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Background: The COVID-19 outbreak in 2019 has presented in the form of pneumonia of unknown etiology in Wuhan. The complete clinical profile including the prevalence of different clinical symptoms of COVID-19 infection among Indian patients who develop a severe disease is largely unknown. This study is aimed to provide a detailed clinical characterization of the cohort of patients who visited our institute with signs and symptoms of COVID-19. Material(s) and Method(s): This was for inpatient hospital (inpatient) based prospective cohort study involving 520 COVID-19 patients admitted to the hospital. The adverse outcome included death and mechanical ventilation. Result(s): Total 520 participants enrolled in the study, (6.9%) participants died, (8.3%) participants required ICU and (5.5%) participants required mechanical ventilation. only signs and symptoms suggestive of severe respiratory system involvement or widespread infection were associated with adverse outcomes, T presence of dyspnoea, cyanosis and hypoxia. The most common chronic disease among patients with adverse outcomes were diabetes, hypertension and pre-existing respiratory disease, personal habit both smoking, and alcoholism was also associated with adverse clinical outcome. Conclusion(s): The adverse clinical outcome among COVID-19 patients is determined by several factors including advanced age, multi-morbidities, and the presence of severe respiratory symptoms.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Background: Ever since the beginning of the COVID-19 pandemic, physicians started investigating the clinical features and lab markers that can assist in predicting the outcome among hospitalized COVID-19 patients. Aim(s): This study aimed to investigate the association between initial chest CT scan findings and adverse outcomes of COVID-19. Material(s) and Method(s): This was a single centre;hospital (inpatient) based prospective cohort study involving 497 COVID-19 patients admitted to the hospital. The adverse outcome included death and mechanical ventilation. We collected data about 14 identifiable parameters available for the HRCT scan. Result(s): Among 14 studied parameters, only 8 features differed significantly among the patients who had favourable and unfavourable outcomes. These features included number of lobes of lungs involved (3 versus 5, p = 0.008), CT Severity score (16 versus 20, p = 0.004), air bronchogram (p=0.003), crazy paving (p=0.029), consolidation (p=0.021), and pleural effusion (p=0.026). We observed that high CT scores coupled with the diffuse distribution of lung lesions were responsible for poor prognosis in most patients. Conclusion(s): Several features of HRCT when combined can accurately predict adverse outcomes among participants and help in triaging the patient for admission in ICU.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Background: Improving basic infection control (IC) practices, diagnostics and anti-microbial stewardship (AMS) are key tools to handle antimicrobial resistance (AMR). Material(s) and Method(s): This is a retrospective study done over 6 years (2016-2021) in an oncology centre in North India with many on-going interventions to improve IC practices, diagnostics and AMS. This study looked into AMR patterns from clinical isolates, rates of hospital acquired infections (HAI) and clinical outcomes. Result(s): Over all, 98,915 samples were sent for culture from 158,191 admitted patients. Most commonly isolated organism was E. coli (n = 6951;30.1%) followed by Klebsiella pneumoniae (n = 5801;25.1%) and Pseudomonas aeroginosa (n = 3041;13.1%). VRE (Vancomycin resistant Enterococcus) rates fell down from 43.5% in Jan-June 2016 to 12.2% in July-Dec 2021, same was seen in CR (carbapenem resistant) Pseudomonas (23.0%-20.6%, CR Acinetobacter (66.6%-17.02%) and CR E. coli (21.6%-19.4%) over the same study period. Rate of isolation of Candida spp. from non-sterile sites also showed reduction (1.68 per 100 patients to 0.65 per 100 patients). Incidence of health care associated infections also fell from 2.3 to 1.19 per 1000 line days for CLABSI, 2.28 to 1.88 per 1000 catheter days for CAUTI. There was no change in overall mortality rates across the study period. Conclusion(s): This study emphasizes the point that improving compliance to standard IC recommendations and improving diagnostics can help in reducing the burden of antimicrobial resistance.Copyright © 2023 Indian Association of Medical Microbiologists
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Background: Clinical outcome and parenchymal lung abnormalities (PLA) data from hospitalized patients with COVID 19 pneumonia are limited. Objective(s): (1) Understand and compare the patterns of PLA on high resolution computed tomographic (HRCT) at admission, 4-8 weeks post-admission in all patients and 10-12 weeks post-admission in a subgroup of patients (2) follow up their general health status on phone 6 months post admissionMethods: Prospective, observational study of consecutive adult patients hospitalized with RT-PCR confirmed COVID-19 pneumonia in a tertiary centre, India. Clinical data and HRCT image patterns and distribution of PLA at admission, 4-8 weeks in all patients and at 10-12 weeks in a subgroup of patients were analysed using a novel, composite radiological score (CRS). Surviving patients were followed up telephonically 6 months later. Finding(s): Of 179 patients, HRCT features were ground glass opacity (144, 80.4%), consolidation (23, 12.8%) and reticulation (7, 4%) at admission. 74% demonstrated resolving PLA with 14% showing complete resolution at 4-8 weeks. Fine reticulations were seen in 12% at 8 weeks and 20% in a subgroup of 44 patients who had persisting symptoms at 10-12 weeks. CRS correlated well with clinical severity and recovery (p=0.003). At 6 months, 144 responded to the phone follow up, reported no functional impairment and had returned to their pre-COVID health status. Conclusion(s): PLA resolved in 88% at 8 weeks and all the 144 patients who were followed up at 6 months reported return to pre-COVID 19 health status. This is quite reassuring amidst concerns of 'long COVID'.
