Combating Toxicity, Harassment, and Abuse in Online Social Spaces: A Workshop at CHI 2023

Online social spaces provide much needed connection and belonging - particularly in a context of continued lack of global mobility due to the ongoing Covid-19 pandemic and climate crisis. However, the norms of online social spaces can create environments in which toxic behaviour is normalized, tolerated or even celebrated. This can occur without consequence, leaving its members vulnerable to hate, harassment, and abuse. A vast majority of adults have experienced toxicity online and the harm is even more prevalent for members of marginalized and minoritized groups, who are more often the targets of online abuse. Although there is significant work on toxicity in the SIGCHI community, approaches and knowledge have typically been siloed by the domain of investigation (e.g., social media, multiplayer games, social VR). We argue that cross-disciplinary efforts will benefit not only the various communities and situations in which abuse occurs, but that bringing together researchers from different backgrounds and specialties will provide a robust and rich understanding of how to tackle online toxicity at scale. © 2023 Owner/Author.

Initial COVID-19 Severity and Long-COVID Manifestations: An Observational Analysis

OBJECTIVE: New-onset or persistent symptoms beyond after 4 weeks from COVID-19 are termed "long-COVID." Whether the initial severity of COVID-19 has a bearing on the clinicoradiological manifestations of long COVID is an area of interest. MATERIAL AND METHODS: We did an observational analysis of the long-COVID patients after categorizing them based on their course of COVID-19 illness into mild, moderate, and severe groups. The clinical and radiological profile was compared across these groups. RESULT(S): Out of 150 long-COVID patients recruited in the study, about 79% (118), 14% (22), and 7% (10) had a history of mild, moderate, and severe COVID-19, respectively. Fatigue (P = .001), breathlessness (P = .001), tachycardia (P = .002), tachypnea (P < .001), raised blood pressure (P < .001), crepitations (P = .04), hypoxia at rest (P < .001), significant desaturation in 6-minute walk test (P = .27), type 1 respiratory failure (P = .001), and type 2 respiratory failure (P = .001) were found to be significantly higher in the long-COVID patients with a history of severe COVID-19. These patients also had the highest prevalence of abnormal chest X-ray (60%) and honeycombing in computed tomography scan thorax (25%, P = .027). CONCLUSION(S): The course of long COVID bears a relationship with initial COVID-19 severity. Patients with severe COVID-19 are prone to develop more serious long-COVID manifestations.Copyright © Author(s).

The need for systematic quality controls in implementing N95 reprocessing and sterilization.

BACKGROUND: Due to increased requirement for personal protective equipment during the coronavirus disease 2019 pandemic, many medical centres utilized sterilization systems approved under Food and Drug Administration Emergency Use Authorization for single-use N95 mask re-use. However, few studies have examined the real-world clinical challenges and the role of ongoing quality control measures in successful implementation. AIMS: To demonstrate successful implementation of quality control measures in mask reprocessing, and the importance of continued quality assurance. METHODS: A prospective quality improvement study was conducted at a tertiary care medical centre. In total, 982 3M 1860 masks and Kimberly-Clark Tecnol PFR95 masks worn by healthcare workers underwent sterilization using a vaporized hydrogen peroxide gas plasma-based reprocessing system. Post-processing qualitative fit testing (QFT) was performed on 265 masks. Mannequin testing at the National Institute for Occupational Safety and Health (NIOSH) laboratory was used to evaluate the impact of repeated sterilization on mask filtration efficacy and fit. A locally designed platform evaluated the filtration efficiency of clinically used and reprocessed masks. FINDINGS: In total, 255 N95 masks underwent QFT. Of these, 240 masks underwent post-processing analysis: 205 were 3M 1860 masks and 35 were PFR95 masks. Twenty-five (12.2%) of the 3M masks and 10 (28.5%) of the PFR95 masks failed post-processing QFT. Characteristics of the failed masks included mask deformation (N=3, all 3M masks), soiled masks (N=3), weakened elastic bands (N=5, three PFR95 masks), and concern about mask shrinkage (N=3, two 3M masks). NIOSH testing demonstrated that while filter efficiency remained >98% after two cycles, mask strap elasticity decreased by 5.6% after reprocessing. CONCLUSIONS: This study demonstrated successful quality control implementation for N95 mask disinfection, and highlights the importance of real-world clinical testing beyond laboratory conditions.

