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Background: During the coronavirus disease 2019 (COVID-19) pandemic, established best practices in cancer care were modified to diminish the risk of COVID-19 infection among patients and health-care workers. Objective(s): We aimed to study the modifications in cancer-directed therapy during the first wave of the COVID-19 pandemic. Material(s) and Method(s): A cross-sectional study of patients with cancers of the head and neck, thoracic, urologic, and central nervous systems who visited the medical oncology department of the Tata Memorial Hospital, Mumbai, India, between April 22, 2020 and June 01, 2020, was conducted. Data were prospectively collected in an online pro forma and supplemented from the electronic medical records. Result(s): Of a total of 514 patients, 363 (71%) were men. The most common malignancy was lung cancer in 234 patients (46%). Cancer-directed therapy was modified in 83 patients (16%). Deviations consisted of modification of the chemotherapy regimen (48%), temporary discontinuation of chemotherapy in 37%, and interim chemotherapy to delay surgery in 5%. Changes in the chemotherapy regimen included a shift to a less intensive regimen in 45%, changing from intravenous to oral in 40%, and less frequent dosing of immunotherapy in 7%. Considering missed appointments as a deviation from planned cancer therapy, 68% of patients had a deviation in the standard planned cancer care. Conclusion(s): Almost two-thirds of the patients could not reach the hospital during the COVID-19 pandemic lockdown in India. Of those who could reach the hospital, one of out every six patients with cancer had a change in their cancer-directed treatment, half of which consisted of a modification in the standard chemotherapy regimens. The effects of these therapy deviations are likely to be long-lasting. (Clinical Trials Registry-India, CTRI/2020/07/026533).Copyright © 2023 Neurology India, Neurological Society of India Published by Wolters Kluwer - Medknow.
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Covid 19 is an illness caused by the recently discovered Coronavirus. The virus causes an unparalleled range of coagulopathy related disorders in affected patients. In this paper, we aim to understand the linkage between abnormal clot formation and the Coronavirus. The clotting parameters of Covid infected patients were studied to elucidate a better understanding of the coagulation disorder. A comparative analysis of the diagnostic reports collected from five different labs across the world aids us comprehend the elevated levels of coagulation parameters observed in these Covid infected patients. Initial coagulopathy of COVID 19 has been characterized as increased levels of prothrombin time, activated partial thromboplastin time, and platelet counts followed by elevated concentrations of D dimer and fibrin degradation products. Coagulation assays used to determine these clotting factors were through invasive methods. Conventional coagulation assays being invasive had their drawbacks taken care of with the advent of non-invasive methods. With the current scenario of this pandemic, the necessity for technological improvements in non-invasive and point of care testing methods are substantial. © 2023 Author(s).
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Acute hepatitis of unknown origin in children has been recently described in the literature, and a case definition has also been proposed for this condition. The exact etiology is unknown and exclusion of infectious, metabolic, autoimmune and toxin mediated injuries is essential. Management for this condition is supportive, but some may require liver transplantation. Infection prevention and control practices are important as the etiology remains unidentified.Copyright © 2023, Indian Academy of Pediatrics.
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Anxiety disorders have seen an elevating number since the Covid-19 pandemic. This paper aims at identifying more about the various anxiety disorders using machine learning Techniques. Further, symptoms of the types of anxiety disorders: Generalized Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder, Obsessive-Compulsive Disorder and Social Anxiety Disorder are also discussed. The datasets used in the paper are collected by researchers from hospitals/organizations/educational institutions mainly through questionnaires and surveys. Some of the many Machine Learning techniques used for prediction of these anxiety disorders include Random Forest, Linear Regression, Support Vector Machine among others. Lastly, the performance metric for the techniques is presented here and henceforth, the result is drawn from this available data followed by the conclusion. © 2022 IEEE.
