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Purpose: COVID-19 pandemic has overturned the work and family life challenging the world in unpredictable ways that were previously unimaginable. With universities shutting down and emergence of online classes, this phenomenon is prevalent among academicians as well. With this background, the current study aims to investigate the direct relationships between workplace isolation (WPI) during COVID-19 and work–family conflict (WFC) with psychological stress (PS) mediating and organizational identification (OI) moderating the relationship between the two. Design/methodology/approach: The authors employed time lagged survey and collected data at three different time intervals (T1, T2, T3) from 203 academicians working across various universities and colleges in India. The data were analyzed quantitatively using SPSS PROCESS Macro and AMOS. Findings: The results indicated that WPI during COVID-19 has a significant positive relationship with PS and WFC. It was also found that PS partially mediated the relationship between WPI during COVID-19 and WFC. Further, OI emerged as a potential moderator. Originality/value: Based on the current empirical studies, it remains unclear if WPI during COVID-19 is associated with WFC. Therefore, drawing upon stress–strain–outcome (SSO) model and the conservation of resource theory, this study makes a significant contribution to the existing body of literature by exploring the unexplored associations. To the best of the authors' knowledge, such an association has not received much scholarly attention before. © 2023, Emerald Publishing Limited.
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This study is carried out to find novel active drug candidates which can effectively bind to key residues of main protease (Mpro) of SARS-CoV-2. We performed molecular docking of fifty-seven (57) ligands from two classes: vanillylacetone and its derivatives and beta-hydroxy ketone derivatives against Mpro of SARS-CoV-2. We also docked three antiviral drugs as reference/benchmark drugs including remdesivir (RDV), chloroquine (CQ), and hydroxychloroquine (HCQ) against Mpro for comparison of inhibition tendencies of selected ligands. Binding energies of our reference drugs are as: CQ = -5.1 kcal mol-1 (with predicted inhibition constant (Ki pred) = 177 mu mol), HCQ = -5.7 kcal mol-1 (Ki pred = 64.07 mu mol) and RDV -6.3 kcal mol-1 (Ki pred = 13.95 mu mol). We got remarkable results for our docked ligands as 79% of total ligands indicated binding energies better than CQ, 39 % better than both HCQ and CQ, and 19 % better than all reference drugs. More interestingly interaction analysis of eight best-docked ligands showed that they interacted with desired key residues of Mpro. We further selected the four best-docked ligands L1 = -6.6 kcal mol-1 (Ki pred=13.95 mu mol), L6 = -7.0 kcal mol-1 (Ki pred = 7.08 mu mol), L34 = -6.0 kcal mol-1 (Ki pred = 38.54 mu mol), and L50 = -6.6 kcal mol-1 (Ki pred=13.95 mu mol) for further analysis by quantum chemical study, molecular dynamic (MD) simulations and ADMET analysis. We have also carried out MD-simulations of six more docked ligand L2, L14, L20, L36, L46 and L48 some of which were showing weak binding affinities and some average binding affinities to check their simulation behavior. Their RMSD, RMSF and binding free energy results were also quite satisfying. We believe the current investigation will evoke the scientific community and highlights the potential of selected compounds for potential use as antiviral compounds against Mpro of SARS-CoV-2.
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The current COVID-19 pandemic has resulted in increased psychological issues such as excessive social media networking sites usage (SMNSU), loneliness, social anxiety, and depression. In this quantitative study, we examined how SMNSU can directly and indirectly influence depression, with loneliness and social anxiety examined as mediator variables. A 39-item questionnaire was used to collect survey data on SMNSU, loneliness, social anxiety, and depression from 244 blended learning undergraduate students from universities in the Hunan province in China. Partial least squares structural equation modeling was conducted using SmartPLS 3.3.3 to measure the relationships between the stated variables of interest. Results indicated that SMNSU has a direct, significant, and positive relationship with depression. In terms of mediating effects, both loneliness and social anxiety have an intervening role in the association between SMNSU and depression. This study focused on the higher education sector of China by recruiting students who were enrolled in blended learning courses during the COVID-19 pandemic and experiencing psychological problems. We found that excessive SMNSU is associated with depression. Loneliness and social anxiety also increase depression along with excessive SMNSU among blended learning students during unprecedented situations, in this case, the COVID-19 pandemic. The valuable implications of these findings for teachers, counselors, and university managers are discussed, along with a consideration of future research directions.