Evaluation and comparison of utility of neutrophil-to-lymphocyte ratio (NLR) as a diagnostic marker in covid-19 infection

Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first described during a pneumonia outbreak in Wuhan, has attracted tremendous attention in a short period of time as the death toll and the number of confirmed cases is growing unceasingly. Although molecular testing is the gold standard method of SARS-CoV-2 detection, the existence of the false-negative results presents a major limitation to this method. Material(s) and Method(s): Our present study aimed to determine the relationship between NLR and COVID-19 patients underwent treatment. The study was an analytical observational with a cross-sectional approach from May 2021 to January 2022 at the SMMH Medical College, Saharanpur, Uttar Pradesh. Result(s): COVID-19 infection is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Diabetes mellitus and heart disease comorbid have high morbidity and mortality. Increased Neutrophils to Lymphocyte Ratio (NLR) assist in early screening of disease severity, especially patients admitted in the Intensive Care Unit (ICU). There was a correlation between NLR in COVID-19 patients who were severely ill and admitted in the ICU with p=0.012. Conclusion(s): Increased NLR of COVID-19 patients occurs due to infiltration of the innate and adaptive immune system in infected tissue, resulting in decreased circulating lymphocytes. This subsequently increases NLR in COVID-19 patients. This study found a moderate positive correlation between NLR in COVID-19 patients who were severely ill. Copyright © 2022 Ubiquity Press. All rights reserved.

On the Design and Testing of an Origami Inspired Nasal Cover: Mitigating Aerosol Risks During Endoscopic Sinus Procedures

Aerosols generated during endoscopic sinus procedures present a concern to the health and safety of healthcare personnel, especially with the presence of coronavirus disease (COVID-19). The purpose of this study is to describe the design and testing of a nasal cover to restrict aerosolized pathogens. The nasal cover was designed to sit overtop the nose with conformal slits for insertion of endoscopic instrumentation. Polydimethylsiloxane (PDMS) was chosen as the nasal mask material and its composition, thickness, and slit geometry were selected using a Taguchi experimental design and survey with clinical collaborators at Penn State Milton S. Hershey Medical Center. The nasal cover was designed using principles of origami engineering to be manufactured flat and then folded into its operating state. Form and functionality were evaluated by surgeons, fellows, and residents in the aforementioned survey. Aerosol containment was evaluated by measuring smoke, representative of surgical aerosols, with an optical particle counter. A 25:1 composition PDMS with 3 mm thickness and vertical slit geometry was chosen for the nasal cover design. Survey results demonstrated that the origami cover sat well on the nose and did not significantly impact the surgical conditions with single instrumentation. On average, this nasal cover was found to restrict more than 93% of 0.3 mu m aerosols, and more than 99% of all aerosols larger than 0.5 mu m in size. The use of a patient worn nasal cover has the potential to drastically reduce the risk to hospital personnel during endonasal surgeries by reducing aerosol generation and potential pathogen spread.

Safety and feasibility of introducing a day case transarterial chemoembolization (TACE) strategy for liver HCC

Purpose Many interventional radiology procedures are suitable as day case procedures. Other, historically inpatient procedures, may be suitable as day case procedures with appropriate safeguards and evaluation. With increasing inpatient bed pressures, and the risks to patients from the COVID pandemic, we evaluated the recent introduction of a day case pathway for patients undergoing TACE for hepatocellular carcinoma (HCC). Materials and methods Patients undergoing TACE at our centre between 01/01/2020 and 09/11/2021 were identified using radiology archive systems (PACS). A day case procedure was defined as a patient who was admitted, and discharged on, the day of the procedure. All patients received a maximum of 50mg of Doxorubicin instilled embospheres. Electronic patient data systems were scrutinised to identify any post-procedural adverse events, defined as either an unplanned admission to hospital, in-hospital complications, or post-procedural mortality within 30 days. Results During the study period, 55 patients underwent TACE procedures, of which 40 were day case procedures. 3/40 (7.5%) day case patients experienced adverse events. One patient was admitted overnight due to abdominal pain, one re-admission to hospital with cholecystitis and one postprocedural mortality. 2/15 (13.3%) of non-day case TACE patients experienced adverse events, with one post-procedural mortality and one hospital readmission with cholecystitis. Conclusion A day case strategy was feasible in the majority of patients undergoing TACE (40/55, 73%). In our initial experience, adverse events were not increased in patients undergoing day case TACE procedures, and this remains a safe option for patients.

