Students' perceptions on the effect of COVID 19 on agricultural higher education in India

The study analysed the temporal changes in the perceptions of students of agricultural higher education due to disruption of the COVID 19 pandemic and recommends strategies to deal with it. An online survey was conducted involving students of agricultural higher education at two intervals to capture their perceptions on the academic, physical, and psychological disruptions due to the COVID 19 pandemic. Among these three aspects, changes in behavioural aspects are significant over time, which is reflected in terms of viz., attitude, frustration, anxiety, depression, uncertainty, desire for cocooning and boredom. Students showed a positive response towards continuing educational activities through online and e-learning modes. Adapting to new normal necessitated extensive use of digital technologies in education that challenged the face to face instructions, approaches to learning and assessment. Counselling and mentoring of students are found mandatory in pandemics. The development of a sustainable digital ecosystem of learning with equal weightage on students' physical and psychological well-being is needed. New approaches of learning are to evolve due to the COVID19 pandemic.

RISK OF CANNULA-SITE INFECTION FOR BEDSIDE PERCUTANEOUS CANNULATIONS PERFORMED BY INTENSIVISTS: A RETROSPECTIVE, SINGLE-INSTITUTION CASE SERIES

SESSION TITLE: Not the Normal Host: Infections Still Matter SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Utilization of ECMO support for refractory cardiogenic, and respiratory failure has increased exponentially over the last 20 years. The advent of miniaturized and portable machines has led to a shift of cannulation strategies in the operating room/cath lab to the bedside. Transitioning to bedside cannulation has been previously reported as safe, with minimal risk for mortality or catheter site infections. However, bedside cannulations in the critically ill crashing patient raises concern for sterility. The aim of this study was to assess the risk of ECMO cannula site infections in bedside vs operating room/catheterization suite. METHODS: It is a retrospective single institution case series review of 52 adult and pediatric patients who were required either Veno-Venous (VV) or Veno-Arterial (VA) ECMO. Data gathering was used to quantify the rate of catheter site infections after initiation of extracorporeal support. Catheter site infections were defined as localized erythema, fluctuance, or purulence from the cannula site within 7 days of of ECMO cannula placement. RESULTS: A total of 42 (81%) pts had bedside cannulation, and the other 10 (19%), were done in IR suite/cath lab. The total number of catheter site infections was 1 (2.4%) in the bedside cannulation group. There were no infections in the non-bedside cannulation groups. 13 (30%) of the bedside cannulations, and 3 (30%) of the non-bedside cannulation group were on antibiotics during or prior to cannula insertion. CONCLUSIONS: Current literature suggests that the prevalence of infections on ECMO is 10-12%,. Traditionally, this has predisposed most cannulations to be performed in the surgical setting rather than at bedside. During the recent COVID pandemic, the frequency of bedside cannulation for ECMO had increased and was not associated with significant morbidity, and mortality. The risk of infection from the catheter site had also been determined to be minimal to none. From the data gathered above, it can be safely assumed that the risk of catheter site infection with bedside cannulation is minimal. However, the major contributing factor to decreased infection risk appears to be meticulous cannula site nursing care. The current ECMO nursing protocol utilized at our hospital required twice daily dressing changes with stringent chlorhexidine cleanses prior to redressing. The only case of catheter site infection we experienced was when this protocol was deviated. CLINICAL IMPLICATIONS: Utilizations of bedside ECMO cannulation techniques carries minimal risk for catheter site infections. It is important to state that nursing driven protocols for cannula site dressing changes, has one of the biggest implications on the risk of catheter site infections. Therefore, with the employment of appropriate nursing protocols, the concern for catheter site infections should not preclude the decision to proceed with bedside cannulation. DISCLOSURES: No relevant relationships by Ajit Alexander No relevant relationships by Melodie Blackmon Scientific Medical Advisor relationship with ALung Technologies, Inc. Please note: $5001 - $20000 by Steven Conrad, value=Consulting fee No relevant relationships by ANIBAL DOMINGUEZ no disclosure on file for Jonathan Eaton;No relevant relationships by Laurie Grier No relevant relationships by Rajkamal Hansra No relevant relationships by Prathik Krishnan No relevant relationships by Nathaniel LSUHSC-Shreveport No relevant relationships by Alex Manuel No relevant relationships by Jonathan Packer No relevant relationships by arunima sharma no disclosure on file for Chris Trosclair;No relevant relationships by Gregory Vo No relevant relationships by Robert Walter