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Purpose The breakout of the COVID-19 pandemic has forced governments all over the globe to bring radical changes to all walks of life. Strict lockdowns are not only adversely affecting the social, economic, and psychological wellbeing of individuals but also questioning the sustainability of most businesses. In wake of the current scenario, this study is aimed at exploring how the COVID-19 pandemic is influencing the sustainability of entrepreneurship particularly from a female perspective and further providing insights into the role of Islamic financial institutions in the sustainability of businesses during COVID-19. Design/methodology/approach This is a qualitative study that takes social constructivism approach to study the underlying phenomenon. Semi-structured interviews are conducted to collect primary data. Secondary data are also utilized in this study to theoretically define various concepts relating to entrepreneurial sustainability. The application of thematic analysis revealed various risks associated with sustainability. The interviews reveal the ground realities and tell us about the hardships being faced by the entrepreneurs due to ongoing crises. The participants of the study also shed light on the role of Islamic financial institutions during the pandemic. Findings The study results revealed that it may look impossible for women entrepreneurs to halt or avoid the adverse consequences of the pandemic;however, a few female entrepreneurs strived to guard their existing portfolios with the help of Islamic microfinance institutions. Whereas, several women, especially those running home-based businesses, lost their income streams. Despite these rapid challenges, most female entrepreneurs are working on inventive online systems to sustain their business activities during the crisis. Finally, guidelines are suggested which can help achieve sustainability of the entrepreneurial startups. Research limitations/implications The outcomes of this study are expedient for funding agencies, government authorities and Islamic financial institutions as well as for non-government institutions to establish sustainable and broader policies for women to become successful entrepreneurs during severe disasters like COVID-19. Moreover, the study is a helpful tool for women entrepreneurs to avert the worst impact of the pandemic with the help of Islamic microfinance institutions. The themes of this study help generate realistic information to appraise the strategies to create facilitating business environments that drive the women to carry out the entrepreneurial activity during any crisis like the COVID-19. Practical implications The results of this study provide evidence that crisis can be anticipated up to some extent if entrepreneurs become able to take proactive decisions in case of expected or identifiable threats. The study may also help the women entrepreneurs to comprehend the serious consequences of the pandemic by shifting their mode of financing to Islamic finance. Although this pandemic is a cause of physical discomfort instead this research may encourage the female entrepreneurs not to lose heart, just find the potential opportunities for their home-based and small businesses and manage funding from the Islamic microfinance institutions. Originality/value The study adds to the existing literature on entrepreneurial sustainability with a particular focus on the role of Islamic microfinance institutions for women entrepreneurs' sustainability in Pakistan. Secondly, the study employs the entrepreneurial sustainability model (ESM) that, according to the best of our knowledge, has not been used by the researchers earlier to study the given research phenomenon. Thirdly, the study findings are expedient for funding agencies, government authorities and financial institutions as well as for non-government institutions to establish sustainable and broader policies for women to become successful entrepreneurs during disasters like COVID-19.
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Background: Diabetes is a common disease known to cause morbidity and mortality. Individuals with diabetes are at greater risk of complications from coronavirus and have recently gains attention of researchers and practitioners. Aim: To assess the effect of diabetes mellitus on clinical course and outcome of coronavirus infection. Study design: Prospective cohort study Place and duration of study: Coronavirus Disease High Dependency Unit Jinnah Hospital, Lahore from 01-01-2021 to03-04-2021. Methodology: Three hundred and seventy six patients of either genders and age range of 15-75 years were enrolled. They were divided into diabetic or non-diabetic groups. The various attributes such as demographic data, medical history, COVID-19 exposure history, symptoms and signs, laboratory findings, chest radiograph findings, the treatment measures and complications of diabetes and in hospital outcome were compared for both the groups. Result: Statistically different from each other in terms of oxygen requirement, lymphocyte %, neutrophil to lymphocyte ratio (P=0.026), alanine aminotransferase (P=0.038), C-reactive protein (P=0.048), ferritin (P=0.031), lactic acid dehydrogenase (LDH) (P=0.011), Ddimer (P=0.024), Quick sequential organ failure assessment score (qSOFA score) (P=0.001) and Chest X-ray (P=0.049), blood sugar random (P=0.000), treatment during hospital stay (P=0.000), insulin dose increase (P=0.000), complications during hospital stay (P=0.042) and shifting to the intensive care unit (P=0.002). Conclusion: Diabetic coronavirus patients have poorer prognosis due to higher risk of severe pneumonia and related complications including mortality than their non-diabetic counterparts.
