Respiratory Disorders: Contemporary Issues in 2020

Respiratory system bears the major brunt of environmental insults. Respiratory infections such as pneumonias continue to threaten human health. The corona virus pandemic (COVID-19) is the most recent example of a respiratory infection threatening the human kind. Tuberculosis is one of the most ancient diseases which continue to pose as a clinical problem. Besides infections, there is a huge burden of chronic respiratory disorders in terms of morbidity and mortality. Chronic respiratory disease (CRD) is among the most common non-communicable diseases (NCDs) identified by the World Health Organization. Chronic obstructive pulmonary disease (COPD) is the third most common cause of death the world over. Respiratory allergies such as bronchial asthma, environmental, occupational and other interstitial lung diseases are other common chronic lung diseases which are increasing in incidence. Several new diagnostic and treatment modalities have been added in our armamentarium to fight against these disorders. Besides the medical and surgical treatments, some of these interventions are non-pharmacological in nature such as the pulmonary rehabilitation and patient education programmes. Newer strategies and governmental programmes constitute other important steps to control the disease-burden. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.

Proposed Experimental Design of a Portable COVID-19 Screening Device Using Cough Audio Samples

With the proliferation of COVID-19 cases, it has become indispensable to conceive of innovative solutions to abate the mortality count due to the pandemic. With a steep rise in daily cases, it is a known fact that the current testing capacity is a major hindrance in providing the right healthcare for the individuals. The common methods of detection include swab tests, blood test results, CT scan images, and using cough sounds paired with AI. The unavailability of data for the application of deep learning techniques has proved to be a major issue in the development of deep learning-enabled solutions. In this work, a novel solution of a screening device that is capable of collecting audio samples and utilizing deep learning techniques to predict the probability of an individual to be diagnosed with COVID-19 is proposed. The model is trained on public datasets, which is to be manually examined and processed. Audio features are extracted to create a dataset for the model which will be developed using the TensorFlow framework. The trained model is deployed on an ARM CortexM4 based nRF52840 microcontroller using the lite version of the model. The in-built PDM-based microphone is to be used to capture the audio samples. The captured audio sample will be used as an input for the model for screening. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Experimental Implementation of COVID-19 Safety Measures in Ride-Sharing Cabs Using Deep Learning and Internet of Things

Increased urbanization and on-demand mobility have resulted in the boon of many ride-sharing companies. Besides providing faster, economical, and comfortable rides, these rideshares are also environment-friendly as they save a lot of energy. This research work presents a model which would be beneficial for the passengers riding these carpools as it would not only help to curb the spread of infection in current pandemic but also detect whether the driver is drowsy or not to prevent possible road accidents. The proposed web application includes three detections based on novel deep learning algorithms implementing face recognition, facemask, and drowsiness detection of the driver with an alert mechanism to send immediate email alerts to the company and driver. The novelty of the proposed application is that the current and live status of the driver is continuously recorded using latest technologies like convolutional neural networks (CNNs), histogram of oriented gradients (HOG), support vector machine (SVM) classifier, and computer vision. In addition to this, a real-time vehicle tracking device is also implemented using Node MCU, Global Positioning System (GPS) module, and Blynk app to keep the company updated about the real-time location of the rideshare. The name of the recognized driver is displayed as output. Face mask and drowsiness detection is done with an accuracy of 99%, and the real-time location of the cab is indicated in Google Maps on the Blynk app. The proposed web application would be very beneficial for ride-sharing companies in the current COVID situation. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Design and implementation of IoT enabled ultraviolet C(UVC) irradiation-based sanitizer system for public transport with remote monitoring