POST-COVID-19 ORGANIZING PNEUMONIA: A RARER ENTITY THAN PREVIOUSLY IMAGINED

SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Organizing pneumonia (OP) is well known complication of severe viral infections. Recent reviews of postmortem biopsies and CT imaging suggest that a subset of patients develop secondary organizing pneumonia following infection with SAR-COV2. High dose steroids have previously been proven efficacious in post viral OP following infections such as H1N1, severe acute respiratory syndrome and MERS. This study aims to discover the incidence and impact of high dose steroids in treatment of Covid 19 patients who have characteristics of OP following initial infection. METHODS: We reviewed records of adult patients over age 18 hospitalized with respiratory failure due to COVID-19 pneumonia between 3/1/20 and 6/30/21 in our institution. We isolated patients who survived initial presentation but developed persistent hypoxia and CT evidence of progression to OP. Of these, we reviewed those treated with high dose prednisone, the usual dexamethasone, or no steroid treatment. We documented age, gender, timing of initiation of steroids, timing of steroid tapering, oxygen requirements at initiation, at day 30, and day 90, and overall outcomes. RESULTS: We identified 881 patients with COVID of which 46 patients met the criteria of having OP. Age ranged from 18-73, median age of 60.5. 52% were male. 3 patients had lung biopsy to confirm OP. All other patients were diagnosed based on CT and clinical presentation. 23 patients were treated with Prednisone after the initial 10-day course of dexamethasone. 24 patients were treated with just 10 days of dexamethasone. 5 patients were not treated with steroids. CONCLUSIONS: The incidence of post-covid OP appears to be lower than anticipated, with an incidence rate of roughly 0.05% in our study population. A significant proportion of patients had at least 2 underlying medical conditions. Patients on lower supplemental oxygen requirement (<2 L NC) were not continued on steroids and did well with only 2 of the 23 requiring oxygen at 30 days with mortality. Patients on higher supplemental oxygen at 10 days (>2L NC) were continued on steroids and the mortality rate was high, ~40%. We would conclude the incidence of post-Covid associated OP seems to be low in this small cohort of patients, and the decision to continue steroids should be based on individual patient characteristics such as supplemental oxygen requirements at 10 days, rather than CT findings of OP and that they seem to have higher mortality. In the future, larger multicenter cohort studies would help to understand further treatment. CLINICAL IMPLICATIONS: Although our incidence of post-covid OP is low, the mortality and morbidity in select patients appears to be high. Anticipating specific populations who may be at higher risk and starting treatment earlier could help reduce mortality. Larger cohort studies are needed to help develop better treatment strategies. DISCLOSURES: No relevant relationships by Hajra Channa No relevant relationships by Cesar Davila-Chapa No relevant relationships by Prathik Krishnan No relevant relationships by uzoamaka ogbonnah No relevant relationships by arunima sharma no disclosure on file for Diana Song;No relevant relationships by Fereshteh Yazdi

DiCOVA Challenge: Dataset, task, and baseline system for COVID-19 diagnosis using acoustics

The DiCOVA challenge aims at accelerating research in diagnosing COVID-19 using acoustics (DiCOVA), a topic at the intersection of speech and audio processing, respiratory health diagnosis, and machine learning. This challenge is an open call for researchers to analyze a dataset of sound recordings, collected from COVID-19 infected and non-COVID-19 individuals, for a two-class classification. These recordings were collected via crowdsourcing from multiple countries, through a website application. The challenge features two tracks, one focusing on cough sounds, and the other on using a collection of breath, sustained vowel phonation, and number counting speech recordings. In this paper, we introduce the challenge and provide a detailed description of the task, and present a baseline system for the task.

