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INTRODUCTION AND OBJECTIVE: Contemporary rates of burnout amongst urologists are reported to be 60-80%. These rates have significant implications on physician well-being and retention. We investigated predictors of burnout in female surgeons. METHOD(S): An electronic census survey was distributed to residents, fellows and practicing urologists by the Society of Women in Urology in the United States and territories via email and social media between February and May 2022. We assessed participant demographics, personal and professional characteristics, practice environment, compensation, and burnout with chi-square and t-test analyses. RESULT(S): There were 379 survey participants with an average age of 42 years (SD 10). A majority identified as cis-gendered heterosexual females (96%) and were practicing urologists (74%), while 10% were fellows and 15% residents/interns. Average reported time in practice was 9 years (SD 9 years). Most respondents reported burnout (273, 72%), with 87% agreeing COVID worsened burnout in the community. Those reporting burnout worked an average of 58 (SD 15) hours per week versus 49 (SD 18) hours (p<0.00001). Table 1 demonstrates significant personal and professional characteristics for participants who reported burnout. On multivariable logistic regression analysis, increased hours worked per week (OR 1.03, p=0.002), Relative Value Unit based pay versus salary (OR 4.4, p=0.007), correlated to burnout and feeling income is comparable to peers (OR 0.4, p=0.03) was inversely related. Common shared experiences included lack of staffing, reduced operating room time, lack of administrative support, predominance of non-operative referrals, gender and racial inequity or microaggressions, electronic health records with increased documentation demands, increased non-clinical administrative duties, and insufficient compensation or lack of financial advancement. CONCLUSION(S): A majority of women in urology report burnout with work-hours and compensation inequity as leading contributing factors. Concerns raised in this study such as lack of support staff, racial and gender inequity, and poor referral patterns should be further evaluated to determine a comprehensive plan to reduce burnout. (Figure Presented).
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Objectives: The aim of this study was to explore the association of the plasma levels of coagulation proteins with venous thromboembolic events (VTE) in COVID-19 and identify candidate early markers of VTE. Background(s): Coagulopathy and thromboembolism are known complications of SARS-CoV-2 infection. The mechanisms of COVID-19-associated hematologic complications involve endothelial cell and platelet dysfunction and immunothrombosis and have been intensively studied. Yet, a full understanding of the pathogenesis and factors that lead to COVID-19 associated coagulopathy is lacking. Previous studies investigated only small numbers of coagulation proteins together, and they were limited in their ability to adjust for confounders. Method(s): This study was a post-hoc analysis of a previously published dataset (Filbin et al., 2021). We included in our analysis 305 subjects with confirmed SARS-CoV-2 infection who presented to an urban Emergency Department with acute respiratory distress during the first COVID-19 surge in 2020;13 (4.2%) were subsequently diagnosed with venous thromboembolism during hospitalization. Serial samples were obtained on days 0, 3, and 7 and assays were performed on two highly-multiplexed proteomic platforms, that in combination cover 1472 + 4776 proteins. We included 31 coagulation proteins in our analysis. Result(s): Nine coagulation proteins were differentially expressed in patients with thromboembolic events. In multivariable models, day 0 levels of P-selectin, a cell adhesion molecule on the surface of activated endothelial cells, displayed the strongest association with the diagnosis of VTE, independent of disease severity and other confounders (p=0.0025). P-selectin together with D-dimer upon hospital presentation provided better discriminative ability for VTE diagnosis than D-dimer alone (AUROC = 0.834 vs. 0.783). Conclusion(s): Our results suggest that plasma P-selectin is a potential early biomarker for the risk stratification of VTE in COVID-19 disease. Our findings support the importance of endothelial activation in the mechanistic pathway of venous thromboembolism in COVID-19.Copyright © 2023
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Currently, humanity is suffering from a highly contagious and infectious novel coron-avirus disease. Due to the unavailability of any specifically approved therapy to eradicate this pathogenic virus, day by day, it is claiming more and more lives of humans. Observing the current scenario, human civilization seems to be in dangerous situation, and the development of a potential vaccine against this invisible enemy may take some more time. It was observed that the individual immune system plays an important role in the fight against the novel coronavirus. Additionally, the innate immune system of the host acts as the first line of defense against invading pathogenic virus-es. The host innate immune cells can detect and detoxify the evading viruses. Thus, boosting the innate immune response via targeting activator or inhibitory immune check points pathways for en-hancing T-cell immune response may potentially help the patients to fight against this deadly virus. The aim of this editorial is to discuss in brief about the pathogenesis of COVID-19, the role of innate immunity and autophagy during viral clearance.Copyright © 2021 Bentham Science Publishers.
