Early Signs of COVID-19 in Pakistan

Background: The outbreak of novel coronavirus (COVID-19) has turned into a public health emergency of international concern. With no antiviral drugs nor vaccine, presence of carriers without obvious symptoms and varied clinical characteristics, the traditional public health measures are certainly less effective. The early signs of COVID-19 and epidemiological data are essential to strengthen the overwhelmed healthcare systems. Aim: To detect, assess and analyse the early signs of COVID-19 in Pakistan before the official reporting of cases in the country. Methods: The study uses the EpiWATCH observatory to extract data from 1 November 2019 to 1 April 2020. The trend of pneumonia of unknown origin cases in Pakistan was observed to assess if cases of COVID-19 could have been detected before the first official case was reported. A descriptive analysis of the obtained data was achieved on the basis of geographic and demographic features. Results: A total of 151 entries were included in the study. Before the identification of the first official case of COVID-19 in Pakistan, 54 reports of cases of pneumonia of unknown origin were recorded. After the first case of COVID-19 was reported, 97 reports of cases of COVID-19 were recorded. The study findings suggest that there were early signs of COVID-19 in Pakistan since the second week of January 2020, a month and a half prior to the first case being reported in the country. © 2021 The Author(s).

Learning from Machines? Social Bots Influence on COVID-19 Vaccination-Related Discussions: 2021 in Review

The World Health Organization defines vaccine hesitancy as a delay in acceptance or refusal of vaccination despite the availability of vaccination services. Vaccine hesitancy contributes to lower rates of vaccination in a population and delayed vaccine coverage. A large number of COVID-19 vaccines have been administered worldwide against COVID-19. Due to concerns people have about COVID-19 vaccine adverse events, a significant proportion of people exhibit hesitancy towards the vaccines. These are often prompted by information and misinformation spread through social media conversation, which is not driven exclusively by genuine human-run accounts. Social bots have been shown to be very active during the pandemic participating in discussions about vaccines, including the spread of conflicting and misleading information. Using a novel ensemble technique, we sought to identify and describe the involvement of social bots in COVID-19 vaccination-related discussions on Twitter and how this could have influenced sentiments and hesitancies about COVID-19 vaccines. We included tweets from January to December 2021 to present a whole year's analysis in relation to the vaccines. Unique usernames from these posts were passed to Botometer and Tweetbotornot, programs that review Twitter accounts, to detect a broad range of social bots using a scoring system. A domain-oriented transfer learning technique is applied by finetuning the CT-BERT V2 model to detect the influence of social bots on COVID-19 vaccine sentiments. We computed the ratio of sentiment transmission from bots-to-human, human-to-human, human-to-bots, and bots-to-bots. BERTopic was used to extract the topics of discussion to identify the amplified or transferred hesitancies. Social bots' participation in online discussions noticeably influenced human sentiments and hesitancies about COVID-19 vaccination. A major portion of sentiments transferred from bot to human during the period of study appeared to amplify or transfer hesitancies regarding COVID-19 vaccination. © 2023 ACM.

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.

OCR for TIFF Compressed Document Images Directly in Compressed Domain Using Text segmentation and Hidden Markov Model

In today's technological era, document images play an important and integral part in our day to day life, and specifically with the surge of Covid-19, digitally scanned documents have become key source of communication, thus avoiding any sort of infection through physical contact. Storage and transmission of scanned document images is a very memory intensive task, hence compression techniques are being used to reduce the image size before archival and transmission. To extract information or to operate on the compressed images, we have two ways of doing it. The first way is to decompress the image and operate on it and subsequently compress it again for the efficiency of storage and transmission. The other way is to use the characteristics of the underlying compression algorithm to directly process the images in their compressed form without involving decompression and re-compression. In this paper, we propose a novel idea of developing an OCR for CCITT (The International Telegraph and Telephone Consultative Committee) compressed machine printed TIFF document images directly in the compressed domain. After segmenting text regions into lines and words, HMM is applied for recognition using three coding modes of CCITT-horizontal, vertical and the pass mode. Experimental results show that OCR on pass modes give a promising results. © 2022 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.