The levels of Physical Activity, Mental Health, and Sedentary Behaviour of Health Science students in UTAR during COVID-19 pandemic

Background: The COVID-19 pandemic forcing the students to stay at home to curb the spread of the coronavirus, which inevitably affects their mental and physical health. Thus, the evaluation of mental health (MH), physical activity (PA) and Sedentary Behaviour (SB) of Health Science students during COVID-19 is a need. Objective: To evaluate the physical activity level, mental health and sedentary behaviour of Health Science students in UTAR during COVID-19 and find the correlation among them. Method: 258 health science students were participated in this study via social media, like Facebook and WhatsApp, The Depression, anxiety, stress scale-21 (DASS-21) was used to assess mental health and the International Physical Activity Questionnaire (IPAQ) was used to assess physical activity levels and sedentary behaviour. Result: There were 34.89%, 55.04% and 25.58% of Health Science students were suffering moderate to extremely severe level of depression, anxiety and stress, respectively. Females had a higher prevalence in anxiety (F:55.49%, M: 53.95%) and stress (F:26.37%, M:23.69%), while depression more prevalent in males (M:42.81%, F: 31.87%). The Chinese Medicine students had the poorest mental health and this followed by Physiotherapy, M.B.B.S and Nursing students. Besides, the prevalence of physical inactivity was 48.99%, which a higher prevalence in females (51.43%) than males (43.10%). Besides, 39.53% of Chinese Medicine Students, 62% of M.B.B.S students, 55.56% of Nursing students and 44.83% of Physiotherapy students were categorized as physical inactivity. The prevalence of sedentary behaviour was 48.10% in Health Science students. Besides, no significant correlation found between physical activity and mental health, and sedentary behaviour and mental health. A weak negative correlation was found between physical activity and sedentary behaviour. Conclusion: The prevalence of Depression, Anxiety, Stress, Physical Inactivity and Sedentary Behaviour during the pandemic was very alarming. From government to institution, adequate and regular surveillance, policy monitoring and further research should be taken.

Nutrition, atherosclerosis, arterial imaging, cardiovascular risk stratification, and manifestations in COVID-19 framework: a narrative review.

Background: Atherosclerosis is the primary cause of the cardiovascular disease (CVD). Several risk factors lead to atherosclerosis, and altered nutrition is one among those. Nutrition has been ignored quite often in the process of CVD risk assessment. Altered nutrition along with carotid ultrasound imaging-driven atherosclerotic plaque features can help in understanding and banishing the problems associated with the late diagnosis of CVD. Artificial intelligence (AI) is another promisingly adopted technology for CVD risk assessment and management. Therefore, we hypothesize that the risk of atherosclerotic CVD can be accurately monitored using carotid ultrasound imaging, predicted using AI-based algorithms, and reduced with the help of proper nutrition. Layout: The review presents a pathophysiological link between nutrition and atherosclerosis by gaining a deep insight into the processes involved at each stage of plaque development. After targeting the causes and finding out results by low-cost, user-friendly, ultrasound-based arterial imaging, it is important to (i) stratify the risks and (ii) monitor them by measuring plaque burden and computing risk score as part of the preventive framework. Artificial intelligence (AI)-based strategies are used to provide efficient CVD risk assessments. Finally, the review presents the role of AI for CVD risk assessment during COVID-19. Conclusions: By studying the mechanism of low-density lipoprotein formation, saturated and trans fat, and other dietary components that lead to plaque formation, we demonstrate the use of CVD risk assessment due to nutrition and atherosclerosis disease formation during normal and COVID times. Further, nutrition if included, as a part of the associated risk factors can benefit from atherosclerotic disease progression and its management using AI-based CVD risk assessment.

