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Sensor technology has become an integral part of the diagnosis, monitoring, therapeutic and surgical areas of medical science. Various sensors like glucose biosensors for diagnosis of diabetes mellitus or fluorescent sensors for gene expression and protein localization have become a common part of the biomedical field. Due to their widespread applications, various advances and improvements have taken place in medical sensor technology which has led to an increase in the ease and accuracy of diagnosis as well as treatment of diseases. This review article aims at studying various novel and innovative developments in biosensors, fibre optic sensors, sensors used for microelectromechanical systems, flexible sensors and wearable sensors. This article also explores new sensing methodologies and techniques in different medical domains like dentistry, robotic surgery and diagnosis of severe life-threatening diseases like cancer and diabetes. Various sensors and systems used for rapid detection of the SARS-CoV-2 virus which is responsible for the COVID-19 pandemic have also been discussed in this article. Comparison of novel sensor-based systems for detection of various medical parameters with traditional techniques is included. Further research is necessary to develop low cost, highly accurate and easy-to-use medical devices with the help of these innovative sensor technologies. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Aim and objectives: To compare the mortality and outcome of patients with acute kidney injury (AKI) associated with leptospirosis and/or COVID-19 pneumonia. Materials and methods: The study was conducted by the Department of Nephrology in a tertiary care setup with 97 patients with acute kidney injury over a period of 3 months from July 2020 to September 2020. All the patients were divided into 3 main categories: 1. Leptospirosis with AKI. 2. COVID-19 pneumonia with AKI and 3. Patients having both leptospirosis and COVID-19 pneumonia with AKI. AKI was defined and staging was done as per KDIGO guidelines. Need for renal replacement therapy as well mechanical ventilation was noted. Thereby, the outcome and mortality were compared among the three groups. Results: Out of 97 patients included in the study, 57 (53.6%) patients had leptospirosis with AKI (group I), 25 (25.8%) patients had COVID-19 pneumonia with AKI (group II), whereas 20 (20.6%) patients suffered from leptospirosis and COVID-19 pneumonia with AKI (group III). There was a statistically significant difference between mortality rates in patients with leptospirosis, COVID, and both infections (χ2 = 6.210, p = 0.045). The mortality rate was 25% in leptospirosis patients and 52% in patients with COVID. This difference was statistically significant (p = 0.019). The mortality rate among patients with both leptospirosis and COVID was 45%. 15.4% of patients of group I required renal replacement therapy (RRT) in comparison to 16% of patients of group II and 35% of patients of group III. There was no statistically significant difference noted between the 3 groups (p value = 0.149). Mechanical ventilation requirement: Group I - 14/52 patients (26.9%). Group II - 7/25 (28%). Group III - 13/20 (65%). There was a significant difference in the number of patients requiring mechanical ventilation among the three groups (χ2 = 9.930, p = 0.007) with group III requiring the highest. Conclusion: AKI in patients with dual infection with leptospirosis and COVID-19 results in an increased need for mechanical ventilation without a concomitant increase in the need for RRT. Despite this, the mortality remains the highest in patients with COVID-19 and AKI as compared to those with dual infection and AKI.
