A Secure Wearable Framework for Stress Detection in Patients Affected by Communicable Diseases

The emergence of COVID-19 has drastically altered the lifestyle of people around the world, resulting in significant consequences on people's physical and mental well-being. Fear of COVID-19, prolonged isolation, quarantine, and the pandemic itself have contributed to a rise in hypertension among the general populace globally. Protracted exposure to stress has been linked with the onset of numerous diseases and even an increased frequency of suicides. Stress monitoring is a critical component of any strategy used to intervene in the case of stress. However, constant monitoring during activities of daily living using clinical means is not viable. During the current pandemic, isolation protocols, quarantines, and overloaded hospitals have made it physically challenging for subjects to be monitored in clinical settings. This study presents a proposal for a framework that uses unobtrusive wearable sensors, securely connected to an artificial intelligence (AI)-driven cloud-based server for early detection of hypertension and an intervention facilitation system. More precisely, the proposed framework identifies the types of wearable sensors that can be utilized ubiquitously, the enabling technologies required to achieve energy efficiency and secure communication in wearable sensors, and, finally, the proposed use of a combination of machine-learning (ML) classifiers on a cloud-based server to detect instances of sustained stress and all associated risks during times of a communicable disease epidemic like COVID-19. © 2001-2012 IEEE.

Evaluating Potential Delays and Outcomes of Patients Undergoing Surgical Resection for Locally Advanced and Recurrent Colorectal Cancer during a Pandemic

Aim: The COVID-19 pandemic resulted in a significant disruption of colorectal cancer (CRC) care pathways. This study evaluates the management and outcomes of patients with primary locally advanced or recurrent CRC during the pandemic in a single tertiary referral center. Method(s): Patients undergoing elective surgery for advanced or recurrent CRC with curative intent between March 2020 -March 2021 were identified. Following first MDT discussion patients were broadly classified into two groups: straight to surgery (n = 22, 45%) or neoadjuvant therapy followed by surgery (n = 27, 55%). Primary outcome was COVID-19 related complication rate. Result(s): 49 patients were included with a median age of 66 years (IQR:54-73). No patients developed a COVID-19 infection or related complication during hospital admission. Significant delays were identified in the treatment pathway of patients in straight to surgery group, mostly due to delays in referral from external centers. 9/22 in the straight to surgery group had evidence of tumour progression vs 3/27 in neoadjuvant group, (P = 0.015839). 7/27 in the neoadjuvant group showed evidence of tumour regression. During the study, surgical waiting times were reduced and more operations were performed during the second wave of COVID-19. Conclusion(s): This study suggests that it is possible to mitigate the risks of COVID-19 related complications in patients undergoing complex surgery for locally advanced and recurrent CRC. Delay in surgical intervention is associated with tumour progression, particularly in patients who may not have neoadjuvant therapy. Efforts should be made to prioritize resources for patients requiring time-sensitive surgery for advanced and recurrent CRC.

A Secure Wearable Framework for Stress Detection in Patients Affected by Communicable Diseases

The emergence of COVID-19 has drastically altered the lifestyle of people around the world, resulting in significant consequences in people’s physical and mental wellbeing. Fear of COVID-19, prolonged isolation, quarantine, and the pandemic itself have contributed to a rise in hypertension amongst the general populace globally. Protracted exposure to stress has been linked with the onset of numerous diseases and even increased frequency in suicides. Stress monitoring is a critical component of any strategy used to intervene in case of stress. However, constant monitoring during activities of daily living using clinical means is not viable. During the current pandemic, isolation protocols, quarantines and overloaded hospitals have made it physically challenging for subjects to be monitored in clinical settings. This study presents a proposal for a framework that uses unobtrusive wearable sensors, securely connected to an AI-driven cloud-based server for early detection of hypertension and an intervention facilitation system. More precisely, the proposed framework identifies the types of wearable sensors that can be utilized ubiquitously, the enabling technologies required to achieve energy efficiency and secure communication in wearable sensors and finally, the proposed use of a combination of machine learning classifiers on a cloud-based server to detect instances of sustained stress and all associated risks during times of a communicable disease epidemic like COVID-19. IEEE

Evaluating potential delays and outcomes of patients undergoing surgical resection for locally advanced and recurrent colorectal cancer during a pandemic.