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Introduction: The COVID-19 could be a dangerous widespread that has influenced each angle of life including education. The educational institutes have been closed to avoid the spread of the infection, and they have changed over their system into distance education. Completing the semester there's a have to be address the risky issues within the modern framework to create it for future usage Objectives: 1-To explore the effects of Covid-19 on life style 2- To know the perceptions and suggestions regarding online education in pandemic Material and Methods Study design: Qualitative Settings: Rawalpindi Medical University Duration: Six months i.e. 1st January 2021 to 30th June 2021 Data Collection procedure: It was focus group discussion conducted via Zoom link. There were 15 medical students were selected from all five classes of MBBS randomly after taking informed consent. A variety of issues that were obtained from the discussion were identified. Results: The findings have uncovered that most of the members were influenced by the widespread period contrarily Anxiety, hope less, and fatigue. It is clear from the findings that education process has had its shortcomings instead of its advantages such as need of interaction, and communication which lead the students to segregation, issues about exams, conventional instructive habits, the load of assignments, and time administration. On the other side the advantages regarding flexibility of place and time to learn and comfort in assessment Conclusion: It is evident that the COVID-19 widespread process has influenced the students' lives adversely. These negative sentiments have not been overcome by the instruction they uncovered all through the period. While, in conventional campus life they would be at the side their companions and teachers and they would overcome the issues together through socializing. Distance education system tried to facilitating teaching. The COVID-19 widespread period ought to be regarded as an opportunity for teachers to consider how to push the distance education framework forward. Within the light of the findings, it would be awesome to create the current distance education practices which we may well are beyond any doubt that long-term executions get a solid premise.
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Breast cancer (Bc(a)) causes the highest rate of mortality in females owing to the out-of-control cell division in breast cells. In this work, we perform an in-silico screening based on molecular docking and molecular dynamic of curcumin derivatives against ER alpha. In this study, we carry out, molecular docking of fifty (50) curcumin derivatives having anticancer potential by using virtual screening tools. Ten (10) ligands were selected based on binding energy ranged from (-7.4 kcal/mol to -9 kcal/mol), lower values of inhibition constant (0.23 mu mol to 3.59 mu mol), and visualisation of intermolecular interactions. Additionally, we also assess ADMET properties of selected ligands for prediction of their toxicity and drug-likeness. The molecular dynamic simulations (MD) including RMSD, RMSF, Rg, SASA, number of H-bonds and MM-PBSA binding free energy results showed that ligand L2 and L8 bind to estrogen protein ER alpha more proficiently with good stability over 120 ns. These results suggest lead anticancer compounds L2 (Salicylidenecurcumin) and L8 (Curcumin difluorinated) are the most promising inhibitor against ER alpha of Bc(a) with increment G(bind) values of (-2.939 and -4.369) kcal/mol. we expect that our findings will evoke the scientific community to further do in-vitro and in-vivo investigations for screened curcumin derivatives against ER alpha of Bc(a.)
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Context: From the past few years, Application Programming Interface (API) is widely used for mobile- and web-based application developments. Software developers can integrate third-party services into their projects to achieve their development goals efficiently using APIs;however, with the rapid increase in the number of APIs, the manual selection of Mashup-oriented API is becoming more difficult for the developer. Objective: In the COVID-19 pandemic, everyone wants an update about the latest Standard Operating Procedures (SOPs) and the latest information on COVID-19. Additionally, a software developer wants to develop an application that provides the SOPs and latest information of COVID-19;a developer can add these functionalities into an application using COVID-19-based APIs. Moreover, the current work aims at proposing a COVID-19-based API recommendation system for the developers. Method: In this study, we propose a COVID-19-based API recommendation system for developers. The recommendation system takes a developer query as input and recommends top-3 APIs and supported features, which help the developer during software development. Furthermore, the proposed COVID-19-based API recommendation system ensures the maximum participation of the developers by validating the recommended APIs and recommendation system from the expert developers using research questionnaires. Results: Additionally, the proposed COVID-19-based API recommendation system's output is validated by expert developers and evaluated on 120 expert developers' queries. In addition, experiment results show that single value decomposition achieves better prediction. Conclusion: We conclude that it is significantly important to recommend APIs along with supported features to the developer for project development, and future work is needed to take more developer's queries also to build Integrated Development Environment for the developers. © 2022 World Scientific Publishing Co.