CARDIAC TAMPONADE WITHOUT CHARACTERISTIC ECHOCARDIOGRAPHIC FEATURES DUE TO HIGH RIGHT HEART PRESSURE FROM PULMONARY HYPERTENSION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Introduction: Cardiac tamponade occurs when pericardial effusion leads to equalization of intrapericardial pressure and diastolic intracardiac pressure, which reduces the systemic venous-to-right atrial pressure gradient, leading to depression in cardiac output. The lower this gradient, the greater the risk for cardiac tamponade. Cardiac tamponade manifests clinically as shock, jugular venous distention, and muffled heart sounds, known collectively as Beck's triad. Typical findings on echocardiogram are right atrial and ventricular collapse.[2] These findings may not be seen in patients with elevated right-sided intracardiac pressure and can lead to misdiagnosis or delay in diagnosis of cardiac tamponade.[1] We present a patient with a cardiac tamponade to highlight this point. CASE PRESENTATION: Case presentation: A 46 year old male with hypoxia and respiratory failure from COVID-19 pneumonia supported with mechanical ventilation for several weeks developed refractory shock of multifactorial etiology. The patient was known to have pulmonary hypertension with dilated right atrial and ventricular pressure in addition to paradoxical septal motion, as seen on echocardiogram of recent past. Clinical examination revealed jugular venous distention and muffled heart sounds. Electrocardiogram detected sinus tachycardia and low cardiac voltage. Echocardiogram revealed large pericardial effusion without right atrial or ventricular collapse, and therefore cardiac tamponade was not considered as the cause of shock. As shock remained refractory to multiple vasopressors and inspiratory variation of the mitral valve inflow was noted on echocardiogram, it was decided to initiate pericardial drainage. However, the patient went into cardiac arrest before it could be performed. DISCUSSION: Discussion: A clinical diagnosis of cardiac tamponade can be made in the presence of Beck's triad. However, echocardiogram is most often relied on to make the diagnosis. The most sensitive echocardiographic findings of cardiac tamponade are right atrial and ventricular collapse.[2] Though sensitive, these changes may not be present in a patient who has preexisting elevated right sided intracardiac pressure. In such cases, the diagnosis must be based on clinical evidence and can be aided by the findings of exaggerated changes in mitral/tricuspid inflow during respiration. CONCLUSIONS: Conclusion: A hallmark finding of cardiac tamponade is right atrial or ventricular collapse on echocardiogram. However, these findings may be absent in the setting of elevated right-sided intracardiac pressure. The absence of right atrial or ventricular collapse in our patient can be attributed to the elevated right-sided intracardiac pressure due to pulmonary hypertension.[3] In such cases, the diagnosis of cardiac tamponade should be made on clinical grounds and pericardial drainage should not be delayed. REFERENCE #1: 1. Adams JR, Tonelli AR, Rokadia HK, Duggal A. Cardiac tamponade in severe pulmonary hypertension. A therapeutic challenge revisited. Ann Am Thorac Soc. 2015;12(3):455-460. REFERENCE #2: 2. Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003;349(7):684-690. REFERENCE #3: 3. Vallabhajosyula, S., Kanuri, S., Sundaragiri, P., & Alla, V. (2014). Management of cardiac tamponade in severe pulmonary hypertension. Chest, 146(4). DISCLOSURES: No relevant relationships by George Apergis, source=Web Response No relevant relationships by Dushyant Damania, source=Web Response No relevant relationships by Aaron Douen, source=Web Response No relevant relationships by Padmanabhan Krishnan, source=Web Response No relevant relationships by George Mbolu, source=Web Response No relevant relationships by Ryan Panetti, source=Web Response

SARS-CoV-2 Superspread in Fitness Center, Hong Kong, China, March 2021

To investigate a superspreading event at a fitness center in Hong Kong, China, we used genomic sequencing to analyze 102 reverse transcription PCR-confirmed cases of severe acute respiratory syndrome coronavirus 2 infection. Our finding highlights the risk for virus transmission in confined spaces with poor ventilation and limited public health interventions.

Short term neonatal outcomes of colocating and breastfeeding infants of mothers who tested positive for SARS-COV-2