During the ongoing Covid19 Pandemic, it is a need of the hour to have a fully sanitized public transport system, free from Covid19 virus. Public transport is one of the major segments responsible for the spreading of covid19 like pandemic infections. It is required to sanitize public transport before every new trip. During the Covid19 pandemic, human beings are forced to live with viruses, hence making disinfection a routine work and making disinfection more user-friendly and efficient is the main objective of this research work. Spraying alcohol-based solution inside public transport is not suitable due to fire safety and other reasons. Ultraviolet C (UVC) based disinfection is more suitable in such applications, as disinfection can be done anytime, anywhere without damaging the interiors of the vehicle. It can kill viruses or bacteria in less than 20 seconds and can disinfect any surfaces, seats, or any point of public contact inside any public transport by effectively killing bacteria, fungi, dust mites, viruses, etc. This research paper aims to offer the design and implementation of an Ultraviolet C irradiation-based sanitizer system for the public transport system, which can disinfect the public contact surfaces inside the public transport, to make our travel safe from Covid19 like viruses. The sanitization system is developed using a NODEMCU microcontroller, UVC led arrays, switching circuit, PIR sensor, and mobile app. Ultraviolet sensor is used to read UVC irradiation index inside the transport to measure the effectiveness of the developed system and real-time data is linked with internet cloud for remote monitoring and control. © 2022 IEEE.

Indian Guidelines on Nebulization Therapy.

Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.

IoT based Wearable Health Monitoring System for COVID-19 Patients

Whenever the patient is admitted to a hospital, the doctors and nurses have to keep a regular check on each of them and also maintain a record of all the vital health parameters of patient. In a situation of pandemic like the one due to COVID-19 a huge number of patients are admitted at once which becomes very difficult for hospital staff to monitor each of them continuously. So, the model proposed here is a IoT based wearable system which is an assistive device for patient monitoring which will help the doctors, nurses and patient's relatives to keep a track of some vital health parameters like heartbeat, temperature and blood oxygen levels. All of these sensor data will be stored into the cloud platform "Thingspeak"and also to the mobile app "Blynk". And this system is made automatic so it will keep on monitoring and storing the sensor data at regular intervals which can be accessed from anywhere via the internet and even the alert system will notify about the emergency. Another part of the model which is separate from the wearable system is to monitor and store volume of drip or IV fluids is given to the patient. © 2022 Copyright for this paper by its authors.

Development of a clinical score for the use of nebulizers in primary care through consensus by an expert working group

Background: The use of nebulizers is an important and useful method for delivering drugs to the lungs in patients with various airway and lung parenchymal disorders. Use of nebulization had markedly increased during the COVID-19 pandemic. This had raised concerns about the potential spread of infection to others in the surroundings exposed to the virus dissemination through aerosolized particles. We considered it necessary to ensure appropriate use of nebulizers by primary care physicians and therefore developed a simple nebulization score to decide when to use nebulizers. Methods: An expert working group (EWG) of pulmonologists was formed who using a semi-Delphi method developed a list of variables and a cut-off score. The EWG started with 55 variables developed through an exhaustive review of literature. These were further reduced to smaller number that had the maximum score as well as concordance with the EWG. The scores ranged from 1-10 (completely disagree to completely agree) and only those above 7.5 were selected. Results: A total of 8 variables with the highest scores were selected [Table 1] which had a total maximum score of 40. A score of <15 was suggested to indicate not-to use and >20 to suggest a definite-use of nebulizer. A score between 15-20 was suggested to use as per physician judgement. A separate table of 12 conditions was made where use of nebulizers was mandatory. Conclusion: This first of its kind nebulizer score should be used by primary care physicians to decide which patients should be put on nebulization treatment.

New COVID-19 Normal: An Experimental Prototype of Smart Face Mask Vending Machine—An Indispensable Kiosk

In the ongoing COVID19 situation, one of the most basic yet necessary supplies for any human being is the face mask. Medical stores are facing shortage of face masks and it is also leading to crowding in confined spaces like medical stores hence aggravating the situation. The only solution to this is increasing the sources from where the citizens can get face masks and at the same time avoiding crowding and contact with any other human. The proposed Mask Vending Machine will make this happen. The physical machine that will store and vend the masks will have the Raspberry Pi as the central processing unit and the additional components like the steppers motors and monitor for display will be controlled by the Raspberry Pi. For payment and choice of quantity, an app has been designed. A QR code will be displayed on the monitor of the vending machine which has to be scanned with the app. Once scanned, it will ask the user for the number of masks needed and also facilitate the transaction process. Once successful, the masks will be vended. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

IoT based Resuscitation and Hypoxemia Diagnosis System using Embedded Microcontroller Architecture and IFTTT Implementation