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Pair trading strategy is a well-known profitable strategy in stock, forex, and commodity markets. As most of the world stock markets declined during COVID-19 period, therefore this study is going to observe whether this strategy is still profitable after COVID-19 pandemic. One of the powerful algorithms of DBSCAN under the umbrella of unsupervised machine learning is applied and three clusters were formed by using market and accounting data. The formation of these three clusters was based on book value per share, earning per share, classification of sector, market capitalisation and with other factors formed from PCA on the returns of daily data of six months of the 80 sample firms for year 2019-2020. An average of -0.32% average excess monthly return with Sharpe ratio of -0.0012 and Treynor ratio of -0.0231 is to be observed in COVID-19 pandemic period. However, the result of risk-adjusted performance under Jensen's alpha is observed to be insignificant. The policy implication of this study, for different portfolios and fund managers is suggested to use machine learning approach to get positive and higher returns for their clients. © 2022 World Scientific Publishing Company.
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Effective software requirements elicitation plays a vital role in the success or failure of a project. However, ambiguity in the requirement’s statements indicate the presence of a tacit knowledge, which ultimately act as a root cause of critical complications in later stages of software development as user’s needs might remain hidden. Additionally, the existence of numerous stakeholders escalates the problem as their perceptions may contrast mainly due to their experiences and roles in a specific application domain. Hence, witlessness of relevant stakeholder(s) and ambiguous requirements cause the compromise for a product quality. Eventually, it paves the way towards the failure of a project. Furthermore, COVID-19 has affected all walks of life, more specifically requirements elicitation process as it heavily depends on human-to-human interaction. Motivated by this, current study aims at identifying the requirements elicitation techniques and challenges through a systematic literature review protocol. Furthermore, we have performed an exploratory study to identify the traditional elicitation techniques that can be used specifically for eliciting the tacit requirements. Additionally, we validate the top 15 critical challenges in a normal and pandemic scenario. To validate the result’s authenticity and legitimacy, appropriate statistical tests have been applied on the obtained results. Based on the attained results, it is observed that transfer of tacit knowledge remains a most crucial challenge. To effectively handle the tacit knowledge challenge, we propose a novel conceptual model supporting COVID-19 context. Similarly, we employ expert-validation mechanism for empirically evaluation of the proposed conceptual model. Moreover, the current study provides the guidelines for the practitioners to mitigate the highlighted effects on the requirements elicitation process during current pandemic time. Finally, we believe that proposed conceptual model supports the practitioners in effectively gathering the tacit-knowledge based requirements in the COVID-19 context. Author
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TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Carbon Monoxide (CO) is a colorless, odorless gas found in fumes produced from carbon fuels in engines, stoves, and fireplaces. CO binds to hemoglobin forming a molecule called carboxyhemoglobin (CO-Hb), which has higher affinity to O2 than hemoglobin itself which leads to symptoms of hypoxia and ischemia. Given an adequate history, clinicians can quickly initiate treatment but differentials for shortness of breath (SOB) must be sought and ruled out. Our case report will discuss the importance of CO poisoning and its involvement in thrombus formation and development of a pulmonary embolism (PE). CASE PRESENTATION: 62 year old female with history of COPD was brought to ED due to acute SOB and lethargy. Upon EMS arrival, CO level was 800. While in transport in EMS, the patient's CO-Hb level was 34 (trended to 11.4). The patient was found to have sp02 of 86% on room air (RA), and was placed on 10L nonrebreather mask. Patient was hemodynamically stable and afebrile. Labs revealed WBC 17.96, platelet 409k (clumped), troponin 0.08 ng/mL, LDH 405 units/L, and CRP 22.3 