The Effect of Driving Pressure on Mortality in Intubated Covid-19 Ards Patients: Lower Is Better

INTRODUCTION: Coronavirus disease 2019 (Covid-19) represents viral pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In non-COVID ARDS patients, high driving pressure (DP = Plateau pressure - PEEP) has been associated with higher mortality. Pathophysiological features of COVID ARDS have been considered different from non-COVID ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. The objective of this study is to evaluate the effect of DP on mortality in intubated COVID-19 ARDS patients. METHOD(S): All data were retrospectively collected from EHR of COVID-19 patients admitted to our ICU in2020. COVID ARDS patients in our institution are managed based on ARDS management guidelines that include lung protective ventilation strategy, PEEP protocol, and prone positioning for persistent PaO2/FiO2 (P/F) ratio < 150. Average P/F, Plateau pressure (PP), DP, and SOFA scores were collected and calculated on first three days of mechanical ventilation and correlated with mortality. RESULT(S): A total of 46 patients intubated with COVID-19 ARDS were included, with 25 survivors and 21 nonsurvivors (ICU mortality rate 46%). Compared to Non-survivor group, the survivor group had similar age (60 +/-12 vs 66 +/-12, p = 0.1), similar P/F ratios(D1: 147 +/-96 vs 136 +/-98, p = 0.7;D3: 136 +/-88 vs 128 +/-74, p = 0.7), similar PP (D1: 23 +/-7 vs 25 +/-6, p = 0.2;D2: 24 +/-6 vs 26 +/-7, p = 0.2;D3: 28 +/-7 vs 29 +/-7, p = 0.7), less number of comorbidities (1.7 +/-1.6 vs 3.2 +/-2.8, p = 0.03), better SOFA score change (SOFA D3 minus D1: 0.4 +/-0.5 vs 1.7 +/-1.7, p = 0.0006), and significantly less DP (D1: 11 +/-5 vs 15 +/-4, p = 0.006;D2: 12 +/-3 vs 15 +/-6, p = 0.01;D3: 14 +/-5 vs 19 +/-8, p = 0.02). CONCLUSION(S): Similar to other forms of ARDS, low driving pressure (less than 15 cmH2O) in COVID-19 ARDS is associated with lower mortality. These findings should be investigated in large multicenter prospective studies.

The Effect of Fluid Balance on Proning and Successful Extubation in Intubated Covid-19 Patients

INTRODUCTION: Coronavirus disease 2019 (Covid-19) represents viral pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In ARDS patients, positive fluid balance has been associated with prolonged mechanical ventilation, longer length of stay, and higher mortality. As a result, restrictive fluid strategies improved oxygenation and reduced duration of mechanical ventilation. Optimal fluid management strategy for invasively ventilated COVID-19 patients is lacking. The objective of this study is to evaluate the effect of fluid balance on need for proning and successful liberation of invasive mechanical ventilation (MV) in patients with COVID-19 ARDS. METHOD(S): All data were retrospectively collected from EHR of COVID-19 patients admitted to our ICU. COVID ARDS patients in our institution are managed based on ARDS management guidelines that include lung protective ventilation strategy, PEEP protocol, and prone positioning for persistent PaO2/FiO2 (P/F) ratio < 150. Fluid balance in ml was calculated on Day 1 (F1) and Day 7 (F7) of ICU admission. Groups were divided into those successfully liberated (L-group) and those unable to be liberated from MV (U-group). RESULT(S): A total of 57 patients intubated with COVID-19 ARDS were included, with 29 in the L-group and 28 in the U-group. Compared to U-group, L-group had similar age (64 +/- 13 vs 64 +/- 13, p = 1.0), number of comorbidities (2.3 +/- 2.2 vs 2.7 +/- 2.5, p = 0.5), P/F ratio on day 1 (D1, 144 +/- 110 vs 130 +/- 95, p = 0.6), D1 SOFA score (6.4 +/- 4.5 vs 5.9 +/- 4.3, p = 0.7), and F1 (434 +/- 1106 vs 413 +/- 1301, p = 0.9). F7 was significantly less for L-group than U-group (290 +/- 2500 vs 2000 +/- 4000, p = 0.05). [F7 - F1] was also significantly less for L-group compared to U-group (- 144 +/- 1400 vs 1600 +/- 2800, p = 0.004). There was less need for proning (38 % vs 72 %, p = 0.01), and lower mortality (24% vs 86 %, p < 0.001) in the L-group compared to the U-group. CONCLUSION(S): In a cohort of invasively ventilated patients with COVID-19 ARDS, a lower cumulative fluid balance was associated with less need for proning and more successful liberation of MV, indicating that restricted fluid management in these patients may be beneficial. These findings should be investigated in large multicenter prospective studies.