Background: There is a paucity of data on the neonatal outcomes of maternal SARS-COV2 infection which has emerged as a pandemic spreading rapidly across the world. Further, conflicts in current guidelines exist on whether to routinely separate infants from infected mothers in the hospital, to utilize shared decision-making to regulate care or to encourage exclusive breastfeeding and standard feeding guidelines for these infants. At our hospital in New York City which has been the epicenter of the infection in the US, shared decision-making between the mother and clinical team was utilized. Mothers who elected to room-in were encouraged to initiate skin-to-skin care and follow routine breast-feeding practices while following strict hand washing and use of masks. Infected mothers who were restricted from NICU and mothers of isolated infants were encouraged to provide pumped breastmilk. We aimed to elucidate the outcomes of the infants born to mothers with COVID-19 infection following these practices. Methods: We identified all neonates born to mothers who were tested positive for SARS-CoV-2 from March 19 to April 22, 2020 at Elmhurst Hospital (Table Presented) Center. All infants were tested by nasopharyngeal PCR swabs. Data regarding demographic, epidemiologic, clinical features, breastfeeding practices and short-term outcomes including outpatient follow up through telemedicine or in-person visits were obtained by retrospective chart review of medical records. Results: Among 118 mothers tested during the study period, 45 (38%) of mothers tested positive of which 18(40%) were asymptomatic. All the infants were screened for SARS-CoV-2 and none were positive. 3 infants initially tested positive for SARS-CoV-2 on a screen at <24 hours of age, but tested negative on 2 repeated screens and were considered false positives. All the infants were asymptomatic for COVID-19 in the hospital. Demographic characteristics are described in Table 1. 33 babies were roomed with the mother while 7 required NICU admission. 5 newborns were isolated from the mother at birth due to maternal request. 31 infants were breastfed directly, 9 received expressed breastmilk and 5 did not receive any breastmilk. 41 babies were discharged to the same household as mother, one is still in the hospital and 3 were discharged to a different household (Table 2). During follow up, there was a 93% adherence to the initial in-person newborn visit while there was a 100 % compliance to the tele-medicine visit around 14 days. All infants were asymptomatic at follow up visits and none had COVID-19 related emergency department visits or subsequent hospital admissions. Conclusion: We report no short term adverse neonatal outcomes to skin-to-skin care, rooming-in or breastfeeding in infants of SARS-CoV-2 positive mothers in our population. Although this data is preliminary, it could help decide best practices for these infants.

A narrative review on characterization of acute respiratory distress syndrome in COVID-19-infected lungs using artificial intelligence.

COVID-19 has infected 77.4 million people worldwide and has caused 1.7 million fatalities as of December 21, 2020. The primary cause of death due to COVID-19 is Acute Respiratory Distress Syndrome (ARDS). According to the World Health Organization (WHO), people who are at least 60 years old or have comorbidities that have primarily been targeted are at the highest risk from SARS-CoV-2. Medical imaging provides a non-invasive, touch-free, and relatively safer alternative tool for diagnosis during the current ongoing pandemic. Artificial intelligence (AI) scientists are developing several intelligent computer-aided diagnosis (CAD) tools in multiple imaging modalities, i.e., lung computed tomography (CT), chest X-rays, and lung ultrasounds. These AI tools assist the pulmonary and critical care clinicians through (a) faster detection of the presence of a virus, (b) classifying pneumonia types, and (c) measuring the severity of viral damage in COVID-19-infected patients. Thus, it is of the utmost importance to fully understand the requirements of for a fast and successful, and timely lung scans analysis. This narrative review first presents the pathological layout of the lungs in the COVID-19 scenario, followed by understanding and then explains the comorbid statistical distributions in the ARDS framework. The novelty of this review is the approach to classifying the AI models as per the by school of thought (SoTs), exhibiting based on segregation of techniques and their characteristics. The study also discusses the identification of AI models and its extension from non-ARDS lungs (pre-COVID-19) to ARDS lungs (post-COVID-19). Furthermore, it also presents AI workflow considerations of for medical imaging modalities in the COVID-19 framework. Finally, clinical AI design considerations will be discussed. We conclude that the design of the current existing AI models can be improved by considering comorbidity as an independent factor. Furthermore, ARDS post-processing clinical systems must involve include (i) the clinical validation and verification of AI-models, (ii) reliability and stability criteria, and (iii) easily adaptable, and (iv) generalization assessments of AI systems for their use in pulmonary, critical care, and radiological settings.