mg/L. Patient was deemed not a candidate for hyperbaric oxygen therapy. CT Head without contrast ruled out intracranial pathology and UA ruled out UTI. Chest X-ray revealed bilateral hazy opacities. CTPE revealed RUL/RML segmental and subsegmental PE as well as bilateral GGO reflecting interstitial edema in the setting of CO poisoning. Echo revealed EF of 65% with no wall motion abnormalities. COVID PCR test resulted negative making PE more likely as cause for SOB and patient was started on therapeutic Lovenox and empiric Azithromycin and Ceftriaxone. Within 24 hours, patient clinically improved and was discharged on Xarelto. DISCUSSION: PE in patients with CO poisoning should be suspected if the patient does not clinically improve with initial treatment. CO toxicity has been known to cause inflammatory and obstructive changes to arterioles and venules. Furthermore, it may induce vasospasms and increase platelet aggregation, leading to venous thrombus formation. CO poisoning may also increase oxidative stress with nitric oxide and oxygen free radicals causing further damage to endothelial lining1 and leading to further platelet dysfunction. 2 This combination of vessel wall injury and stasis in blood flow are important for development of thrombus. Treatment of given thrombus will lead to moderate resolution of symptoms. CONCLUSIONS: Treatment may be delayed in patients with coexisting PE and CO poisoning as it may be misdiagnosed. It is especially difficult to identify PE in patients with stable O2 saturation. However, the combination of endothelial damage and eventual increased platelet aggregation plays a critical role in thrombus formation in patients with CO toxicity. As a result, it is an important differential for patients with CO poisoning especially when symptoms do not respond to initial treatment. REFERENCE #1: Ruth-Sahd LA, Zulkosky K, Fetter ME. Carbon monoxide poisoning: case studies and review. Dimens Crit Care Nurs. 2011 Nov-Dec;30(6):303-14. doi: 10.1097/DCC.0b013e31822fb017. PMID: 21983502. REFERENCE #2: Ikeda H, Koga Y, Oda T, Kuwano K, Nakayama H, Ueno T, Toshima H, Michael LH, Entman ML. Free oxygen radicals contribute to platelet aggregation and cyclic flow variations in stenosed and endothelium-injured canine coronary arteries. J Am Coll Cardiol. 1994 Dec;24(7):1749-56. doi: 10.1016/0735-1097(94)90183-x. PMID: 7963124. REFERENCE #3: Sevinc A, Savli H, Atmaca H. An interesting cause of pulmonary emboli: acute carbon monoxide poisoning. Clin Appl Thromb Hemost. 2005 Jul;11(3):353-7. doi: 10.1177/107602960501100317. PMID: 16015424. DISCLOSURES: no disclosure on file for Jagadish Akella;No relevant relationships by Javed Iqbal, source=Web Response No relevant relationships by Vaishali Mehta, source=Web Response No relevant relationships by Najia Sayedy, source=Web Response
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Objective: To analyze the most frequent radiographic abnormalities in COVID-19 patients. Methods: In this multicenter retrospective study, chest X-ray films and reports of COVID-19 patients admitted between March 2020 and June 2020 in three tertiary care hospitals of Lahore were analyzed for abnormalities. Patients of age > 18 years with positive COVID-19 RT-PCR, who underwent X-ray chest at presentation were enrolled. The study included pregnant patients as well. Results: Total 150 patients fulfilling inclusion criteria were enrolled. There was male predominance with mean age 50 years. Chest X-ray were abnormal in 127 (98%) patients. Predominant pattern of lung Involvement was bilateral lesions in 121(95%), left lower zone 89(70%), right lower zone 85(67%), right mid zone 57(45%), left mid zone 50(39%), and diffuse involvement in 36 (28%). GGOs was the most common lung lesion found in 53 (42%), followed by GGOs and consolidation combined. Peripheral distribution was noted in 36(28%), peripheral and peri hilar combined 58(45%), random 27(21%) and perihilar in 6(5%). Peri bronchial cuffing was seen in 23(18 %), reticulation 20(16%), nodular lesions 8(6%) pneumomediastinum (1.5%) and minimal pleural effusion 1(0.7%). Among 20 pregnant females, 15 (75%) had normal X- rays. All of abnormal CXR 5 (25%), had bilateral, mid and lower zone GGOs and consolidation. Distribution was random 3(60%), peripheral and perihilar combined 2(40%), patchy 1(20%) and confluent in 4(80%). Conclusion: The most predominant radiological features of COVID-19 in our population were bilateral, lower zone, patchy, pure GGOs or combined GGOs and consolidation with peripheral and perihilar distribution.