In recent times, the World has taken a critical blow from the novel Coronavirus. Moreover, with its research ongoing and multiple variants emerging, uncertainty is on the rise. Lung damage and cardiac issues occur during and post recovery which is why there is a requirement to constantly monitor the patient’s vitals. This also applies to patients suffering from other lung diseases and heart conditions. They need immediate attention to avoid complications and further deterioration in their health. The proposed system aims to do so by observing the health parameters such as oxygen saturation in blood and heartbeat constantly and making the data available for the user by displaying it. In case of abnormality, it alerts the person related to the patient about the developments and relays the required information to help like symptom details and the patient’s location, this ensures that actions are taken quickly. Simultaneously, it provides assistance in breathing during the interlude till professional help arrives and the patient receives the necessary treatment. This is achieved with a combination of sensors, modules and other components integrated with a microcontroller as well as the implementation of Internet of Things (IoT) using a web service.

High Resolution Computed Tomography Findings of Pulmonary Fibrosis in COVID-19 Survivors and its Association with Inflammatory Markers-A Retrospective Study

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection enters human body through respiratory tract and then rapidly spread to involve lungs and multiply swiftly leading to severe hypoxic pneumonia. Clinically, Coronavirus disease 2019 (COVID-19) infection is identified by three stages based on viral infection, lung involvement with inflammation and pulmonary fibrosis. High resolution Computed Tomography (HRCT) lung play an important role in diagnosis and management of lung fibrosis in coronavirus disease patients. Aim: To study association between inflammatory markers and development of lung fibrosis in post COVID-19 patients. Study also aimed at assessment of chest Computed Tomography (CT) Involvement Score (CT-IS) and COVID-19 Reporting and Data System (CO-RADS) for chest CT in post COVID patients presented with lung fibrosis. Materials and Methods: This retrospective study included elaborate evaluation of HRCT findings and inflammatory markers of 54 patients presented with pulmonary fibrosis at tertiary care centre for duration of six months from 1st June to 30th November 2020. Only those patients were included in which both HRCT findings and clinical laboratory parameters were available. Interleukin-6 (IL-6), C-Reactive Protein (CRP), serum ferritin, Lactate Dehydrogenase (LDH), Erythrocyte Sedimentation Rate (ESR) and Procalcitonin (PCT) markers were studied. Statistical analysis was conducted using chi-square test to compare the inflammatory markers with CT-IS score with p-value <0.05 was considered significant. Results: Total 536 corona positive patients were admitted in hospital and underwent HRCT lung from June 2020 to November 2020. Out of 536, 54 (10.07%) patients showed findings of lung fibrosis on follow-up CT scan. Among 54 patients with lung fibrosis, CRP, serum ferritin and IL-6 levels were high in 46 (85.19%), 42 (77.77%) and 48 (88.89%) patients respectively. Lactate dehydrogenase, ESR and PCT were increased in 12 (22.22%), 15 (27.78%) and 06 (11.11%) patients respectively. These levels were higher in Fibrotic phase compared to prefibrotic phase. Erythrocyte sedimentation rate was significantly associated with the severity of lung fibrosis, having significant p-value=0.004. Conclusion: Among all inflammatory markers, ESR value may be useful as a surrogate marker to predict the pulmonary fibrosis in COVID-19 patients. C-reactive protein, IL-6, LDH, serum ferritin and PCT levels do not show significant association with lung fibrosis on HRCT scan.

Experimental Design and Implementation of Fingerprint Based Exam Hall Authentication System with Temperature Sensing and Analysis using Internet of Things

The world is going through a global crisis due to the contemporary COVID 19 pandemic situations. In these taxing times, students have been severely affected. So our government has not compromised their future and has decided to conduct all competitive examinations. Thus, it becomes crucial for the students to register for the exams. However, the traditional exam hall authentication system does not assure that the students would not be exposed to the infection. So it is important to come up with a solution for this scenario. This paper presents a model in which the student's registration and authentication happen using the fingerprint sensor and Atmega328 microcontroller in addition to recording the student's body temperature by the LM35 temperature sensor. The data is transferred to a cloud server where it can be monitored and analyzed. The cloud server shall store the time of recording and the temperature of the student. If the temperature is higher than standard body temperature, an email alert is sent to the concerned authorities. The authorities can consequently take appropriate action and this would help in curbing the spread of the virus among the students present in the exam hall. © 2020 IEEE.