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Background: To enhance dissemination of resources promoting evidence-based care of emergency department (ED) patients with opioid use disorder (OUD) and assess practices related to OUD care in EDs with a range of characteristics and resources, we developed the ACEP Emergency Medicine Quality Network (E-QUAL) Opioid Initiative. This national ED-focused practice-based learning network seeks to increase provision of naloxone and medication for the treatment of OUD (MOUD) by supporting local quality improvement (QI) through a curated toolkit with webinars and resources, a QI chart review to assess and benchmark ED care, and the dissemination of best practices. Method(s): In March of 2021, participating EDs were requested to complete a structured chart review of 30 randomly selected ED visits between September 2020 - February 2021 (baseline) with ICD-10 codes for opioid overdose or OUD, and to report on the following measures: substance use evaluation in the ED, naloxone offer/provision, MOUD administration (methadone or buprenorphine) in the ED, buprenorphine prescription at discharge, documented overdose prevention or harm reduction provision, and referral to OUD treatment. In November 2021, EDs were requested to review and submit metrics from an additional 30 charts for visits between July 2021- October 2021 (follow-up). Descriptive statistics and student's t tests were used to evaluate differences. Result(s): Among the 385 EDs participating in the 2021 E-QUAL Opioid Initiative learning collaborative, the median annual ED visit volume for adults was 14,552, with 138 (36%) classified as rural and 43 (11%) as critical access. Chart review data were submitted for 4,877 ED visits during the baseline period and 5,629 visits during follow-up. Between the baseline and follow-up periods, documented substance use evaluation in the ED increased from 89% to 93% (p<0.001) and OUD referral rate increased from 63% to 84% (p<0.001). Overall, the discussion or provision of naloxone (34% to 27%;p<0.001) and the documentation of overdose prevention and harm reduction counseling (67% to 60%;p<0.001) decreased across the two time points, although among the subset of patients with opioid overdose, naloxone discussion/provision increased (36% to 43%;p<0.001). Provision of buprenorphine and methadone in the ED (1% to 4%;p<0.001) and provision of an outpatient prescription of buprenorphine (2% to 3%;p<0.05) increased as well. Conclusion(s): EDs participating in a national practice-based learning network demonstrated improvement in several measures of ED OUD care. This study represents the first feasibility assessment of collection of measures from a nationwide sample including rural and community EDs for this purpose. Although improvements are modest, improved rates of OUD evaluation, treatment referral and MOUD treatment provision after participation in an online learning collaborative amidst the COVID-19 pandemic demonstrate the importance and potential for ongoing education and quality improvement. Yes, authors have interests to disclose Disclosure: Foundation for Opioid Response (FORE) Foundation Grant Support Foundation for Opioid Response (FORE) Foundation Copyright © 2022
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Since the corona virus has emerged, genuine clinical resources, such as a paucity of experts and healthcare workers, a lack of adequate equipment and medications, and so on, have reached their peak of inaccessibility. Several people have died as a consequence of the medical profession’s concern. Individuals began self-medicating due to a lack of supply, which exacerbated an already precarious health situation. A rise in new ideas for automation is being spurred by machine learning’s recent success in a varied variety of applications. In this paper, we have proposed a two-phase Decision Tree Classifier based on Artificial Neural networks (DTNN). The work is based on the satisfaction of the drugs among patients with the help of their comments as positive or negative polarity. The dataset of drugs used in this paper is Cymablta and Depopovera. The proposed results are compared with the existing methodology of Support Vector Machine Neural Network (SVMNN). The results are shown in graphical and tabular form which shows the efficiency of the proposed methodology. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Introduction: Coronavirus disease-19 (COVID-19)has become a global pandemic, giving rise to a serious health threat worldwide. So far, several countries have seen a two-wave pattern of reported cases. Methodology: This was a retrospective study of all hospitalized cases of SARS-CoV-2. All the patients admitted between March to December 2020 were considered to be in first wave and those admitted from April to June 2021were considered to be in second wave. All hospitalized patients had SARS-CoV-2 infection confirmed by RT-PCR. Results and Discussion: Total 4581 patients in first wave & 1565 in second wavetested positive for SARS-CoV-2 infection using RT-PCR at the hospital.In the first wave highest admissions occurred in the month of November 2020. In the second wave, the highest admissions occurred in the month of April 2021. In first wave 71% were male and 29% were female while in second wave 67% male and 33% were female. The mean age of first and second wave was 54.9±16.6 and 55.2±15.5. CT severity scores were 18.8±9.9 in wave 1 versus 21.4±10.4 in wave 2.