INTRODUCTION: The COVID-19 pandemic resulted in a significant disruption of colorectal cancer (CRC) care pathways. This study evaluates the management and outcomes of patients with primary locally advanced or recurrent CRC during the pandemic in a single tertiary referral centre. METHODS: Patients undergoing elective surgery for advanced or recurrent CRC with curative intent between March 2020 and March 2021 were identified. Following first multidisciplinary team discussion patients were broadly classified into two groups: straight to surgery (n=22, 45%) or neoadjuvant therapy followed by surgery (n=27, 55%). Primary outcome was COVID-19-related complication rate. RESULTS: Forty-nine patients with a median age of 66 years (interquartile range: 54-73) were included. No patients developed a COVID-19 infection or related complication during hospital admission. Significant delays were identified in the treatment pathway of patients in the straight to surgery group, mostly due to delays in referral from external centres. Nine of 22 patients in the straight to surgery group had evidence of tumour progression compared with 3 of 27 in the neoadjuvant group (p=0.015839). Seven of 27 patients in the neoadjuvant group showed evidence of tumour regression. During the study, surgical waiting times were reduced, and more operations were performed during the second wave of COVID-19. CONCLUSION: This study suggests that it is possible to mitigate the risks of COVID-19-related complications in patients undergoing complex surgery for locally advanced and recurrent CRC. Delay in surgical intervention is associated with tumour progression, particularly in patients who may not have neoadjuvant therapy. Efforts should be made to prioritise resources for patients requiring time-sensitive surgery for advanced and recurrent CRC.

Effect of Covid 19 lockdown and online education on health related quality of life in private university students

Objective: To determine the effect of COVID-19 lockdown on the health-related Quality of life in undergraduate students taking online classes from different private institutions. Methodology: It was a cross-sectional study involving 211participants. Sample size was calculated by "EpiTool" with 95% confidence level. They were selected through convenient sampling technique. RAND health-related quality of life (QoL) SF-36 form was used to collect data. The questionnaires included demographics details and SF-36 questions divided into eight domains. Results: Average age group was 21-23 years. The mean values of eight SF36 domains were calculated separately and the range for male was 36.23-74.21 points while for females were 29.19-65.62. The paired sample t-test showed p>0.005 in all domains of SF-36 except pain, Energy/Fatigue, and General health QoL. A total of 175 respondents out of 211 mentioned that they had better health now as compared to a year ago. Conclusion: There was a marked decrease in the quality of life of the undergraduate students taking online classes in private Universities of Lahore. Other than Social functioning domain of SF36 both gender were equally affected by the COVID-19 lockdown in term of QoL which showed no significant gender dependent difference.

Predicting mortality in COVID-19: Comparison of apache iv, mews, and MSOFA

INTRODUCTION: The novel coronavirus disease (COVID-19), is an infectious disease caused by the newly discovered virus (SARS-CoV-2). A few COVID-19 patients can have severe disease that is life-threatening and require ICU admission. The objective of this study is to compare the performance of APACHE IV (Acute Physiology and Chronic Health Evaluation), MEWS (Modified Early Warning Score), and mSOFA (Modified Sequential Organ Failure Assessment) in predicting mortality in COVID-19 patients admitted to the ICU. METHODS: All data ware retrospectively collected from electronic health records of COVID-19 patients on day 1 of admission to our ICU between March 1st and May 30th, 2020. Data was used to calculate APACHE IV, MEWS, and mSOFA for each patient. Student t test was used to compare means. The C statistic was calculated as a measure of the overall strength of prediction for both CSS and APACHE IV. Receiver-operating characteristic (ROC) curves were used to assess the mortality predictions. RESULTS: A total of 79 patients with COVID-19 were included, with 50 survivors (S) and 29 nonsurvivors (NS);mortality rate of 36.7 %. Compared to S, NS were older (70 ± 14 vs 61 ± 14, p = 0.0001), had higher APACHE IV scores (79 ± 37 vs 51 ± 23, p = 0.0001), similar MEWS (3.2 ± 2.2 vs 2.9 ± 1.9, p = 0.4), and higher mSOFA (4.3 ± 3.7 vs 3.0 ± 2.6, p = 0.01). Estimating the ROC area under the curve (AUC) showed that APACHE IV was a significantly better predictor of hospital mortality compared to MEWS or mSOFA (AUC = 0.78 ± 0.05 for APACHE IV compared to 0.60 ± 0.04 for MEWS [p < 0.0001], and compared to 0.66 +/- 0.04 for mSOFA [p = 0.0001]). CONCLUSIONS: APACHE IV was a better predictor of mortality than either MEWS or mSOFA in patients with COVID-19 admitted to ICU. These findings should be further investigated in large multicenter prospective studies.