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Management of hospital wastewater is a challenging task, particularly during the situations like coronavirus 2019 (COVID-19) pandemic. The hospital effluent streams are likely to contain many known and unknown contaminants including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) along with a variety of pollutants arising from pharmaceuticals, life-style chemicals, drugs, radioactive species, and human excreta from the patients. The effluents are a mixed bag of contaminants with some of them capable of infecting through contact. Hence, it is essential to identify appropriate treatment strategies for hospital waste streams. In this work, various pollutants emerging in the context of COVID-19 are examined. A methodical review is conducted on the occurrence and disinfection methods of SARS-CoV-2 in wastewater. An emphasis is given to the necessity of addressing the challenges of handling hospital effluents dynamically involved during the pandemic scenario to ensure human and environmental safety. A comparative evaluation of disinfection strategies makes it evident that the non-contact methods like ultraviolet irradiation, hydrogen peroxide vapor, and preventive approaches such as the usage of antimicrobial surface coating offer promise in reducing the chance of disease transmission. These methods are also highly efficient in comparison with other strategies. Chemical disinfection strategies such as chlorination may lead to further disinfection byproducts, complicating the treatment processes. An overall analysis of various disinfection methods is presented here, including developing methods such as membrane technologies, highlighting the merits and demerits of each of these processes. Finally, the wastewater surveillance adopted during the COVID-19 outbreak is discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s13762-023-04803-1.
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Background: The Internet of Medical Things (IoMT) is now being connected to medical equipment to make patients more comfortable, offer better and more affordable health care options, and make it easier for people to get good care in the comfort of their own homes. Objective(s): The primary purpose of this study is to highlight the architecture and use of IoMT (Internet of Medical Things) technology in the healthcare system. Method(s): Several sources were used to acquire the material, including review articles published in various journals that had keywords such as, Internet of Medical Things, Wireless Fidelity, Remote Healthcare Monitoring (RHM), Point-of-care testing (POCT), and Sensors. Result(s): IoMT has succeeded in lowering both the cost of digital healthcare systems and the amount of energy they use. Sensors are used to measure a wide range of things, from physiological to emotional responses. They can be used to predict illness before it happens. Conclusion(s): The term "Internet of Medical Things" refers to the broad adoption of healthcare solutions that may be provided in the home. Making such systems intelligent and efficient for timely prediction of important illnesses has the potential to save millions of lives while decreasing the burden on conventional healthcare institutions, such as hospitals. patients and physicians may now access real-time data due to advancements in IoM. Copyright © 2022 Wal et al.
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Introduction: High Resolution Computed Tomography (HRCT) of the chest is often performed in patients with Coronavirus Disease 2019 (COVID-19) to assess the severity of lung involvement. Multiorgan dysfunction is a well-known complication of COVID-19 infection. Bilateral Perinephric Fat Stranding (PFS) is often observed in cases of COVID-19 infection while reporting the chest Computed Tomography (CT) scans, which might represent associated acute kidney injury. It is still not known whether a correlation exists between the severity of COVID-19 infection and presence of PFS or renal dysfunction. Aim(s): To determine the association between PFS, Computed Tomography Severity Index (CTSI) and serum creatinine levels in patients with COVID-19 infection. Material(s) and Method(s): This retrospective cohort study was conducted in Department of Radiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India, from April 2021 to June 2021. A total of 90 COVID-19 positive patients of all ages and gender, who underwent HRCT of chest were included in the study. The chest scans were retrospectively reviewed for severity of lung involvement using a CTSI. The cases were divided equally into two groups A (n=45) and B (n=45). Group A included cases showing PFS on CT and group B included cases with no evidence of PFS. Serum creatinine levels (obtained within 24 hrs of the scan) of all patients were noted and analysed to determine any possible association between the PFS, CTSI and serum creatinine levels. Analysis was done using Mann-Whitney U test, for continuous variables and Chi-square test was used for categorical data. Result(s): The mean age of patients (p-value=0.047) and the male to female ratio (p-value<0.001) was significantly higher in group A than in group B. Statistically significant association was found between PFS and serum creatinine (W=1375.500, p-value=0.003) PFS as an indicator of renal dysfunction had a sensitivity of 73.3%, specificity of 54.7%, Positive Predictive Value (PPV) of 24.4%, Negative Predictive Value (NPV) of 91.1% and a diagnostic accuracy of 57.8%. with an odds ratio of 3.32. Conclusion(s): Presence of PFS at imaging can serve as a useful screening tool for detecting underlying renal dysfunction in patients with COVID-19 infection. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.