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Background With the COVID-19 pandemic there was an acute drop in procedural volume for trainees, highlighting the need and potential of simulation-based training (SBT). Prior to the pandemic, the uptake of simulation was poorly categorized and inconsistent across programs despite the variety of endoscopic simulators available. We aimed to evaluate the current state of endoscopy training internationally in the wake of the pandemic as perceived by trainees. Methods This cross-sectional study utilized a survey composed of 21 questions eliciting demographic data, COVID-19-related training experiences, and experience with SBT. This survey was distributed internationally (USA, Canada, EU, Philippines, Singapore) to gastroenterology trainees between August 2021 to October 2021. Results The questionnaire was completed by 182 fellows, with 55 (30.2%) from the USA and 127 (69.8%) from other countries. Of the respondents, 79.1% were fellows during the first year of the pandemic. A majority (69.2%) found endoscopy training in general to be negatively impacted. Of those who reported a negative impact from the pandemic, 75.0% attributed it to a decline in endoscopic volume, 40.0% to institutional/regional guidelines, 25.0% to a shortage of personal protective equipment. Overall, 47.2% of respondents believed COVID-19 will negatively affect their endoscopic proficiency upon fellowship completion. A total of 71 respondents (39.0%) had experienced SBT before or during fellowship, with 27 from the USA (49.1% of respondents from USA) and 44 from other countries (34.6% of respondents from other countries). In the USA, 63.0% had used virtual reality (VR), 37.0% mechanical models, and 37.0% animal models compared to 47.7% VR, 68.2% mechanical models, and 27.3% animal models in other countries. Respondents agreed that SBT was most helpful with developing technical skills such as ergonomic handling, torque steering, and fine tip control. A majority (52.1%) found SBT appropriate to their level of training. Respondents believed increased access to SBT (43.7%) and mentored training (54.9%) would improve the experience. Conclusion While current data supports the use of SBT early in training, the cumulative uptake of SBT across programs before and during the COVID-19 pandemic remained low. In the USA and abroad, fellows perceive a negative impact of COVID-19 on their training and proficiency upon graduation. Compared to other countries, the USA had higher utilization of VR and lower utilization of mechanical models. Decrease in endoscopic volume was reported as the main factor negatively impacting endoscopic training. This survey highlights the potential benefit of SBT with low case volumes and further prospective evaluation of SBT in achieving endoscopic competence. (Table Presented)
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Background: At 140 million, India has the second largest population of old people in the world, as per the 2011 census.1 The covid 19 pandemic has wreaked havoc in millions of lives. Elderly are especially vulnerable to COVID-19 and experience high morbidity and mortality as a result of immunosenescence. Age is independently linked with mortality, but age alone does not adequately capture the robustness of older adults who are a heterogeneous group. The current research was done in a tertiary healthcare hospital in Maharashtra to understand the clinical profile and factors that affected the outcome of elderly during the second wave of the COVID pandemic. Method: This was a single centre retrospective observational study done in a tertiary hospital which was admitting both covid and non-covid patients during the time of this study. All elderly patients admitted with COVID 19 disease in Covid ward and covid ICU (Intensive care unit) were included in the study. Their Demographic details, duration of illness, vital parameters, oxygen saturation, partial pressure of arterial oxygen compared to fraction of inspired oxygen (PaO2-FiO2 ratio) were recorded and also relevant investigations such as complete blood count, kidney function tests, liver function tests, arterial blood gases, chest X-rayand ECG (Electrocardiogram),CT scan of the brain, CSF(cerebrospinal fluid) studies and other tests where relevant were recorded. Inflammatory markers such as C-Reactive Protein (CRP), Ferritin, D-Dimer and Chest CT scan were noted. Clinical profiles and outcomes were noted till discharge or death. Results: Among 231 patients that were included in this study, 81(35%) were female and 150 (65%) were male. Ninety-two patients died (39.8%) while 139 patients (60.2%) survived in our study. Majority of our patients (211;91.3%) presented in category E(pneumonia with respiratory failure) or category F(pneumonia with respiratory failure and multiorgan dysfunction syndrome). Factors which had a major impact on mortality were- a low PaO2-FiO2 ratio on admission, high C-Reactive Protein (CRP) levels, high d-dimer levels, a finding of bilateral ground glass opacities on x-ray, and need for invasive ventilation on admission. Conclusions: Elderly remain vulnerable to severe consequences of COVID-19 infection owing to the increasing comorbidities and immunosenescence in them. Prolonged oxygen therapy and intensive respiratory rehabilitation are the mainstays of effective management. Given the constant threat of mutating virus, masking, maintaining hand sanitization, vaccination and also caring for our elders while still maintaining social distance are our best bet against a fatal third wave. © 2022 Journal of Association of Physicians of India. All rights reserved.