(p=0.0001)A total of 54 (1.2%) deaths occurred in the first wave and 26 (1.7%) in the second wave. Conclusion: Lung involvement on CT scan was more extensive in wave 2 compared to wave. A large number of patients were admitted during the second wave, they were younger and fewer number of deaths was reported corresponding with results reported by previous research in several countries.
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Background: In December of 2019 a new corona virus was identified by WHO, secondary to an unfamiliar pneumonia in Wuhan, China, which was initially named 2019 Novel Corona Virus (2019-nCoV), and later named Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2). Diagnosis was made on the basis of RT-PCR test. Methods: With use of RT-PCR as the reference standard, the performance of chest CT in the diagnosis of COVID-19 was assessed. Findings of the investigations such as HRCT, D-dimer, Sr. Ferritin, CRP, and LDH are recorded and analysed. Results: Total patients included in the study are 217 persons of which 57.89% are males, 42.10% are females. The mean age was 45.14-years. CT severity score was found to be positively correlated with increased D-dimer, LDH and S. ferritin levels. It was found that with increasing HRCT chest severity, there was increase in inflammatory marker parameters. Conclusion: Our data suggest the potential role of D-dimer, S. Ferritin and LDH for predicting severity of disease and CT scan. CT score is highly correlated to laboratory findings and might be beneficial to speed up diagnostic workup in symptomatic patients and also play a vital role in predicting the severity in places where HRCT scan is not available.
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Background: This research leverages Clinical Emergency Data Registry (CEDR) data collected from 2019 to 2020. Developed by ACEP, CEDR is the first Emergency Medicine (EM) specialty-wide registry to measure acute care quality, outcomes, practice patterns, and trends in emergency care. ACEP began CEDR in 2015 focusing on quantifying and enhancing quality of emergency care through collection of quality data and development of EM-specific quality metrics. CEDR has collected data for 50 million visits representing 30 million unique patients. Study Objectives: Early in the pandemic, impact on emergency departments (ED) was substantial. By May, ED visits declined nearly 40%. CDC data indicated ED visits for patients younger than 14 declined by 70%. While several studies evaluated pandemic impact on pediatric cases, most focused on children’s hospitals or particular illnesses. This research assesses the impact on pediatric visits to all US EDs over the more extended timeline of the pandemic, including total visits, visits for influenza, and visits for COVID-19. Methods: The database was queried for visit data on patients 18 years and younger from January 2019 to December 2020. Visits were counted, not individuals, so two visits by the same individual count as two visits. Percentage of visits in this cohort with a diagnosis of influenza (ICD 10 Codes: J09.X2, J10.-, J11.-) and COVID-19 (ICD 10 Code: U07.1) were calculated. Data were compared to age-agnostic ED visits and percentage of visits for COVID-19 and influenza in the general public. This data was obtained from the National Syndromic Surveillance Program (NSSP), run by the CDC. NSSP received data from 93% of US hospitals and is provided to ACEP through an agreement with the CDC. It includes data on the number of ED visits and percentage of those visits made for COVID-19 and influenza. Simple descriptive analysis was used. Results: Pediatric ED visits experienced a 72% decline starting week 11 of 2020, coinciding with the WHO characterization of COVID-19 as a pandemic. Sharp decline continues for six weeks before plateauing. However, pediatric visits remain 38% below previous visit rates (Figure 1). General population ED visits decline significantly over an identical period, however, only decrease by 42%. These ED visits make a quicker recovery, returning to 88% of previous patient volume. When reviewing influenza and COVID-19 data, general public visits indicated a considerable lack of influenza cases during COVID-19 surges. Conversely, pediatric visits do not demonstrate the same surges. Instead, data showed repeated smaller COVID-19 spikes during the year. In addition, pediatrics did not reveal influenza suppression seen in the general public. Spiking in pediatric influenza was proportional to COVID-19 spikes, offset in time (Figure 2). Conclusion: This study reveals pediatric ED visits sharply decreased in early weeks of the pandemic. Recovery of ED visits is slower in pediatric populations compared to the general population. Further, percentage of visits for influenza and COVID-19 remain low in this population and do not show typical “waves” seen in the general population. The reduction in 2020 influenza cases seen in the adult population is not reflected in the pediatric population. Influenza spiked uniquely in the pediatric population throughout 2020. Isolation of children at home during the COVID-19 pandemic may account for limited vaccination resulting in equal exposure risks. [Formula presented] [Formula presented]