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Introduction: Novel coronavirus disease-2019 pandemic continues to rage the world with enormous economic loss, sickness, and deaths. In management of infectious diseases, nurses play crucial roles in rendering care to patients by risking their own lives, going beyond their training and capacities. Frontline nurses are vulnerable for the development of diagnosable and subclinical psychological problems most often triggered with deaths of colleagues, exposure to the mass scale of deaths, perceived inability to save lives despite best efforts, lack of social supports, shift duties, and working in high-risk environment. Aim: The aim of the study is to assess the depression, anxiety, and stress among nurses working in COVID wards versus non-COVID wards. Materials and Methods: A multicenter observational study was done among 176 frontline nurses from seven different referral government hospitals. Psychological ailments were measured on validated instruments of Depression, Anxiety, and Stress Scale-42 items (DASS-42) and Perceived Stress Scale-10 (PSS-10). Results: Using SPSS version 23.0, data were analyzed using Pearson's Chi-square test, with P < 0.055 being considered statistically significant. On PSS, perceived stress was high in 75% of COVID ward nurses and 67% of non-COVID ward ones. On DASS-42 scale, depression, anxiety, and stress levels among nurses in the COVID-19 wards were 21.64% (n = 21), 32.98% (n = 32), and 20.61% (n = 20) compared to 17.72% (n = 14), 24.05% (n = 19), and 15.18%, (n = 12) in the non-COVID wards, respectively. Conclusions: The amount of reported stress, anxiety, and depression was higher in both groups of nurses, i.e., those working in COVID-19 wards and general wards as compared to general population.
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The coronavirus disease 2019 (COVID-19) pandemic has been universal and swift in its spread. As orthopaedic surgeons, for the most of us this timeframe has reduced our activity to emergency and trauma cases only, with virtual outpatient clinics and no elective surgeries. With some of the common deformity problems including clubfoot etc, which comprises a large number of children in the developing world, the management has been deferred, without any regional and national guidelines being framed. Updated guidelines relating to the management of clubfoot patients, in which parents can safely consult with the orthopaedic surgeon and physical rehabilitation specialists will allow them to cope with this unprecedented situation. We revisit the current scenario and the possible management protocol in the context of COVID-19 pandemic. © 2022 The Author(s).
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Experts in the field are predicting a third COVID-19 peak very soon in coming times, it is important to assess recent knowledge, attitude in view of prolonged exhaustion and adherence to preventive practices of HCWs. This cross-sectional study involved 168 HCWs (42 doctors, 42 nurses, 42 paramedical staff and 42 ANMs). Data was collected through online survey tool Google forms in July and August 2021. First section included sociodemographic information and infection with SARS-CoV-2, section 2 assessed recent knowledge, section 3 practices of COVID-19 appropriate behavior and section 4 assessed attitude of HCWs. Shapiro Wilk test was used to determine normality of distribution of variables. Kruskal-Wallis and Mann-Whitney U tests were used to determine the association between two variables. Pairwise comparison was done following a significant Kruskal-Wallis test using Bonferroni's correction. 42.9% of the HCWs and family members of 44.6% HCWs were infected with SARS-CoV-2. 54.1% of infected HCWs were infected during the March-May 2021 peak. 85.1% HCWs had taken COVID-19 vaccine. Mean knowledge, attitude, practice scores were 7.88 +/- 3.03(maximum score: 12), 20.35 +/- 3.2 (maximum score: 25), 69.89 +/- 9.39 (maximum score: 85) respectively. Only 48.8% HCWs had good knowledge about more recent COVID-19 information. A significant association was observed between profession and knowledge scores (p<0.001). Over 85% HCWs had good scores for attitude towards COVID-19 and 88.7% HCWs scored good in COVID-19 appropriate behavior practices. Our HCWs need to be better equipped with the more recently available knowledge about COVID-19 to improve our preparedness for the next anticipated peak.
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Online mode during COVID-19 has raised mental health issues among students along with the stigma around it that continues to exist. As a result of which, there are people who are not comfortable in disclosing their personal details to outsiders for help. This brings in the use of AI applications that can help in this critical issue requiring regular monitoring. In this paper, a survey is conducted to know about awareness about this topic. A review about many conversational AI chatbots is provided that are helpful for handling mental health issues such as stress, anxiety, and depression in a number of ways. These include voice and text based chatbots developed in the last decade. The strengths and limitations of these are also discussed. © 2022 IEEE.