Should statins be considered for treatment of COVID-19 patients?

INTRODUCTION: The novel coronavirus disease (COVID-19), is an infectious disease caused by the newly discovered virus (SARS-CoV-2). Statin therapy might be considered for patients with COVID-19 based on following rationales. First, one of the greatest risk factors for severe COVID-19 disease is underlying cardiovascular disease. Several cardiovascular complications of COVID-19 infection have been described and statins might be beneficial in preventing some of these. Secondly, there is a hypothesis that statins may protect innate immune responses to viral respiratory infections (including to SARS-CoV) through inhibiting the MYD88 pathway. Thirdly, statins are generally considered 'safe'. Some COVID-19 patients have severe disease that is life-threatening and requires ICU admission. The objective of this study was to compare outcomes of patients admitted to the ICU with COVID-19 who were on chronic statins (S Group) vs those who never were on statins (NS group). METHODS: All data ware retrospectively collected from electronic health records of COVID-19 patients admitted to our ICU between March 1st and May 30th, 2020. Data was used to calculate APACHE IV (Acute Physiology and Chronic Health Evaluation), MEWS (Modified Early Warning Score), and mSOFA (Modified Sequential Organ Failure Assessment) on day 1 of ICU admission for each patient's baseline characteristics. Student t test was used to compare means. Outcomes included ICU length of stay in days (ICU LOS), hospital length of stay in days (hospital LOS), ICU mortality, and hospital mortality. RESULTS: A total of 74 patients with COVID-19 were included, with 35 in the S group and 39 in the NS group. Compared to NS group, S group had similar APACHE IV scores (61 ± 28 vs 62 ± 35, p = 0.9), similar MEWS (2.6 ± 1.7 vs 3.3 ± 2.3, p = 0.2), and similar mSOFA (3.6 ± 2.3 vs 3.7 ± 3.7, p = 0.9). There were no statistically significant differences in ICU LOS (13 +/- 15 vs 10 +/- 11, p = 0.4), hospital LOS (19 +/- 16 vs 16 +/- 16, p = 0.4), ICU mortality (37% vs 31 %, p = 0.6), or hospital mortality (40% vs 36 %, p = 0.7). CONCLUSIONS: In a single center study, statins were not associated with protective effect against COVID-19 patients that required ICU admission. Statins for COVID-19 should be investigated in prospective studies.

Predicting mortality in COVID-19: Comparison of novel score with apache IV

INTRODUCTION: The novel coronavirus disease (COVID-19), is an infectious disease caused by the newly discovered virus (SARS-CoV-2). A few COVID-19 patients can have severe disease that is life-threatening and require ICU admission. The objectives of this study are to evaluate the performance of a novel scoring system in predicting mortality in COVID-19 patients admitted to the ICU, and to compare outcome prediction to APACHE IV. METHODS: A novel scoring system (COVID-19 severity score, CSS) is calculated from neutrophil/lymphocyte ratio (NLR), CRP, Ferritin levels (F), and D-dimer levels (D) as follows: CSS = (NLR X CRP X F X D)/10,000. All data ware retrospectively collected from electronic health records of COVID-19 patients on day 1 of admission to our ICU between March 1st and May 30th, 2020. Student t test was used to compare means. The C statistic was calculated as a measure of the overall strength of prediction for both CSS and APACHE IV. Receiver-operating characteristic (ROC) curves were used to assess the mortality predictions. RESULTS: A total of 40 patients with COVID-19 were included, with 27 survivors (S) and 13 nonsurvivors (NS);ICU mortality rate of 32.5 %. Compared to S, NS were older (68 ± 19 vs 61 ± 14, p = 0.07), had higher APACHE IV scores (75 ± 37 vs 56 ± 28, p = 0.01), higher NLR (8.8 ± 8.6 vs 3.8 ± 2.2, p = 0.0006), lower CRP (75 ± 37 vs 99 ± 61, p = 0.04), similar F (3300 ± 5200 vs 2500 ± 2100, p = 0.4), similar D (2.8 ± 1.2 vs 2.7 ± 1.3, p = 0.7), and higher CSS (520 ± 1000 vs 147 ± 120, p = 0.03). Estimating the ROC area under the curve (AUC) showed that CSS was a significantly better predictor of hospital mortality compared to APACHE IV (AUC = 0.75 ± 0.05 for CSS compared to 0.70 ± 0.05 for APACHE IV (p < 0.0001). CONCLUSIONS: CSS was a strong predictor of mortality in patients with COVID-19 admitted to ICU. These findings should be further investigated in large multicenter prospective studies.