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Background In recent years, research has demonstrated the disparities in cardiovascular disease diagnosis and outcomes for various populations. We aim to study the demographic and COVID-19-related disparities in the door to electrocardiogram (DtE) time for patients presenting with chest pain in a diverse public city hospital. Methods We conducted a retrospective chart review of patients presenting with chest pain to the emergency department between June 1, 2019 and July 31, 2022. Data regarding age, sex, race, COVID-19 status, and DtE time were collected. Wilcoxon rank sum and Kruskal Wallis tests were used to compare medians. Linear regression was performed to further understand the relationship between age and DtE time. Results Of 10,918 patients, 51% were female (age: 49 +/- 17) and 49% were male (age: 48 +/- 16). A significantly lower median DtE time was noted in males (z=2, p=0.045), patients without COVID-19 (z= -2.84, p=0.004) and in age less than 45 years (z=2.38, p=0.017). In a linear regression adjusting for age, sex, race, and COVID-19 status, advancing age was directly correlated with greater DtE time. For every 10-year increase in age, the DtE time increased by 6.2 minutes (p<0.001). Conclusion DtE time was longer in females and in patients with COVID-19. No race-based disparities were found in this analysis. Paradoxically, younger patients presenting with chest pain had a significantly shorter DtE time, despite a higher prevalence of acute coronary syndrome in older age groups. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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Background: Various studies have pinned longevity of protective Immunoglobulin-G (IgG) titres at 2-5 months. The robustness and longevity of the IgG antibody response to COVID-19 infection has been gauged in a cohort of 214 single institutional health care workers by serial quantitative immunometric tests. Currently no separate guidelines exist for vaccination of COVID-survivors and this study provides data to fill this lacuna in knowledge. Methodology: Prospective longitudinal panel survey administered to the same cohort of Health Care Workers (HCW) till such time they got vaccinated under Indian Government's free vaccination drive for HCW. Depending upon the date of contraction of infection the HCW could be longitudinally monitored for variable periods (2-9 months). The survey questionnaire comprising multiple-choice, dichotomous, matrix and Likert-scale questions was deployed to the respondents online via email/WhatsApp. Data was expressed as box-whisker plots, trendlines and trend areas. A p-value<0.05 was considered statistically significant. The composite index of 'Effective Immunity' was calculated. Result(s): The mean IgG antibody titre was 11.13+/-8.6AU at 1-2m, 9.68+/-8.9AU at 3-4m, 8.35+/-5.9 AU at 6-7m and 7.87+/-4.4 AU at 8-9m after first symptom, respectively. The lowest titre at all time points was 0 while the highest titres were 46.8 AU, 56.5 AU, 23.4 AU and 17.4 AU at 1-2m, 3-4m, 6-7m and 8-9m, respectively. Conclusion(s): Adaptive active immunity acquired through natural infection may last for at least 9 months post-initial exposure and lies in the moderate protection range in 77% HCW, which can be extrapolated to vaccination and immunity passports. Separate vaccination guidelines are required for COVID-survivors. The first shot of vaccine serves as a booster second exposure/booster dose in all COVID-survivors.HCW with low IgG-titre may suffer from a false sense of security. Periodic quantitative IgG-titre based serological tests can help guide timing of second shot of vaccination and predict likelihood of re-infection.Copyright © 2022 Indian Medical Association. All rights reserved.