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Background: During the COVID-19 pandemic, healthcare workers (HCWs) were required to make flexible decisions in a rapidly changing environment under significant stress. Linking subjective and physiological markers of stress to quantitative measures of decision-making is critical for understanding the resilience of healthcare workers during the pandemic. The aim of this study was to utilize an explore-exploit computational psychiatry paradigm to measure the effects of COVID-19 related stress on decision-making flexibility. Methods: We utilized biomarker and survey data to query chronic stress;123 participants completed the survey and 54 hair samples were collected. Cortisol was measured with LC/MS/MS. We evaluated explore/exploit behavior with a resting three-arm bandit task, and 66 completed the task. Results: Eighty-seven met criteria for COVID-19 related PTSD, however, we found no significant correlation between hair cortisol and symptoms measures. In contrast, we found that participants with higher hair cortisol exhibited greater exploitation (Pearsons’ r=-0.36, p=0.046). Additionally, explore-state reward-dependent switching behavior, a state-specific measure of learning from reward, significantly decreased with increasing cortisol (r=-0.49, p=0.007). Further, in a basic 3-parameter reinforcement learning model, the learning rate alpha inversely correlated with cortisol (r =-0.467, p=0.007). Conclusions: Computational model-derived decision-making variables demonstrated a robust correlation with hair cortisol concentrations. Without this task, biomarker data may appear independent of chronic stress. This study highlights the importance of quantitative behavioral tasks and physiological signals to understanding the interaction of mood and cognition with stress. Supported By: This work was supported by the University of Minnesota Office of Academic and Clinical Affairs COVID-19 Rapid Response Grant. Research in this publication was also supported in part by the Office Of The Director, National Institutes of Health under Award Number P51OD011106 to the Wisconsin National Primate Research Center, University of Wisconsin-Madison. This research was conducted in part (as applicable) at a facility constructed with support from Research Facilities Improvement Program grant numbers RR15459-01 and RR020141-01. Keywords: Cognitive Flexibility, Hair Cortisol, COVID-19 Pandemic, Computational Psychiatry
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Introduction: Only 60% of atrial fibrillation (AF) patients with elevated stroke risk receive anticoagulation (AC). Closing this gap in AC use is particularly challenging in the face of the COVID19 pandemic. Electronic health record (EHR) alerts integrated into in-person and telehealth visits have the potential to close the gap. Hypothesis: A triad approach consisting of interventions at the practice provider at patient level could improve anticoagulation rates in patients with atrial fibrillation. Methods: In collaboration with the Heart Rhythm Society Quality Improvement Committee and UMass, University of Florida (UFL) Jacksonville launched a 2020 quality improvement (QI) intervention, including several Plan-Do-Study-Act (PDSA) cycles, centered around an outpatient, electronic health record (EHR) alert linked to an order set for AC meds, labs, and specialty referrals. The alert fired when cardiologists or primary care physicians saw AF patients in clinic with a CHA2DS2-VASc score of ≥2 who were not on AC. Due to COVID-19, several of the PDSA interventions required adjustments due to redeployment of information technology staff mobilized to generate COVID-19 reports, a pivot for clinicians and patients to telehealth visits, and a change in clinician and patient priorities from routine cardiovascular/preventive care to COVID-19 diagnosis and prevention. To assess intervention effectiveness, the change in AC use as a function of time was measured using a weighted least squares linear regression. Results: At time of launch, 2357 of 3555 eligible patients (56.3%) were on AC. At study end, six months later, the percentage of patients on AC increased by 1.5% to 57.8 %. Based on the population of untreated patients at UFL and the stroke rate for untreated patients (available from large registry data), and assuming absence of any competing/secular trend to explain the growth in AC use, we calculated that a 1.5% increase in the AC treatment percentage could result in the prevention of 1.5 strokes over one year. Conclusion: We demonstrated that an EHR alert can raise the rate of AC use in patients with AF after several rounds of PDSAs. In future efforts, we plan to reassess the AC percentage in our population and confirm the sustainability of our QI efforts as attention focuses back from the pandemic to routine cardiovascular/ preventive care.