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Background: SARS-Cov-2 infection (COVID-19) and associated gastrointestinal manifestations have been well documented during the pandemic. To date, several centers have reported isolated cases of COVID-19 and its effect on the pancreas. Here, we present a case series of 13 patients with acute pancreatitis (AP) due to COVID-19, which represents one of the larger case series to date. Methods: A retrospective review was performed from 3/1/2020 through 4/1/2020 at 4 NYC academic medical centers. Patients with a diagnosis of AP and COVID-19 were included. AP was diagnosed based on AGA criteria. COVID-19 infection was confirmed via nasopharyngeal viral PCR testing. All patients with a prior history of AP were excluded. Patients with apparent/suspected etiologies of AP (including gallstones, alcohol, hypertriglyceridemia, post ERCP, medication, and other viral etiologies) were excluded. 13 patients met our inclusion and exclusion criteria. Outcomes studied included mortality, ICU admission, length of stay, BISAP scores on admission and at 48 hours. Results: 7 of the 13 patients in this cohort were African American, 8 of 13 were men, and the median age was 51 years of age. The youngest patient was 18 years old and the oldest patient was 71 years old. Of the 13 patients, 5 patients died during their hospital course. Of those 5 who passed, 4 were African American, and all 5 were > 50 years of age. 6 of the 13 required ICU level of care. The mean length of stay for all patients was 23 days. On admission, 4 patients had BISAP scores > 3, at 48 hours 3 patients had BISAP scores > 3. Discussion: We report the characteristics of 13 patients with confirmed SARS-Cov-2 infection and AP without other common etiologies. We suspect that SARS-Cov-2 was a direct cause of AP in these patients. 5 patients died (38.5%) due to multiorgan failure from Acute Respiratory Distress Syndrome. Patients with COVID-19 and AP had a higher mortality rate than the overall mortality reported with COVID-19 during the same period. The mortality of patients in our series far exceeds the reported mortality in mild or moderate AP (less than 1%)1,2. Currently molecular theories suggest that viral attachment to ACE-2 receptors on pancreatic acinar cells leads to apoptosis, inhibition of nitric oxide production, and programmed cell death that ultimately leads to AP. Conclusion: This case series indicates a possible association between COVID-19 and AP and the increased mortality in this subset of patients. Further research is needed concerning the molecular mechanisms and clinical management of this entity. Larger studies are needed to confirm the worse outcomes with AP associated with COVID-19. Ref: 1. Russo MW et al. Digestive and liver diseases statistics, 2004. Gastroenterology. 2004;126:1448–53. 2. Triester SL et al. Prognostic factors in acute pancreatitis. J Clin Gastroenterol. 2002;34:167–76.
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Background and Purpose: Various neurological complications have been reported in association with COVID-19. We report our experience of COVID-19 with stroke at a single center over a period of eight months spanning 1 March to 31 October 2020.
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Background and Purpose: Various neurological complications have been reported in association with COVID-19. We report our experience of COVID-19 with stroke at a single center over a period of eight months spanning 1 March to 31 October 2020. Methods: We recruited all patients admitted to Internal Medicine with an acute stroke, who also tested positive for COVID-19 on RTPCR. We included all stroke cases in our analysis for prediction of in-hospital mortality, and separately analyzed arterial infarcts for vascular territory of ischemic strokes. Results: There were 62 stroke cases among 3923 COVID-19 admissions (incidence 1.6%). Data was available for 58 patients {mean age 52.6 years;age range 17–91;F/M=20/38;24% (14/58) aged ≤40;51% (30/58) hypertensive;36% (21/58) diabetic;41% (24/58) with O2 saturation <95% at admission;32/58 (55.17 %) in-hospital mortality}. Among 58 strokes, there were 44 arterial infarcts, seven bleeds, three arterial infarcts with associated cerebral venous sinus thrombosis, two combined infarct and bleed, and two of indeterminate type. Among the total 49 infarcts, Carotid territory was the commonest affected (36/49;73.5%), followed by vertebrobasilar (7/49;14.3%) and both (6/49;12.2%). Concordant arterial block was seen in 61% (19 of 31 infarcts with angiography done). ‘Early stroke’ (within 48 hours of respiratory symptoms) was seen in 82.7% (48/58) patients. Patients with poor saturation at admission were older (58 vs 49 years) and had more comorbidities and higher mortality (79% vs 38%). Mortality was similar in young strokes and older patients, although the latter required more intense respiratory support. Logistic regression analysis showed that low Glasgow coma score (GCS) and requirement for increasing intensity of respiratory support predicted in-hospital mortality. Conclusions: We had a 1.6% incidence of COVID-19 related stroke of which the majority were carotid territory infarcts. In-hospital mortality was 55.17%, predicted by low GCS at admission. © 2021 Journal of Association of Physicians of India. All rights reserved.
