, mean age was 39. Cough was the most common presenting symptom (92.7%), followed by subjective fever (63.3%), myalgia (57.9%), and chills (46.8%)(Fig 1). RNs [110 (34.8%)] and physicians [39 (12.3%)] accounted for nearly 50% of cases. Hospitalizations occurred in 22(6.9%);2(0.6%) died from COVID-19. See Fig 2 for symptoms associated with hospitalizations. African Americans (OR 4.52, CI95 1.54-12.50), and those with hypertension (3.14, 1.32-7.23) and obesity (2.98, 1.25-6.89) were more likely to be hospitalized. Conclusion: HCW remain at risk for COVID-19 infection with respiratory and constitutional symptoms as the most common presentation. RNs were among the most affected. This study supports other reports that African Americans and those with pre-existing comorbidities have greater morbidity with COVID-19 - we have documented that these inequities are also prevalent amongst HCW. This should be considered when testing for and implementing practices to avoid risk of COVID-19 among HCW. (Figure Presented).

Impact of covid-19 and social distancing on mental health

The Coronavirus Disease 2019 started in Wuhan Province, China and which spread to half a dozen countries between 2019 and 2020 and was declared a pandemic. This resulted in the implementation of a lockdown in different parts of the world, explaining it was an effective and essential way to break the cycle of infection. Physical distancing is the most important measure to break this infection cycle which affected many people’s lives in different aspects. Mental health is considered to be one of the important components of the overall health as the definition given by the World Health Organization. It says that the person should be well-adjusted with the environment and should not be easily upset. He should know his needs, problems and goals properly;moreover, if he faces problems, he tries to solve them intelligently for which he tries to cope up with stress and anxiety. Along with all these things, he has good self-control balances between rationality and emotionality. It has likewise set off a wide variety of mental issues, for example, anxiety, panic disorder and depression. Most of the studies have reported negative impacts, including anger, stress symptoms and confusion. Education and training on pandemic should be provided by the authorities and health care workers.