AT89S52-Microcontroller Based Elevator with UV-C disinfection to prevent the transmission of COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus, responsible for the ongoing COVID-19 pandemic. SARS-CoV-2 spreads primarily through exposure to respiratory droplets expelled by infected individuals. This exposure may occur if a person touches his/her mouth, nose or eyes after contact with a contaminated surface. Elevators are small enclosed spaces used in a wide variety of settings and often see multiple users in quick succession. This puts users at risk of contracting COVID-19 and other diseases that follow similar transmission patterns. The ongoing pandemic shows us a need to redesign current systems, including elevators to prevent the transmission of such diseases. Current methods rely on manual cleaning and disinfection of elevator cabins, which is time and manpower consuming. Elevator hygiene protocols such hand sanitization and wearing masks depend on user compliance. This work proposes a system for the automatic disinfection of elevator cabins using UV-C light. This is done in a manner that does not disrupt regular elevator operation, which is controlled using a microcontroller. In order to further improve safety standards, physical buttons are replaced with touch-less ones using ultrasonic sensors. © 2020 IEEE.

Nanotechnology based approaches for corn batting COVID-19 viral infection

The novel coronavirus pneumonia pandemic was declared as 'public-health emergency of international concern' by the World Health Organization on 30 January 2020. The sudden emergence of the viral pathogen responsible for this outbreak, the novel coronavirus, SARS-CoV-2, has triggered alarm for their instant management using anti-viral measures and diagnostic tools. Early diagnosis will enable containment of COVID-19 (coronavirus disease 2019), allowing quick implementation of control measures for limiting the spread of this disease. Due to high human to human transmission, the development of effective anti-SARS-CoV-2 therapeutics for treating affected patients will help to slow down the transfer ofviruses from patients to healthy individuals. However, till the time any effective therapeutic or vaccine is developed, preventing exposure to SARS- CoV-2 virus is the best way out. The development of more effective personal protective equipments (PPEs) is essential to maintain the safety of healthcare professionals and the public at large. Taking into consideration the current severity of this disease and the imperative need of SARS-CoV-2 specific treatment and diagnostic tools, nanotechnology-based approaches can provide promising alternatives to conventional ways of disease diagnosis, treatment, and preventing exposure to SARS-CoV-2. In this review, we inform about the different ways in which nanotechnology can help in the detection and treatment of prevailing SARS-CoV-2 infection as well as help to improve the PPE devices.

Post-COVID-19 respiratory management: expert panel report

This report is the first expert panel report on the management of post-COVID-19 patients from India. The report contains high risk groups, post-COVID-19 patient management at primary care level, general principles of medical management of post-COVID-19 in primary care settings, management of post-COVID-19 symptoms in primary care settings, recommendations for inclusion and exclusion into the Pulmonary Rehabilitation Programme, post-COVID-19 patient management at tertiary care level, post-COVID-19 complete assessment and management, and respiratory disease-specific conditions requiring expert opinion and further research.

Increasing lung cancer screening rates in HIV clinics

Background: Data at our institution shows lung cancer is more prevalent and aggressive in HIV patients. A study of lung cancer patients revealed a mean age of 55.8 years in those with HIV vs. 68.0 in those without. Additionally, 67% of HIV patients had metastasis at time of diagnosis, compared to 49% in the overall population. One study found an 18.9% reduction in lung cancer mortality among HIV patients who receive NLST-recommended screening. Despite this, data from 2018 estimated only 13% of eligible HIV patients had completed screening at our institution. We pursued a quality improvement initiative to increase lung cancer screening in our HIV clinics. Methods: Our multi-disciplinary team studied charts of the 628 HIV clinic patients seen in a four-month span to identify those who had not received lung cancer screening and potential reasons why referrals were not made. We also spoke our dedicated screening coordinator, who contacts patients to arrange for CT scans. We plotted trends in appointment referrals on a run chart. Results: Areas for improvement included EMR documentation to assess screening eligibility and an occasional lack of awareness regarding criteria. Providers also cited time constraints may limit referrals. Our team identified patients that met screening criteria and generated EMR reminders for providers to refer patients to radiology. We also held sessions with providers and nursing staff to increase awareness of our screening program. Of 628 patients, 128 (20.4%) had sufficient documented smoking history to assess for screening eligibility. 81 patients (63.3%) met our criteria. Of these patients, 58 (71.6%) had not been screened or referred for screening. Through our most recent interventions, 16 (31.3%) patients have been referred to our screening coordinator, and 7 (12.1%) have received screening CT scans. Our interventions ultimately led to an increase from 23 of 81 (28.4%) patients with completed screening to a projected 46 of 81 (56.8%). Conclusions: Providing education and EMR alerts to raise awareness regarding eligibility, we substantially increased the screening rate in our clinics. Our interventions will be broadened as we return from COVID stoppages. Future interventions include increasing smoking history documentation in the EMR to allow for automated identification of screening eligibility. PDSA and interventions are ongoing with continued follow-up of efficacy.