Coswara - A database of breathing, cough, and voice sounds for COVID-19 diagnosis

The COVID-19 pandemic presents global challenges transcending boundaries of country, race, religion, and economy. The current gold standard method for COVID-19 detection is the reverse transcription polymerase chain reaction (RT-PCR) testing. However, this method is expensive, time-consuming, and violates social distancing. Also, as the pandemic is expected to stay for a while, there is a need for an alternate diagnosis tool which overcomes these limitations, and is deployable at a large scale. The prominent symptoms of COVID-19 include cough and breathing difficulties. We foresee that respiratory sounds, when analyzed using machine learning techniques, can provide useful insights, enabling the design of a diagnostic tool. Towards this, the paper presents an early effort in creating (and analyzing) a database, called Coswara, of respiratory sounds, namely, cough, breath, and voice. The sound samples are collected via worldwide crowdsourcing using a website application. The curated dataset is released as open access. As the pandemic is evolving, the data collection and analysis is a work in progress. We believe that insights from analysis of Coswara can be effective in enabling sound based technology solutions for point-of-care diagnosis of respiratory infection, and in the near future this can help to diagnose COVID-19. © 2020 ISCA

RECOGNITION OF A TRACHEOESOPHAGEAL FISTULA IN A MECHANICALLY VENTILATED PATIENT

SESSION TITLE: Fellows Critical Care Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Tracheoesophageal fistula (TEF) can present as either congenital or acquired abnormality. Acquired TEF is usually secondary to malignant tumors. Prolonged mechanical ventilation with cuff related injury leading to a non-malignant TEF usually presents post extubation although it has become rare with the introduction of high-volume low-pressure cuffs(1). Occurrence of TEF & its early identification in a mechanically ventilated patient is of critical importance to prevent severe ventilator inefficiency, sepsis and compromised nutrition. Here we present a case of TEF presenting in a ventilator dependent patient. CASE PRESENTATION: A 69 year old female with past medical history of diabetes and hypertension presented with hypoxemic respiratory failure due to COVID-19 pneumonia requiring mechanical ventilation. Course was complicated by methicillin resistant Staphylococcus aureus (MRSA) bacteremia treated with intravenous Vancomycin. After 3 weeks of mechanical ventilation, surgical tracheostomy was performed. One week later, she developed tracheostomy site MRSA infection. Two weeks later, the patient developed sudden severe abdominal distension and tachypnea with higher oxygen requirements. Abdominal x-ray showed severely distended bowel loops which improved with orogastric (OG) tube suctioning but recurred when it was turned off (fig 1). The ventilator volume graphs revealed a large air leak despite an adequately inflated cuff and the external tip of the OG tube under water showed continuous bubbling. Above findings raised suspicion of TEF which was confirmed by CT imaging (fig 2). As patient was unstable for surgical intervention, the regular tracheostomy tube replaced with an extended length (XLT) tracheostomy tube which led to resolution of air leak. DISCUSSION: Acquired TEF can occur in the setting of prolonged mechanical ventilation, indwelling tracheal or esophageal stents, mediastinal infections and trauma or iatrogenic injuries. Common presenting complaint is persistent cough upon food consumption post extubation. It is a rare complication occurring in less than 1% of patients undergoing tracheostomy. In ventilator dependent patients, presenting signs include persistent air leak even with a fully inflated cuff, abdominal distension and airway contamination with gastric contents(2). Endoscopy is considered the best diagnostic method, though small TEFs may be missed in the esophageal folds. Bronchoscopy with methylene blue installation identifies the defect better. Imaging with CT/MRI is preferred in ventilator dependent patients. The mainstay of treatment of TEF in ventilated patients is usually conservative management with XLT tracheostomy tube or esophageal stenting. CONCLUSIONS: TEF is a rare complication. Acute bowel distension with a large continuous air leak on the ventilator & through OG tube (bubbling underwater), despite a fully inflated cuff should raise clinical suspicion. Reference #1: 1.Reed MF, Mathisen DJ. Tracheoesophageal fistula. Chest Surg Clin N Am. 2003;13(2):271-289. doi:10.1016/s1052-3359(03)00030-9 Reference #2: 2.Paraschiv M. Tracheoesophageal fistula–a complication of prolonged tracheal intubation. J Med Life. 2014;7(4):516-521. DISCLOSURES: No relevant relationships by padmanabhan krishnan, source=Web Response No relevant relationships by Chetana Pendkar, source=Web Response No relevant relationships by Sumedha Sonde, source=Web Response No relevant relationships by Nishanth Vallumsetla, source=Web Response