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The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) causes a severe acute respiratory illness but also has a major crosstalk with other organs. Amongst these, the kidney is described as a major target for the infection related acute complications with even a pre-existing abnormal kidney function becoming a risk factor for severe infection and adverse outcomes.
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Introduction: COVID-19 is a worldwide pandemic. Pieces of evidence are suggesting a strong association between COVID-19 and prothrombotic states. We are reporting a case of critical COVID- 19 complicated by a right atrial thrombus. We describe a patient with COVID-19 pneumonia and a clinical hyperinflammatory state. She developed hypoxia and required O2 support. Echocardiography suggestive of right atrial thrombus. She was managed with oxygen therapy and thrombolysis. Case presentation: A 55-year-old woman came with chief complaints of fever, dyspnea, bilateral pedal edema, and oliguria for 4 days. she was in a known c/o immunocompromised state for 2 years on tenofovir, lamivudine, and efavirenz regimen. She was diagnosed with COVID-19 based on RT-PCR testing which detected SARS-CoV-2. There is no history of i.v. drug abuse. General examination: Febrile+, pulse = 100/ minute, blood pressure-130/90 mm Hg, bilateral pedal edema+, no pallor/icterus/cyanosis/clubbing/lymphadenopathy, jugular venous pressure - raised, tachypneic + SpO2 78% on room air. Systemic Examination: Respiratory system - bilateral basal crepts. Cardiovascular System - holosystolic murmur of tricuspid regurgitation+. Nervous system-normal. Per abdomen-soft, nontender. Investigations: HB-13 g% WBC-3,900, platelets 187,000. BUN/creatinine-22/1.3. SGOT/SGPT-149/89. HIV1-Reactive. CD4-259. HbsAg and HCV-Non-reactive.ESR-33. C-reactive protein-9. D-dimer-2,054.63 ng/mL [normal-500 (cut-off)]. ECG s/o P-Pulmonale. Chest X-ray (CXR)-s/o cardiomegaly and bilateral peripheral pulmonary infiltrates. SARS-CoV-2 RT-PCR-positive 2D ECHO-right ventricle volume overload pattern, dilated right atrium and right ventricle, mild mitral regurgitation, severe tricuspid regurgitation, mild pulmonary regurgitation, mild pulmonary arterial hypertension, aortic valve pressure gradient (AVPG)-7, pulmonary arterial pressure gradient (PASP)-31. Bilateral lower limb Doppler-s/o mild atherosclerotic changes along with bilateral lower limb arterial system biphasic waveform in bilateral anterior tibial artery (ATA), posterior tibial artery (PTA), and dorsalis pedis artery (DPA). CT pulmonary angiography-Moderate cardiomegaly with dilated right atrial, right ventricle, and prominent pulmonary arteries, mild pericardial effusion s/o pulmonary hypertension. Few non-enhancing filling defects in right atrium just distal to opening of superior vena cava anteriorly and along the anterior wall of right Atrium with largest measuring 1.3 × 1 cm distal to opening of superior vena cava s/o thrombosis. Early opacification of inferior vena cava and hepatic veins on arterial phase s/o tricuspid regurgitation. Course in the ward: Patient was tachypneic on admission with SpO2 of 78% on room air, she was treated with oxygen, antibiotics, inj. Lasix, and inj. heparin. The patient had a long stay of 1 month in the ward, initially, the oxygen requirement was quite high about 15 L/minute by a non-rebreather mask. Oxygen tapered off gradually and shifted to O2 by nasal prongs thereafter weaned off from O2, urine output improved and the patient discharged on oral anticoagulation therapy after patient being asymptomatic and negative COVID swab. Materials and methods: COVID-19 cases in tertiary care center. Results: The hypercoagulation state in critically ill COVID-2019 pneumopnia patients should be monitored closely, and anticoagulation therapy should be considered in treatment early in the course of disease Early investigations and treatment with anticoagulants remains the cornerstone of treatment of COVID 19 to avoid further complications. Discussions: Severe COVID-19 infection is associated with hypercoagulable states. It is associated with a high risk for arterial as well as venous thrombosis and pulmonary thromboembolism. Prophylactic anticoagulants are