Treatment Fluid Volume May Predict Stroke Volume Improvement

INTRODUCTION: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) and Stroke Volume (SV) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. In the FRESH study, we have previously shown the impact of the volume of administered treatment fluid on fluid balance and patient outcome. The goal of this study was to explore the relationship between volume of fluid and stroke volume improvement in septic patients. METHOD(S): The Starling Registry study is an observational registry study evaluating trends in CO and SV over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in SV (first SV measurement compared to last SV measurement) were compared to those who did not exhibit improvement. RESULT(S): A total of 201 patients received hemodynamic monitoring during their stay at three different ICUs. 46% were female, and the average age was 63 years. 72% of the patients had sepsis, and 20% of patients were positive for COVID. When patients who improved their stroke volume over the course of treatment were compared to those who did not improve, results indicate that SV improved patients had received a total volume fluid of 1241 ml, while patients did not improve received 893 ml fluid, for a difference of 348 ml (p=0.018). CONCLUSION(S): Registry patients with minimal change in stroke volume appear to receive less fluid volume. FRESH and other studies have shown improved outcomes in restricting fluid in non-preload dependent (non-fluid responsive) state. Further research in the phenotype of nonresponsive patients may be helpful in identifying new methods to improve outcomes in this group.

Stroke Volume Change May Predict Outcome in Patients with Lv/Rv Dysfunction

INTRODUCTION: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) and Stroke volume (SV) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. In the FRESH study, we have previously shown that patients who improve CO and SV exhibit improved outcome such as decreased mortality and decreased need for ventilation. The goal of this study was to explore the relationship between the change in stroke volume and cardiac output in patients with LV and RV Dysfunction. METHOD(S): The Starling Registry study is an observational registry study evaluating trends in CO and SV over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in CO (first CO measurement compared to last CO measurement) were compared to those who did not exhibit improvement. RESULT(S): 71 patients with LV/RV dysfunction received hemodynamic monitoring during their stay across 4 units at 3 hospitals. 48% were female, and the average age was 68 years. 67% of the patients had sepsis, and 17% of patients were positive for COVID. Notably, in this population of LV/ RV dysfunction, patients with COVID (p=0.016), pneumonia (p=0.034) and those that required oxygen treatment (p=0.034) were less likely to improve Cardiac Output following fluid challenge. CONCLUSION(S): Patients with LV/RV dysfunction represent a vulnerable population. We have previously shown the benefits of trending cardiac output and stroke volume in this patient population (ATS, 2018). Trends observed in this population may help indicate which patients may be at risk for more negative outcome.