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Introduction: First identified in Wuhan, China in December 2019, COVID-19 infection, caused by severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), is responsible for the ongoing global pandemic that has claimed more than 1.5 million lives. The United States has become one of the epicenters for the outbreak. The effects of asthma or chronic obstructive pulmonary disease (COPD) are unknown with regards to the outcomes of patients with COVID-19 infection. This study aims to evaluate the effect of asthma or COPD on patients admitted with COVID-19 viral infection at a safety-net hospital in Long Island, New York. Method: In this retrospective single-center study, we identified 636 patients (age ≥18), admitted to our institution for COVID-19 infection from March 2020 to May 2020. Diagnosis of asthma or COPD was documented through patient history upon admission. The primary outcome was in-hospital all-cause mortality. In addition, secondary outcomes included cardiac arrest, acute respiratory distress syndrome (ARDS), intubation/mechanical ventilation, shock, and hospital and intensive care unit length of stay. Chi-square tests and independent T-sample tests were used to analyze categorical and continuous variables, respectively. Multivariate logistic regression analyses were performed to measure the odds of inpatient mortality and other secondary outcomes. All statistical analyses were performed using SPSS. Results: Of the 636 patients, 67 (10.5%) reported a history of asthma or COPD, 567 (89.2%) denied and 2 (0.3%) were unable to provide history. Patients with asthma or COPD had a statistically elevated risk of mortality than those without (44.8% vs. 30.7%, p=0.008) and a higher rate of cardiac arrest (35.8% vs. 21.5%, p=0.021). Patients with asthma or COPD had an increased rate of comorbidities compared to those without (Table 1). There was no statistical difference in between groups for other secondary outcomes including intubation, shock, ARDS, and arrhythmias. Mean age in those with asthma or COPD was 66.3 versus 59.1 (standard deviation 14.1 and 15.9 respectively, p=0.243). There was also no statistical difference between the two groups in the hospital or intensive care unit (ICU) length of stay (Table 1). Conclusion: Our study supports that COVID-19 patients with asthma or chronic obstructive pulmonary disease (COPD) demonstrated an elevated risk of all-cause in-hospital mortality and cardiac arrest but did not correlate with an increase in intubation, ARDS, arrhythmias, shock, and hospital/ICU length of stay.
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Introduction:Pulmonary fibrosis (PF) is characterized by excessive deposition of extracellular matrix components and destruction of the pulmonary parenchyma. Studies have shown severe Coronavirus Disease 2019 (COVID-19) can lead to PF with residual lung function abnormalities and fibrotic remodeling. As of today, there is no consensus on treatment for PF caused by COVID-19. We are reporting a case series of three post-COVID-19 PF patients treated with tapering prednisone. Case Series:Patient 1 is 52-year-old male presented to the clinic after a 3-month hospital course of COVID-19 requiring hyperbaric hood. He was discharged with 2L of home oxygen. The patient saturated at 95% at rest but desaturated to 70% on exertion. Chest X-ray (CXR) and CT thorax showed diffuse ground glass opacity with pulmonary fibrosis and scarring. Tapering prednisone from 40mg over 1 month was initiated. Follow-up visit after one month confirmed reduce home oxygen requirement. CXR also revealed mild improvement in interstitial infiltrates. Patient 2 is a 56-year-old male hospitalized 2 months ago for COVID-19 where he required non-rebreather mask for oxygen supply. In the office, he complained of shortness of breath on exertion. CXR showed diffuse bilateral airspace opacities and thickened interstitial lung markings. Pulmonary function test (PFT) revealed moderate restrictive pattern with reduced lung volumes. He was sent home with a course of tapering prednisone over 1 month and weekly office follow up. His symptoms improved. Repeat CXR showed improving bilateral diffuse reticular markings. Repeat PFT improved to mild restrictive lung pattern. Patient 3 is a 70-year-old male hospitalized for 1 moth for COVID-19 requiring face mask with recent discharge on 4L home oxygen. After 2 weeks of hospital discharge, the patient still required 2L of oxygen at home. CXR showed streaky lung opacities predominantly in the left lower lung field. The patient was started on tapering prednisone. At 2-month follow-up, he admitted clinical improvement of symptoms and was able to titrate off home oxygen at rest. Repeat CXR also showed improvement of streaky opacity in the left mid/lower lung. Discussion:No evidence-based treatment is available for post-COVID-19 PF. Corticosteroid is used for treatment of acute exacerbation of other forms of PF by decreasing inflammation in the lungs, and therefore may improve symptoms of post-COVID-19 PF. Our patients received 1-month course of tapering prednisone treatment showed mild clinical improvement with no major adverse effect. Further clinical trials should address the utility and risks of corticosteroid in post-COVID-19 PF.