recommended in all patients with severe COVID-19 infection. Full therapeutic dose of anticoagulants is required in patients with proven venous thromboembolism. The dysfunction of endothelial cells induced by infection and hypoxia found in severe C VID-19 can stimulate thrombosis not only by increasing blood viscosity but also through a hypoxia-inducible transcription factor-dependent signaling pathway. A case series of COVID-19 patients with clinically significant coagulopathy, antiphospholipid antibodies, and multiple infarcts in the brain, both digital and pulmonary, has been described. However, these antibodies can also arise transiently in patients with critical illness and various infections. The presence of these antibodies may in rare cases lead to thrombotic events that are difficult to differentiate from other causes of multifocal thrombosis in critically ill patients, such as DIC, heparin-induced thrombocytopenia, and thrombotic microangiopathy. All reported patients had severe hypoxemia and markedly elevated D-dimer levels. Our patient has developed a right atrial thrombus and was having elevated D-dimer level. She was treated with anticoagulation therapy. The international society of thrombosis and hemostasis recommends that all the hospitalized COVID-19 patients should receive a prophylactic dose of LMWH unless they have contraindications (active bleeding and low platelet count). There is a rare occurrence of COVID-19 pneumonia complicated by right atrial thrombus. Conclusion: The hypercoagulation state in critically ill COVID-19 pneumonia patients should be monitored closely, and anticoagulation therapy should be considered in treatment early in the course of the disease. Early investigations and treatment with anticoagulants remain the cornerstone of treatment of COVID-19 to avoid further complications. We are reporting this case for its rare occurrence.
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Objectives: The use of mobile health (mHealth) applications to deliver behavioral interventions stands as a possible means to overcome barriers for adolescents with socially complex needs. Having socially complex needs refers to facing multiple adversities, such as being from a traditionally underserved population (eg, low socioeconomic status;racial, ethnic, gender, and/or sexual minority populations) or experiencing adverse childhood experiences. However, it is poorly understood regarding: 1) how adolescents with socially complex needs use mobile phones;2) what specific vulnerabilities this technology creates for them;and 3) how to best fit their needs in their real-world environments. The purpose of this project was to utilize user-centered design (UCD) practices to assess the specific needs of adolescents from the West Side communities of Chicago who may benefit from access to mHealth tools to improve mental and behavioral health targets. Methods: Twenty adolescents, ages 12 to 17 years, and parents/caregivers (n = 20) are being recruited and screened through Rush University Medical Center–affiliated outpatient sites to participate in focus groups and complete self-report questionnaires. Focus groups follow a semi-structured interview format to assess usage practices and acceptability of mHealth tools for teens with socially complex needs, as well as needed cultural adaptations. Results: Recruitment and data collection are ongoing. All data will be collected and reported at the time of the conference regarding the mHealth practices and unmet needs of adolescents with socially complex needs. Qualitative data from focus groups will evaluate elements such as mobile phone usage and mental health needs. Quantitative data from self-report measures will assess elements such as psychological distress symptoms, mobile phone usage, and the impact of COVID-19 on families. Conclusions: These evaluations offer critical insights to optimize design opportunities for mHealth interventions to assess and access adolescents with socially complex needs. Given the current COVID-19 pandemic, subsequent shelter-in-place orders, and social distancing policies, the study also highlights tele- and e-consent methodologies, remote recruitment methods, and engagement of focus groups via HIPAA-compliant and secure video services. SII, OTH, TVM