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This paper attempts to give an overview of the system which is designed keeping social distancing guidelines in mind. Our system will detect in real-time, if the person in the captured live video is wearing a mask properly or not using a mask detecting algorithm developed using deep learning and neural networks with an accuracy of 96.05%. If and only if the person is wearing a mask, they will be allowed to scan the iris and hence record their attendance, which can be stored in excel or CSV formats. The location of iris biometric is translated to a real-life position in the 3D space with the resolution of 0.lmm. To scan the located biometric this system comprises a robotic arm. End effector of this robotic arm traverses to the translated position of the person's eye to scan iris with an iris scanner. The system employs a 'four degrees of motion' robotic arm that can autonomously align itself to the iris with an accuracy of 96.86%. It is battery operated and has a cylindrical workspace with maximum range of 300mm, hence it is easily deployable in institutions requiring secure authorization while monitoring COVID-19 safety norms. © 2022 IEEE.
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PurposeThe present study aims to understand the relationship between psychological contract breach (PCB) and outcome variables with mediation role of job stress, psychological empowerment and moderating role of learned helplessness.Design/methodology/approachDescriptive cross-sectional research design was deployed. Data were collected from the Indian public sector bank employees, especially from those who are regularly going to the banks even during the lockdown situation. A total of 239 respondents were contacted via online and offline method.FindingsThe authors reported that bank employees feel the breach of psychological contract which induced job stress. Further, job stress negatively impacts their psychological empowerment and psychological empowered employees exhibit increased innovative behavior and well-being. The authors also found that job stress and psychological empowerment mediated the relationship between PCB and outcome variables, and learned helplessness moderates this relationship. The current study captures the psychological response of employees during the pandemic era.Originality/valueThe study also highlights that during the pandemic, when majority of the employers have given work from home, the public sector employees were regularly going to the banks with fragile mindset. The banks' managers and HR managers can also understand that how the fulfillment of expectations is important not only for employee well-being but also for the health of the organization.
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Introduction: Delivering a breast service during The COVID-19 pandemic has been challenging. At our tertiary referral centre, we have had to coordinate care across multiple sites in order to maintain provision of services. This study looks at how this was achieved at The Nottingham breast Institute (NBI) by a team of 6 Consultant Surgeons. Method(s): This was a retrospective review of a prospective data base (managed by one Consultant oncoplastic surgeon) of all patients treated at The NBI over a period of 18 months, at The start The pandemic from March 2020 to October 2021. Data collected included patient demographics, hospital site, and type of surgery. Result(s): Over The 18 months 1191 patients were operated on. The average age was 57.8 years (range 17 to 86);as expected The commonest indication was Cancer (93.1%). 11.3% of those patients (125/1109) received neoadjuvant chemotherapy. of these 37.4% of patients (N=446) were operated on at our usual operative base site (NBI). 49.5% and The majority of cases (N=589) were performed across two independent hospitals and a smaller proportion (12.9%) was conducted at a fourth hospital which of fered 23 hour stay facilities. Conclusion(s): Despite The challenges of securing operative capacity, thus far, we have been able to deLiver over 1000 breast Cancer surgeries during The COVID-19 pandemic. This is due in part to multisite working, surgeon flexibility, and oversight of all The patient pathways collated on one database by a dedicated surgeon.
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Purpose: The study aims to explore and validate the revised psychological contract scale in this new normal era. Design/methodology/approach: To serve the purpose, four studies were conducted. Study 1 was conducted for item generation through the extant literature review and phenomenological study. Study 2 highlighted the expert review. Study 3 explained the confirmatory factor analysis. At the end of study 3, the new psychological contract content had 14 items along with 15 traditional psychological contract content items. The nomological study validated the scale with the help of antecedent, i.e. supervisor's support, and outcomes, i.e. well-being and innovative behavior. Findings: The revised psychological contract was bifurcated into two categories: new and traditional. Further, the revised psychological contract scale was having two dimensions: content and breach/fulfillment. The new content was the outcome of changes in perceived obligations due to pandemic. The nomological study found that supervisor support had a positive impact on the content of the psychological contract and fulfillment/breach of the psychological contract. Further, it was found that the new content of psychological contract was impacting more on well-being and innovative behavior than the traditional psychological contract. Research limitations/implications: In the new normal era, the working style and patterns have changed. Thus, it was important to capture changes in perceived obligations and employees' perception regarding to which extent their organizations were able to meet these altered perceived obligations. The study has direct implications for the practitioners as the revised psychological contract scale enlisted the perceived obligations of the employee and the extent to which these obligations were fulfilled by the employer. The study is also helpful in developing new normal HR policies and practices in the organization. Originality/value: The study is original as it creates a new scale to measure the content of psychological contract and fulfillment/breach of psychological contract during new normal. © 2022, Emerald Publishing Limited.