Assessment of Predictors of Mortality in COVID-19 Patients Treated with Tocilizumab

Background: A hypersensitivity condition called cytokine storm is the main cause of death in COVID-19 patients. A monoclonal antibody called tocilizumab may be able to suppress the Interleukin-6 receptors (IL-6R) and lessen the likelihood that the body would have a hypersensitive immune response. Aim(s): To evaluate the mortality advantages of tocilizumab in individuals with COVID-19. Study design: Retrospective study. Place and duration of study: Bahria Town International Hospital Lahore from 16th June 2020 to 17th September 2021. Methodology: Patients with 96 confirmed instances of COVID-19 were enrolled. Two groups of patients were created. A single dosage of tocilizumab was administered to 52 participants in the first group, referred to as the survivors, and 44 patients in the second group, who passed away within 14 days. From the patients' medical records, the demographic information, co-morbid conditions, and laboratory values were obtained. The hospital's institutional review board and ethics committee (IRBEC) gave its approval for this study. The permission was ignored because this was a retroactive analysis. Result(s): 54.24 16.58 was the average age, and 54 (56.25%) of the population were men. 52 (54.16%) patients were survivors, compared to 44(45.83%) patients in the non-survivor group. In non-survivors compared to survivors, the older age group was shown to be statistically significant (62.78+/-12.86 vs. 51.65+/-11.68, p=0.003). Additionally, non-survivors had a greater BMI (p=0.006). In our study, hypertension and diabetes were the two co-morbid conditions that were most frequently detected (35.24% and 28.94%, respectively). The mortality rates among patients with diabetes, asthma, COPD, and cancer were all considerably higher (P=0.01, 0.006, and 0.004, respectively). Cancer and type-2 diabetes patients had death rates that were considerably higher (p=0.05 and p=0.01, respectively). C-reactive protein (CRP), D. Dimer, procalcitonin (PCT), and IL-6 were discovered to be the significant predictors of mortality (p 0.0001, 0.05, 0.001, and 0.004 respectively). Conclusion(s): Even though tocilizumab is authorised and has been shown to have positive results, people with diabetes, COPD, and asthma are more likely to experience negative results even after getting a single dosage of the medication. Similar to CRP, D. Dimer levels are reliable indicators of death. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

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

ADJUNCTIVE USE OF DISPOSABLE 1.1-MM CRYOPROBE WITH ROBOTIC-ASSISTED BRONCHOSCOPY

SESSION TITLE: Tales in Bronchoscopy SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Peripheral pulmonary nodule biopsy can be challenging based on its location and size. Robotic bronchoscopy is augmenting peripheral navigation, allowing for approximation of peripheral nodules. The diagnostic yield is variable and is primarily dependent upon operator experience, selection of biopsy equipment and nodule texture. Hard pulmonary nodules are difficult to biopsy with a needle, brush and forceps. We report a case of utilizing combined disposable 1.1 mm cryoprobe and robotic bronchoscopy to diagnose a right lower lobe nodule. CASE PRESENTATION: A 83-year-old woman with a remote history of non-Hodgkin's lymphoma presented with dyspnea and fatigue. 18F-FDG PET/CT revealed a 2.7 cm hypermetabolic nodule with central photopenia in the right lower lobe (RLL) along with patchy bilateral ground-glass opacities related to COVID-19 infection. After a few weeks, robotic navigation was used for approximation of the RLL superior segment nodule. Under fluoroscopic and radial guidance with circumferential signal, 6 forcep biopsies and 5 fine needle aspirations with 21-gauge needle yielded a non-diagnostic sample. A decision was made to utilize a 1.1 mm disposable cryoprobe, which was inserted through the opening made by the forceps into the target lesion. Six cryo biopsies were obtained with 4-6 seconds freeze time. Minimal bleeding was encountered and no pneumothorax occurred. Histopathological examination revealed necrotizing granulomatous inflammation. DISCUSSION: To the best of our knowledge, this is the first reported case of combination 1.1 mm disposable cryoprobe biopsy with robotic bronchoscopy. Interventional pulmonologists are primarily using cryo probe for mechanical tumor debulking and peripheral lung biopsy for diagnosis of interstitial lung disease. The use of a 1.1 mm cryoprobe under robotic guidance allows for well-preserved tissue samples and possibly boosting diagnostic yield. The advantage of the 1.1 mm cryoprobe lies with its size and excellent flexibility. The robotic platform also corrects for any unwanted deflection. One limitation of using a flexible cryoprobe is its blunt tip, requiring an additional step in gaining access to nodules located outside the airway with either the biopsy needle or forceps. Future improvements in cryoprobe design with a sharp tip may address this limitation. CONCLUSIONS: Combining 1.1 mm disposable cryoprobe with robotic bronchoscopy is safe and can be considered as an adjunct to conventional biopsy, allowing for well-preserved tissue. Further prospective studies to evaluate its performance and safety is warranted. Reference #1: Kho SS, Chai CS, Nyanti LE, et al. Combination of 1.1 mm flexible cryoprobe with conventional guide sheath and therapeutic bronchoscope in biopsy of apical upper lobe solitary pulmonary nodule. BMC Pulm Med. 2020. 158(20). doi.org/10.1186/s12890-020-01199-3 Reference #2: Chen AC, Pastis NJ Jr, Mahajan AK, et al. Robotic Bronchoscopy for Peripheral Pulmonary Lesions: A Multicenter Pilot and Feasibility Study (BENEFIT). Chest. 2021;159(2):845-852. doi:10.1016/j.chest.2020.08.2047 Reference #3: Sahajal Dhooria, Inderpaul Singh Sehgal, Ashutosh NA Digambar Behera, Ritesh Agarwal. Diagnostic Yield and Safety of Cryoprobe Transbronchial Lung Biopsy in Diffuse Parenchymal Lung Diseases: Systematic Review and Meta-Analysis. Respiratory Care. 2016. 61(5):700-712. doi.org/10.4187/respcare.04488 DISCLOSURES: No relevant relationships by Sailendra Chundu No relevant relationships by Moiz Javed No relevant relationships by Abid Khokar No relevant relationships by Ali Saeed No relevant relationships by Andrew Talon No relevant relationships by Melinda Wang