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Background: Covid-19, an extremely contagious and rapidly spreading viral infection, caused by a novel corona virus SARS-COV-2 was first reported in China on December 5, 2019. It was declared as pandemic by WHO on March 11, 2020. The novel infection yet under research exhibits wide spectrum of severity ranging from no symptom to severe pneumonia leading even to death. Aim: To evaluate the role of NLR as a prognostic indicator for severe COVID-19, due to its positive correlation with disease severity, easy accessibility and low cost. Methods: It was multicenter retrospective observational study conducted in COVID wards of two tertiary care hospitals of Lahore treating COVID-19 patients between March and June 2020. A predesigned proforma was filled to collect the data. SPSS 21 was used for statistical analysis of this research. Results: Record of 100 COVID-19 patients admitted between March and June 2020 fulfilling the inclusion criteria was included in the study. All patients were divided into two groups. Non-severe group included 37 patients while severe group included 63 patients. The mean age of study population was 56 years with male predominance (63%). Overall, 50% patients in non-severe group and 71% patients in severe group had some co-existent comorbidity. Fever and cough were the most commonly reported symptoms in both groups while shortness of breath was more commonly reported in severe group (74.2%). The mean NLR in non-severe group was 4 as compared to 12 in severe group. Conclusion: Higher Neutrophil lymphocyte ratio (NLR) is associated with severe COVID -19 and can be used as an effective tool to predict progression of non-severe disease to severe disease.
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SESSION TITLE: New Developments in the Diagnosis and Management of Mycobacterial and Bacterial Chest Infections SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: The United States has become the new epicenter for COVID-19 infection. The role of obesity in COVID-19 infection and ARDS is unclear. Previous studies indicate obese hospitalized patients may have better outcomes including mortality, a phenomenon referred to as “obesity paradox.” This study aims to evaluate the effect of obesity on patients admitted with COVID-19 infection in a suburban safety-net hospital in New York. METHODS: A retrospective unmatched single-center study of the first 142 patients (age≥18 y) admitted to our facility from March 9, 2020 to March 30, 2020 with the diagnosis of COVID-19 infection. Body mass index (kg/m2) was used to stratify patients into nonobese (BMI <30) and obese (BMI>30). Further subdivisions based on WHO classification include underweight (<18.5), normal weight (≥18.5 to 24.9), overweight (≥25.0 to 29.9). Obesity subdivided into Class I (30.0 to 34.9), Class II (35.0 to 39.9), Class III morbid obesity (≥40). Statistical analyses were performed using SPSS. The primary outcome was all-cause mortality, secondary outcomes include ICU admission, intubation, ARDS and more. RESULTS: Out of the total 142 patients, 54 (37.46%) were obese. Obese patients had statistically significant higher rates of requiring ICU admission (50% vs 27% p=0.014), developing ARDS (48.1% vs. 29.2%), had longer hospital length of stay (11.2 vs. 8.2, p=0.031) and were more likely to be admitted directly to the ICU from ED (29.6% vs. 11.2%, p=0.019). Obese patients had higher mortality (42.6% vs. 36.0%, p= 0.429) than nonobese. Obese Covid-19 patients had more severe hypoxia on initial presentation (55.6% vs. 42.7% p=0.136), intubation (40.7% vs. 28.1%, p=0.118), worse PaO2/FIO2 ratios (173.9 vs. 276.6, p=0.635) and septic shock (31.5% vs. 20.2%, p=0.129). No statistical significance was seen between groups in terms of ethnicities, comorbidities including hypertension, diabetes and Charlson Comorbidity Index. No statistical significance was observed in obesity subdivisions, however the morbidly obese group had the highest frequency of mortality at 54%. CONCLUSIONS: Our study does not support the evidence of “Obesity Paradox” in COVID-19 infection, as obesity does not confer a statistical reduction in mortality. In contrast, our study suggests increased morbidity based on increased ICU admissions, development of ARDS and longer hospital stay in obese patients. Further studies are required to evaluate the role of obesity as an independent risk factor in COVID-19. CLINICAL IMPLICATIONS: Contrary to the "Obesity Paradox", Obese patients with COVID-19 infection may have worse clinical outcomes than non-obese. DISCLOSURES: No relevant relationships by Shiva Arjun, source=Web Response No relevant relationships by Andres Castillo, source=Web Response No relevant relationships by Jiten Desai, source=Web Response No relevant relationships by Kristen Farraj, source=Web Response No relevant relationships by Sandra Gomez Paz, source=Web Response No relevant relationships by Jaehyuck Im, source=Web Response No relevant relationships by Javed Iqbal, source=Web Response No relevant relationships by Paul Mustacchia, source=Web Response No relevant relationships by Upenkumar Patel, source=Web Response No relevant relationships by Rajmohan Rammohan, source=Web Response No relevant relationships by Kevin Yeroushalmi, source=Web Response