CENTRAL AND PERIPHERAL VENOUS THROMBOSIS IN NON-MECHANICALLY VENTILATED SURVIVORS OF COVID-19

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Novel coronavirus disease 2019 (COVID-19) is associated with significant morbidity and high mortality, however, 70-81% of all cases are classified as non-severe. COVID-19 disease is being increasingly recognized as a prothrombotic state with a high incidence of coagulopathy. Up to 30% of intensive care unit patients with COVID-19 develop a venous thromboembolism (VTE). Limited studies of non-ICU and non-mechanically ventilated patients have suggested a 5 to 10% risk of VTE. However, these studies have been limited in scope and may not be generalizable to patients seen in the United States. The goal of this study is to further characterize non-critically ill COVID-19 patients at our institution who develop VTEs. METHODS: This is a retrospective cohort study using data from the electronic medical record. It examined all adult inpatients diagnosed with COVID-19 based on a positive nasopharyngeal/oropharyngeal swab who were not mechanically ventilated during hospitalization and who were discharged alive from three hospitals comprising an integrated health system in Bronx, NY between March 11, 2020 and May 2, 2020. Patients were eligible for study inclusion if an upper or lower extremity duplex or Computerized Tomography (CT) imaging with contrast to rule out PE was performed during admission or within 14 days of discharge. Summary statistics were used to characterize patients with and without VTE based on imaging findings. Unpaired two-tailed t-test, Wilcoxon rank sum test or test of proportion were used to compare the groups. RESULTS: Of the 2671 adult inpatients with COVID-19 who were not mechanically ventilated and survived to discharge, 313 (11.7%) completed CT or duplex imaging to identify VTE, and 72 patients (72/2671, 2.7%) were found to have a confirmed VTE. Out of the 72 VTE identified, 31 were located in peripheral veins, 38 were in pulmonary veins, and 3 were in both peripheral and pulmonary veins. Compared to patients without VTE on imaging, patients with VTE were of similar age (60.3 vs 61.5 years, p=0.55) and body mass index (30.8 vs 30.2, p=0.56). Patients who developed a VTE had a longer length of stay (10 vs 8 days, p=0.02) and a more elevated admission white blood cell count (10.3 vs 8.4 k/uL, p=0.002), d-dimer (4.37 vs 1.67 ug/mL, p<0.001) and lactic acid dehydrogenase (474 vs 373 mg/dL, p=0.005). CONCLUSIONS: Patients with a non-severe form of COVID-19 who survive to discharge may be prone to developing VTE, though their baseline risk factors for COVID-19 related disease were the same as those without a VTE in our cohort. CLINICAL IMPLICATIONS: Laboratory findings at the time of admission may help identify those patients with COVID-19 at higher risk of being diagnosed with VTE. DISCLOSURES: Employee relationship with Sanofi Pasteur Please note: $1-$1000 Added 06/19/2020 by Andrei Assa, source=Web Response, value=Salary My spouse/partner as a Investor relationship with Extend Fertility Please note: $20001 - $100000 Added 06/01/2020 by Sarah Baron, source=Web Response, value=Ownership interest No relevant relationships by Sweta Chekuri, source=Web Response No relevant relationships by Galina Glazman-Kuczaj, source=Web Response No relevant relationships by Shawn Jindal, source=Web Response No relevant relationships by Laurel Mohrmann, source=Web Response No relevant relationships by Peter Nauka, source=Web Response No relevant relationships by Erick Oran, source=Web Response No relevant relationships by William Southern, source=Web Response