FLUID RESPONSIVENESS AND PATIENT OUTCOMES

SESSION TITLE: Sepsis: Beyond 30cc/kg and Antibiotics SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Cardiac function is known to be negatively impacted by sepsis. Stroke volume (SV) change in response to Passive Leg Raise (PLR) is an effective method to predict fluid responsiveness (FR) or cardiac response to preload expansion. We have previously shown that short-term sepsis resuscitation phenotypes based responses to passive leg raise (PLR) can identify discrete patient sub-groups. The goal of this study was to identify resuscitation phenotypes and explore the relationship between the cardiac physiology and patient outcome. METHODS: The Starling Registry study is an observational registry study evaluating trends in cardiac output (CO) and SV over time as related to patient outcome (NCT04648293). Patients were classified as FR if SV increased ≥ 10% when measured with non-invasive bioreactance (Starling Monitor, Baxter Healthcare). Patients were characterized Non FR if SV increased <10%. Patients were grouped into 6 different sextets based on the percentage of FR PLRs within each group. RESULTS: 222 critical care patients received hemodynamic monitoring during their ICU stay across two different hospitals. 46 % were female, and the average age was 64 years. 65% of the patients had sepsis, and 20% of patients were positive for COVID. There were an equal percentage of septic patient in whose who were not FR (68%) and patients who were 100% FR (65%, p=0.334). Patients who were not FR received significantly less resuscitation fluid (609 ml) compared to patients who were 100% FR (1094 ml, p<0.0001). Patients who were 100% FR exhibited a decreased incidence of mortality (20.2%) compared to patient with 0% incidence FR (35.5%, p= 0.028). CONCLUSIONS: Short-term sepsis resuscitation phenotypes based responses to PLR identify discrete patient sub-groups. We have previously shown patients who improve CO in response to the resuscitation exhibited improved outcome. The ability to respond to the addition of IV fluid by increasing CO and SV may improve perfusion and lead to decreased adverse events. As there were an equal number of septic patients in both groups, a 0% incidence of FR may reflect a reduced EF or cardiac dysfunction instead of peripheral leakage. The results provided by a real time dynamic assessment may predict patient outcome and demonstrate physiology based on fluid responsiveness. CLINICAL IMPLICATIONS: Monitoring cardiac function closely is a high priority to prevent clinically relevant changes in patient outcome. DISCLOSURES: Employee relationship with Cheetah Medical Please note: >$100000 by Douglas Hansell, value=Salary Stock Holder relationship with Baxter Please note: 13 years Added 03/29/2022 by Kai Harenski, value=Stocks No relevant relationships by Muhammad Ali Javed Speaker/Speaker's Bureau relationship with Cheetah Medical Inc Please note: $1001 - $5000 by Heath Latham, value=Consulting fee Removed 03/28/2022 by Heath Latham Speaker/Speaker's Bureau relationship with Baxter Please note: 1/2021 - 3-2022 Added 03/28/2022 by Heath Latham, value=Consulting fee Employee relationship with Baxter Healthcare Please note: 15 months by Jennifer Sahatjian, value=Salary