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Background: The novel COVID-19 pandemic created an unprecedented strain on healthcare systems, particularly on intensive care services. Balancing demand for intensive care unit beds with increased patient acuity challenged facility's abilities to provide access to care for patients with advanced liver disease. We report the development of unique practices designed to maintain clinical operations of our Medical Intensive Liver Unit (MILU). Methods: Consecutive patients admitted to the MILU at a United States quaternary care LT center between 08/27/2018 and 12/31/2020 were enrolled in a prospective registry and followed from admission to hospital discharge, LT or death. In March 2020, the MILU was geographically relocated to accommodate the COVID-19 pandemic surge and to protect the at-risk patients with liver disease. To facilitate this transition, new protocols were developed to rapidly train nursing and support staff and to adjust ICU throughput. Procedures were implemented to facilitate virtual models of clinical care and communication. Clinical working groups were assembled to re-design protocols encompassing acute liver failure, acute kidney injury, nutrition optimization, sepsis pathways, and perioperative management. Results: In 2020, 373 patients were admitted to the MILU, accounting for 408 hospital admissions and 472 MILU admissions. Of these patients, 124 patients (30.3%) died in-hospital. 279 patients (74.5%) were cirrhotic, and 26 patients (6.9%) were admitted for acute liver failure. The most common etiology of liver disease in patients with cirrhosis was alcohol-related liver disease (42.6%), increased from 2019 (33.3%). Average MELD-Na score was 30.1, increased from 2019 (27.2). 48 (12.9%) of these patients underwent LT in 2020, 35 (72.9%) of whom were transplanted during the same hospitalization as their MILU admission, and 22 (45.8%) directly from MILU. Conclusion: Data previously presented supports the MILU as a promising sub-specialty model for the improved intensive care of patients with advanced liver disease. The COVID-19 pandemic presented both logistical and clinical challenges for the delivery of care to this vulnerable patient population. Our experience mirrors national trends in increased severity of illness for hospitalized hepatology patients during the pandemic. Collaborative efforts in ensuring adherence to novel protocols and maintained communication within a multi-disciplinary team resulted in successful optimization strategies for bridging higher acuity patients to LT.
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Introduction: Bartter's syndrome (BS) is a rare genetic tubulopathy affecting the loop of Henle leading to salt wasting. Acquired BS is very rare and is associated with underlying medical conditions or certain drugs. We report a unique case of idiopathic BSlike phenotype that was diagnosed in the setting of COVID infection. Case Description: 71-year-old man with coronary artery disease, hypertension and diabetes presented after a mechanical fall. On admission, he was found to be hypotensive to 107/88 mmHg. Physical exam was within normal limits. Initial blood work was significant for Potassium 2.6 mEq/L, Bicarbonate 34 mEq/L, Calcium 8.0 mg/dL and Magnesium 1.7 mg/dL. Patient also tested positive for COVID-19. Upon further questioning, patient reported a remote history of hypokalemia but never needed any oral supplementation. He denied diuretic use or surreptitious vomiting. Hypokalemia work up revealed increased urinary potassium of 85.4 mEq/L, Renin 15.72 ng/mL/hour and Aldosterone 8 ng/dL. Patient was then started on aggressive intravenous and oral potassium repletion. He continued to require multiple doses of intravenous potassium to maintain potassium levels of 3 mEq/L. He was subsequently started on Eplerenone on Day 3 of admission with excellent response. He remained otherwise asymptomatic from COVID and as his infection improved, hypokalemia stabilized and he was ultimately discharged with a Potassium level of 3.6 mEq/L. Discussion: The primary defect in BS is in sodium chloride reabsorption in the medullary thick ascending limb of the loop of Henle resulting in hypokalemia, metabolic alkalosis and secondary hyperaldosteronism. Rare cases of acquired BS are reported in association with tuberculosis, sarcoidosis, sjogrens, and certain drugs. All of these were ruled out in our patient and hence a diagnosis of idiopathic BS like phenotype was made. In our patient, we attribute the BS like phenotype to underlying COVID infection. As his infection improved, his hypokalemia also resolved. Hyperkalemia is a more common finding in COVID infection. However, in our patient, hypokalemia secondary to BS like phenotype was a unique presentation which was challenging to treat. In the absence of usual causes of acquired BS, unexplained hypokalemia in a patient with COVID infection should prompt suspicion for BS-like phenotype. Early and aggressive correction of electrolyte abnormalities is crucial.