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Background. Remdesivir is a nucleotide analogue antiviral that was FDA approved for the treatment of hospitalized patients with coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). Remdesivir has been associated with elevations in serum aminotransferase levels but most cases being mild to moderate and reversible upon discontinuation. Although national COVID-19 guidelines and the American Association for the Study of Liver Diseases (AASLD) currently recommend remdesivir for use in hospitalized patients requiring supplemental oxygen, data is limited using remdesivir in patients with chronic liver disease. Here, we describe our experience with remdesivir in patients with liver cirrhosis. Methods. Patients with liver cirrhosis who received remdesivir were identified either prospectively or retrospectively by primary or secondary ICD-10 codes indicating liver disease. Data collected included patient demographics, underlying cause of cirrhosis, co-morbidities, Child-Pugh score, laboratory values (serum aminotransferase levels, serum creatinine) during and following remdesivir, adverse reactions attributed to remdesivir, and mortality (in-hospital, 30-day, and 90-day). Results. A total of 4 patients with underlying liver cirrhosis completed a 5-day course of remdesivir treatment. On admission, Child-Pugh class was A for 1 patient, B for 2 patients, and C for 1 patient. Causes for cirrhosis were nonalcoholic steatohepatitis (NASH), hepatic amyloidosis, and chronic hepatitis B. There were no acute elevations in aminotransferase levels or adverse events attributed to remdesivir therapy. Mortality was high with 50% in-hospital mortality. Of the 2 other patients who survived to discharge, one was discharged to home hospice and the other was readmitted within 30 days and expired during that admission. Conclusion. Since there is limited data available using remdesivir in patients with advanced liver disease, we did not identify any safety concerns related to remdesivir in our cirrhotic patients. Mortality was high illustrating the poor outcomes of patients with advanced liver disease and COVID-19. Patients with cirrhosis should be offered remdesivir if clinically appropriate.
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Crisis opens the doors for innovation and a business needs to form cross-functional teams to find a balanced way to transform and bring about a revolutionary change in the organizations. This chapter focuses on challenges faced by the logistics industry in India and the measures taken to address these challenges and convert them into an opportunity to sustain and thrive in these pandemic times. Interviews of global leaders were conducted to gain an insight on what are the measures and changes made in the organization to deal with the current crisis in areas like operations, sales, HR, finance, and new client acquisition and how these activities have become a part of change management. In the present chapter, we have discussed the effect of COVID-19 on supply chains and economy of India. It was found that there has been a huge amount of reduction in the overall imports and exports during the lockdown period. Many small logistic services providers have gone out of business, whereas on the other hand some entrepreneurs with their entrepreneurial spirit were able to make the best use of the opportunities that the pandemic offered. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Introduction: Although home health aides (HHAs) often care for adults with heart failure (HF), studies have found that the majority have not received HF training and lack confidence with HF caregiving. To address this, we tested the feasibility, acceptability, and effectiveness of a virtual HF training course for HHAs. Methods: We partnered with the Education Fund of the 1199SEIU United Health Care Workers East, the largest healthcare union in the US, which provides training to 55,000 HHAs in NYC. HHAs typically receive in-person training, but due to COVID-19, we conducted this course virtually. The 2- hour course, taught in English and Spanish, utilized case-based learning and motivational interviewing to engage HHAs in interactive discussions on HF signs, symptoms, and HF self-care. HHAs with access to Zoom (via smartphone, computer, or tablet) were eligible. We conducted pre/post surveys and semi-structured interviews. Measures included: a) feasibility (attendance, retention), b) acceptability (modality, technological ease, satisfaction);and