Sars-Cov-2 Specific Antibody Detection in Health Care Workers in Tertiary Care Hospital

Objective: To estimate the sero-positivity of SARS-CoV-2 in health care workers based on specific antibodies in a tertiary care hospital. Study Design: Comparative cross-sectional study. Place and Duration of Study: Combined Military Hospital Kohat Pakistan, Jun to Jul 2020. Methodology: 292 Health Care Workers from different departments were included by non-probability consecutive sampling. They were divided into three groups (High risk, Intermediate risk and low risk) according to the exposure risk to COVID-19 patients. In addition, serum samples for SARS-CoV-2 specific quantitative antibodies were collected. The odds ratio for SARS-CoV-2 Ab risk was calculated for different risk groups and male and female health care workers. Result: Out of 292 Health Care Workers, 243 (83.22) were male, and 49 (16.78) were female, with a mean age of 34.64±7.25 years. SARS-CoV-2 specific Ab was detected in 43 (14.72) individuals. The risk of sero-positivity was higher in the high-risk group than the intermediate-risk group (Odds ratio 1.171 vs 0.878) and higher in the intermediate-risk group than the low-risk group (odds ratio 1.120 vs 0.747). The risk was also higher in females than in males (Odds ratio 1.676 vs 0.878). Conclusion: The sero-positivity of SARS-CoV-2 in healthcare workers in tertiary care hospitals is high. The results indicate that we must improve our local hygiene and protective standards. © 2022, Army Medical College. All rights reserved.

Teaching Undergraduate Software Engineering: Xamarin Mobile App Development During the Covid-19 Pandemic

The CS 4204 Software Engineering instructor was tasked with finding distance alternatives in teaching undergraduate face-to-face lab sessions in the fall 2020 semester. This was due to university policies established during the Covid-19 pandemic. This study describes teaching the course lab sessions utilizing Xamarin mobile app development on Mac and PC computers, with deployment to iOS and Android emulators and devices. Xamarin was chosen for flexibility as it could be used for both face-to-face and distance student learning. The teaching process is demonstrated in using stock and modified Xamarin tutorials which lead to a culminating mobile app development project. Student and instructor perceptions are discussed surrounding issues of facilitating software development instruction during the pandemic. © 2021 IEEE.

Cardiac output change predicts patient outcome

Introduction: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. The goal of this study was to explore the relationship between the change in stroke volume and outcome in critically ill patients. Methods: The Starling Registry study is an observational registry study evaluating trends in CO and SV (Stroke Volume) over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in CO (first CO measurement compared to last CO measurement) were compared to those who did not exhibit improvement. Results: A total of 229 critical care patients received hemodynamic monitoring during their ICU stay across three different hospitals. 48% were female, and the average age was 64 years. 64% of the patients had sepsis, and 17% of patients were positive for COVID. Notably, patients who exhibited an overall improvement in CO exhibited a decrease need for mechanical ventilation (4.8% vs 15%, p = 0.041) and a trend toward a decrease in mortality (16.4%) compared to those who did not improve (28.0%, p = 0.080) (Fig. 1). Conclusions: We have previously shown that patients who show an improvement in CO in response to the resuscitation exhibited improved outcome. Trending cardiac output over a 1-3 day monitoring period revealed additional usefulness in predicting patients with improved outcome. These results highlight the importance of trending hemodynamics in therapy. (Figure Presented).