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Household consumption induces aggregated economic activities by pushing market demand, capital accumulation and financial growth in the economy;on the other hand, instability in household consumption adversely affects the overall economic progress. Thus, exploring the key determinants responsible for household consumption instability is essential. The motivation of the study is to gauge the role of pandemic uncertainties and remittance inflow on household consumption in lower, Lower-middle, and Upper-Middle-income Countries for the period 1996 to 2020. The study employed several econometrical tools, including a panel cointegration test with the error correction term, dynamic SUR. The panel unit root test following CADF and CIPS documented variables are stationary after the first difference, and long-run associations are confirmed with the panel cointegration test. The coefficient of Dynamic Seemingly Unrelated Regression exposed pandemic uncertainties and has a negative impact on household consumption in all three-panel estimations;however, the coefficient of PUI is more prominent with COVID-19 effects. Remittances’ role in household consumption was positive and statistically significant, suggesting migrant remittances encourage additional consumption among households. On the policy aspect, the study proposed that the government should undertake macro policies to manage policy uncertainties so that the normal course of consumption level should not be interrupted because household consumption volatility creates discomfort in aggregated development. Moreover, efficient reallocation and remittance channels should be ensured in the economy;therefore, efficient institutional development has to be confirmed. Copyright © 2022 Yin, Qamruzzaman, Xiao, Mehta, Naqvi and Baig.
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Background: The coronavirus disease (COVID-19) is profoundly affecting life around the globe. Social Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment threatening the mental health of young adults significantly. Objectives: The present study aims to assess the impact of Social Isolation on the mental health of young adults during the pandemic. Methods: A web based research was conducted on a sample of 438 college students of age 18-24 years. The participants were asked for responding to a standardized online questionnaire that included questions related to their anxiety levels and the 7-item Generalized Anxiety Disorder Scale (GAD-7). Results: The results revealed 78.4% of the study populations were suffering with mild (35.2%), moderate (23.7%), and severe anxiety (19.4%) respectively. Univariate and Logistic Regression Analysis revealed gender and course/year of study had a significant effect on the level of anxiety (p<0.05). Also, students living alone and having a relative or an acquaintance infected with COVID-19 were likely to be more anxious (p<0.05). Spearman correlation analysis depicted Social Isolation as the main Covid-19 related stressor which was positively correlated and highly significant (p=0.0001) to the level of anxiety of young adults. Conclusions: The present study revealed approximately 43% of young adults is suffering from moderate to severe anxiety levels which require urgent attention. © 2022 Verma A and Mehta A.
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Objective. Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological symptoms. To compare the clinical features, imaging and treatments in patients with and without COVID 19. To compare the mortality and in-hospital stay among patients with and without COVID 19 and negative patients. Materials and methods. In this retrospective, single-center study, we included all the patients who attended the department of neurology with neurologic symptoms with confirmed COVID-19 and long COVID-19 from June 2020 to January 2021. Data on clinical signs, diagnosis, laboratory findings were collected and analyzed from the records for positive patients and compared with neurologic patients without COVID-19 admitted in the same period. Statistical analysis: The mean values between study groups were compared using an independent sample t-test and Mann Whitney u test. Categorical outcomes were compared using the Chi square test. Data was analyzed using coGuide soft-ware. Results. Headache was the common neurologic manifestation present in COVID positive patients compared to COVID negative patients (39.13%). There was no statistically significant difference between the two groups in baseline parame-ters. Laboratory parameters like CRP, Serum Ferritin, LDH, D-dimer, ESR, and IL-6 showed a significant increase in COVID positive patients (P <0.05). In-hospital mortality was more in COVID positive patients than COVID negative patients (P <0.011). Conclusion. The study showed varied neurologic symptoms in COVID patients, with headache as the common symptom. Hospital stay, morbidity, mortality, and inflammatory parameters were more in COVID positive patients compared to COVID negative patients.