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SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Though acute pulmonary manifestations of COVID-19 infection are well documented, the long-term sequelae from this viral infection are unclear. We report a case of a patient presenting with persistent respiratory failure after recovery from COVID-19 infection with imaging showing evidence of new onset pulmonary fibrosis. CASE PRESENTATION: 56 year-old Hispanic male with Diabetes Mellitus presents to ED for shortness of breath on exertion after recent hospitalization 16 days ago for Covid-19 infection. He reports progressive dyspnea since discharge, interfering with daily activities including walking to the bathroom and preparing food. He denies dyspnea at rest, cough, constitutional symptoms, or exposure to sick contacts. On his last visit, he was hospitalized for 24 days for Covid-19 pneumonia, and finished a course of antibiotics, hydroxychloroquine and steroids. PaO2/Fio2 ratio was 250, and oxygen requirements were met with nasal cannula, with gradual improvement to 95% saturation on room air. He denied previous hospitalizations, family history, occupational exposures and substance abuse. Vital Signs showed blood pressure 137/91 mmHg, Pulse 116 BPM, RR 22 Temperature 98.4 F. Physical exam was pertinent for fine velcro-like inspiratory and expiratory crackles auscultated at lung bases, saturating 94% on room air at rest but desaturating to 85% after walking 5 steps. Labs revealed chest x-ray showed patchy opacities diffusely worsened from previous visit. CTPE showed no pulmonary embolism, but diffuse bilateral patchy infiltrates with ground glass opacities and bronchiectasis. WBC was 8.64 [K/mm3], absolute lymphocyte count 1.73 K/mm3. BNP, procalcitonin, lactate, autoimmune workup and Echocardiogram were normal. Inflammatory markers were elevated but decreased from last admission. Quantiferon Gold was positive with three negative AFB smears suggesting latent tuberculosis. PFTs showed a moderate restrictive pattern. He was treated with methylprednisolone and oxygen to prevent further fibrosis in areas of active inflammation and isoniazid for latent TB. After symptomatic improvement, he was discharged on home oxygen and steroid taper with outpatient follow up. DISCUSSION: The true long term implications of COVID-19 are uncertain. We highlight a patient who recovered from COVID-19 infection with mild ARDS yet has profound hypoxia on exertion with imaging showing severe fibrotic changes and areas of active inflammation. While severe ARDS alone has been shown to cause rapidly forming pulmonary fibrosis, exact sequelae of mild COVID-19 respiratory failure is unknown. Possible mechanisms include proliferation of proinflammatory cytokines like IL-6 during the acute infection, which has been linked to development of fibrosis. CONCLUSIONS: Our case reinforces the need for close outpatient follow-up of COVID-19 recovered patients and outlines a potential cause of hospital readmissions. Reference #1: Spagnolo P, Balestro E, Aliberti S, et al. Pulmonary fibrosis secondary to COVID-19: a call to arms? [published online ahead of print, 2020 May 15]. Lancet Respir Med. 2020;S2213-2600(20)30222-8. doi:10.1016/S2213-2600(20)30222-8 Reference #2: Leask A. COVID-19: is fibrosis the killer? [published online ahead of print, 2020 May 13]. J Cell Commun Signal. 2020;1. doi:10.1007/s12079-020-00569-0 Reference #3: Cabrera-Benitez NE, Laffey JG, Parotto M, et al. Mechanical ventilation-associated lung fibrosis in acute respiratory distress syndrome: a significant contributor to poor outcome. Anesthesiology. 2014;121(1):189-198. doi:10.1097/ALN.0000000000000264 DISCLOSURES: No relevant relationships by Fatima Anjum, source=Web Response No relevant relationships by Shiva Arjun, source=Web Response No relevant relationships by Javed Iqbal, source=Web Response No relevant relationships by Dolly Patel, source=Web Response No relevant relationships by Raghavendra Sanivarapu, source=Web Res onse