A Cloud Based Intelligent Model for Predicting the Pre-Testing Corona Virus Infection Outbreak

Corona virus disease (COVID) is a transmittable disease caused by a newly discovered corona virus. For this a system is require which trace the location and predict the health of the people. In the present study, a cloud based a model is proposed. The proposed model will be connect with a cloud computing system that will predict the corona virus infected patients using naïve bayes classifier and provides geographic based danger areas to prevent the spreading of corona virus. This way will provide the great help to the local administration and health care agencies to control the spreading of covid. © 2022 IEEE.

COVID-19 Mediated Exacerbation of Complex Regional Pain Syndrome Treated With Spinal Cord Stimulator

Introduction: Complex regional pain syndrome (CRPS) is a debilitating condition characterized by disproportionate pain to the inciting event, changes in sensation, autonomic abnormalities, and motor dysfunction, as defined by the Budapest criteria. It is difficult to treat, often requiring trials of multiple medications or more invasive measures such as a spinal cord stimulator (SCS) to manage symptoms. The onset of symptoms typically follows tissue damage and may be exacerbated by further injury or systemic stressors. One such stressor appears to be COVID-19 infection, which has already been implicated in cases of neuropathic pain. We present a case of a 60-year-old woman with CRPS type I status post SCS placement with a flare-up attributable to COVID-19 infection. Methods: We describe the following patient's case in pertinent detail. The patient's written consent was obtained prior to the undertaking of this report. Results: A 60-year-old woman presented with a right-sided rotator cuff tear with subsequent repair in 2018 which incited pain and related symptoms. CRPS was diagnosed when her symptoms progressed to right thumb numbness as well as right hand color changes, numbness, and weakness. An SCS was placed in August 2019 which provided pain relief, but the patient presented with exacerbation of symptoms in December 2020, coinciding with COVID-19 infection. She experienced migration of symptoms into the right shoulder which has been significantly interfering with work and sleep. She continued to report pain, swelling, stiffness, dry skin, and temperature changes in her right hand. Conclusion: COVID-19 has been found to present with a widely variable clinical presentation with equally varied sequelae, termed Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Human coronaviruses are known to possess neuroinvasive capabilities, typically manifesting as anosmia in the case of COVID-19 but may also present as neuropathic pain. If not attributable to direct viral invasion, the pathophysiologic underpinnings may be related to proinflammatory cytokines and pain-generating neuropeptides. Our case suggests that COVID-19 infection may play a role in exacerbating symptoms of CRPS. Disclosure: Gabrielle Fernandez, BA: None, Ganiru Anunike, BA: None, Nitin Goyal, MD: None

Safety and Tolerability of SARS-Cov-2 Vaccination in Patients with Neuromuscular Disorders: A Single Center Experience