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Introduction: Pulmonary Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor;with approximately 248 cases of reported in the literature, making diagnosis and management challenging. Case: A 57-year-old female with past history of hypertension, hyperthyroidism and scoliosis was admitted with worsening chronic right flank pain. Initial lab workup was unremarkable. revealed COVID-19 PCR test was negative. CT chest revealed bilateral pleural effusions and CT abdomen showed 2.8 x2.0cm vague hypo-attenuating lesion in the right hepatic lobe. A repeat CT scan following thoracentesis demonstrated multiple bilateral pulmonary nodules, with the largest located in the right lower lobe (RLL) measuring 2.1cm (Image). Flowcytometry on bronchoalveolar lavage fluid was significant for a CD4/CD8 ratio of 5;however, the transbronchial biopsy was unremarkable. Differential diagnosis included sarcoidosis and hence patient was discharged on prednisone with Bactrim prophylaxis. She underwent VATS lung biopsy. RLL and pleural biopsies revealed EHE. Following the prednisone taper, patient was placed on pazopanib 800mg. The dose of medication subsequently reduced to 300-600mg due to adverse events. Repeat CT scans at 3 months demonstrated minimal change in size of the nodules. Patient continues to be followed on regular basis with a stable clinical status. Discussion: EHE is a low-intermediate grade malignancy which affects mostly liver, lungs and bones;although it can be found in any bodily tissue. Up to 50- 76% of patients are asymptomatic at diagnosis, with the most common symptomatic being local pain. Radiologically, Pulmonary EHE consists of bilateral perivascular nodularity. Our case describes the clinical course of a rare and poorly understood disease. Clinicians must be aware of the characteristics of unusual diseases and pursue robust diagnostic approach. In our case, biopsy led to the definitive diagnosis of EHE. Because of its rarity, there is no standard therapy for metastatic disease. Pazopanib has demonstrated prolonged long-term disease control in observational studies. Some other reports have shown response to cytotoxic chemotherapy such as doxorubicin-containing regimens, however, long-term survival is compromised. Lenalidomide, sorafenib and sunitinib have also been used, but the experience is limited. Our patient is currently on her 4th month of treatment with pazopanib, with 3-month follow-up showing no progression of disease. (Figure Presented).
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Background: SARS-CoV-2 viremia is associated with adverse outcomes in COVID-19. The immunologic mediators of this relationship remain under-explored. In this study, we aimed to evaluate the correlation between immune exhaustion markers, SARS-CoV-2 viremia clearance and clinical outcomes. Methods: We included 126 participants with confirmed SARS-CoV-2 infection who were hospitalized at an urban hospital in Boston, Massachusetts, during the first surge of the COVID-19 pandemic in early 2020. Plasma samples from days 0, 3, and 7 of hospitalization were available for analyses. The plasma SARS-CoV-2 viral load was determined by reverse transcription quantitative PCR (RT-qPCR). Proteomics data were generated using the Olink platform and neutralization level was assessed using a pseudovirus neutralization assay. Viremia persistence was defined as >40 copies/ml (detection limit) if the baseline detectable viremia was <1000 copies/ml, or >100 copies/ml (quantification limit) if the baseline viremia was ≥1000 copies/ml at day 7 of admission. Partial least-squares discriminant analysis (PLS-DA) was used to select exhaustion markers that could distinguish viremia persistence and clearance. An exhaustion score was generated based on features selected by PLS-DA and was divided into four quartiles. Differentially expressed proteins between 1st and 4th quartiles were determined by linear model adjusting for baseline characteristics. R (4.1.0) was used for statistics. Results: Viremia persistence was associated with a higher level of baseline viremia, a higher rate of severe diseases and mortality within 28 days of follow-up. Viremia persistence was associated with elevation of certain exhaustion protein markers including TIM3, PDL1, LGALS9, LAG3 and IL2RA. With PLS-DA, we selected TIM3, PDL1, and LGALS9 into the exhaustion score modeling. A higher exhaustion score was associated with higher baseline viremia, persistent viremia, severe disease, and death (Figure). When compared to the lowest exhaustion score (1st quartile), the highest exhaustion score (4th quartile) was associated with elevation in proteins belonging to IL-18 signaling pathway, lung fibrosis, and immune evasion in COVID-19. The immune exhaustion level was not associated with the neutralization level. Conclusion: In participants with COVID-19, soluble exhaustion markers are associated with delayed viremia clearance, immune evasion independent of humoral immunity development, and adverse outcomes.