c) effectiveness (change in knowledge [Dutch Heart Failure Knowledge Scale, range 0-15] and caregiving self-efficacy [HF Caregiver Self-efficacy Scale, range 0-100]). Results: 48 HHAs employed by 15 distinct home care agencies enrolled and completed the course;course size ranged from 4-9 participants. The majority were middle-age women (60% Hispanic, 10% non-Hispanic Black). To participate, 59% used a smartphone, 32% a computer, and 10% a tablet. Compared to prior in-person courses, 83% participants reported that the course ran more smoothly and was more convenient;only 7% reported technical problems. Participants and course instructors reported high levels of satisfaction and engagement. Post-course data showed significant and clinically meaningful improvements in HF knowledge (11.21 [1.90] v. 12.21 [1.85];p = 0.0000) and HF caregiving self-efficacy (75.21 [16.57] v. 82.29 [16.49];p = 0.0017). Conclusions: A virtual HF training course was feasible and acceptable among HHAs and improved their HF knowledge and caregiving confidence. Efforts to scale and disseminate the course may be warranted. Future studies are needed to test the effect of the course among HHAs and their patients.
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Background: In this pandemic of covid 19 Parturient patients are facing double problem of carrying foetus with lung involvement leading to hypoxia to both mother and baby. Case Report: A young 31 years old lady, primi with 34 weeks pregnancy presented with 5 days history of covid 19 with acute SOB, fever, HRCT-Corad 6 and RTPCR +VE. Her SPO2 was 65%despite receiving oxygen @20L/mt. Looking to the hypoxemia to the patient and the foetus, the pulmonologist advised to terminate the pregnancy so that foetus can be saved and patient can be ventilated better. Looking to the lungs condition GA was avoided. Patient was given sub arachnoid block with 2.2ml bupivacaine 0.5% heavy. When she laid down, she developed dyspnoea (B.P. remained normal) for which she was given positive ventilation through mask. Her saturation remained 65% and respiratory rate 45. As soon as the baby was delivered, her saturation improved to 80% & and respiratory rate declined to 24. Patient stood surgery well and shifted back to ICU at SPO2 80%. The patient deteriorated later on with almost 95% lung involvement. Even after 50 days post surgery she is on oxygen support. Conclusion: The covid 19 has detrimental effects on Lung Parenchyma and conduction of anaesthesia in such morbid patients is always challenging. Choice of anaesthesia and selection of drugs is always tricky. A good outcome cannot always be guaranteed.
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The novel Coronavirus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can present with a multitude of clinical symptoms. The virus, disease symptomatology, pathogenesis and complications are being studied and new concepts are evolving rapidly. The current worldwide situation caused by the disease makes it exceedingly important to recognise varied presentations of the disease. Three cases are being discussed hereby, wherein the patients presented with altered sensorium secondary to hyponatremia as the initial and only presentation of SARS-CoV-2 infection, in the absence of fever or any respiratory involvement. Acute symptomatic hyponatremia is an under-recognised presentation with only a few cases reported till date and needs further awareness and understanding.
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Solid waste management (SWM) including biomedical waste in this Covid-19 pandemic is one of the biggest challenges in India in terms of economical as well as environmental aspect. Improper practices for handling and management of solid waste drain natural resources which pollute an environment, and in turn, it causes threat to inhabitants. The purpose of the given review is to enhance understanding the concept of municipal solid waste management planning, infrastructure, components and strategies that are useful in the current Covid-19 outbreak. This paper aims to review rules and practical problem and implementation of various practices of SWM and biomedical waste. Appropriate management of solid waste could be quiet expensive in terms of resources and time as well. Systematic review has been done for the biomedical waste management system for its disposal and treatment for Covid-19. During this crisis, it is very important to find out various feasible options for properly managing and handling the waste in an effective manner which should be sustainable and safe too. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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The Epidemic Diseases Act, 1897 is a colonial era legislation that is still used as the primary law to control a mass epidemic. The act, most recently, has been invoked by a number of Indian states to fight the COVID-19 pandemic. This article aims to understand the existing scheme under the act, its limitations, judicial scrutiny and the need for a new holistic law from a public health perspective.