Objective: To describe side effects from SARS-Cov-2 vaccination and its effect on underlying neuromuscular disease amongst patients followed at the University of California, Irvine Neuromuscular Center. Background: Extensive data on safety and tolerability of SARS-Cov-2 vaccines exists for healthy individuals. However, patients with neuromuscular conditions and especially those on immune modulatory therapy were not included in the pivotal vaccine trials. It is primarily through expert consensus that vaccination is recommended for this patient population. Design/Methods: Patients were advised to inform the study team about their vaccination status. We collected data during in-person clinic visits or via telehealth encounters using a standardized questionnaire between December 2020 and August 2021. When information was provided about upcoming vaccination dates, patients were contacted within 2 weeks for follow up. Results: Information on 363 administered vaccine doses in 214 patients was recorded, including 199 Pfizer-BioNT, 155 Moderna and 9 Johnson & Johnson doses. Our cohort included 84 patients with myasthenia gravis (MG) and 34 with motor neuron disease (Amyotrophic Lateral Sclerosis, Primary Lateral Sclerosis). The remainder (96 patients) included other immunemediated disorders (idiopathic inflammatory myopathies, Chronic Inflammatory Demyelinating Neuropathy, Guillain-Barre Syndrome and other immune neuropathies) as well as acquired and inherited neuromuscular disorders (Inclusion Body Myositis, muscular dystrophy, inherited and acquired neuropathies). One patient with generalized MG had MG exacerbation, and another experienced impending crisis within one week of vaccine administration;both recovered with appropriate therapy. Detailed analyses of the dataset are being performed and will be presented at the meeting. Conclusions: SARS-Cov-2 vaccinations were well tolerated for the majority of our neuromuscular cohort, similar to what has been reported in healthy individuals. Vaccination did not result in disease exacerbation in the majority of patients with immune-mediated neuromuscular disorders.

Effect of BMI on Tightness of Iliopsoas Muscle in Students due to Prolonged Sitting for Online Classes during COVID-19 Pandemic

Introduction: Muscle tightness is produced by a reduction in a muscle’s capacity to deform. As a result of prolong sitting pelvic position can be changed which can lead to iliopsoas tightness. During the COVID-19 pandemic, as a result of online classes, student’s hours of sitting have increased drastically. Aim: To compare iliopsoas muscle tightness in students who were engaged in prolonged sitting due to online classes with higher Body Mass Index (BMI) and students with normal BMI. Materials and Methods: This cross-sectional study was conducted in Department of Physiotherapy at Institute of Applied Medicine and Research, Ghaziabad, Uttar Pradesh, India, from April 2021 to January 2022 on 101 students. Height and weight of the subject were measured by the ruler and digital weighing machine respectively for the BMI calculation. Two groups were made, group with normal BMI students and group with High BMI students. Using modified Thomas test, iliopsoas muscle were measured for the flexibility. Independent sample t-test was used for statistical analysis. Results: Total 51 students were with normal BMI and 50 were with higher BMI were included in the study. The mean age of the subjects was 19.59 years including 59 females and 42 males. The significantly increased Modified Thomas Test (MTT) angle was found in students with higher BMI when compared to students with normal BMI for both right (p-value=0.003) and left side (p-value <0.001). Iliopsoas muscle tightness was present in more in higher BMI group as compared to normal BMI group. Conclusion: The study concluded that both the groups had the iliopsoas muscle tightness but the students with higher BMI had more muscle tightness.

Are we adequately prepared to handle the anticipated 3rd peak of COVID-19: A KAP survey among HCWs

Experts in the field are predicting a third COVID-19 peak very soon in coming times, it is important to assess recent knowledge, attitude in view of prolonged exhaustion and adherence to preventive practices of HCWs. This cross-sectional study involved 168 HCWs (42 doctors, 42 nurses, 42 paramedical staff and 42 ANMs). Data was collected through online survey tool Google forms in July and August 2021. First section included sociodemographic information and infection with SARS-CoV-2, section 2 assessed recent knowledge, section 3 practices of COVID-19 appropriate behavior and section 4 assessed attitude of HCWs. Shapiro Wilk test was used to determine normality of distribution of variables. Kruskal-Wallis and Mann-Whitney U tests were used to determine the association between two variables. Pairwise comparison was done following a significant Kruskal-Wallis test using Bonferroni's correction. 42.9% of the HCWs and family members of 44.6% HCWs were infected with SARS-CoV-2. 54.1% of infected HCWs were infected during the March-May 2021 peak. 85.1% HCWs had taken COVID-19 vaccine. Mean knowledge, attitude, practice scores were 7.88 +/- 3.03(maximum score: 12), 20.35 +/- 3.2 (maximum score: 25), 69.89 +/- 9.39 (maximum score: 85) respectively. Only 48.8% HCWs had good knowledge about more recent COVID-19 information. A significant association was observed between profession and knowledge scores (p<0.001). Over 85% HCWs had good scores for attitude towards COVID-19 and 88.7% HCWs scored good in COVID-19 appropriate behavior practices. Our HCWs need to be better equipped with the more recently available knowledge about COVID-19 to improve our preparedness for the next anticipated peak.