Stroke volume change predicts patient outcome

INTRODUCTION: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) and Stroke volume (SV) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. The goal of this study was to explore the relationship between the change in stroke volume and outcome in critically ill patients. METHODS: The Starling Registry study is an observational registry study evaluating trends in CO and SV over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in SV (first SV measurement compared to last SV measurement) were compared to those who did not exhibit improvement. RESULTS: 127 critical care patients received hemodynamic monitoring during their ICU stay across two different hospitals. 51 % were female, and the average age was 64 years. 64% of the patients had sepsis, and 15% of patients were positive for COVID. The average time between first and last SV measurement was approximately 7 hours. Notably, patients who exhibited an overall improvement in SV exhibited a decrease in mortality (14.9%) compared to those who did not improve (35.0%, p=0.018) CONCLUSIONS: We have previously shown that patients who show an improvement in SV in response to the resuscitation exhibited improved outcome. Trending cardiac output over a 1-3 day monitoring period revealed additional usefulness in predicting patients with improved outcome. These results highlight the importance of trending hemodynamics in therapy.

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.

The impact of the COVID-19 pandemic on subsistence consumers' well-being and coping strategies: Insights from India and Bangladesh.

The impact of the COVID-19 pandemic on the overall well-being of consumers is disastrous. However, there is limited understanding of how the COVID-19 situation affects consumer well-being and how subsistence consumers mitigate well-being concerns and unique stresses. Following an exploratory, qualitative approach, 39 in-depth semi-structured interviews with subsistence consumers were conducted in India and Bangladesh. Findings from the thematic analysis reveal that subsistence consumers experienced unique stresses and hardships during COVID-19, which are unforeseen transitory financial stress, psychosocial stress, and marketplace and consumption-related stresses. Drawing on the appraisal theory of stress, our analysis of the data identifies the co-existence of two emotion-focused coping strategies-religiosity and social support-that interplay to overcome their well-being concerns in the emerging countries of India and Bangladesh. Therefore, it may be of particular interest to managers and policymakers who seek to address the severe consequences of the COVID-19 pandemic on socio-economically subsistence consumers.

Spontaneous Pneumothorax Complicating COVID-19 Pneumonia: AMulticenter Analysis

Background: Spontaneous pneumothorax is a rare complication seen in patients of COVID-19 pneumonia. The risk factors associated with this complication and its incidence remain unknown largely. We herein, review and present the incidence, clinical characteristics and outcomes of spontaneous pneumothorax in 1767 patients admitted in three COVID treatment tertiary care centers in Lahore. Study Design: Retrospective study Place and Duration of Study: Services Institute of Medical Sciences Lahore and Bahria International Hospital Lahore from 15th April 2020 to 15th May 2021. Methodology: One thousandseven hundred and sixty-seven patients who were diagnosed with a spontaneous pneumothorax were enrolled. Clinical characteristics of these cases were also reviewed and recorded. Results: One thousand and five hundred patients had positive RT PCR from nasopharyngeal swab. Eleven (.62%) cases of COVID-19 patients who developed spontaneous pneumothorax were identified. The initial HRCT imaging showed typical and diffuse bilateral ground-glass opacities and consolidations, mainly in their peripheral, posterior and basal lung regions. Three patients had pneumothorax late in the course of disease after they were discharged home. We had only one mortality among those (11) cases and that was also not related to the pneumothorax directly but to development of sepsis and multi-organ failure. Conclusion: Spontaneous pneumothorax is a rare complication seen in COVID-19 pneumonia.