The association between HbA1C and outcomes in COVID-19 patients

INTRODUCTION: The novel coronavirus disease (COVID-19), is an infectious disease caused by the newly discovered virus (SARS-CoV-2). Some patients with COVID-19 develop severe disease that is life-threatening and leads to ICU admission. Diabetes is a proposed risk factor in development of SARS-CoV-2 infection and might be associated with the prognosis of COVID-19. The objective of this study was to evaluate the relationship between elevated glycosylated hemoglobin (HbA1C) levels, and its association in COVID-19 patients. METHODS: All data ware retrospectively collected from electronic health records of COVID-19 patients on day 1 of admission to our ICUs between March 1st and May 30th, 2020. Data were used to investigate the relationship between elevated HbA1C levels, hospital and ICU length of stay (LOS), and ventilator free days. RESULTS: Out of 79 patients with COVID-19, a total of 29 patients with HbA1C results were included. They were divided into two groups: group A with HbA1C level greater or equal to 6%, and group B with HbA1C less than 6%. A one side t test was preformed to analyze if these groups of patients had a significantly difference in vent free days, ICU LOS and hospital LOS. A significant difference was found in all 3 categories. Compared with group B patients, group A patients had significantly longer hospital LOS (22.83 ± 17.6, p < 0.05), ICU LOS (16.48 ± 15.7, p < 0.05) and shorter ventilator free days (6.56 ± 10.1, p < 0.05). CONCLUSIONS: Elevated HbA1C level greater than or equal to 6% is significantly associated with longer hospital, ICU LOS, and shorter ventilator free days in COVID-19 patients. These findings should be further investigated in large multicenter prospective studies.

COVID-19-related perceived stress in healthcare workers

INTRODUCTION: It is uniformly accepted that the current COVID-19 pandemic has caused an unprecedented strain on all facets of life around the world. This is especially true for both healthcare workers and patients who have been significantly affected. Our aim was to objectively quantify how this pandemic particularly affected the stress levels of healthcare workers (HCW). METHODS: The Cohen Perceived Stress Scale (CPSS) is a psychological instrument used to measure the degree to which situations in one's life are appraised as stressful. The CPSS has been used in studies exploring perceived self-helplessness and self-efficacy. Over the course of 2 weeks, ICU HCW: medical doctors, nurses, respiratory therapists, patient care assistants, and pharmacists;were asked to complete the CPSS survey that was sent via email. The department leaders, via email, reminded HCW to complete the survey once. A total of 144 HCW responded. A comparison of the results was conducted based on profession, gender, and years of work experience. RESULTS: The results range between 11.9-14.7 indicating significant levels of stress in HCW during the COVID-19 pandemic. We analyzed the data collected using analysis of variance to determine the P-Value. When the scores were organized by the three categories of profession, gender, and years of work experience, we found no significant difference (P<0.05) in the quantitative level of stress reported. CONCLUSIONS: The results of the survey confirm significant levels of stress reported by all participants. There is no significant difference in stress levels between professions, gender, or years of work experience. We propose that stress reduction management should be implemented for all HCW. Furthermore, the survey should be repeated once stress mitigation techniques are used to objectify reduction in stress levels. Finally, we intend to repeat the survey once the pandemic has ended to evaluate baseline stress levels in non-pandemic situations. This study is limited by respondent bias in a pandemic situation. There was no baseline assessment of stress levels for comparison. Conducting this type of survey at the end of the pandemic, in non-pandemic situation, and on a yearly basis would better quantify the levels of stress in ICU HCW.