Analysis of Sentiments of Twitter Data on Remote Working

COVID-19 has significantly increased interest in remote working. The phenomenon of this increase was examined in this paper by examining tweets on Twitter by analysis the sentiments of people working remotely. Data were collected by downloading tweets by using keywords “#remoteworking.” The study also explored magazines like HR people matters, HBR, and articles from reputed journals, and by visiting regularly NASSCOM Web site and newspapers. Compiled data are then refined through data mining techniques, and then, sentiment analyses have been deployed. Sentiment index was found greater than one which reflected that people are very happy with having remote working. It was also found that the issue of remote work increased nearly 15 times in a year, reaching an epidemic peak in March 2020. The study has shown that in the post-COVID period it will stay permanently. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Embracing the future of the policy sciences: Big data in pedagogy and practice

Although the emergence of Big Data provides an opportunity to synthesize and mobilize ever greater amounts of policy-relevant knowledge, it has not received adequate attention in studies of policy pedagogy and practice. In this chapter, we highlight the relevance of Big Data to policy analysis, policy implementation, and policy studies through a discussion of basic machine learning techniques and an illustration of their application in the case of better understanding policy response to COVID-19. Subsequently - based on a bibliometric review of nearly 2, 500 publications on big data in public policy and content analysis of course titles and descriptions in 122 programs worldwide - we make an evidence-informed appeal to increase the uptake of big data in policy research as well as teaching. We conclude that appropriate engagement with the big data phenomenon can help the policy sciences remain relevant and move a step closer to integrating policy research, pedagogy, and practice. © Anis Ben Brik and Leslie A. Pal 2021.

Being Present-CML: A Distress Reduction Intervention for Patients with Chronic Myeloid Leukemia Taking Tyrosine Kinase Inhibitors