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Background: The clinical presentation of Covid-19 positive person can range from asymptomatic to severe pneumonia with acute respiratory diseases. The major impact of Covid-19 is identified on respiratory system of the human and leading to death. There are different types of treatment options available for managing the health of the people but first was remdesivir that approved by the FDA. The dexamethasone has been associated with decreased mortality in recovery of the medicine trail. Apart from this, the major benefits of interleukin 6 antagonists are still subject of debate as tocilizumab FDA approved the interleukin 6 for treatment considering the side effects too. Aim: The study aims to assess the role of tocilizumab with or without remdesivir in COVID-19 diabetic patients Method: The current study is retrospective, single centered, observational cohort and based on the patients who were diagnosed with Covid-19 considering the PCR test and hospitalized at ESI Chitrakoot Nagar, Udaipur under RNT Medical College, Udaipur from October-20 to December-21. The study has involved the patients who were 18 years and older and had the clinical association with diabetes mellitus. Moreover, the respiratory findings also defined as infiltrates, SPO2 < 93% on room air and requirements of respiratory assistance. For the current study, the data was collected related to demographics, co-morbidities, symptom, oxygen support category, laboratory values and outcome of the therapies. The level of oxygen support was analyzed considering the ACTT-1. Results: There were total of 127 patients considered for analyzing the role of tocilizumab with or without remdesivir in COVID-19 diabetic patients. The group 1 is involving the 54 patients and group 2 has 73 covid-19 patients. According to the outcome of the analysis, the mean age of both groups were 62 and 64 years for group 1 and 2. There was significant difference identified for respiratory support received by the patients and obesity, COPD and CVD. However, there was no significant difference found for diabetes patients as the P value was more than 0.05. As per the outcome of the study focusing on the Chi Square, most of the variables have shown significant difference but Remdesivir, and low vitamin D levels have shown the no significant difference Conclusion: From the analysis, it has been concluded that the combinations of tocilizumab and remdesivir did not have any significant difference in mortality but the patients who recovered from the covid-19 has influenced with diabetic issues. The improvement in practice and advancement in laboratory trail has helped to improve the effectiveness of these treatment options.
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Background:Coronavirus disease 2019 (COVID-19) is defined as an illness caused by a novel coronavirus, now called Severe Acute Respiratory Syndrome Coronavirus 2. The present study was conducted to assess knowledge and attitude of interns in the prevention and control of COVID-19. Materials & Methods:50 interns of both genders were included. A questionnaire assessed knowledge comprising of each item contained 3 options, namely, “true”, “false” and “don’t know”;1 point was given for a correct answer, and 0 points were awarded for an incorrect answer or a “don’t know” response. The total score of this section ranged from 0 to 13, and higher scores were correlated with more knowledge. The attitude section included items, and a Likert scale was used to assess the level of agreement with the statements;response options ranged from 1 (strongly disagree) to 5 (strongly agree). Results: Out of 50 subjects, males were 22 and females were 28. What causes COVID-19 replied correct by 94%, incubation period of COVID-19 by 95%, overall mortality of COVID-19 by 84%, what are laboratory test available by 98%, family gatherings may spread infection by 89%, washing hands frequently, wearing masks and other measures can effectively prevent infection by 99%, most have good prognosis by 82% and suspected and confirmed patients should be isolated and treated in designated hospitals by 94%. Attitude was strongly agree, agree, not sure, disagree and strongly disagree in response to I pay close attention to the development of the epidemic situation in 94%, 5%, 1% respectively, I think I am playing an important role in controlling the epidemic in 92%, 3%, 3%, 1% and 1% respectively. It is believed that the outbreak will soon be contained in 90%, 2%, 5%, 2% and 1% and I am willing to cooperate with the relevant departments to take prevention and control measures in 82%, 8%, 6%, 3% and 1% respectively. Conclusion: Interns had sufficient knowledge and attitude in the prevention and control of COVID-19.