Background: Tyrosine kinase inhibitors (TKIs) enable patients with chronic phase chronic myeloid leukemia (CP-CML) to achieve similar overall survival to the general population, but can cause side effects that negatively impact quality of life (QOL) and contribute to distress. Since most CP-CML patients remain on TKIs indefinitely, there is a need to develop targeted interventions to address their physical and psychosocial complications. Mindfulness meditation interventions have improved QOL and decreased distress, depression, anxiety, fatigue, and pain in patients with solid tumors;however, such interventions have not previously been evaluated in patients with CP-CML. In Being Present-CML, we sought to determine if a mindfulness meditation-based program is feasible and acceptable to patients with CP-CML, and to explore its preliminary efficacy. Methods: Being Present-CML is a prospective, single-arm clinical trial of an 8-week, online mindfulness meditation-based intervention effective in patients with gastrointestinal cancers (Atreya, et al. PLoS One, 2018). Participants were recruited from a single academic institution. Eligibility included adult patients with CP-CML taking TKIs. Participants were instructed to independently play audio-guided meditations at least 5 times per week on a secure website and to participate in once weekly, instructor-led meditation classes on Zoom in assigned cohorts. Qigong was incorporated into the classes to target fatigue, a common TKI side effect. Class content was recorded and uploaded to the website for those unable to attend live. Feasibility was assessed through measurement of recruitment and attrition. Adherence was determined by web capture. Acceptability was determined by feedback from study surveys and qualitative interviews. Preliminary efficacy was evaluated using patient-reported outcome measures (PROMs) at baseline (week 0) and post-intervention (week 8) using the NCCN Distress Thermometer (DT) and Patient-Reported Outcomes Measurement Information System (PROMIS) short forms for anxiety, depression, fatigue, pain interference, and sleep disturbance. A DT score ≥4 is consistent with moderate to severe distress. PROMIS scores use T-scores where the mean score for the general population is 50 (standard deviation [SD] +/-10);higher scores indicate worse symptoms. Descriptive statistics and two-tailed paired t-tests (p <0.05) were used to summarize the data. Results: Between October 2020-April 2021, 98 eligible participants were approached to participate in the study;88 (89.8%) patients agreed to learn more, and 37 (37.8%) patients provided consent. The median age was 51 (range 23-72), 51.5% (n=19/37) were male, and 89.1% (n=33/37) were non-Hispanic White. At time of study start, 83.7% (n=31/37) had a BCR-ABL1 PCR transcript ≤1% and a median time since diagnosis of 71 months (range 2-234) (Table 1). Of 37 participants, 29 (78.4%) completed end of study procedures;4 (10.8%) dropped out, and 4 (10.8%) did not complete week 8 surveys. The median number of audio meditations listened to per participant was 34 with an average of 4.3 per week. The median number of weekly classes attended and/or recordings viewed per participant was 7 (range 1-8). At baseline, participants had a median DT score of 5 (range 2-8). Average baseline PROMIS scores were slightly worse than the general population in depression (51.4, SD 8.8), anxiety (55.9, SD 7.8), sleep disturbance (51.8, SD 6.9), fatigue (53.9, SD 10.6), and pain interference (52.2, SD 9.9). By week 8, the median DT score improved to 3 (p=0.003) (Figure 1). Post-study PROMIS scores improved in sleep disturbance (p=0.001) and depression (p=0.01) (Figure 2), but not anxiety (p=0.12), fatigue (p=0.10), or pain interference (p=0.98). Of those who conducted post-study interviews, 77% (n=20/26) reported their symptoms during the study were not influenced by the COVID-19 pandemic. Nearly all participants found the study helpful (Figure 3) and would recommend it to others (median score of 8 on a 1-10 scale;10=extremely likely). Concl sions: Patients with CP-CML taking TKIs found the mindfulness meditation-based intervention to be feasible and acceptable. PROM results suggest promise of clinical benefit in this patient population, including patients with well-controlled disease and a long history of CML. A randomized controlled trial is being planned to validate these findings. [Formula presented] Disclosures: Smith: Astellas Pharma: Consultancy, Research Funding;FUJIFILM: Research Funding;Daiichi Sankyo: Consultancy;Revolutions Medicine: Research Funding;AbbVie: Research Funding;Amgen: Honoraria. Shah: Bristol-Myers Squibb: Research Funding. Atreya: Guardant Health: Research Funding;Pionyr Immunotherapeutics: Membership on an entity's Board of Directors or advisory committees;Array Biopharma: Membership on an entity's Board of Directors or advisory committees;Merck: Research Funding;Bristol-Meyers Squibb: Research Funding;Gossamer Bio: Research Funding;Novartis: Research Funding.

Sars-cov-2 in pre-existing autoimmune myasthenia gravis: An institutional experience

The impact of SARS-CoV-2 on pre-existing chronic neuromuscular junction disorders like myasthenia gravis (MG) is not known. We report three patients with pre-existing acetylcholine receptor autoantibody-positive myasthenia gravis who were infected with SARS-CoV-2. We observed the clinical course of these patients during hospitalization, none of the three patients had an exacerbation of peripheral myasthenia syndromes like ptosis, extra-ocular muscle weakness, bulbar or limb weakness during hospitalization. Therapy for MG was not altered during hospitalization for any of the patients. While two of the patients had a favorable outcome, one succumbed to the complications of SARS-CoV-2. Our findings suggest that the clinical course of MG remains unaffected during course, how-ever outcome is variable depending on severity of SARS-CoV-2. Further large observations are needed to define best management and treatment principals and determinants of outcomes in this unique patient population of co-occurrence of SARS-CoV-2 and myasthenia gravis.

An intelligent fine-tuned forecasting technique for covid-19 prediction using neuralprophet model

COVID-19, being the virus of fear and anxiety, is one of the most recent and emergent of various respiratory disorders. It is similar to the MERS-COV and SARS-COV, the viruses that affected a large population of different countries in the year 2012 and 2002, respectively. Various standard models have been used for COVID-19 epidemic prediction but they suffered from low accuracy due to lesser data availability and a high level of uncertainty. The proposed approach used a machine learning-based time-series Facebook NeuralProphet model for prediction of the number of death as well as confirmed cases and compared it with Poisson Distribution, and Random Forest Model. The analysis upon dataset has been performed considering the time duration from January 1st 2020 to16th July 2021. The model has been developed to obtain the forecast values till September 2021. This study aimed to determine the pandemic prediction of COVID-19 in the second wave of coronavirus in India using the latest Time-Series model to observe and predict the coronavirus pandemic situation across the country. In India, the cases are rapidly increasing day-by-day since mid of Feb 2021. The prediction of death rate using the proposed model has a good ability to forecast the COVID-19 dataset essentially in the second wave. To empower the prediction for future validation, the proposed model works effectively. © 2022 Tech Science Press. All rights reserved.

Recovery from AKI requiring kidney replacement therapy in critically ill patients with COVID-19

Background: Acute kidney injury (AKI) requiring kidney replacement therapy (KRT) occurs in as many as one in five critically ill patients with COVID-19. Expanding on previous work by this group, we examined the association of clinical factors at the time of KRT initiation with the outcome of kidney recovery at hospital discharge, accounting for the competing outcome of death. Methods: We used data from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID), a multicenter cohort study that enrolled adults with COVID-19 admitted to ICUs at 68 hospitals across the US from March 4 to June 22, 2020. Among those who acutely required KRT, the outcome of kidney non-recovery (continued dialysis dependence at hospital discharge) was explored with multinomial logistic regression, with kidney recovery (independence from dialysis at discharge) as the reference outcome and death as an alternate outcome. Exposures of interest included demographics, baseline medical status, and markers of illness acuity at the time of KRT initiation. Results: Of 876 patients with AKI-KRT, 588 (67%) died, 95 (11%) survived to discharge and remained dependent on KRT, and 193 (22%) survived to discharge without KRT dependence. Patients with lower baseline eGFR had greater odds of kidney non-recovery, with OR 8.58 (95% CI: 3.03-24.28) among patients with eGFR ≤15 vs >60. Reduced urine output on the day of KRT initiation was also associated with kidney non-recovery, with OR 4.23 (95% CI: 1.61-11.15) for urine output <50 mL/day vs >500 mL/day (Figure). Conclusions: Among critically ill patients with COVID-19 with AKI requiring KRT, lower baseline kidney function and reduced urine output at the time of KRT initiation are associated with kidney non-recovery.

Impact of COVID on tracheotomy practices

Introduction: Coronavirus disease 2019 (COVID) can cause respiratory distress, which can lead to intubation and even tracheotomy. With the risk of viral aerosolization, tracheotomy practices were directly affected by the COVID pandemic. Our study analyzes these practices at the pandemic's inception. Method: This was a single-institution retrospective study that included patients undergoing tracheotomy from December 2019 to June 2020. Patients were divided into 2 groups: pre- COVID (December 2019-March 2020) and post-COVID (March 2020-June 2020). Data were collected from the electronic medical record. Statistical analyses were done via 2-tailed independent t tests and Fisher exact tests. Results: There were 42 patients in the pre-COVID group and 25 patients in the post-COVID group. None of the patients were COVID positive. The main indication for tracheotomy in both groups was prolonged intubation followed by adjunct to head and neck surgery. Before the pandemic, otolaryngology performed 36% of tracheotomies, followed by thoracic surgery (29%) and trauma (26%). After the start of the pandemic, trauma performed 40% of tracheotomies, followed by otolaryngology (28%) and thoracic surgery (28%). This shift in departments was not significant (P = .62). There was a significant increase in the percentage of tracheotomies performed in the operating room (OR;P = .04). In the pre- and post-COVID cohorts, 57% and 64% of tracheotomies were performed open, respectively (P = .62). For patients undergoing tracheotomy for prolonged intubation, the means and ranges for time to tracheotomy in the pre- and post-COVID groups were 18 (4-40) and 20 (3-42) days, respectively (P = .55). There was no significant difference in overall length of stay (P = .77) or length of mechanical ventilation (P = .56) between the 2 groups. Conclusion: At the start of the pandemic, there was a significant increase in tracheotomies performed in the OR, likely to limit viral spread, despite all patients being COVID negative. Although not significant, there was a trend toward performing more open tracheotomies. It is important to note that these data were collected early in the pandemic and additional trends may become apparent over time.